1 Diseases of children




[B illegible 31]
Proposed plan
name – history symptoms & causes
[Regar] plan of treatment minutely described
Other modes of treatment
Miscellaneous remedies
N.B. Collect all his remarks on 
art of practising medicine


Contents page
Introduction
Tumour of the head from difficult parturition 5
Cutting the frenum linguae 5
Congenital hydrocele 5
Management of children – as to 
Particular appetites – Preventive medicine 5
General nature of the diseases of children 6
General operation of remedies in children
Diseases within the month
Retention of the meconium 8
Jaundice 11
Acidity, Flatulence, Hiccough etc. 12
mothers milk & cows milk 12
Costiveness & its consequences 12:a
Vomiting 12:d
Diarrhoea 12:f
Prolapsus ani 12:l.
Aphthae 13
Eruptions in general 19
Strophilus interlinctus or Red gum 19
Strophilus candidus 21
Crusta Sactea 22



Eruptions of Dentition 24
Eruption resembling the itch 24
Venereal Eruptions 25
Infantile Erysipelas (Rose rash) 27
Sore ears (Intertrigo) 30
Tinea capitis 
[???phlicus]- [illegible] [illegible] on [illegible] [1821-2] 32
Dentition 34
Cholera Infantum 40
Infantile Remittent 55
Mesenteric Fever 61
Tympanitis 66
Worms 69
Volvulus 86
Nervous Rheumatism Infantile [remedy] 89:a.
Convulsions 90
Epilepsy 96
Catalepsy 99
Chorea 100
Ulcerated mouth 103:a.
Gangrene of the mouth 104
Parotitis or mumps 112
Tonsillitis or Quinsy 115
Rosalia or Scarlet fever 120


Croup or Bronchitis 132
Laryngitis 139
Epidemic catarrh resembling croup 141
Whooping cough or Pertussis 144
Rickets 158
Scrofula 162
Mesenteric fever
Hydrocephalus 164
Chilblains 176
Painful aff. from cold without
discoloration 177
Burns 177
The cause either is to be found in [???uctural] [illegible] for the 
[illegible] This will [illegible] men to trust their lives to 
unknown men, or to fictitious names in the newspapers, where
they would not trust property even to a small amount
# Formerly prescription of an experienced physician
very often set aside for that of the nurse or a 
negro woman


1
Diseases of children
1  In this part of our course I direct your attention 
to the history of man in relation to his habits, diseases, & their
remedies in his infant state
That this subject has occupied the attention of the 
learned less than any other branch of the medical
profession, is universally acknowledged
2 – It is unnecessary for me to enforce
the importance of the subject, by any remarks which 
might be made concerning the evil to society from 
a neglect of a part of the practice in which the community 
is so deeply interested
3 – I need but advert to the evils which must
result from the practice of committing the
management of the diseases of infants to a class in society
which is the lowest in point of intelligence
6* [the opinion of the nurse is sometimes taken 
in opposition to that of the physician – On this subject
the world seems to desert its principles of reasoning
on other subjects. If a point of law is to be decided men 
will not trust to a petty of the court, in 
preference to that of an experienced
If a text of scripture is to be explained, men 
apply to a learned divine in preference to the mere
servant of the church & on the subject of wearing apparel
it prefers the opinion of the master to that of the 
apprentice.]



4 – That this subject has occupied the attention of
the learned less than any other branch of our profession 
is universally acknowledged. (The French & Germans
however, have neglected it less than the English;
and the American physicians have been in the 
habit of paying more attention to diseases of children
than the Europeans)
8 Great attention has been paid to diseases of children
within the last 30 or 40 years
It has been most neglected in Europe, but less by 
the French & Germans than by the English
17 European practice differs from ours – but less so 
at present than formerly because the constitution 
of our countrymen are coming to resemble those
of Europeans
12 It is also the case that European diseases differ from ours on account 
Disease, here is [illegible] more violent owing probably to the greater
of climate etc. Angina [Trachealis] is much 
milder with them & requires much milder treatment
# vicissitudes of the weather



2
5 - The causes which have excluded physicians
from the treatment of [infantile] diseases infants, having ceased to exist
the subject is now receiving the attention which its
importance demands
6 – These causes may be enumerated in few
words – viz. the exclusion of the faculty from the
practice of midwifery – from the difficulty of
obtaining correct ideas upon the subject from its
obscurity – the prejudices of the public on this subject – 
attributing as they do intuitive skill to nurses 
and matrons * vid. page [illegible] & perhaps also the indifference
of the profession
7 – At the present period, however, the enlightened
physician watches the mother during the
whole period of gestation, receives the child upon its 
first introduction to the light, & prescribes for its
diseases from infancy to old age
9 – As knowledge however must on this subject, as
on every other, be progressive, it follows that this
part of the profession having but recently received 
the attention of physicians, has not attained
the perfection of the other branches
10 – American physicians need American treatises on this as on other medical subjectds
13 – European practice, as exhibited in 
their works, is too slow and mild to meet and
overcome the morbid excitement of acute diseases in 
our climate. [Chronic diseases may be treated 



They practice no deceit


3
with mild remedies, but acute diseases are made
worse by remedies if those remedies are not sufficient
to overcome the disease The action 
of the remedy falls in with the diseased action
and aggravates all the symptoms if it is not 
powerful enough to overcome the diseased action
IN such cases disease is to be taken out of the 
hands of nature. The powerful [enemy] is not to
be irritated unless there is a prospect of overcoming 
him]
14 – The difficulty of acquiring a knowledge
of the seat of the diseases of children, on account 
of their being unable to communicate their
sensations by language, has been made an excuse
by some physicians for neglecting the
subject of infantile diseases We may 
remark however that the difficulty of attaining a correct 
knowledge of a subject, cannot be given
as a reason why it should not be committed to 
men of intellect & science
15 – Though children cannot communicate their
sensations by language, yet the other symptoms by 
which we determine the seat of their diseases are more uniform
in their appearance & more certain in their indications than 
those of adults
16 Children are under no restraint from feeling
fear, [delicacy] or from false modesty In the infant, the 


mind does not react upon the stomach & destroy 
its function 
When Dr Harris published his essay on the
acute diseases of children Sydenham said to him
“you are the first man I ever envied and it is
my firm belief that your little book will be more
useful to mankind than 
# Adult patients also will often deny the existence of
dangerous symptoms; for fear they shall be considered as
very sick
The subject has not yet been thoroughly 
investigated. No regular course on it has been [illegible] until 
quite recently in [illegible] of the European schools. I recollect
the embarrassment under which I laboured under
at the commencement of my practice Cases frequently 
occurred which were not described in any of the books [&]
I was obliged to acquire all my knowledge on the subject from 
older physicians or from experience. My students have often
expressed to me the satisfaction they experience from an examination 
of my notes and they have often quieted the anxieties
of parents by reading extracts from them
# In my embarrassment upon being first called to a sick child
though familiar with the treatment of adults & having attended the first schools in the country I found my information 
& in books as to [illegible] nature or treatment and was
obliged to have recourse to the older physicians
29 [Dewers] is popular addressed to mothers, very prolix
& not intended for a text book but perhaps able [work] & is the
30 [illegible]
# Parents think a young physician will do well enough for a young 
children and are much more apt to call one in for such patients


4
mind does not react upon the stomach & destroy
its function We are at no loss how much to attribute to disease & how much to [illegible] #
17 – Still with all these advantages & notwithstanding the importance of the subject
it has been neglected & has received less attention than any other branch
18 – When Dr Harris published his essay on the 
acute diseases of children Sydenham said to him, you 
are the first man I ever envied, and it is my firm belief
that your little book will be more useful to mankind
all I have written” This opinion was not founded
upon the merits of the book but upon the fact that the attention 
of physicians would be drawn to this part of their
profession, not the least useful though the most neglected
25 Authors on this subject & their merits
26 Underwood 
Still the department has received less attention than
any other branches of our profession
27 Dr Rush in his works, has many remarks
28 Periodicals contain more or less upon the subject
21 – No courses in any of the schools
19 – Some physicians of the first respectability have acknowledged
their ignorance & given up to nurses
20 – I recollect the embarrassment I suffered upon 
this subject # It is a common complaint
22 Since I have lectured upon this subject, our students
at parting have expressed their satisfaction.
23 Young physicians are first called to children
because the older ones neglect them # hence its importance to them
24 Parents however seem, as a matter of fact, to prefer
a young physician, for a young patient! #



34 – I shall first remark upon a few surgical cases 
which occur to the young physician soon after the birth 
of the child
[illegible] cutting the frenum. I have never seen a case in which this operation 
was necessary. It is very common for nurses to insist that 
children are tongue tied. Dr [Eneas Munser] was called in such 
circumstances he remonstrated the nurse was instant until 
finally he drew the back of a knife across the frenum & the child
he told [illegible] [illegible] hurting and this with this [result]
was relieved to the great satisfaction of the nurse. If there is
a false frenum it may be divided.” this [illegible] [frenum] is never 
so short as to confine the tongue & cutting it is a dangerous operation
# They will tell you that this particular appetite is indicated
by the natural crying of the child
The mother will set herself to recollect some former
longing of her own
[illegible] 6 Hydrocele
Young physicians are often called on to prescribe for congenital 
hydrocele in young children The complaint is apt to excite alarm but
neither troublesome nor dangerous. It is readily distinguished from [illegible]
by its transparency, insensibility, & not yielding to pressure. In the course 
of my practice I have had to operate in but one case in children. Dr [Dewers] recommends
pouring considerable quantities of cold water on the part. I myself
have frequently cured it by washing the part with cold water in the morning
and applying camphorated spts in the course of the day. You [illegible]
direct the application of spirt & water, camphorated spirits, [muria??]
of ammonia, [opium], spirits of nitre, in short every discutient
Or you may direct astringent lotion, as a strong decoction of
maple bark, spriaea Fomentosa Geranum, Rhei etc.
Case in which I had to operate year old  probably neglected 2 or 3 inches long 
about as large as a small egg. Operate without a cannula  - with a lancet & catheter
& injecting syringe – water 1/6 or 1/8 port wine – children more irritable - vomiting



5
Tumor on the head
35 Children are sometimes born with a tumour
on the head occasioned by difficult labour
This may be distinguished from a tumor caused by 
a deficiency in the bones of the cranium, by a uniform 
hardness. “We may apply mur. amm. or spt & water”
36 – Cutting the Frenum
37. Hydrocele
31 Management
Appetites 32 A prejudice prevails in some classes of society 
with respect to a point in the management of children
Some children are thought to be born with a strong
appetite for some particular kind of food, which 
was possessed by the mother previous to the birth of the
child & inherited from her. It is thought that the child will [pine] & ultimately 
die, if this [illegible] appetite be not gratified #
It is probable that a belief in this doctrine has caused
many children to be killed by the administration 
of improper food A fact of this kind occurred
in Humphreysville, which nearly proved fatal to 
the child. Vide next page
Preventive
medicine 33 As a general rule medicine is not to 
be given to children in health for fear they should be 
sick. Some are nursed to death, while some die for want
of nursing. Some are fed to death while others are starved
Some are physicked to death while others die for
want of medication
injection immediately with [draw] healed [illegible] with swelling


The child cried much # - a council of females was
called who set themselves to make out what the
child needed Finally the 
mince pie was concluded to be
the article the child sucked down the inside & the 
report was that this effected a cure & saved the life of
the infant. Prof. I inquired of the attending physician who 
informed him that the child was indeed alive and well at
present but that it was made very 8ll by the mince pie
& came near losing its life. The crying of the child in 
this case was probably nothing more than a trifling increase
of the ordinary crying of very young infants, which 
is a natural and wholesome exercise # 
The al. can is large in proportion to the [illegible] of the whole 
system
# The above is a good example of the various prejudices
which have prevailed among [nurses] respecting the management
of children. Owing to the influence of enlightened physicians 
these are no disappearing. (examples to be given)


6
38 – Diseases requiring medical treatment
General considerations
39 – In investigating the causes and seat of the
diseases in infants the mucous membranes claim
particular attention
40 The action of this membrane is greater in 
the infant than in the adult constitution
Its secretions are often morbidly increased & are sometimes
diminished. It is subject to spasmodic action 
and to inflammation [illegible] with [illegible] or decomposed with effusion of 
coagulable lymph. “It is subject to turpidity & to
spasmodic action which by sympathy extend to the whole system 
41 The liver is much larger in proportion to the body the infants than in adults “& its secretions are much of [illegible] as to quality & quantity than in adults”
42 The secretions are much concerned in 
their diseases. They are changed as to quantity 
and quality
# Prescott child no ducts lived 3 or 4 
months and was excessively emaciated – there was no bile
in the stools There was no [previous] duct for the gall bladder
into the disorder



# There is greater susceptibility to action & tendency
to conversion
# Just as emetics are given to a stomach [complaint]
from excessive quantity of food


7
42 The nervous system of infants is more easily excited,
and more affected by the various causes of irritation
such as dentition worms acrid substances in the 
first primae via passages etc.
43 – The blood vessels are more rarely the seat o f
disease in infants than in adults – particularly, primarily 
so much as irritative
[acid] if they were affected the action is not [illegible]
44 – Consequently their fevers are fevers of irritation, rarely 
enteric or those of inflammation 
45 Operation of medicines
Children bear evacuation better than adults
witness the long continued diarrhoea without much 
debility following, or the salivation for mouths during 
dentition without a waste of vital energy
In operating upon the abdominal viscera it should be [illegible] it is
not for the purpose of mere evacuation, it is to produce
an excitement for the purpose of overcoming a morbid
excitement also to produce healthy excitement a case of 
torpor # The milder purgatives should be used, the
drastic being irritative.
Emetics
Bleeding
Do not bear narcotics vide p. 11


2 – In general the evacuation of the meconium should be
effected by the [colostrium] or first milk of the mother
which has a laxative property # The child should be
put to the breast within 2 or 3 hours from birth # unless [illegible]
Instead of suffering the nurse to feed the child for the
first 2 or 3 days the breast should soon be presented
for if the child feeds it is in danger of losing the 
instinct to suck If the [colostrium] does not bring
away the meconium we may begin with soda as
mentioned below or with cold sweetened water 
Some give a little cold water at first vide [infra]
5 – In strong children cold bathing may be employed
with advantage, but the bath should be made
tepid for weak ones & gradually used colder as the 
child can bear it
# “If from the exhaustion of parturition the mother be unable
to suckle let the nurse commence feeding at the end of 3 hours” vide infra
Give a grain of carborate of soda in a teaspoonful
of water until iii qts [have] given
# The meconium is frequently evacuated during parturition.
After birth also the al. canal is set in notion by the crying
and mother of the child and the stimulus of the
air upon it vide p. 10 skin. # Colostrium is of a yellowish colour
probably contains bile & is cathartic
# It was formerly supposed that the child
should not suck at first. The consequence often was
that the child lost the interest to suck



8
Retention of Meconium
1 – The first diseases of infants which claim the attention 
of the physician are those which arise from retention of the 
meconium. The meconium is a matter always existing
in the bowels at birth & having a dark green colour
when evacuated. It resembles tea but is more mucilaginous # 
It will ordinarily be sufficient to give a little molasses 
and water to the child until it receives the [illegible] or first
milk from the mother which has a laxative quality 
6 – If it is suffered to remain a train of diseases may 
follow. In the diseases which occur within the 
first moth after birth the retention of the meconium 
is always to be suspected as the cause
7 – The diseases caused by retention of the meconium 
are Severe paroxysms of pain in the bowels
indicated by crying & writhing – Tumefaction of the
bowels. Convulsions. Epileptic fits. Trismus
nascertium or Locked Jaw This last disease is
very common in some of the West Indian islands, but
I have never seen it in this place
8 – Whatever disease may arise from 
retention of the meconium the principal indication 
will be to remove the irritation by evacuating the 
bowels. This is effected by cathartics. A teaspoonful
of castor oil is generally sufficient. If [illegible] necessary


1st indic to remove meconium
2nd obviate effects
# IT will be sufficient to pour on boiling water instead of boiling
the materials in the water The strength however is of little consequence
Sometimes the most powerful remedies are to 
be used beginning with mild. These used
full doses of calomel, scammony 2 to 4 yrs – [illegible]
assisted by injection, & warm bath until the bowels
were moved Wait how long for the operation of each?
# By emollient injection, irritation is allayed, and if the
lower part of the bowels is excited the rest will be
Dose 2 to 6 pills each pill containing 1 gr. of 
(calomel)
# Chalk & calomel is a substitute for blue pill – perhaps
the chalk qualifies the cal & at least it
corrects acidity
Antimony should scarcely ever given to children
within the mouth
# A great part of the calomel has no effect
[illegible] it does not come in contact with the coats 
covered with mucus In cases where there was great
quantities of [mucus] I have given full doses of cal.


9
the dose may be repeated every 4th or 5 hours 
until half an ounce has been given
8 – If the oil is rejected from the stomach Senna & Manna 
may be given – zi of the former to zss of the latter
boiled in gill of water # & administered freely until 
the bowels are moved once in ¼ or ½ hour
“ Rx Sennae zi [illegible] ferv. 1 gill 1 or 2 teaspf every ½ hour”
9 – The operation of the cathartic
should be assisted by emollient injection #
10 – Fomentations to the bowels will assist the 
operation of cathartics & if spasms exist, will always
be needed for their relief
11 Cathartics of various kinds
12 The best cathartic which I have used
for infants within the first month after birth is the blue
pill (or [mellated] pill It rarely offends the stomach
and never produces griping By it the action of the 
liver & the secretions from the mucous membrane
of the intestines are excited more than by any other
cathartic except perhaps calomel. In my 
practice I have never known an infant salivated
by it. # 
13 In severe cases where the blue
pill is insufficient we must have recourse to 
calomel, which may be given in doses of from two 
to 10 grains. It is often necessary to give as large 
doses of calomel to children as to adults owing to the 
great quantity of mucus in the intestines by which 
they are defended from its action. # The meconium 


scammony or jalap as a laxative & had them
operate mildly If the cots were [naked] [illegible]
a dose would prove fatal for irritation
# This is a mild cathartic and supposed to act chemically.
# “Evaporate the [illegible] over the fire stirring it until 
thick then add chalk till it is of a consistence suitable
for pilling Each pill may contain 1 or 2 gr. of
Dose from 2 to 5 gr. Or it may be dissolved in herb
Fish, gall has been recommended [illegible] gall 
Rattlesnake has been thought to have specific
properties especially in fevers. This article
is bitter, tonic [illegible], laxative, & [illegible]
Continued from page 8
“The infant may be put to the
breast in one or tow hours from birth This course will 
produce permanent contraction of the [uterus] & tend to stop [hemorrhage]
& prevent milk fever” When an infant is first
born it is well to wet its mouth with half a teaspoonful
of coldwater and give it nothing else until it is applied
to the breat


10
while retained will likewise prevent the operation 
of the remedy by involving it in its viscid substance
14 Chalk & calomel may be used in doses
of 1 gr. cal. to 4 or 5 chalk repeated once in 2 or 3 
hours
15 Other cathartics which may be used are
or as recommended by Dewers
1 gr. carb. sod. to a teaspoonful of water repeated every 
“it operates”
15 minutes until 10 gr have been given. # Decoction 
of the flowers of the dandelion & the mullein 
Senna 2 dr. to with 4 dr. of aromatic herbs or seeds 
The bile of animals (ox gall) is a good cathartic
Perhaps we may consider it as acting as a substitute
for the childs own bile. It may be given in 
[catnap] tea milk etc. # 16 An injection of bitter or 
16 aromatic herbs will allways assist the operation of 
whatever cathartic you use & in mild cases frequently will be 
sufficient of themselves – superceding the necessity
of giving anything by the mouth
Continued from p. 8 The stimulus of sound upon 
the child, crying, irritation of the air upon the
skin, and especially muscular motion, excites the peristaltic motion 
of the child. The influence of muscular motion upon the
peristaltic action of the bowels, is considerable, as is seen in horses
while travelling, the costiveness of sedentary persons etc.


“The warm bath at the temperature of 98 or 100 assists the 
operation of cathartics renders their action more mild 
equalises the action of the system and nervous irritation
It is especially useful when convulsions are present and may 
be used at any period except in cases of extreme exhaustion”
# It is the most powerful antispasmodic for children
[have] acting upon the extremities of so many nerves
Jaundice
“Jaundice sometimes appears at birth indicated
by the yellow colour of the countenance and arising from obstruction
of the liver etc. Such cases are generally incurable.
The first remedies are the mild deobstructant 
plant, small doses of calomel etc.”



11
When convulsions are present the warm bath should
be used to assist the operation of whatever cathartic
is used, to render the operation mor mild, to equalise 
excitement and to remove irritation. This remedy
may be safely used at any period after birth #
After the cause which excited the convulsions has been
removed, if the morbid irritation of the
nerves continues, the bath will again be serviceable
18 Antispasmodics may likewise be used
such as valerian, aqua ammoniae, elix. asth.
artificial musk infusions of catnip etc.
We may use aqua amm. 3 or 4 drops
or carb. amm 3 or 4 gr.
or asafoetida a teaspoonful of the tinct.
in milk & water, or camphor by enema
Be [cautious] of giving narcotics to children
Some are more susceptible than others. And some children
are accustomed to [them] from birth. Case of 
a mother who had inured a child of 3 m. to bear
30 dr. of SS. I proposed to give paregoric, beginning
with 8 or 10 drops, and found that the child had often
taken with impunity 31 dr. of SS. to produce sleep



4 – “Child bed women are generally to be treated with 
mild diet for the first week after delivery, unless their
strength has been much reduced by parturition, when 
they may take port wine in moderate doses”
# “If light stools indicate a deficiency of bile the administration 
of oxgall will be found very serviceable 
vide [illegible]
If acidity is produced, add limewater, 
If diarrhoea is produced, use arrow root
instead of the water, or any other [fecula]
Children are apt to receive too much food; hence cow’s
milk should be diluted with water. Milk may sometimes coagulate
in the stomach of children, in large quantities and occasion much
uneasiness Meat should not be given under 6 mo. unless in 
particular cases which are exceptions to the general rule, where
milk disagrees or perhaps in the case of some scrofulous children


12
Acidity Flatulence Hiccough
1 – Very young children are often troubled with 
acidity, flatulence & hiccough These affections 
may be removed by a free use of magnesia, lime
water, or aqua ammoniae
2 – It will not always be sufficient safe? to 
administer these articles to the child alone. The 
mother or nurse must often take them likewise
3 – Sometimes the mothers milk disagrees
with the child. This will be known by the constant
disorder of the bowels of the child. by the evacuation 
and pain suffering after nursing both child
and [illegible] mother may seem to suffer without a cause
The stools may be slimy# The child may cry obstinately
5 – If the mother’s milk continues to 
disagree we may use cow’s milk diluted with one
third or one half water & “sweetened” or with arrow root mixed
first with a table spoonful of cold & then with one of hot
water, in order to make a homogeneous mixture 
6 – Children fed on cow’s milk are more apt 
to be costive. To prevent this give a little magnesia, decoct.
of dandelion etc. Peach tree blossoms are much 
used, but are too violent in their operation 


The injection will start the machine again 
The injection may be made of Eupatorium, catnep,
elderflowers mallows etc. etc.
Apply first whatever can be first prepared
counterirritants for instance. Spirit or 
mustard to the fat ammonia etc. ammonia to the mouth
and nostrils etc. endeavouring to rouse the patient
4 – [A young physician should be careful to know what to do in 
sudden cases (much depends on a favorable impression 
at first) Neighbors and friends usually assemble around
a child and the expect the physician will be able to prescribe
at the moment. In such cases set some of the bystanders 
to preparing a warm or tepid bath – no matter if 
eventually if it should not be used. Set others to preparing 
some other thing and so on. Thus while the attendants are
all employed he will be able to devise some course to 
pursue] I recollect an old physician in this situation
who was pressed what to do & replied “stop 
let us think about it”


12:a.
Costiveness & its consequences
1 – Physicians are frequently called upon to prescribe for
infants who are in health except that they are costive
Children fed from a spoon or bottle are mor to be thus affected
than those who are nourished from the breast. If costiveness
is produced by improper quantity or quality of the 
food as is sometimes the case, the diet must be changed
2 – Costiveness if not attended to in time produces
flatulence, watchfulness, startings, hiccough, diarrhoea
vomiting & convulsions
3 – A physician is frequently called to children
I fits, who have been apparently well until the convulsions
come on The safest and most efficacious prescription 
that can be made, is an injection & indeed is 
all the treatment that most cases will require. Let
a warm bath be immediately prepared & the patient put in 
it if the enema does not relieve. While the convulsions
continue the mouth is closed & we can operate on the system
mainly by the rectum & the skin
5 Be careful to make your directions for administering an
enema very definite, unless you know that the family are 
familiar with injections Case of a mason’s man hands & 
knees shooting somewhat off fright rolling over murder
The enema may consist of simple warm water, or milk 
& water, or of tea of thoroughwort or catnep etc. a table 
spoonful of salt may be added finally castor or other
oils may be thrown up in extreme cases the rectum has been filled with lard The water for the tepid 





12:b.
bath should be about blood warm. Be careful 
to bathe the child, & not merely to scatter or sprinkle
water on it. The length of time during which the child
may be kept in the bath may be from 5 to 20 min.
While the patient is in the bath if it is
sufficiently relieved to be capable of swallowing give a 
dose of calomel for a child of 6 months 6, 8 or even
10 gr. If improper food is the cause 20 gr. are not 
dangerous, for infants will bear full doses of cathartics
though very small ones of narcotics
In bad cases of convulsions the means to which 
we have it in our power to resort, are external irritants
such as garlic draughts to the feet, injections of [nervines]
the most powerful of which will be a teaspoonful 
of tinct. camphor thrown up in a gill of milk & water & the
warm bath until we can administer articles by the
mouth
“If the child be feeble & exhausted upon coming 
out of the bath give cordials or tonics”
Any quantity of food in the stomach & bowels
which is not congenial, interrupts the process of digestion 
& the peristaltic motion functions whose importance is 
second on ly to that of respiration. When these functions 
are interrupted the muscles are brought into convulsive 
action to relieve the system



Be particular in your enquiries about food for those who 
have the care of children are very careless and children
will swallow whatever is put into the mouth. I recollect
being called to see a very strange worm which a child 
had voided. The imagination of the attending physician 
& parent were excited. To me whose imagination was
cooler the worm appeared to be a piece of bark I enquired
if the child had had no slippery elm bark & found that it
had been chewing some. Then the supposed worm was accounted for
Rye flour is more apt to become acid than 
oatmeal
# Cal. sometimes by its irritation produces convulsions I have
known a family, all the children of which were thrown into convulsion 
by cal. & I was obliged to be very cautious & use blue pill injections etc.
There are several milk remedies such as dandelion
which is tonic laxative, & deobstrument acting on the 
liver, mullein fl. elder [blo??] tea
“The pollens of most plants has a laxative quality”
I have seen no danger from the prussic acid of the
[illegible] flower & it is much used [illegible] from [illegible]
also among the French they hold a place the French Pharm.
Wild liquorice [gal??] [Circa???] resemble
the dandelion
Moderate friction excites the bowels
Sometimes alkalie or chalk, though generally they are
rather constipating, prove laxative probably on account
of the acid combining


12:c.
II II Where is a tendency to costiveness, the use of oatmeal gruel
or porridge will be beneficial or a porridge made of wheat
flour with the bran, strained through a cloth & mixed with 
the milk with which the child is fed also rye meal gruel or 
rye bran gruel
If the health is not affected by the constipation 
be cautious about giving much medicine. It is always better
to cure this affection by food than by medicine. #
Castor oil from a teaspoonful to a table spoonful
is the best cathartic magnesia given with the milk is a good
remedy but not always sufficient. Elixir salutis is one of the 
most common family medicines. This article with castile soap
dissolved in it has been found very serviceable. The gall of 
animals may be recommended. The blue pill operates gently 
as a cathartic & is useful in changing the habitual disposition 
to costiveness. I have prescribed with advantage decoction 
of the flowers of the dandelion, or mullein. The flowers of the 
peach tree are much used for the same purpose but
“are rather too powerful for ordinary cases” “They are powerful even for adults”
& sometimes gripe unless combined with aromatics
Calomel may be used with safety # “In severe cases
mustard and ginger may be applied to the abdomen”
Mechanical manes in the form of suppositories 
are much used by nurses such as a piece of molasses 
candy or a roll of paper moistened with oil. They are
beneficial.
# If the child has been weaned pay particular 
attention to its food. Nurses are very careless.



# “No serious evil will arise unless young & anxious
mothers should give medicines and thus make the
child sick”
“If vomiting arises from dentition we must
remove the irritation Give laxatives, as magnesia, & 
narcotic
Children should be early accustomed to the reception of 
enemata to prevent subsequent prejudices upon the subject.
I recollect the case of a child about 12 who was suffering
from an obstinate constipation caused by an affection of
the lower spinal nerves which produced a partial paralysis 
of the rectum and bladder so that a catheter had to be introduced
& injections were [illegible] demanded. But all the
efforts of the nurses (women) were unable to administer an 
enema Calomel had been given until the mouth was affected, yet
without producing an evacuation. Finally the patient went
into an insensible state, and injections were given & 
produced free evacuation. I have heard adults say they 
would die before submitting to receive an enema.



12:d.
Vomiting
Spontaneous vomiting in infants arises from over distention of the
stomach. The discharge is made without nausea & almost without
effort, & consists of pure milk or milk coagulated. The mother
should simply be cautioned not to allow the child to nurse
so long at a time. # Children and old people vomit with 
more facility than the middle aged
If vomiting arises from the sympathy of the
stomach with some other part of the system which is in a morbid
state, the primary disease must be first cured & used for the irr. of stom.
For the vomiting itself in palliative we may prescribe lime water & 
milk. a teaspoonful of each; soda water, or any 
liquid affording an abundance of carbonic acid.
Vomiting from irritability of the stomach
or free [illegible] requires particular attention. The attendant symptoms will 
be paleness of the countenance, quick & feeble pulse, & cold
extremities. Irritants must be applied over the region 
of the stomach. They may consist of ginger, mustard, horseradish 
leaves, mint etc. aqu. amm. [illegible] essent oil dissolved in alcohol” The alkalies such as pearl ash, also 
soda water “lime water” may be given internally. Excite a discharge
from the bowels by injection or a calomel cathartic to remedy the irritated action of the stomach “[illegible] counterirritation”
The warm bath will be very serviceable, soothing the nerves
of the skin & by sympathy producing the same effect upon 
those of the stomach nervines also may be given We may try putting a little brandy
into the mouth or a small quantity of capsicum tea. Hot
cloths & fomentations may also be applied externally.
A large bulk of warm water water may be thrown up the rectum
in obstinate cases, use stimulating injections..


One of the most convenient modes of administering a large
injection is by a pipe fastened to a large ox bladder
Press the fingers against the end of the pipe which 
the bladder is fastened so as to make a valve and
prevent the escape of the fluid contained in the bladder,
until after the pipe has been completely introduced
into the rectum
# I used to carry this recipe about me when I practiced in the country
Frequently irr. of stom. is overcome by irr. o f
the rectum by an enema of salt & water or by a large
injection to produce a peristaltic motion downwards


12:e.
Ren “Remove the cause, which is frequently 
indigestion. If it proceeds from the teeth, lance the gums
The following is an excellent recipe # in these cases
Rx Cret. ppt zii sem. card. zi bi carb. potas. zfs grind
aqua bullientis 0 fs Give a tablespoonful every half hour
I am inclined to the opinion that the alkalis, such 
as pearlast act by creating an excitability
Emetics are particularly safe for children
much more so than for adults. Ipecac is generally 
the best unless the disease in which the emetic is indicated
is very threatening, when antimony should be used
Squills are indicated in emetic doses in complaints of the
chest “with [illegible] [illegible] but should not be administered when there 
is much inflammatory action in the system.
“Warwick’s powder a preparation of antimony,
was once popular and often administered without 
the advice of a physician. I have known it endanger
life Nurses should never prescribe antimony”


Some situations are more liable – low situations
[seashore]
Children shut up in low dark apartments suffer
from want of amusement.
If a diarrhoea from teething is suddenly stopped
the brain is apt to be affected. This affection of the brain 
is peculiarly liable to occur in children. There is no 
outlet to the brain


12:f.
Diarrhoea
This complaint sometimes affects children for months & even
years Some families are more subject to it than others & I
have known those in which all the children would be affected 
with diarrhoea from a period soon after birth until they 
were three or foru years old. The children who have this predisposition 
to the disease are born with diseased liver and bowels
& have indeed all the chylopoietic viscera in a disordered 
condition. Hence among the causes of diarrhoea we may 
rank a bad constitution. Other causes are want of 
cleanliness, bad food “want of sufficient clothing” bad air damp rooms, confinement
& want of exercise. Exposure to cold & moisture
A bad air probably causes diarrhoea mainly by 
its depressing influence. The effect of confinement and want
of exercise is very great. Young animals suffer in the same way 
Even vegetables seem to need motion for I think I have observed
a great deficiency of fruit & a sickly appearance of 
fruit trees after a season uncommonly free from wind. Confinement
is injurious in another manner Children need
mental stimulus from a variety of external objects. I have
known surprising cures effected apparently by the operation 
of this very principle.
Teething is a frequent cause & whenever
it is we must palliate & check, but may not stop the diarrhoea
From the sudden stoppage of a diarrhoea during dentition you may 
expect an affection of the brain to follow. The discharge from the 
bowels in this case is similar to that of tears from an irritated 



This will be convenient in many cases as in travelling
Other mints may be used spearmint is most agreeable
I have given this in the latter stages of the diarrhoea of
adults with advantage
Almost any cath. will often check a diarrh. Cal or 
blue pill is generally best
Judgment is to be exercised whether to prescribe an
emetic or a cathartic & as to the choice of a catheter
Ipecac however is almost always safe children bear
emetics well
Put the parents & the nurse upon investigating as
to [diet] Persons are apt to very careless about giving
things to children And they may have wrong notions as 
to particular articles
Prohibit solid oily food, crude
vegetables and esculent roots. Potatoes are very 
bad in diarrhoea so are the analogous roots. They 
contain indeed much fecula, but also much 


12:g.
eye, or of mucus from the lungs
The expressed juice of mentha vulgaris, boiled
skimmed and mixed with white sugar is an agreeable, & useful
article for the cure of a diarrhoea, which has continued but a 
short time & is not severe.
In the early stages of a diarrhoea, which 
is sufficiently severe to demand the attention of a physician
it will generally be best to commence the treatment with a
cathartic; though if fever accompanies it an emetic of ipecacuanha 
should be the first article administered.
Judgement must be exercised in the choice of a cathartic. Calomel
will be best if the child be not particularly feeble or of a very 
delicate constitution & for a feeble child the blue poll. I myself
was for formerly many years unable to take any other cathartic than the 
blue pill without being griped. Generally it will be best to combine
chalk with the calomel, as the latter is indicated for its deobstruent, 
rather than for its purgative effect. The dose may be about
2 gr. cal. with 5 or 6 of chalk
If improper diet is the cause the food must
be changed; & it will generally be necessary to be particular in 
our enquiries with regard to the diet for the parents may 
consider many things a safe which would be strictly forbidden
by the physician. Especially will it be necessary to attend to 
the diet if the child feeds instead of sucking. Every thing 
hard of digestion, such as salted & oil food should be prohibited
The diet should be arrow root and in case of diarrhoea this 
article will be improved if prepared with a little laudanum 
or wine sago taipica, which is probably a hydrate of 



besides They are apt to become acids & acrid in 
the bowels. In the Polyn. islands The inhabitants
living upon taro are very liable to diarrh.
West of the Rocky Mts Lewis & Clark found the 
inhab. subject to diarrhoea for living on a root [illegible] [illegible] men suffered in the
same way after they arrived among them
In the evacuations & the evacuations of children shd always be exam
[may] [illegible] that potatoes remain undigested
Cullen & Rush thought different of potatoes
The evac. of chil. should always be [illegible]
Pies cakes articles containing much sugar
hot bread should be prohibited Bread shd be toasted
The juice of meat will often be beneficial
No gravy (i.e. artificial or carbonized fat with flour etc.)
Potatoe starch, pure, is perhaps not 
inferior to the tapioca etc.
Boiled flour becomes s hard as stone
almost hydrate It is an old practice It is an
excellent preparation make a porrige of it grated
Tapioca I suppose is made by sprinkling
casserva root, powdered, with water & baking it
making a preparation what appears like gum arabic. I have not 
been able to learn how it is made, but have made
it this way a similar substance of arrow root
Arrow root & the tapioca are cooked
by first dissolving them with a small quantity of cold water
& then adding hot water. In this way [illegible] are avoided


12:h.
flour or roasted or baked flour made into a
porridge with equal parts of milk and lime water. The bread
should be toasted and butter should be used very sparingly 
gravy not at all. Casserva sago etc.
An article similar to tapioca, if not the same 
may be made in the following manner. Tie up a quantity of 
wheat flour tightly in a clean cloth & boil it for 5 or 6 hours
The result will be a hard substance which is to be grated &
“[illegible] milk & water or with lime water” 
made into a porridge this will be palatable & good Rice
in gruel, or thoroughly cooked by boiling 
The worst cases of diarrhoea are attended
with feeble pulse, cold extremities, dry skin, & 
generally a rise of fever once or twice in the 24 hours. Soften
the skin by the tepid bath which is [illegible] etc. and keep up an action on it by 
flannel unless there is fever & in such cases use also absorbents freely with 
tonics & aromatics. The chalk julep or white decoction will 
be as good a preparation as any. Rx Chalk [illegible] zfs to zi pul. cinnam. to zii
zii, bum arab zi carb. potas. zi water lb I. boil ½ hour Sometimes
[illegible] a similar recipe shd be used” The Europeans add [illegible] use [illegible]”
a little laudanum may be added. Of this feed freely, giving
say a table spoonful from ½ tab sp. to I once in an hour sometimes. As a tonic the
vitriolic or tonic solution of Moseley is inferior to none in such
cases Rx zinci sulph ziii alum zi water lbi Give from 
four to twenty drops. Tonics must sometimes be combined
with absorbents
Opium is always safe in cases where the 
bowels have been thoroughly evacuated. It is generally 
better to combine it with ipecac, which will determine its
action to the skin and act as a gentle tonic & laxative


The tepid bath is [illegible] as it may be called) 
relieves the irritation of the bowels through the 
skin
Chalk does not act mechanically or chemically it
has a specific action upon the stomach as much as
bark
Make white decoction in various ways if cinnamon
offends use some other spice Sometimes add
astringents or [illegible]
Tonic sol. sulph [illegible] ziii al. zi Mosely sometimes
used al. zii In 3 or 4 gtt it is anti emetic
In larger doses it may be emetic & cathartic
This is a state of the system similar to the collapse
of cholera Asiatica It is a collapse taking place
during diarrhoea. I have found advantage from
stimulating or acrid injections as salt & water, mustard
In chronic diarrhoea opium is often
invaluable. Some families are obliged to give it 2 or
3 times a day for along time to their children until they are so 
old as not to be liable to continual diarrhoea
The stools may be green clayey from deficiency of bile sour curdled [illegible] or very
fetid, so much so as to be very offensive turning the
stomach of the attendants.


12:i.
In cases of chronic diarrhoea where there is attending it
much sensibility and irritability of the bowels opium combined
with diaphoretics cathartics or tonics is an invaluable
remedy
Sometimes violent symptoms supervene vomiting supervenes & the diarrhoea 
stops the patients hands & feet grow cold his pulse
grows small, & if the most active measures are not
take used the patient dies in 24 hours. When this change
of symptoms take place we must resort to the most
powerful means of exciting counterirritation such as application 
to the epigastrium of mustard, horse radish leaves
ol. monardae punctulae, ol. turpent. etc. Such articles 
as pimento will be grateful and stimulating given internally
We may give calomel, opium & the carbon. acid, and use 
stimulating injections. “Effervescing mixture with SS. [illegible] appt”
Particular attention should be paid to the
kind of They may be sour & curdled, or mucousy, [illegible] clay colored, water
stools for much may be learned from their inspection.
Acid is often formed in the whole alimentary canal, producing 
sour and curdled stools which will indicate lime water
or other absorbents, with aromatics. The acid may 
arise from fermentation or more probably from secretion 
Such cases I have often cured by the expressed juice of the
spear mint prepared as above mentioned & given freely.
When the stools are green white, or clayey, give
opium to allay irritation. Ipecac to equalise excitement, & 
the blue pill as a deobstruent, the latter in small doses so as 
to move the bowels, but once or twice in the 24 hours. 
Alkalis are useful as 


# Noel’s plaister was made of white lead red lead castile
soap and olive oil, boiled till the red lead was so far decomposed
by the oil that the mixture was of a cream colour It is a 
smooth plaister and is less stimulating than [illegible]
Use soft charcoal by burning cork, which is
the popular kind or cedar Dose teaspoonful
to a tablespoonful in a convenient liquid
Lime water & other alkalies may always
be given They may be mixed with the food
without [injurious] the taste
When the disease has continued long & 
patient is [illegible] phlegmatic temperament we may 
bandage the bowels, to give mechanical support 
[Opium] also will be useful applied externally in this way
Adults from the Wt. I. with chronic
diarrhoea will look like a mummy
Bog water is a very soft water & contains
carb. hyd.
Astringents [illegible] tinct. vitriol
decoct. of oak bark with milk & sugar & spice
Bandaging & plaisters Take any adhesive
plaster and mix about ½ opium Or soap and opium
Acetate of lead is not a new remedy 1 2 or 3 gr a day
1 gr at a time continued as long as the relaxed state of the bowels
continues as long as they last lead [cholic] cannot take place for 


12:j.
are also enemata formed by dissolving castile soap
in mallows or catnip tea. If there is much griping with 
tumefaction of the bowels injections of camomile tea give
great relief. In diarrhoea of this kind the following is also 
a good stimulating & correcting laxative Rx castile soap zi
elix. sal. zi dissolve & give it 3 or 4 times a day of teaspoonful or ½ teaspoonful doses.
If the stools are fetid give charcoal
internally. It will correct the fetor & it sometimes cures
the disease. For sour stools vie last paragraph of this lecture
During the long continuance of chronic
diarrhoea it will of ten be advisable to apply mechanical
support to the abdomen. We may apply a plaister of
white diachylon [illegible] plaister alone or with opium or of lead and soap & a bandage.
In chronic diarrhoea the skin becomes 
brown, of a dark & dirty appearance, & very dry and husky
If the tepid bath does not relieve this symptom, we may apply 
water from peat swamps, which contains carburetted
hydrogen. Vide Duncan’s commentaries
In the last stages of diarrhoea we must 
resort to tonic solution to astringents, absorbents & aromatics
we may also use opium with cathartics, emetics & absorbents
& If we met with a great craving for salt food it should be 
gratified. The gratification of such an appetite will prove 
a stimulus, especially to the mind & consequently the more
powerful. We meet with similar cases among adults also. Case
of a man who could retain no medicines upon his stomach & 
finally recovered upon bread & cheese, given at his request
In the latter stages also of chronic diarrhoea, acetate of lead 



the [illegible] [become] very lax and there is generally a prolapsus ani
patient being [semiphlegmatic] I saw this article
much used in this way when a young man and though expecting
bad colic no injury resulted.
Prof. Smith was very fond of chocolate [illegible]
It sometimes acts like a charm
Spiraea may be given in decoction or
extract. [illegible][illegible] is not so good being unpleasant
having a fishy taste & offending the stomach Ger. mac. & [illegible]
[arom.] are pure astringents & unobjectionable on 
this score. I have prescribed sometimes one, or another,
according to convenience of locality where I 
happened to be
The root of typh. latif. is used as food by the aborigines
European physicians give [althea] [illegible] which 
is the true marshmallows
Usually when diarrhoea has continued 
long the kidneys become affected. Mucilage will then 
prove diuretic probably by their [illegible] affect. The terebinthinates 
will then be useful. The most common practice in 
this neighborhood is a decoction of white pine bark especially 
with a little milk it is called healing to the bowels. There is
also nutriment in it for the aborigines, sometimes live on it
When mucilages to wear out we may resort to terebinth.
The species of [polygnomic] knot grass are 



12:k.
may be given internally. There will be no danger
of the production of colic, by this remedy, for the bowels are
too much relaxed.
The astringents just mentioned may be various 
We have at least fifty indigenous vegetables, which may be used
given in decoction of milk or water such as the bark of the
currant, the raspberry, the various species of oak, of viburnum
chocolate of acorns etc. white pine bark in milk etc.
the roots of the [illegible] of the [geranium] etc. The viburnum
Especially deserving of recommendation are the spiraea tomentosa
& cornus circinata. The latter of which equalises excitement
Of mucilages we may have occasion to 
use a variety for irritation for any one article may become worn out & another be more grateful
We have typha latifolia, twigs of sassafras, hibiscus, malva
bran, flax seed, slippery elm, gum arabic etc. all the mallows, all the [illegible] marshmallows hibiscus palustris
called rose of [illegible] in the gardens root is [illegible] [illegible] & sub astringent 
Sour stools Be particular in forbidding the use of animal
food. If there be want of bile, give ox gall, lactescent plants
dandelion etc. with mild mercurials; e.g. calomel 2 gr. with 
6 gr. chalk. Aromatics also may be combined. Astringents
elg. [illegible] speraea cornus & geranium do well. Also the following
Rx calc. magn. zfs rhei palm. gr. 8 acaciae zi ol. anisi gtt vi
aquae purae zi Give a teaspoonful at a dose. “once in 2 hours”
In bowel complaints with griping attended with green
or sour stools Rx magn. ust zfs pulv. rhei grs viii pulv. gum ar. zi
ess. menth pip. gtts vi water zi dose, teaspoonful Spiraea & cornus




used – they are mucilaginous sub astringent & diuretic
Articles of a stimulating kind are often needed in 
the latter stages especially erigeron canadande (colt tail) [illegible]
The bitter [illegible] which grows in similar situations (ambrosia [elatio??]
is also used as a bitter apparently nervine in diarrhoea
Roman wormwood) [Cupron] is acrid, sub astringent & diuretic much 
used in the middle states improper when there is entonic action
case of cholerine cured last summer by this garden young
man called etc. chewing the plant etc. The other species
of erigeron have similar properties espec. E. phil.
Various recipes are given for diarrhoea in 
children Ex mag. zfs rhei gr. 8 [illegible] zi ess. pep. gtts 6 gum ar. zi
The popular remedies are generally absorbent [illegible] mucilaginous
astringent etc.
Much benefit may often be derived from 
copious mucilaginous injections mutton broth is the most popular
probably other broth (fat meat) would answer still mutton 
suet is less apt to become rancid. It is thought to be 
useful also as nourishment I have not though much 
of this may of nourishing
Laudanum may be added Also
laudanum & starch injections may be advisable to check the
excess of the discharge It will generally be best to begin with 
about 10 drops of SS. though a teaspoonful may be required
vide p. 2 [illegible] 2



12:l.
Prolapsis Ani
This is a troublesome symptom which sometimes occurs in 
diarrhoea. The protruded intestine should be immediately 
replaced. Most writers recommend to do this with a 
dry cloth, but this will irritate the sphincter ani & make
it contract. The smoothest and least irritating article
within my knowledge, is the crop of a fowl, or the neck
of a bladder, turned inside out & filled with warm water # 
Afterwards we may apply astringent washes & injections
of white oak bark or other similar articles, or
of acetate of lead. The latter article may also be given 
internally in doses of from 1 to 2 grains. It will 
have a tendency to overcome the relaxation.
Astringents are multitudinous
& have had a specific [illegible], which proved to be the
bark of [?strea] virginica At another time I had a specific
sent me which proved to be viburnum sentago all
the vib. are astringent
Prolapsus ani “The part is relaxed
and passes down and is then strangulated by the sphincter. For a
permanent cure we must resort to astringents & tonics, but the
part must be [illegible] by mechanical means If 
the intestine is not replaced, [illegible] or suppuration 
will be the consequence” “Take 1 bladder, cut
off the neck, turn it inside out, fill it half full of 
warm water, and tie up the neck”


“This disease was very common at the commencement
of my practice but is now rare. The change has arisen in a great
degree from the more correct notions respecting the proper management
of the mother and child which now prevail. It is possible
however that it may appear in [epidemics] and that case we
should expect that it would appear for a time and the disappear
# It frequently follows other diseases both in children
and adults
# According to the law of contagious diseases and
that it is of no use to prevent it
# Heat is a stimulus but too much of it produces a 
debility which may be [illegible] perhaps in direct debility
“Since a free ventilation of nurseries has been practical the
disease has been rare. laying aside the use of the preparations 
of alcohol has also been beneficial.” 


13
Aphthae or Thrush
White thrush from [illegible] (to inflame)
This disease often appears within the mouth 
is then generally unaccompanied with fever. In some
cases it is idiopathic but it more generally is a 
consequence of morbid affection of the primae viae #
It is frequently found in adults of robust constitution 
which have been very much debilitated by previous that disease
infancy and old age are most subject to it & in infants,
as was just mentioned it is often an idiopathic affection
In some families every infant is several with this
affection. The vulgar error however, which very generally prevails
that all children have the thrush at some sooner or late period other #
is contradicted by the fact that many children as I have
known never have the least appearance of it 
at any time “and it may probably in all cases, be prevented”
The most feeble and delicate children are affected with the most violence, hence & from the fact of
its being an affection of old age & a frequent sequel of other disease
in adults, it may be inferred that this is a disease of 
debility & this [illegible] will be confirmed by the predisposing
causes which we find to be, confined air, a
very hot room & improper food# It is caused among
the poor by bad air & among the rich by too great warmth 
& confinement. The fever likewise which accompanies it
in many cases is of a typhoid character.
# “Caused by neglect of the nurse by want of cleanliness
& is often the effect of costiveness”


# And have been led to prescribe remedies to prevent 
the thrush
“commences on the inner part of the lower lip & corners of the
mouth & extends over the tongue & inside of the cheeks & gums
sometimes all these parts are affected & sometimes only one of
them”
“It appears in small eruptions or vesicles containing a whitish
fluid resembling a coagulum of milk these vesicles
often coalesce so as to form patches”
“extend down the oesophagus to the cardia & here in all
known cases it has stopped”
Prof. Tully has seen p.m. [illegible] which the thrush the al canal [illegible]
“The feces are sometimes covered with aphthous sloughs”
“in its severest the eruptions are of a dark brown
or deep red colour”
“The alvine discharges are very acrid”


14
Symptoms – The disease is preceded by languor and sleeping
This is so generally the case that it is common for nurses to 
say that the child is sleeping for the sore mouth
In adults I have observed the same fact, & have predicted
the appearance of thrush from the drowsiness of my patient #
The symptoms of thrush are very obvious. It commences
with white specks upon the lips #, angles of the mouth, & 
tongue effervescence. # In severe cases the specks in crease in number
and size until they cover the whole inside of the mouth
the throat & are found indeed upon the 
stomach x & throughout the whole intestinal canal
though this is disputed. One thing is certain, whether these
specks or flocculi extend throughout whole alimentary 
canal or not, viz. that they are found upon the rectum,
agreeably the law that the orifices of tubes are
most affected The white crust will 
fall off and be succeeded by one of a darker colour.
The coats of thrush are often many times renewed
& in this case the formation of a new one is preceded
by unusually protracted sleep. A typhoid fever
may accompany.
It seems to be an eruptive disease
determined [illegible] the al. canal.


“In its milder form it is confined to some particular
part of the mouth or to the mouth itself. The eruption is
white & the mouth appears “as if a stratum of coagulated
milk were spread over it” & but one separation of
the curd like crust will take place. The general health
will be but little disturbed”
“In severer cases two or three successive crop
are formed & the habit being unhealthy, the food innutrient,
& the frame weak and atrophous, the under [surface] ulcerates
and spreads & a low typhoid fever ensues”
# “Your principal object should be to produce an
excitement in the bowels by some mild medicine”
# Because it is an eruptive disease however diaphoretic
seen to be indicated & those which [illegible]
action “The treatment is ordinarily a gentle laxative
but there is a choice in the kind of laxative. Some practitioners 
recommend oily medicines, as butter, goose oil, pigs foot oil
etc. But these articles do mischief As the vital powers of the stomach 
are weak, these oils will become rancid”
# In such circumstances the oils become rancid & 
consequently irritate. I never allow oils to be
given, yet it is a common practice to swab the
mouth with oils, especially goose oil (or [illegible]?)
# Chalk shd generally be preferred the other articles
dissolve more slowly & may act in part
mechanically”


15
It is thought that this disease has often
been prevented, by giving soon after birth a teaspoonful
of cold water & repeating the remedy every
morning, for some time taking care also that the bowels
be kept open There may be some foundation for
this belief inasmuch as the disease is brought on 
by heat and debility. “In families where the children
have uniformly been subject to this disease. I have recommended
cold water as directed that the room should be well ventilated
and the child not covered with too much clothing”
In mild cases & where the constitution 
of the child is robust, a gentle laxative will be sufficient
to remove the complaint # 
Castor oil is very often prescribed for it
& it may be proper to five it to assist the operation 
of other cathartics But there are several objections to 
this article. It does not affect the secretions so much 
as other cathartics. It does not evacuate the contents of
the bowels so thoroughly as others & it tends to 
# relax the coasts of the intestines, already in a state of 
morbid relaxation “It will not remove the mucus of the intestines”
For mild cases magnesia is the best laxative 
where it can be given in sufficient quantities. If the
bowels should not need a cathartic chalk or some one
of the other testacious powders may be given “as [illegible]
oyster shells, crabs eyes, crabs claws etc.” #
Because it is an eruptive disease however, diaphoretics 
and articles which translate action seem to be indicated 



# “Give at first the clear liquor of this infusion and if this does
not operate stir it up and give the substance
(1) “After the stomach and bowels have been evacuated the
ipecac should be given in small doses ¼ to 1/6 of a grain, to 
keep the bowels open, to produce a tonic effect, to determine
to the surface & to prevent convulsion Ipecac has
more claim to be considered as a specific than any thing
else. It obviates the morbid secretions of the bowels it acts as
a tonic never produces unequal excitement or other tonics
& it does not like astrigents produce constrictions Whenever
there is a tendency to unequal excitement it must be
obviated or tonics will do no good”
# I rely upon the ipecac though I use [illegible]
sometimes especially white root asc. tul.
# Indeed “if diarrhoea is present, prepared chalk is a
good remedy as is also charcoal: the best form of which 
is burnt oak for this can do no mechanical injury”
# “I have found this almost a specific” Since I have
used this treatment I have not lost an infant by 
this disease” Ipecac in small doses as an alteration 
approaches as near to a specific in any remedy can
# which is not to be expected
# Astringents must be avoided, though tonics are indicated
because they produce unequal & local excitement & 
stricture they must be given in the latter stages after excitement
has been [equalised]
A little borax may be given
Moseley’s solut. zinc ziii al. zi [illegible] 1 pt


16
In the commencement of the disease if the symptoms do 
not indicate the probability of a severe case an emetic
of ipecac is the best remedy Antimony has been recommended
but it is not a safe emetic for children within
the mouth Infuse [illegible] of ipecac in 6 teaspoonfuls
of warm water & give a teaspoonful every half hour
until the patient vomits or purges. # Ipecac has the advantage
over antimony in its tonic and antispasmodic
properties & in the mildness of its operation, never producing
alarming symptoms # 
If the ipecac empties the stomach and not
the bowels, a blue pill should be given of the size of
from 2 to 8 grains. If this be found insufficient, it may 
be assisted by a dose of calomel, or magnesia or an enema 
(1) After the bowels have been thoroughly cleansed
the ipecac should be given in small quantities a fourth or 
a sixth of a grain to determine to the surface & to prevent
convulsions # If this dose moves the bowels too much, we
may add “[illegible] or 1/6” one sixth of a 1/8 drop of Laudanum to each
dose The absorbent powder or the white decoction may 
be given at the same time#
Astringents should be cautiously avoided
until the stomach and bowels been thoroughly 
evacuated # “& if there is much fever” Where this has been done we may make
use of Moseley’s tonic solution, or cornus [circinata] [illegible] alba, or sericea or saffron safely & with advantage


It is to be remarked that chemical action is prevented by the
vital principle acting upon the food or articles introduced
introduced into the stomach, and putrefactive or [acetous]
fermentation if the vital powers of the stomach are [vigorous]
This principle applies to vegetables Plants taken up in 
full blown in August and packed in live [sphagnum]
will be preserved by the life of the sphagnum
In thrush the powers of life are weakened & not only
substances taken in but the secretions themselves are
subject to fermentation hance the use of obviating the 
effects by alkalies limewater magnesia, chalk [illegible]
absorbent powders
white decoct. Rx.
“To prevent the increase of vesicles of effervescences, syringe
off the acrimonious fluid as well as you are able, by some diluent 
or detergent gargle and expedite the separation of the
sloughs by invigorating astringents” vide Dr Good vol [illegilble] p. 30
“A little borax & ergot may be put into the mouth. But if the mouth
is dry & parched, this and other astringent shd not be used. In such cases
we should give mucilaginous substances as gum ar. slip. elm. or sassaf
X 5 or 6 gr a drachm? of each in a gill of water
# or viola pedata (parsley violet) or comfrey
We must be very cautious about administering it to infants


17
To correct the acidity which often attends this disease
we may administer prepared chalk or lime water
& milk Or Rx magn. usta 10 or 12 fr. elix. pareg.
xx gtts water zi given in teaspoonful doses every hour
If the stools are watery and the child is robust give
coct. ppt # vi gr. cal. 1 gr or the compd powder
of chalk in doses of vi gr. or a small quantity
fo rhubarb instead of the cal.
For watery stools give dal. 1 gr & chalk 6 grs or compd powder of chalk
It is too much the practice to scratch or rub 
off the aphthae in a violent manner with a brush
or swab. As well might the cure of any other
eruptive disease be attempted by violently rubbing
or scraping off the pustules. Rubbing the mouth with
a brush or swab until the bleeds is a cruelty which  
ought to be deprecated
Still something must generally be done
to the mouth in order to satisfy the importunity of 
nurses & prevent their mischievous attempts
A little borax and sugar X is as safe as any thing
If the mouth is dry it may be lubricated with 
muc. gum arab. slippery elm or sassafras twigs
When the mouth is in a very high state of irritation 
probably a small quantity fo sugar of
lead would be serviceable. I have not myself
ventured to administer it to infants within the mouth 
For the proper local treatment of ulcers vide ulceration 
of the mouth


From the sympathy which exists between these parts
and the surface, tonics should be combined with diaphoretics
I have given [illegible] [has] or [illegible] it is [illegible]
observed by tonic and determines to the surface
# It is mucilaginous sub-emetic & diaphoretic. It
may be given freely as a wash or administered
freely internally laxative diaphoretic soothing
antirritant “The other [illegible] may be as good”
The disease of which we have been speaking is 
a local disease


18
Ipecacuanha in this disease is emetic, tonic, diaphoretic
etc. alterative & since I have used it I have not lost
a single infant with thrush
The viola pedata (parsley violet in some 
degree resembles ipecac is its qualities & may be internally 
administered in its stead # “give a teaspoonful of 
of the decoction”
The peculiar kind of thrush of which I have been 
treating is a local eruptive disease of infants
but as it appears in children more advanced it
a critical determination of diseased action. It
is not unfrequently a favorable symptom, particularly
when it succeeds strong morbid action & 
[illegible] early in the disease In the latter stages & 
when the system is exhausted it is unfavorable
For instance in hydrocephalus, when the whole 
mouth will sometimes become sore, and the disease
seen to be translated to the mouth “from the brain to the muc. memb”
In the latter stages of any disease not
so fatal as hydrocephalus it is a very dangerous
symptom of exhaustion “In cholera infantum
it is a dangerous symptom. [illegible] there is not
translation from [illegible] essential part”


18 ½
Eruptions in General
Children of all ages are subject to various eruptions
These are generally occasioned by the quantity or quality
of their food. They are frequently cured by change
of diet alone & the greatest attention should always
paid to the diet is managing them Oily food particularly
nuts, must be strictly prohibited, as they often
cause eruptions. I have known some adults invariably
affected with eruptions about the lips or other
parts of the face after eating freely of walnuts
Fish & poke week may likewise [illegible] the eruption 
We may use the tepid bath for the purpose of 
cleansing the skin. The frequent use of the [illegible]
bath is important especially in chronic eruptive
diseases of children & adults vide p. 21 & p. 20
For infantile [illegible] [illegible] p. 1831-2 of Good
Case of a peculiar eruptive disease
vide [illegible] [illegible] P. 1831 1 [illegible] art.
The eruption was periodical, appearing at a certain hour every day
At first a light coloured opaque elevation of the skin about half an inch
log & a quarter broad like the sting of a bee or wasp. Soon after their appearance blood began to ooze
from them & producing a drop which concreted into a scab, & at the end of 3 days
fall off 8 or ten eruptions came out daily. Treatment was ineffective 
until a change of air & diet, which effected a cure
“Child 8 or 10 yrs of age about 5 p.m. it would complain of a pain
in the face then would appear elevation of the skin to the number of 10 or 12 
the issue was treated as if [illegible]
bark was tried also nit. sil. sulph zinc. arsenic & other minerals
emetics cathartics new diet finally fruit was recom ate freely 
of oranges & was benefitted. Then change of air & travelling were tried
or the first day the eruptions diminished & on the third disappeared
In such cases try changes of mineral waters & dieting”



19
Red Gum
Allied to thrush is that eruption called red gum
The original word was red gown (from a sort of spotted
red calico) which has been corrupted into red gum
It is called by [Willa??] strophilus intertinctus
It is a populous eruption & said to be peculiar to children
but this last is doubtful
The eruption is sometimes confined & sometimes
diffused over the whole body. The papulae rise
above the skin are distinct from each other & of a
rarely contain lymph
bright red colour. The vesicles contain by [illegible] only & 
terminate in scurf. Afterwards subsequent eruptions
makes their appearance. The constitution is rarely 
affected. Physicians are not usually called 
unless the nurse is inexperienced Nurses give saffron
Some physicians suppose this disease 
to be the same with aphthae. Dr [Willan] thinks they 
alternate. Dr Russell remarks “I think that aphthae
of infants is of the same nature with those
eruptions called red gum & differs in this respect
that one disease affects the skin & the other the internal
surface of the alimentary canal. Dr [illegible] thinks 
that this affection, preceded by sickness, arises from 
causes similar to those of aphthae, such as confinement,
heat, irritable state of al. can. indigestion [illegible]
If the disease be suddenly repelled
from the surface, vomiting & spasmodic affections 
take place. Hence the European physicians 


Belonging to the primary [page]
Probably the patient was not dieted so strictly as was
intended & I recommended change of air Oranges
however were beneficial. The was too fond
of good living, fond of oily nuts
There was a slight reappearance after it
but of short continuance
It was called [illegible], but improperly
The eruption was preceded by a warming sensation
of pain in the part.
“Red gum is an eruption of fine pimples of a red
colour affecting infants [illegible] within the mouth. It 
is a disease that rarely requires the advice of a physician
The cure is much better effected by diet and [regimen]
by the exhibition of medicines Still the physician
is frequently called in and he must prescribe something
if for no other object than to satisfy the friends
In order any case give a decoction of saffron & 
snake root to keep the eruption from [striking] in 
& keep the bowels soluble with tinct. rhei compd tinct
sennae magnesia, or other mild cathartics”



20
caution is not to expose infants with this eruption upon
them to a current of cold air, or to plunge them
into a cold bath. It is said that fatal consequences
have resulted from such imprudence
The child should be kept clean & 
be subjected to daily ablution of tepid water.
Particular attention should be paid to the quantity 
& quality of its food. If the eruption should be repelled
from the skin the tepid bath will be the best remedy
This disease often occurs within the mouth
& rarely requires the attention of the physician. [illegible]
tone of the mildest of the eruptive diseases
“We may give a decoction of saffron crocus? & snake
root to prevent the eruption from striking inwards 
& keep the bowels soluble by mild cathartics such as 
magnesia & rhubarb. Still more will depend 
upon diet than upon medicine. Wine & water or
one part milk & three water may be given”
[belonging] to p. 18a
“In managing most eruptive diseases more
attention should be paid to diet than to medicine. In 
most cases it is requisite that the quantity of food should be diminished.
If the food is milk, let it be three parts water, or
substitute whey. Infants should take no animal food & 
no crude vegetables within the year. Oily food and the various
kinds of nuts should be prohibited even for 2 or 3 years. A strong
child in the country, with abundance of air and exercise
might be indulged in such excesses with impunity
when a feeble child in one of our cities would be destroyed by them”


The eruption is so small as not to be observed
It is not my object to treat of eruptions in general
with minuteness but to give the general principles of
treatment food etc.
There are many eruptions met with [illegible]
children which cannot be classed or be found described
There is an affection of children appearing
within the weak, which is not described at all. In three
or 4 days after birth elevations of the true skin not of the cuticle upon the 
hands and arms & various parts of the body containing pus and [illegible] or as large, some of them as ½ dollar 
high [illegible] [fever] I have seen but few
cases they were mortal.  The books in such affections
direct bark & tonics. The practice proved
injurious. The disease as I have seen it has been 
inflammatory and required antiphlogistic treatment
It may however be typhoid sometimes perhaps.
If so it should be treated accordingly. I have seen but 3 or 4 
cases. There were inflammatory. I prescribed in all these cases & from an analogy more fancied
than real, between this & [illegible]
Eruptions are generally caused by 
improper quantity or quality of diet. The remedies
frequently get the credit of curing the disease when 
the amended diet cured the patient
Oily & highly stimulating food should be 
avoided. All the nuts one of the worst is the pea nut


21
Strophilus candidus
In this species of strophilus the papulae are larger then 
in any other of the genus. They are not surrounded with 
an inflamed base. They are very distinct smooth and shining & appear
like little pearls under the skin of about 
the size of half a millet seed. They may continue 
for some time. A close examination is necessary for
their detection. They appear on the bosom & chest
They may accompany other diseases
I have seen them accompany cholera infantum in the 
last stages & considered a fatal symptom
[illegible] dyspeptic consumption a dangerous
symptom The chest appearing to be covered
with an oil surface, looking like particles 
of water I have seen persons attempt to wipe 
them off as if water had been sprinkled on the part
Belonging to p 18 ½
Apples pears and fruits etc.
Cleanliness also shd be strictly practised [enjoined]
robust children, much in the open air, may have eruptions
about the face mouth etc. with impunity
when with the same diet delicate children, much confined, would have
fatal eruptions, diarrhoea cholera infantum etc. 


The appearance of the [former] [have] [illegible]
and the parents are often much alarmed. The disease is not
dangerous however, & leaves no scar behind
A scab is formed & the margin continues to suppurate
and matter forms underneath
“There is a thin [illegible] discharge from the part & the scab
comes off leaving a thing pellucid [illegible]” The disease continues
& this film is thrown off & the process is repeated 2 or 3 times 
It is sometimes occasioned by dentition
sometimes it is an effort of the system caused by 
disturbance in the al. can. “A prejudice sometimes prevails
with respect to this disease that it is an effort of nature 
& ought not to be checked It is a loathsome disease extremely 
unpleasant to both to the patient and the nurse & if allowed to continue
some time it would not be safe to stop the evacuation, at 
least without keeping the bowels open” 
Some [Phys.] recommend partic [illegible]
as specifics. Cal. or blue pill occasionally 
may be advantageous
Buckthorn has been much celebrated in 
this and other eruptions It is drastic& hydragogue
It is perhaps milder in form of syrup. Many families
keep it. Half a dozen berries will operate
If there is much plethora, the
neutral salts may be given Magnesia also both
for the indication & as a corrector
I have known the muriatic ether
much prescribed, but have not used it much
myself, substituting for it mur. ac. as below 


22
Crusta Lactea
This is the [illegible] larvata of Bateman
It appears on the lips, forehead & scalp in small pustules
yielding pus, which eventually coalesce & form large loose
scabs & perhaps extend over the whole face, down the neck
and over the whole body. This eruption never leaves a scar
behind it however long it may have continued. The skin is left smooth It is
more unpleasant than dangerous, as the children affected 
with it are fleshy and otherwise health. When it has
continued a considerable period of time, we must be 
cautious of checking it, as it is like a habitual discharge
from an ulcer
Treatment It is very common to give
laxatives, such as syrup of buckthorn, neutral salts, magnesia etc.
The sweet spirits of sea salt (diluted muriatic 
ether) is a very popular remedy. IT is given in doses of
from 5 to 10 drops, diluted with water & repeated 2 or 3 
times a day. I have seen this medicine given in 
hundreds of cases & am inclined to think it sometimes 
of service. It, at least give satisfaction to the parents 
& does no injury. If there is great irritability give 2 or 3 gr.
of cal. with chalk. In cases where I have thought proper 
to remove the eruption. I have given the muriatic
acid instead of ether, prepared in the following manner
Rx mur. ac. zi alcohol zi Give [3] drops night & morning
diluted with water


make [oxyg.] oint. by adding the nit. ac. to
lard until decomposition ceases, and the resulting
ointment is tasteless. It has about the consistence
of wax. Some add sulphuric acid but this is 
not decomposed & is acrid
Sometimes the ointments seem to irritate & 
then we use [illegible] The best is the sulph. pot.
zi to a porter bottle of water. Sulph. of soda
does not materially differ, but it is unpleasant smelling 
like bilge water.
In different cases apparently similar I have tried ointment
& succeeded in one, but failed in another, & succeeded 
by waste
I was led to adopt the use of sulphuret of
potash from the analogy between its solution & the water [of]
sulphur springs
“We may with advantage make application
of dry powders arrow root roasted flower hair
powder taking care to give a cathartic when we check
the discharge. We should pay particular attention to the diet
both of the child and mother making the food weak & [simple]
Laxatives will commonly be removed; a little magnesia
& sulphur so as to move the bowels once or twice a day
“A discharge like this may be checked with 
safety at the commencement, but when it has become habitual
it should not be stopped unless a drain is made
& kept open in another part.”


23
For this eruption I have found the oxygenated 
ointment, very efficacious in removing the scabs & healing
the sores It is always safe if well prepared. ‘It is made
by decomposing nitric acid with
lard’ Perhaps the [citric] ointment (nitrate of mercury
with lard) may be equally efficacious, but it is less
safe. A good ointment may be made by mixing
calomel zii with simple cerate zi or mutton suet zi
The sulphuret of potash is one of the best remedies 
for this & other similar affections Dissolve zii in a
pint of water & give a table spoonful night and morning
also let the part affected be washed with a solution of 
twice the strength “It sometimes [illegible] two or three days and [illegible] [illegible]” Some prefer sulphuret of soda
sulphuret of lime would also be equally efficacious
Such solutions small like bilge water & are analogous to the water of sulphur 
springs I have sometimes used the sulphuret of pot.
as an unguent. Sometimes liquid applications & 
sometimes unguents will succeed best, & if one fails we
may try the other “Calomel ointment may be applied
about the edges”
If the eruption should suddenly dry up 
& fever ensue, a dose of calomel should be given & be followed
by a few drops of antimonial wine 3 or 4 times a day 
or a small quantity of ipecac. White hellebore may be
given
Sometimes the eruption degenerates to a phagedenic
ulcer. In such cases I have used charcoal 
eternally also a variety of poultices. I have seen much 



The const. irr. may expend itself upon the skin
or upon the gland. syst. or upon the al. can. etc.
We must be cautious about suspending
them suddenly
“It is important in all kinds of eruptions
to keep the skin clean and soft & to effect this
we should prescribe the warm or tepid bath, every day or 
2 or 3 times a week. It removes itching and irritation, is always 
safe and almost always beneficial”
May be caused by teething or by food etc.
Such things often withstand various remedies & 
hence are prescribed for very empirically


24
benefit derived from the application of roasted flour. It 
absorbs moisture & excludes the air
Eruptions attendant upon Teething
Children are very commonly affected with eruptions 
when teething. They generally put on the appearance of a
fine rash, but sometimes consist of distinct pustules containing
matter
As they are symptomatic merely, they require
no particular attention to be paid to them & will 
disappear when the teeth get through. The worst consequences
might result from their sudden suppression; as
if this mode of action by which the system relieves itself
from the irritation of the teeth, be interrupted, there is 
great danger that the system will relieve itself by 
morbid action of the brain, or other parts more essential to life
Eruption resembling the itch
Another kind of eruption appears on children of one or 
two years of age. It sonsists of distinct pustules like
those of chicken pock, which form a scab, continue to 
inflame about the edges & contain a watery fluid
It usually makes its appearance in summer & if not cured
disappears spontaneously at the commencement of 
cold weather
It has often been mistaken for the itch, and 
attempted to be cured by [?dock] root, but without success.
The sulphuret of potash used as above is a good remedy 


The tepid bath is apt to be neglected but shd not
Dock root often fails in this. It is
often very successful in children’s eruptions. It is
a very old remedy (centuries) Sometimes goes
into oblivion & is again revived
Prof. Smith thought most highly of R. patientie 
6 feet high in gardens. Woodville mentions
R [aquaticus] I know not that either is better than 
our [common] [illegible] I prefer the [Robtusifoli??] or [horserock]
It is acrid and acts well when ext. [applied]
and is good int. like rhub.
R. crispus also has about the same properties but is
milder. R. sanguinea is kept by many for it is
as a specific for cutaneous eruptions. called also 
jaundice root & used in jaundice I have
used them all and cultivated than all The leaves
of the R. sanguinea have all red veins.
You will often have such cuticles
exhibited to you in families and be [illegible] of about
them. Hence the importance of a knowledge of their prop.
I have never known them in any but
the children of [foreigners] I am inclined to 
think the taint may be dormant.
The eruption at first resembles what
is called “horn pock” “sometimes resemble a [illegible]” The nurse was changed 
& though the new one was
health yet the ulcer appeared on her nipple


25
I think this kind of eruption might be cured by diet
and the warm both. In all cutaneous affections the 
warm bath is very important to relieve the skin
from every thing that may obstruct perspiration
Eruptions & other irritations of
the skin translate action from the viscera. Where irritated
action exists in the viscera they are symptomatic
Gutta rosea of drunkards is an instance of translation of 
action from the liver “When a cutaneous eruption appears
we may generally apprehend that the al. canal is disordered”
I cannot too strongly enforce attention 
to diet. Nothing will avail without it
Venereal Eruptions
These appear infants born of parents tainted with 
syphilis, though they may have no symptoms of it at the
time of the birth of the child. Some physicians are of opinion 
that this child may inherit the disease from its ancestor 
the parents having been apparently free.
The eruption appears in smooth hard, circumscribed 
elevations of the skin of about half the size of a 
pea 7 resembling a wart before it has seeds. They continue
to increase slowly in size for two or three weeks, & become
soft, containing a watery fluid in [honey] like substance Subsequently the skin
gets rubbed off & leaves an ulcer with ragged edges & sometimes resembling a chancre which
is very difficult to cure. I have known one instance
in which the ulcer was communicated from the child to 
the breast of the nurse. Children affected with this 


Eruptions sometimes depend upon morbid state
of the liver analogous to gutta rosea of drunkards
Prescribe to the liver
“The disease often proves very obstinate”
Mercury does not seem to act as in the
primary disease
Corr. sub. given in this way is as
safe as any other article
The bowels should be kept free
“I think the sublimate acts more on the skin & is therefore
preferable to other mercurials”
The plantain was once celebrated for the cure
of cut. aff.
I have known the plaintain in this
way apparently cure after mercurials had failed
Still the mercury might have prepared the system
The plantain is an old English remedy for bites of spiders etc.
It is treated of by Woodville & [Willan] It has as little acrimony 
I have some confidence in its efficacy. There is an old story about a snake & [spider]
I have known nondiscript eruption
which had resisted the prescription of several phys.
cured finally by diet & change of air



26
complaint have a pale & bloated appearance & the powers of
life are feeble
Treatment. Change the nurse if derived from her
Give corr. sub. in doses of 1/30 or 1/40 of a gr. Give the blue
pill in moderate quantities but it subl. is better Give the tepid bath. Try
the preparations of iron, such as the mur. ferri, or 
tartr. ferr. or the alkaline solution of iron. This complaint
is not so easily cured as the primary [illegible]. Sometimes
it will resist the operation of mercurials & all 
the treatment for scrofula. In this case send the patient
into the country & try simple vegetable articles especially 
the expressed juice of the plantain (plantago major) externally
and internally. It is a popular remedy for poison & is apparently 
valuable. I have known patients cured by the use 
of this, and of the air of the country. Still I think its 
main virtue to consist in its bland & mucilaginous quality
[In these cases the whole lymphatic system is
disordered & deobstruents are indicated. Now the expressed
juice of most green vegetables id deobstruent. For instance 
the farmers make use of green rye in the spring
for this purpose] Perhaps the expressed juice of the green
plantain is deobstruent


Infantile Erysipelas is an improper name
vide Gray [illegible] of Erysipelas
Good’s is an entirely different disease and his account 
will completely [illegible] Corresponds perhaps to the 
rose of the W.F. Goods account of the rash may do pretty well
The infantile erysipelas of Europe described in 
the books is a different thing # 
Resembles shingles this is accompanied with fever 
The primary affection is of the al. can. therefore
the attention is not to be directed exclusively to the skin
I commences with [illegible] [illegible] you are to prescribe
to the fever [illegible]
This disease is distinguished by the eruption 
resembling a rose in the shading off of the colour from 
a dark rose to a light colour & in the concentric circles As I have seen the disease
the rash has appeared in patches about the [illegible] thighs 
principally & the local affection gave no [illegible] and was
trifling while the constitutional fever was severe and dangerous.
The fever if not broken up in the commencement will
resemble a severe case of [autumnal] remittent
I have found no satisfactory account
of the disease in the books, not even in the W. P. writers. I have
however been informed a conversation with W. Indians that the 
rose is one of their most severe and dangerous infantile diseases
fatal in a week
and is treated by a vigorous administration of calomel
# I have never seen the infantile erysipelas described as occurring
in the European lying in hospitals contagious & terminating 
in gangrene I have seen common erysipelas upon infants 
however


27
Infantile Erysipelas
The classification of this disease id doubtful. It answers tolerably 
well to the exanthesis roseola of Good “but [illegible] febrile” there is no species in 
Bateman & Willan which corresponds to it
Efflorescence in blushing patches, gradually deepening
to a “dark” rose colour, mostly circular or oval, alternately
fading & growing brighter chiefly on the legs with irregular
appearance somewhat like concentric circles if the patch is not circular the general circumference
This is a disease of rare occurrence with us
I have met with three or four cases.
It is a severe and dangerous disease, apparently 
the same with the dangerous rose of the W.F.
As it appears with us it is very different from 
the erys. that described by European writers & which is sometimes 
epidemic in their hospitals. In children in this country
it is generally a disease sympathetic with a morbid state
of the bowel
The elevation of the skin is less than in erys. of 
adults the discoloration less deep in colour & the skin though
a little tumefied is as smooth to the touch as if not
diseased In the cases to which I just alluded, the erysipelas
began upon the thighs & extended all over the legs. It was accompanied
with considerable fever & a hot dry skin The colour of the 
efflorescence was purplish rather than red ‘We rarely see
watery or bloody vesicles, as in other erysipelas’ I evacuated 
the bowels thoroughly with calomel (for the sake of the excitement
rather than the evacuation) & rubbed the part affected 


The fever will much resemble that of infantile
remittent
“The spots are in patches from the size of a
dollar to 5 or 6 times as large They are shaded in concentric
circles from purple in the center to a lighter colour”
“If the disease is not checked there will be 
increase of fever, constipation and tumefaction of the
bowels irritation of the stomach affection of the brain, [illegible]
death”
Administer a full dose of calomel in the first place
and repeat it once or twice. Work off the cal. with other 
cathartics. The secretion excited by the calomel is
what we want. The cathar. subsequently given bring away 
Antimony in small quant. & nitre may be given
until the liver is subdued
“When the febrile symptoms run high
pulse tense, tongue furred skin hot it is a very dangerous
practice to apply discutients applications to the eternal
affection Acetate of lead applied externally will probably 
translate the disease to the bowels”
“Treatment I first give colored in full
doses to alter the secretions to change
excitement and promote evacuation, but do not depend
upon it as a cathartic I then give [illegible] or [illegible] & [illegible]
etc. to move the bowels I afterwards use the absorbants
or alkalies, or ant. or iped. in small doses, as the case
may require


28
It is attended with constipation & tumefaction
& [illegible] of the bowels; with hiccup & severe fever, & may 
terminate fatally with severe coma
“Pulse small & frequent child dies usually 
on the 5th or 6th day”
“Dr Dewers says that in the cases he has
seen the disease was not local but would spread rapidly 
over the body disappearing in one spot without leaving a trace
behind it & breaking out in an other & perhaps a remote
part thus changing from one end of the body to the other”
Treatment. “Evacuate the stomach with an emetic, as
ipecac” Clear the bowels thoroughly with cathartics, for the
sake of the impression on the system. Give calomel in a 
dose of from 5 to 10 grs. If it do not operate within three
or four hours repeat the dose. If necessary , work off the
calomel with senna (or scammony?) adding aromatics
if the stomach is irritable or with castor oil if the senna
fails using also some laxative injection & the warm bath
to assist. Then keep the bowels open with blue pill & 
“use some mild diaphoretic as aqua amm.” or  give antimony
from from 1/20 to 1/16 of a grain
Pay little regard to the eruption and direct
your attention to the bowels I have letters from physicians
who have followed my directions & treated the disease not as a 
local one but with cathartics which testify the complete success
of this plan of treatment. In the W.F. also where the


“As palliatives after a strong impression has
been made on the bowels by calomel, we may give sweet 
spirits of nitre, aqua ammoniae etc.”
I have tried various either applic. without benefit
I have
“In those cases when the treatment wa local only 
the patients have uniformly died. I have not lost a single
case to which I was called with commencement. I have
conversed upon this subject with medical [illegible] out from
the W.F. and find that the practice there coincide with
mine”
“When called to cases of some standing I have endeavoured 
to arrest the progress of the disease by a blister
as [illegible] in gangrene & in the erysipelas of adults. The 
disease would extend beyond the blister just as if none
had been applied”
There is an erysip. affection which occurs about the
head of children which resembles that of adults which 
I have treated with lead water


29
disease is frequent it is treated by the physician with 
calomel & cathartics. They give calomel 10 gr. & repeat
it in 5 gr. doses until 20 gr. have been given
I once saw a child with a swelling on one
ankle supposed to have been produced by the sting of a bee or bite 
of a spider, which had resisted the operation of poultices & lead
water. I gave cathartics but they did not operate, & the child
finally died
External applications of any activity
should not be used, Still it may be necessary to apply something
in order to satisfy the parents. The best will be roasted
four “dried [illegible] [illegible]. Warm bathing will be very useful. If treated
with lead water & cathartics not used, probably every case 
would be fatal. I have blistered in imitation of Dr
Physick, but never with any advantage
‘If the disease be followed by diarrhoea
give absorbents & aromatics such as compd powd chalk or white
decoction. If followed by weak pulse etc. give tonics’
I have not lost a case when called early 
‘This disease is supposed by some to be hereditary 
I have seen it affect infants on the scalp when it appeared to 
be a local affection merely In cases of this kind I have used
lead water with [illegible] continualy advantage & without any evil consequences’
Cathartics however should be more or less employed
in conjunction “afterward aromatics or tonics as the case may require”
‘It sometimes affects the brain’


[illegible] a more [illegible] or [illegible] intertrigo an attenuation
& sometimes abrasion of the cuticle. The vessels forming
the cuticle are diseased and the skin is formed
in an imperfect manner It occurs also about the
nates, [illegible] etc. where the skin folds upon itself & the
air is excluded sometimes an acrid discharge Cullen
thought it a very thematic affection. The skin looks
like a new skin upon these parts. it arises from 
want of cleanliness & from confinement. The stomach
may in a state of indigestion secrete an acid and the
skin may secrete an acid. Exercise cleanliness
treatment in general of eruptive disease 
When [illegible] flax they would
burn a rag and put it in an axe & rub their finger
on to harden the skin when chafed. A scorched rag is
beneficial & use absorbent powders first nit. [illegible]
might be used keep dry the parts
Nurses apply “powder post” which is made by [worms]
Sometimes it is a vesicular eruption
which upon the head is called [farrigo] & in some situations
is called ring worm
To the [illegible] or intertrigo occurring in 
various parts the nurses sometimes apply the membrane
from suet which is smooth keep off the air, prevents farther
chafing and does well. The absorbent powders as starch
alabaster etc. do well


30
Sore Ears
This forms a very important subject in treating of the
diseases of children. Nature has chosen the part behind the
ear for eliminating irritation from the system. Under this
head I shall speak of purulent discharges from the cavities 
of the ears & nose
Slight blisters and ulcerations behind
the ears of infants are very common & are in most cases, so mild 
as merely to require washing with cold water weak soap
suds & with cold water, & being covered with a scorched rag
or with roasted flour, to prevent irritation from the cap
Frequently the discharge is acrid & excoriates
the adjacent skin. Often a miliary eruption at the part
commences the disease & is followed by excoriation 
Affections of the brain are sometimes relieved
by a discharge from this part. The discharge is very important 
to children in time of teething & when affected
with bowel complaints.
If suddenly stopped fever may follow
with full pulse, tense constipated bowels & fulness of the fontanelles &
“often nearly all the symptoms of hydrocephalus”
cold extremities Blisters behind the ears will generally 
restore the child to health
When an infant is suddenly attacked with 
symptoms of hydrocephalus [illegible] disease, enquire whether it has had sore ears which have 
suddenly dried up, & if so, apply blisters behind 
the ears, for without them nothing perhaps will cure
the new complaint. The same is true of old sore legs stopping of the [illegible] & other charges
The theory of this, in all such cases, is the necessity, not 



The quantity of evacuation will not amount perhaps 
to more than a teaspoonful & the fullness of the fontanelles
[rain] in the head & plethora is not owing to the quantity of
fluid. The same plethora, pain in the head etc. will 
result from cessation of catamena which discharges will 
not amount to more than a table spoonful
So you may bleed to the amount of pounds 
in cessation of a slight discharge for an old sore leg
with out relief. while if you start the ulcer again 
by [illegible] or [mustard] the symptoms will be relieved
Case of a man with ulcers on the legs of 10 to [20] years standing
discharge stopped [illegible] pleurisy & aff. of liver the
discharge restored by [illegible] blisters caustic etc. cure affected
Sulphate zinc 10 gr. to oz or 2 oz
may be applied Solution [illegible] sil. is one of the mildest application for irritated surfaces vide infra
Oxygenated [illegible] is mildest & 
less apt to become acrid Sometimes when the aff
is of an erysipelatous kind [illegible] relax the parts & 
are injurious
Change the nurse also if necessary
If the child is fed upon milk by hand, add perhaps
a little magnesia or lime water 
Similar affections may affect the 
cavity of the ear & the cavity of the nose. If the 
cavity of the ear is affected in this way & neglected ulceration 
is apt to take place & the small bones affected
causing deafness. First reject milk & water or
carb. soda etc. [illegible] Finally if these means fail use
stimulating injections myrrh finally [vit.] sil.
In the use of [illegible] sil. external began with 5 grs to the oz & increase if necessary 
to xv or xx to the oz


31
of the evacuation, as is generally said, but of the habitual
action of the system.
This affection sometimes degenerates into a very 
troublesome ulcer, extending down the neck, accompanied with 
much pain & yielding a discharge so acrid as to excoriate the 
skin wherever it touches it Deep sores will be formed
& the affection may terminate in gangrene & death
In such cases it may be proper to apply 
emollient poultices of bread & milk; to which may be added
poppy leaves, or pulverized stramonium seeds or ac. plum.
Powdered gypsum is one of the best applications Alabaster gypsum
is the finest kind Some apply red precipitate but gypsum is far better. Case in which this alone cured;
Another physician advised red precipitate The oxygenated ointment if well made is a smooth
dressing for them & is the best kind of ointment, where 
ointments do not disagree, as it sometimes the case. The 
bowels should be kept open with cal. or blue pill.
It will sometimes be necessary to correct
the milk of the nurse by administering magnesia & confining
her to a simple diet
Troublesome & sometimes fetid discharges 
on the internal surface
from the ear arising from a kind of eruption may follow this eruption & may cause deafness if neglected I have known also the 
cavity of the nostrils & the frontal sinuses affected in the 
same manner. A cure may 
be affected in either case by exciting the discharge behind
the ear though it may be necessary to keep it open for some time 
If this fails use (in addition?) milk & water Milk 2 part water 2 part lime water 1 part Tinct. of 
myrrh if the discharge is fetid & troublesome a teaspoonful to a gill, as an injection for the ear
Sol. nit. sil. 1 or 2 gr to oz. water? externally


Be very careful in watching the symptom Case of a 
young man who had had such a discharge for years 
checked by astringents [delirius] inflammatory fever
ertc. bled cathartics etc.
Porrigo galeata ([helvetea])
Cuticles below the scales dotted, shining
Said to be contagious. I have never happened to see it so
though I do not doubt the fact. I have never seen more
than one in a family have it
A very troublesome complaint The 
hair becomes pale, perhaps the roots are affected in which 
case mercury is indicated.
Salivation seems to do no good I have 
seen it practised without any benefit
Recent cases I have cured very speedily 
with oxyg. ointment. Any smooth substance applied
to the part & excluding the air, will often cure as for in stance
a bladder, or the membrane of suet what is useful
also for [fret] Poultices do well, whether upon this principle
or moisture changing secretion
When a student I recollect there appeared 
a strong recommendation of poultices A physician of my 
acquaintance prescribed a poultice & left his patient. It adhered
the hair grew into it and the hard
crust formed a helmet indeed. It [was] a long time a
period of week, before it was removed When it came off
however, the disease was removed!



32
Tinea Capitis. Scald Head porrigo
This is a local affection & yet much influenced by diet. Sometimes
however it affects the system, or is sympathetic of a general affection 
of the system.
The disease consists of scaly eruptions, eventually 
covering the head with a hard & generally brownish
coloured crust. The hair often comes off.
Cleanliness holds of course the first place
in the list of remedies; the head should be carefully shaved 
and washed repeatedly with soap and water. Perhaps as
successful a mode of treatment as any will be to shave the
head closely and apply a bladder or affect skin in close contact with the
skin. It excludes the air. Sulphuret of potash zfs or ai to a porter bottle used as a 
wash & given internally tablespoonful 3 times a day has cured the complaint in a 
few days mercurials or corrosive sublimate will be useful, but do not always cure.
Sulph. prt. internally zii to lb i [illegible] ext zii to lb is [illegible]
The ueast poultice is good, but care should
be taken that it do not become dry on the head, which should be 
first shaved. The oxygenated and the citrine ointments
have been found useful, as had also the tar ointment which 
is made as follows Rx tar ziv wax zfs sulphur zi or is
Mercurial cathartics should be given from 
the first and particular attention paid to the diet. # vide last par.
The practice in this complaint has been 
quite empirical & a great variety of remedies, have been 
popular. Veratrum viride & v. albus & [apocynum] [androsaem??] 
olium have used for external washes. Syrup of 
buckthorn is recommended as a cathartic. Muriatic acid


Lunar caustic about 6 grs. to zi of water (rain water)
well water may decompose it
Decoction of cocculus indica, is given
internally & externally.
Cal. zii al burnt zfs red lead zfs z6 zifs spermaceti cerate head shaved & washed with soap sude every
night and afterwards apply this ointment. It is given by 
[illegible] & Bates [illegible] & called
Diet must be attended to 
Terebinthinate ointment as tar ointment
Tar ointment is made of tar and lard or tar & 
simple cerate
There is no difficulty in the diagnosis of the
disease. You will be called to prescribe for scalled head
and you will find that the nurses have not mistaken the
disease. It begins with small pustules the matter
[illegible] which is acrid and soon forms a scab over the whole
head.
The treatment must be principally local. But
mercury may be given occasionally. I have not derived much 
benefit from the common mercurial ointment. Citrine ointment
is good however. Also cal zif lard zi


33
has been used 3 or 4 drops in a wine glass of water
Finally the sorts of the various species of dock (rumex patientia, crispa
obtusifolia, sanguinea, aquatica etc.) have been much used
All the species have about the same properties, being acrid
purgative etc. They are given internally as cathartics, & 
externally applied, made for instance into an ointment, by 
pounding up the fresh root with lard. The following
is a recipe Rx yellow resin zii
best ale lb i finest flour ziii mix the all & flour thoroughly 
together & add them gradually to the melted resin.
# The tepid bath may be used when this is used always
take care to have a supply both of hot and cold water
in order to keep up the proper temperature. Ipecac may be 
administered to equalize excitement in some cases, & as a 
valuable substitute for this article we can use the
root of asclepia, tuberosa, which is expectorant, diaphoretic 
and laxative.
“Vary the remedies according to their affect
soften use decoct. rumex particularly r. obtusifol. 
called horse dock. It at firs increase, the 
irritation & secretion. Use it externally & internally”


The excitement of the al. can. is affected also of
the nervous system
Various cutaneous aff. different kinds also of
local inflammation, or erysipelatous phlegmous gangrenous 
scrofulous the inflammation varying according to the 
constitution scrofulous gangrenous
I have frequently heard Pres. Dwight
speak of the pain he experienced in cutting his wisdom teeth
suffered extreme pain for a whole summer
She did not appear to me to look like a person in the consumption I was puzzled [illegible] [illegible] I looked into her throat and mouth
and found she was cutting r wisdom teeth
# The irritation may continue for mouths, from 
the pressure upon the gum
Those who commence cutting teeth at 10 mo.
to a year or even later do not necessarily suffer more
Delicate & scrofulous children suffer more


34
Dentition
Among the causes of infantile diseases no one more
claims the attention of the physician than dentition. The bowels
and the nervous system are always more or less affected by it
& to this cause we are frequently to refer affections of the lungs
of the brain, of the ear, of the skin, of the glands, & of the cellular
tissue in general. On this subject there is however a difference
of opinion, for it is said by many medical men that children which are
healthy # well teeth with as much ease as adults. Allowing
for the peculiar irritability of [illegible], no doubt they do,
but in granting this we concede nothing, for adults often
suffer extremely from dentition. I well recollect the case
of a Mrs Waters perhaps about 20 or 21 a married woman and the mother of 
said to have a [illegible]
several children, who was supposed to be in the last stage 
a good deal of cough etc. had raised a little blood
on consumption & upon examination & found was cutting
the four wisdom teeth. The gums were divided & 
antispasmodics administered, when she recovered perfectly.
# Case of Mrs Purcell’s child had been sick
with diarrhoea and fever for some time a flush of fever 
coming on every day. I had previously extracted defective teeth
from the [illegible] mouth. I now looked into the mouth lanced
the gum over a double tooth gave no remedies
The period of dentition commences at different
ages times in different children, varying from the fourth to the sixteenth
mouth, but most commonly in 
the sixth. The two central incisors of the lower jaw appear
about the sixth month and are followed in about a month
or six weeks by the corresponding teeth of the upper jaw.


very [illegible] [illegible]
[illegible] cases I have known a double tooth cut
first in others an eye tooth in others all the teeth at once
You must always examine to see what teeth are
cutting You will perceive the gum swollen and harder 
Some children are born with teeth but
such teeth re merely attached to the gum and are useless
and should be removed
Sometimes there is too much anxiety about
dentition generally however not enough Case of a 
child mother called me insisted upon
# irregular distributions of temperature are [illegible]
[illegible] hot 5 [illegible] cold


35
Next come the inferior lateral incisors & after these the corresponding
teeth above About the twelfth or fifteenth or 20th month
appear the anterior molares & are soon succeeded by the 
cuspidati those of each kind in the lower jaw cutting
through before those in the upper. Next we have the posterior
molares. The last molar teeth are not found in the child & hence
their name, dentis sapientiae. They appear from the 18th to the
25th year.
The above is the order in which the teeth 
commonly appear, but they often come irregularly, sometimes
the lateral incisores, sometimes the molares, & in
a few rare instances the cuspidati appearing [illegible]
Some persons never have more than two incisores in each jaw
Occasionally we meet with families who are said to 
be destitute of teeth. I have known a family from Charleston,
who had this peculiarity. The fact however is in such 
cases that the teeth exist but not rise above the level
of the gums, so that they are not ordinarily seen 
Such teeth have this advantage, that they are not subject
to decay & are also very serviceable.
Whenever between the fourth and the eighth
2nd year? month symptoms of irritation exist, the cause of which is
not obvious, the state of the teeth must be examined. The 
symptoms of difficult dentition are fretfulness 
inclination to bit hard substances, putting the fingers into
the mouth, slavering, starting in sleep eruptions about
the face & on the scalp, flushings in the cheeks. # hot head


pupils contracted sometimes dilated sometimes
losing their brilliancy
In delicate children the eff. will be more
chronic & in vigorous more acute
The system relieves itself often by evacuation 
and this is considered often a good symptom as [illegible]
there is a great flow of saliva. The system relieves itself
by diarrh. by salivation by sweating [illegible]
by every mode of equalizing excitement which 
is the great principles on fevers & indeed in most diseases


36
and cold feet, irregular paroxysms of fever, remitting
fever vomiting diarrhoea irregular & green stools wine
small in quantity & voided with pain or in large quantities 
and of a pale colour bloating of the hand feet and 
face contracted pupils. All the symptoms indeed of extreme irritation
may be met with & we likewise find in many 
cases a tendency to phlegmonous inflammation suppuration in various parts of the
body particularly in the ear. Case of a child who was
thought to have an affection of the brain. A tumour was
found under the arm.
Sometimes dentition is accompanied with 
phlegmonous local inflammations in different parts of the 
body & suppuration of the glands about the ar by which 
relief is afforded
Ricketty children cut their teeth more
slowly than others but not in general with greater difficulty.


The child must be held, and the fingers
keep in the mouth to keep it off the tongue
# The guard being made with a spring, so that when 
pressed upon the guard will yield and permit the
lancet to descend (in the slit of the guard)


37
Treatment. The first and most important indication is 
to divide the gums with a gum lancet or other convenient instrument.
The operation is not usually painful the child will 
even press against the edge of the lancet. The relief is often immediate and permanent
Some relief may indeed be afforded by rubbing the gums with 
a hard & polised substance & by giving the child something
of the same kind to bit, but the most effectual relief will be 
afforded by the lancet. The chief difficulty in the performance
of the operation consists in confining the child. It
may be done while the child is asleep & often without
waking it. We must also be cautious not to cut the tongue
To prevent this it would be better to make gum lancets with 
a guard # For the double teeth two incisors
should be made & it may be necessary to make a transverse 
one in order to divide a band of a sort of ligamentory
substance which confines the tooth.
It is sometimes objected to cutting the gums
in particular instances that, if it is done too early, the
cicatrix formed by the healing of the incision will subsequently 
render it more difficult for the teeth to push themselves through
This is not true for the cicatrix though apparently harder [illegible]
less vitality in it than a part which has not been wounded and will be more easily broken through
Solution of continuity is more easily made by disease in a cicatrix
than in a part which has not been wounded vide J. Hunger. It is a 
common maxim that an old scar is apt to break out in to a sore
The gums should be divided as often
as there are any symptoms of irritation, until the teeth 



Some other diseased action may exist in the
system, and the irritation of the teeth be superadded
the lancing will only relieve the latter
# For the gums having been exposed for a long
time to irritation because [illegible], and perhaps
ulcerated and are kept irritated by contact with 
the hard tooth


38
get through I have repeated the operation three or four 
times upon the same teeth. In some cases however cutting
the gums relieves the symptoms only in part. Indeed the irritation
sometimes continues after the teeth get through # “use astringents”
If any disease from the causes attacks the child
during the period of dentition it will be very important to 
remove all irritation from the latter source, for otherwise
all the symptoms may be aggravated & a disease be rendered
mortal which would otherwise have been mild.
In children of a vigorous constitution dentition
is often accompanied with inflammatory symptoms which require 
an antiphlogistic plan of treatment. Lancing the gums
will then be useful as local bleeding & it may even be advisable
to bleed from the arm though a few leeches behind the ear
are preferable.
It must not be forgotten that in 
infants, the bowels afford a great outlet to diseased action
and to irritation: hence the frequent occurrence of a spontaneous
diarrhoea. If the patient is costive or if it has a 
diarrhoea, a dose of calomel should be administered & if
the bowels are soluble a milder mercurial, as blue pill
may be given. During the whole period of dentition the
bowels should be kept open by such cathartics as the state of 
the system may indicate, such as magnesia, rhubarb etc. adding
aromatics if the system is relaxed and debilitated & chalk
if there is acidity
If a diarrhoea suddenly stops and
vomiting supervenes, externally irritant to the [illegible] [surface] generally, injections, calomel


The skin shd be kept moist for diaphoresis
is one of the most powerful means of equalising excitement etc.
If there is much perspiration you may 
depend upon op. alone but whenever there is much 
[unequal] excitement opium alone will not do well and
ipecac shd be combined with it in small doses
# Also by drafts to the [illegible], by local irritants 
to the skin generally also keep the bowels from 
remembering that there is no outlet to the brain 



39
and the warm bath are to be used, as has already
been mentioned under the head of diarrhoea
Another & a powerful mode of equalizing excitement & relieving 
irritation is by diaphoresis. For this use the warm bath & 
small doses of ipecac & opium or of antimony and opium.
Opium will always be useful to allay irritation & particularly 
if combined with ipecac or antimony, & always safe when 
there is no determination to the head
Small blisters behind the ears relieve the 
symptoms of dentition & prevent the disease from terminating 
in hydrocephalus. # If these cannot be kept behind the ears
mercurial ointment or cantharides may be applied to the 
same part. Nervines may be employed either with our 
without ipecac
During dentition exposure to dampness & 
to currents of air should be carefully avoided & the patient
should be kept warm


X summer & autumnal epidemic
Indeed the effects of it sometimes continue through 
the winter
The desire often resembles spasmodic
cholera in the premonitory diarrhoea & the sudden
collapse 


40
Cholera Infantum
This disease appears in New Haven in the month of July 
August September & October. It rarely commences until 
the latter part of July & in October there are few cases except
those which have commenced in one [illegible] other mouths & continued
until this. Indeed cases are sometimes prolonged till 
the middle of November
Symptoms. It begins in various ways; most commonly 
with diarrhoea, which may continue for days & 
even weeks without any very alarming symptoms; At other 
times times with violent vomiting & purging accompanied with high
fever.
The discharges from the bowels very much in their
usually [illegible] from natural colour [illegible] [irritated] [secretion]
appearance. Sometimes they are yellow, brown or green, sometimes 
in small quantities & slimy and bloody & at others in 
large quantities & watery, smelling like water in which 
putrid meat has been washed. Worms likewise may be
found in all these various sorts of discharges “dead in the advanced stages”
The disease is usually accompanied with great
restlessness & often with severe pain, which increases
by paroxysms at intervals of from 
fifteen minutes to two hours
The pulse is usually quick and weak, the
head hot and the extremities cold. The fever is ordinarily remittent
but the exacerbations are frequently quite irregular
The disease is attended with thirst often [illegible]
and after drinking the child vomits.
The eyes often appear languid and hollow  


During the whole progress of the disease [volvulus] may 
occur Be on the look out for it
“The termination of this disease in hydrocephalus 
I have reason to think is more rare than is commonly 
supposed. Many cases of this kind occurring in my 
practice, I have reason to believe were cases of volvulus
Or varying from cholera morbus of [illegible] [remittent]
bilious fever sometimes putting in the form of cholera of [illegible]
at others that of remittent bilious fever


41
while in other cases they may have an unnatural
brightness as in pulmonary consumption indication a high
degree of mental [illegible] excitement “of bad symptoms” Sometimes the eyes are half
open during sleep, as is indeed the case in various bowel complaints 
of children when severe we often find the diseased action 
translated from the bowels to the head and terminating in 
hydrocephalus. Volvulus also may be another termination.
Sometimes the vomiting ceases
for several days and then returns, while the diarrhoea
continues the whole time
Duration As to the duration of the disease, it may 
be very rapid in its progress & terminate fatally in forty eight hours, or continue for
months, & the symptoms may vary very much during the 
progress of the complaint. A damp hot atmosphere will aggravate 
all the symptoms, while cool weather with the wind 
from the northwest will mitigate them. In different
seasons also cholera infantum will have symptoms peculiar
to the year, varying in this respect like other epidemics
Finally when it proves mortal, the child is
carried off in convulsions, or is worm out with emaciation 
& dies with aphthae while in some cases death is ushered in by hydrocephalus,
volvulus & other diseases
Causes. We may consider the cholera infantum 
as an epidemic sometimes an endemic confined to a particular season of the year
analogous (in its grade of action) to the cholera morbus o f
adult “This disease is perhaps most analogous to a remittent
bilious fever varied by the peculiarities of the 


[illegible] [illegible] will see in [Jackson] all that can be said in 
[favour] of the opinion. The very fact that it is often [illlegible]
disproves the opinion besides the fact that the disease does
not occur at all seasons during the period of dentition 
The disease is affected by the state of the atmosphere
being much aggravated by a damp state of the air 
always minded by a cool bracing northeast wind
The kind and gentle excitement produced by 
nursing is important in chronic disease
“Children should not be weaned till dentition is complete or till
1 ½ years & in the fall”


42
infantile constitution”
Dentition has been considered by some as the 
cause of cholera infantum but to this opinion I cannot assent thought it is held by Dr Jackson & many of our most respectable physicians
Dentition may indeed be an exciting cause; it often aggravates
all the symptoms & accelerates the fatal termination 
yet in the winter spring & months it does not produce the disease of
not unfrequently children are affected with cholera infantum
without any appearance of dentition
Worms sometimes make their appearance during 
the progress of the disease but they cannot be considered as
a [illegible] or cause of it. When they exist during the complaint
the irritation which they produce must be obviated by 
such anthelmintics as are not contraindicated by the state
of the system. “I think I have seen the [illegible] productive 
of unfavorable effects.”
The cholera infantum probably arises
from the same remote causes as the (cholera morbus) & the
bilious remitting fever of adults such as damp hot confined
air (which can be counteracted only by exercise in 
the open air) want of cleanliness & bad diet. Improper 
food may be both a remote & an exciting cause & the same
is true of a bad state of the atmosphere muggy or [illegible] of inequality of temperature & exposure to cold. The predisposing
cause produced by these remote ones is debility
Children weaned in the spring are mor apt
to have this complaint, & do not bear the disease 
so well as those at the breast. I would therefore advise
that in places where cholera infantum prevalent.
children should be weaned in the fall




43
Some consider malaria the cause
Like dysentery this is a disease translated from 
the surface to the first passages. The fever is of that kind which 
Sydenham calls febris introversa the action being of an 
irritated kind in general & rarely of an inflammatory 
Commencing at the skin & breaking up the balance of the
system by obstructing the perspiration the morbid action is
transferred to the mucous membrane of the intestines & involves
the liver, pancreas & all the glands immediately sympathizing 
with them.
Indications. The indications are
1st To evacuate the first passages; if this has not been already 
done by the disease itself
2ndly To translate action to the surface & in general to equalize 
excitement
3dly To excite healthy secretory action and regular peristaltic
motion of the bowels
4thly To avoid the causes of irritation and to remove irritation 
when it exists
5thly To restore the tone of the system & particularly of the
stomach and bowels
1st When the disease comes on like the
cholera morbus of adults, the stomach and bowels are sufficiently 
evaluated by the disease generally when the phys. is called and no evacuation s
are to be used. It is to be treated like cholera morbus
with aromatics as essence of peppermint, with Laudanum 


We must be careful not to prescribe for the [name]
of the disease nor necessarily pursue the plan of treatment
generally proper. Often you will find the patient so
much debilitated at first as to require stimulants & acrids
When we have the collapse stage and
a collapse may recur in any disease then the practice
of the nurses is correct in acting on the skin
Some recommend large doses of cal. [illegible] much 
smaller the [common] Dr Jackson recommends large doses
common in the commencement. Dr [illegible], 1 gr. doses
and salt & water I recommend cal. from 
1 to 10 gr Though sometimes small doses repeated may change
the secretion better than large, yet often a large dose 
will operate more kindly, then a small one [which] merely
irritates
“Dr Dewers recommends injections of salt & 
water 2 or 3 teaspoonfuls to a gill, instead of cathartics. Repeat
the injections till full catharsis is produced the morbid
action is changed, by translation of excitement from the stomach & 
small intestines [illegible] [illegible] with cal. ¼ gr. every [illegible] to alter secretion


44
with counterirritants, as mustard, horseradish & brandy on 
the epigastrium & abdomen with the tepid bath & with injections 
of starch and laudanum. But when it attacks
with a diarrhoea, accompanied with occasional vomiting
unless the constitution is very feeble constitution [illegible] extremely delicate the stomach should be evacuated
by ipecac and the bowels by calomel or blue pill
To vigorous patients & often give in the commencement 
six grains & would not hesitate to give 10 grs of calomel & an hour after give from one 
to ten grains of ipecac according to the age and vigour
of the patient for in this way the stomach and bowels are
more thoroughly evacuated than by giving the calomel
after the ipecac has ceased to operate In some cases
a single dose of calomel will thoroughly evacuate the
bowels, but in others it will only remove the contents 
of the stomach and small intestines into the colon & 
a dose of castor oil must be given or one of senna with 
aromatic seeds
The southern physicians, make less use 
of cathartics and depend much upon stimulating injection,
as of salt & water 3 teaspoonfuls to a gill. This 
practice does not succeed well with us. They also give
smaller doses of calomel. This also I cannot approve for
a large dose of calomel, ten grains for instance, will 
evacuate the bowels copiously and kindly, when small
ones produce scanty stools, with irritation of the stomach
and tenesmus. I may mention also that the French expectant 
plan of treatment adopted in Philadelphia will 
frequently be utterly inefficient.


Where excited has not been equalized, calomel
or any other cathartic may act upon the duodenum only 
and not produce
Such facts as there have been given rise to the
opinion that the disease arises from stricture but then 
the al. can. may be subject to unequal action as much 
as the skin
# a castor oil with elix. sal. aa zi every 2 hours
# Yet this practice shd not be adopted indiscriminately
where there is weak morbid action accompanied 
with coldness of [surface] etc. the exhaustion of cathartics
will be injurious 
This is the most important principle in the cure 
of diseases
Sometimes cath. cure the diarrhoea, where
the action is unequal. For instance the lower intestines
may be torpid and the feces accumulate, the bowels above
may be irritated and a diarrhoea of [small] liquid 
stools may pass by the feces



45
If calomel or any other cathartic produces watery stools
in which are small pieces of feces of an ordinary appearance,
and there have not previously been copious evacuations,
we may conclude that a thorough evacuation of the
bowels has been prevented by a spasmodic action of the
intestines which has constricted them in places, & confined, perhaps
a large quantity of fecal matter. Indeed this may be
proved by the success of the treatment, which should be 
the administration of a dose of opium with a little calomel to change action followed at an interval
of one or two hours by a dose of z ¼ and z ½ castor oil or elixir
salutis teaspoonful #. It is of the first importance in all typhoid 
diseases, particularly in those affecting the bowels, that 
thorough evacuations should be made #
2ndly so translate action to the surface and equalize 
excitement This indication will be answered by an emetic
at the commencement, as already directed & by small 
doses of ipecac, repeated throughout the disease, & also
by small doses of mercurial medicines opium being conjoined
in many cases, as will hereafter be mentioned. In 
some calls where there is much arterial action antimony is 
preferable to ipecac & the lancet or leeches may be indicated
but such cases are rare This indication is also answered
by applications to the abdomen of fomentations,
with decoctions of aromatic herbs sinapisms, blisters, burdock 
leaves, horse radish leaves, ginger in spirits aq; amm or the 


Ulceration of the bowels is generally preceded
by aphthae both are effects not causes of the disease
“An [epispastic] should not be applied after 
aphthae have made their appearance. If the pat. is languid
& sleepy we may suspect aphthae.”
Diluents may be used
Obviating irritation by opium is often necessary to have
the proper effect of cal. for instance Give opium first & follow
with cal. & often you will succeed in obtaining the effect of
the cal. when you had failed before
“Ipecac when it acts as a cathartic
is more apt to produce fecal stools than any other article


46
terebinthinate oils An epispastic upon the epigastrium 
is very useful to relieve irritation of the stomach & to prevent
ulceration of the bowels and aphthae. The warm bath 
will tend powerfully to equalize excitement will relieve
vomiting, quiet restlessness, produce a uniform perspiration 
& if used at evening, procure a quiet nights’
rest. It may always be used and at any time, unless 
the patient is in a state of exhaustion.
As a substitute for ipecac, the root of the 
asclepias tuberosa may be used. It is much used in 
infantile diseases as diluent, to determine to the surface
& to promote expectoration.
3dly For changing the secretion of the stomach and 
bowels and keeping up a gentle peristaltic motion I have found
small doses of mercurial cathartics with ipecac of opium
superior to all other remedies. If any article deserves the
name of a specific in any disease, it is ipecac judiciously 
administered in cholera infantum. It relieves this disease
with more certainty as certainly as than cinchona does intermittents. It
may be observed however that a man successful with one
remedy only m ay be compared to a mechanic, very skillful
with a pen knife! My method of administering the articles
is the following. For a child four months old, mix 4 gr.
of ipecac & 5 drops of laudanum in twelve teaspoonfuls 
of water & give a teaspoonful every fourth or fifth hour
& at the same time give so much of the blue pill as to 


You will know when the blue pill begins to have
its appropriate effect by the change in the color of the stools
Pills of blue pill may be given without much difficulty to children there is little
taste except of the saccharine matter. They may be given in food
[illegible] dried huckleberries which I have often called for in the
country where there was difficulty in administering remedies. There
is often great difficulty with respect to this. A child will
often scream at the sight of the doctor
Opium to allay the irritation of the stomach
and prevent the ipecac from being thrown of Ipecac
to equalize excitement & determine to the surface Ipecac
also, to qualify the opium
# Or if this cannot be done, introduce a paste of opium just within
the sphincter
# Case of a child in a family where 3 or 4 children 
had previously died of chil. inf. [Lax] & [illegible] habit
etc. I commenced the treatment
with the pill and ipecac 
I treated it mildly giving blue 
pill instead of calomel N.B. For such cases [illegible]



47
procure an evacuation from the bowels two or three
times in [never twice] in the twenty four hours. For a child a year old
take twice as much ipecac & laudanum with the same
quantity of water and give it in the same way. Sometimes
three times the quantity of laud. will be necessary; for instance
if the child has been in the habit of taking it or if the diarrhoea is very urgent
If the diarrhoea is urgent, it may be necessary 
to administer injections of starch and laudanum & 
to apply to the abdomen ginger & grandy volatile liniment poultices or other irritants
The enema may be made with three table spoonfuls of flour
& about 3 or 4 times as much laudanum as you give by the
mouth say 10, 15, or 20 drops. # I prefer flour to starch 
because the foreign starch often contains acid. The chalk 
mixture or white decoction may also be used.
# “Children of a bucophlegmatic temperament 
and lax habit are very apt to have this disease & with 
them I have sometimes commenced the treatment by administering
blue pill & ipecac.”
The success of this plan of treatment will be strikingly shown
by the following case. A child 10 months old was taken sick in this town
last summer, with cholera infantum, grew worse and was
directed by the physicians to be carried into the country
Unfortunately the child was carried to a situation not more
elevated than N. Haven & while there its strength decayed
and all its symptoms were aggravated. The parents despairing 
of it recovery returned with it to N. Haven & sent for me with 
a request that I would do something to alleviate its sufferings 


On recovery from the disease they usually crave [salt]
food and salt is a grateful stimulus


48
I found it in a state of emaciation, with hippocratic countenance
frequent vomiting, urgent diarrhoea, with stools fetid, watery 
and containing some slime and mucus, & leaving streaks of
blood upon the cloths. The countenance and gestures, expression 
of great anxiety, and there were frequent paroxysms of extreme
distress. I directed ipecac 5 gr. & laud. 10 drops to be put 
in 10 teaspoonfuls of water and a teaspoonful to be given once in 
four hours flannel wet with ginger and brandy to be applied
to the bowels & gave 5 oz. blue pill, & ordered the diet to be of
arrow root flavored with a little brandy. After the second dose the vomiting stopped, the
stools became less frequent & within 24 hours the complexion of
the stools was much improved. The next day the same medicines
were continued and four drops of the tonic solution with 
a little brandy and water. On the fourth day from my 
first visit, the child began to relish salt fish, which was allowed 
Capt. Dennison’s children
To correct fetor in the stools we should give
charcoal. Carbonic acid, by injection, is given for the same
purpose. The mode of injecting carbonic acid, is to place chalk
& vinegar in a bladder, and 
force the gas into the rectum, as it evolved. “This is 
recommended. I have tried it but not very thoroughly”




But if vegetable food undergoes the acetous fermentation
it shd not be used. The putrefactive fermentation 
however is more injurious than the acetous


49
4thly The most common cause of irritation is dentition 
The gums should be often examined, & be divided if they appear
at all swollen. All kinds of food that is hard of digestion 
should be carefully avoided though for children
somewhat advanced perhaps a small quantity of ripe fruit
may not be injurious If the child has not been weaned
the milk of the mother will be the best food; for those children’
who nurse are more apt to recover than those that 
have been just weaned. The act of sucking is highly soothing
and gratifying & operates like a nervine medicine.
The best food for children that have been weaned, will be arrow 
root, with a little brandy or wine as a condiment & as a substitute
for this & similar articles from the shots, we can
direct a porridge made of roasted flour. If in the latter 
stages of the disease the child craves any particular of food, as
salt fish, or salt meat, or wine or brandy, it should be given, & 
all kinds of medicine laid aside if the stomach leathe3s them; for 
strong disgust will debilitate by exciting nausea. Frequently 
however we can succeed in preventing this effect, by a different
mode of administering the medecine the sight of the spoon for 
instance may may give rise to the loathing & nausea.
With respect to food we may lay it down as a general
rule in such cases that when the powers of the stomach are
so weak that food must undergo fermentation in it, vegetable
diet should be preferred to animal.
For local irritations, various applications should be made
& various articles administered, especially in the latter stages 



“Tea juice? boiled beef a teaspoonful with pepper & salt
is grateful frequently & checks vomiting but at
first vegetable preparations are better”
vide supra
The chalk mixture made with a little opium 
in some cases or with astringents etc. a valuable [illegible]


50
of the disease or when we are compelled to try a variety
of remedies. When there is unequal excitement & unequal temperature
blisters may be used. Blisters sometimes produce perspiration.
To relieve irritation of the stomach effervescing mixtures
may be drunk, they are often more grateful. [illegible] we may 
fill the stomach where there is vomiting and dilute its contents with a tumbler of wine whey 
I have often succeeded with it
with a teaspoonful of aqua ammoniae in it as being thrown up will be no objection. If the disease commences
with much irritation in the stomach, it may be useful
to overcome it by counterirritation in the rectum produced by an
injection of soap suds or of salt and water 3 teaspoonfuls of 
salt to a gill of water, for a child a year old. Dr Dewers
relies must upon this latter article in the commencement of cholera 
infantum and repeats the injections until the bowels are
fully evacuated. He likewise recommends small doses 
of calomel, a quarter of a grain for instance repeated once in 
an hour until the bowels are evacuated. In cases of irritation 
of the stomach & torpor of the liver & portal system, this 
practice of salt & water & small dose of calomel does well. In chronic cases he gives magnesia
rhubarb & opium. With respect to small doses of calomel
it may be further observed that they will not answer when 
the intestines are much coated with mucus & that in some
localities they do not answer so well as in other places. On 
the shores of lake Erie for instance the physicians are obliged
to give large doses of calomel than we give
There are cases in which small doses seem
to irritate & large doses operate kindly 


“In the latter stages Rx magnesia grs 4 SS gtts
Rhei gr i.”
C. Florida not so pleasant but loses its mawkish & 
herbaceous taste by keeping (like peruvian bark)
The spiraea is though less inclined to act unequally 
in this state than most other astringents
If one astringent wears out try another
Oak barks
Rose [illegible] (salix [illegible} “A valuable popular remedy” 
has mucilage combined
seeming to resemble ([illegible]) [illegible] was formerly 
much used but is now superseded by native articles
It is well known that because These astringents are often prompt up is specific
[illegible] virginica was specified good [illegible] & [illegible] it
e.g. viburn. lentigo, raspberry, blackberry, [illegible] [illegible] root decoction
recommended by Dr Rush thought to deter to [illegible] used by many) [illegible]
bark has [mucilage]
There is apt to be a paucity of [urine] in this disease
as well as in Diarrhoea & dysentery and then diuretics
are indicated and are highly valuable


51
5th When in the latter stages of the disease the principal 
indication is to restore the tone of the system & particularly of the stomach
and bowels we must make free use of tonic and astringents.
Moseley’s tonic solution will be one of the safest and best articles
in this stage. If the bowels, by a habitual action keep up the 
diarrhoea, astringent will be more specially indicated such
as the compound tincture of vitriol. I prefer however, the 
cornus circinata to all other articles
C. servicea (red [illegible]) C. [illegible] C. alba nearly allied
Of astringent vegetables we can make choice
from a great variety which are indigenous & common. All
the various species of viburnum all the [potentillas] & the 
roots of the strawberry to say nothing of the bark of the oak & 
indeed most of our forest trees, are astringent & may be used
The spiraea tomentosa is much used in decoction or extract 
All the species of [illegible] are astringent & the C. [rivale] is a most
valuable article; as is also the geranium maculatum, which 
may be be given in wine & then we shall have red wine.
The sttici limonium (marsh rosemary) is not so agreeable but
is frequently more efficacious specially if the mouth is sore. Its taste resembles that of salt
mud. When given internally, it is boiled sweetened & has a 
little wine or brandy added. It is also used as a wash in 
case of the supervention of aphthae.
The erigeron canadense, called colt’s tail
& strangury weed has been found a valuable article in the 
latter stage of this complaint and of dysentery given in decoction.
It is acrid pungent like [illegible] bitter & stimulating & acts also
upon the kidneys as a diuretic. It seems likely to prove a 


Give it in decoction or in milk which will cover 
the taste of it
Balsam of copaiba or turpentine cannot be combined
with mucilage so thoroughly as in the white pine 
bark in milk & water diuretic & [sheathing] to the bowels
I have often used the expressed juice of spearmint
as in diarrhoea q.v. It is important in long continued bowel
complaints of children that the medicine shd be grateful
The diuretics are useful both in children and adults
(dysentery diarrhoea & cholera infant) because there is a
paucity of urine and acrid irritating secretions
In some cases of exhaustion we give opium constantly
in small quantities to keep up the [illegible]
Mucilages marshmallows or substitutes for
which hibiscus palustris hib. syrica hib. [illegible] hib.
(rose of [shora])
Mucilages by stopping irritation are
diuretic


52
a valuable article in the latter stages of bowel complaints 
provided there is not too much vascular action. It has been 
long used, vide Barton, the N.Y. Medicophys. Transactions etc.
In 1790 an itinerant came through N. Haven offering to 
cure the dysentery; and attracted a good deal of notice.
It was found that his [illegible] consisted of this article. The 
other species of erigeron have similar properties.
In the latter stages of the diarrhoea mucilages
should be given. They made of any of the various in articles in 
use, but perhaps the most valuable mucilage, will be that made
from the inner bark of the white pine, which will furnish a terebinthinate 
principle in addition to its mucilage
Often in the latter stages of the disease, great
benefit will result from supporting the abdomen by a bandage
and a plaister of white [diachylon] and opium or
a soap plaister (of [illegible] & soap) 2 parts sp. 4 pts plaister
In extreme exhaustion & debility from the 
long continuance of the complaint with cold extremities, aromatics
and stimulants may be required & we may give spiced tea
spiced wine or brandy in small quantities, or the white decoction 
and apply cloths dipped in brandy to the abdomen & to the extremities


Nothing has more affect upon complaints of the 
stomach liver & bowels than the state of the mind as
we see in dyspeptics
The
We are apt to suppose children not subject to 
notice of [illegible] children [illegible]
mental impressions. When the matter has been dissolved
in grief & abandoned to despair
I told them to tray as a last resort carrying
the child in a hack out of town the excitability was entirely 
gone the child might as well die in the back
as any where strange advice On the top of the [illegible]
about two miles out lifted up the child [sound] trees
grass birds, etc. opened its eyes before this had lain
with eyes half closed noticing nothing 


53
Finally when every form of medication seems to fail, our
only remaining resource will be change of air. This is a
most powerful remedy. The physicians of N. York and Philadelphia
are continually recommending it. We are apt to suppose 
that in children it can be only the purer air 
& the exercise of travelling that produces a good effect, when they 
are carried from home for their health, but on the contrary 
the change of scene seems often to have a more powerful effect
upon them than it would upon adults. Children that
have lain sick for weeks, instead of pursuing their accustomed 
amusement even though mere infants seem of ten to settle into
a state of utter despondency from long confinement & the
constant sight of the same unvarying objects around them, & 
appear to loath every thing offered to be done for them. This morbid
condition  of mind seems to be one directly opposite to that of
nostalgia or homesickness & is to be relieved in a corresponding
manner. I well recollect a child apparently 
in articulo mortis cold & vomiting nothing wd [illegible] the vomiting
entirely beyond the influence of medicine
or food. It was carried in a hack to the top of a hill
without the town N.Y. [illegible] where it had a view of the sound, & the
scenery of the country around. While there is brightened up
vomiting ceased and took food staid an hour or more & then was carried back to town, where it
finally recoverd.




54
The symptoms attending cholera infantum very very 
much and give rise to considerable variety of practice
It is probably owing principally to this circumstance more
than to any other that physicians differ from each other
in their mode of treating it.
Post mortem examination show that this disease
affects principally the mucous membrane of the stomach & the
small intestines; rarely the large ones. Sometimes coagulable
lymph is found in the intestines but less frequently than in 
other diseases. Sometimes the mucous membrane of the intestines
is thickening & according to Dr Jackson ulcers are occasionally 
found both in the small & also in the large intestines. The 
liver is usually enlarged without derangement of structure
Ordinarily the brain exhibits no morbid appearances, unless
the disease has made a determination to that part constituting
hydrocephalus 
N.B. The remarks upon asclepias tuberosa
introduced under the Head of [illegible] capitis probably 
belonged here


Fever of the bowels Acute [illegible] of [illegible]
Different writers give different names and do not always give
the same symptoms. The European disease differs somewhat
from ours. It is our infantile winter epidemic.
Typhus infantum of Prof. [Tully] “Disease of the bowels
bowel complaint, plague of the bowels, winter epidemic 
& [illegible] epidemic. Remittent bilious fever
(at south) Musgrave’s spurious [illegible] fever Duncan III or IV”
There is some [illegible] action but more of the
character of irritation like other infantile fevers
Rarely vomiting never diarrhoea in commencement
The morbid excitement often extends to the lungs
putting on the for [illegible] what is called in adults bilious pleurisy
The disease is not common at this time
though it was very much so formerly Probably it will 
return It is almost the only winter infantile disease
& so common has it been also that the nurses call almost
every disease in winter, of childr, by this name 
of choler.
The dis. is to be broken up in its [illegible]
by means various in various patients by a strong impression 
upon the stomach in a strong constitution but by 
an impression upon the whole system in the delicate
constitution Comparison to a weight upon a [illegible] If applied upon one part only it will break it not if applied to [illegible]
It is desirable that vomiting or at least
nausea should talk place from the cal. In enteric 


55
Constipation with Fever
or
Remittent bilious fever of children Musgrave’s spurious worm fever
marasmus acutis
This complaint has been known in N. Haven for more than 50
years by the name of choler. It is called in some places at the 
“It is unfortunate that we have no better [illegible]”
eastward, the plague in the bowels. It is a common bilious 
“It affects however the duodenum & small intestines rather than the liver”
fever produced by causes which operate upon the bowels a 
part of the system which in children more particularly invites
Children are attacked by it from the age of 3 mo. to 2 or 3 yrs.
febrile action. It is often inflammatory in its commencement
Sometimes it [illegible] in the form of typhus
Symptoms The pulse in the commencement of the disease is 
full, frequent & sometimes tense, the skin is hot and dry 
face flushed, respiration, short and laborious, tongue covered
with a white fur, the abdomen fuller and harder, than in health, & the bowels costive; the urine small in quantity
and high coloured & sometimes the fever is attended 
with cough & expectoration. This disease is a fever
which often affects the lungs and always the alimentary 
canal & liver, the secretions being suspended and the 
bowels constipated.
Treatment. This will be antiphlogistic in the commencement
of the fever & the first indication will be to evacuate thoroughly 
the stomach and bowels. This will best be answered by a  
single dose of calomel of from 5 to 10 or 15 or even 20 grains for a child 
from four to twelve months old We shall thus produce a strong
impression upon the whole alimentary canal & upon the
system at large. In entonic cases and vigorous habits a
little tartar emetic may be added to the calomel
Usually the calomel excites both vomiting and purging, but 
sometimes it is retained on the stomach and has no immediate 



cases it may be beat to conjoin tartar emetic for this
purpose.
Sometimes the cal acts upon the stomach & 
duodenum & excites the action of the liver, and spends
itself there, without producing catharsis
Sometimes it is necessary to repeat 10 gr
doses of calomel once in 2 hours until 40 or 50 gr have
been given and cause them to follow with liquid cath.
a [illegible] or jalap or scammony
N.B. If there is great difficulty in giving medicine
repeatedly, we may give powder of jalap in 
coffee or fermented liquor or we may give a teaspoonful
of the tincture of (not briony root but pure jalap
in milk & water which will not be tasted
Feeble constitution must have the warm’
bath. # Rx senna zjs man zi senega zii anise seed zis
liquorice zfs [illegible] ½ [illegible] This I have held the child with. remember large doses are needed
Rx scamm. grs 2 or 3 chalk & diaphoretic antim. this
was called Earl of Warwick’s powder & was kept in the shop
here. Tart. emet. would be a more certain prop. of art. It 
produced violent vomiting. Scammony is better united
with cal. however. # 
# Cautiokn about covering the [illegible] with a blanket
vide
# Cal. was finally substituted for the [diaph.]
ant. This Warwick’s powder used to be a shot preparation
in this town and parent would send for it. From the uncertainty 
of the strength of the diaph. ant. however, [dangerous]
vomiting sometimes occurred from the use of it 


56
effect. In the latter case a second dose may be
given two or three hours after adding from an eighth to a quarter of a grain of
tartar emetic for a vigorous patient Fifteen or twenty 
grains of calomel will often empty the stomach and
bowels freely & remove all the symptoms. The calomel
may however evacuate the bowels but partially & in some 
instances not at all merely moving the contents of the 
small intestines into the large ones. In such cases another
cathartic is needed for completing the purgative operation 
If the calomel appears to have no effect, it should be repeated
in 5 gr. doses every three or four hours, the patient
put immediately into the warm bath & we should
commence feeding the child as freely as the stomach
will bear with the following R fol. sennae zfs, mannae zi
steep in ½ pint of boiling water & if there is a cough, add
senedae zii & rad glycyrrizhe zfs. If the stomach
will not retain the mixture of senna the powder
of jalap or scammony mixed with tea coffee or milk must be substituted, giving 4 
or 5 grains in the intervals between the doses of calomel
Injections vide p. should be given to assist the operations of the
cathartics and repeated every 2 or 3 hours until the 
bowels have been thoroughly evacuated taking care
however not to commence with injection until the cathartics
have had time to operate
When we have succeeded in procuring stools
we shall find them to consist of viscid green mucus mixed
with half digested food. Sometimes in the progress of the disease they exhibit the 
appearance of small pieces of membrane, of 


There is a membrane [illegible] inflammation of the duodenum
similar to that of croup. This indicated by pieces of 
membrane preceded however by pain in the part
obstinate constipation etc. This is a strong indication for
calomel which however will not operate as a cathartic
until the violence of the disease is broken Warm bath
& injections will also be more particularly
In some violent cases of the fever where
calomel seemed to have no effect. I have known acid
as lemon juice advantageously combined with calomel
Among the cathartics and laxatives used in 
the second stage we have the wild liquorice or [illegible] [circa???]
which was formerly a popular article and kept in families. It is 
diaphoretic and laxative and possesses and also deobstruent properties
It is said that with this the Indians formerly [died] their porcupine quills
# The acids are sometimes used in combination with 
mercurials I should not use them unless when
mercury fails
Sometimes it affects the ear & produces suppuration 
& discharge. It may terminate in effusion into the ventricle
of brain. It may terminate by exhaustion Or may 
terminate in thrush “in which case there is a double translation 
1st from the bowels to the head & thence to the mouth oesophagus & bowels



57
& of about the size of petals of peach blossoms, 
floating in a liquid of the same colour. Such stools
as these latter are a sure indication that a farther evacuation 
from the bowels is needed vide p. 207 They are frequently 
evacuated by adults in bilious (or common cholic.
If such continue it is well to vary the cathartic and give
magnesia, or soluble tartar (peerlash & cremer tart.)
or phosphate of soda, or any other neutral salt.
generally the violence of [illegible] [illegible] & The blue pill may be substituted for the calomel & given
three or four times a day, until the stools change their
appearance or the mouth is affected, though this rarely 
happens to children under four years of age. These
stools rarely have any smell & as they indicate a want 
of secretion I the liver & glands of the abdomen, mercurials
are peculiarly appropriate. In some states of 
fever attended with stools of this kind I have known
the free use of acids with mercury very useful # 
After 48 hours the fever generally 
remits, and sometimes it continues in the form of a remittent
for six or eight weeks or more. Very frequently 
however it changes its seat in the course of 15 or 20 days
& terminate in a phlegmous swelling of some of the glands or in phlegmon
or is determined to the head
& puts on symptoms of hydrocephalus, which are best 
relieved by blisters behind the ear, a place which is the natural 
outlet of diseased action in children. They may terminate
naturally by a discharge of purulent matter from the 
cavity of the ear or fatally by effusion into the ventricles of 


I recollect two cases early in my practice, which 
continued 6 or 8 months. They were very violently attacked
They continued 6 or 8 months coma 
Hence we should never despair
In the latter stages it may be proper to 
give tonics or those articles which are called tonic
very unlike the vegetable tonics however. They produce a
[illegible] excitement
Giving arsenic is no new practice 
It is a safe and efficatious remedy, when the dis. continues 
as a remittent It comes after cal. & tart emet. producing 
liquid secretions. If long continued it must be followed 
by bark to restore tone and obviate the debility caused 
by the arsenic Arsenic can only be called a tonic
as it removes disease. It would never be given as a 
[illegible] is pure debility #
# I have used digitalis, in the latter stages to allay irritation
# In many cases the fever continues from habit
& medicines have little affect. There will be an accession 
of fever every afternoon. Here give sol arsen 2 drops
twice a day which is a full dose for a child ½ years old
If this has no effect give it [illegible] times a day”



58
the brain; in two cases I have known them relieved
by a thrush.
If the disease continue a regular remittent
without symptoms of hydrocephalus, it will be proper to give
tonics, such Moseley’s tonic solution or if the fever intermits or remits Fowlers solution of arsenic
the latter in doses of two or three drops the former
from 4 to 20 drops, 3 or 4 times a day. I have known a child
18 months of age cured in this stage of the fever, in the course o f
two or three days by taking 2 drops of Fowler’s solution 3 times
a day. This article however is liable to produce edema or dropsical
effusion & if it does we must substitute the tonic solut.
(beginning with about four drops) or some preparation of
bark. The dose of the tonic solution will depend upon the
irritability of the stomach If irritable from 3 to 6 drops will 
be as much as can be borne
After the inflammatory action has subsided
narcotics anodynes are necessary to remove irritation and
to procure rest We may use opium, either alone or 
better combined with ipecac or antimony # Indeed as the
skin is usually dry antimony is indicated in almost every 
stage. The warm bath also is indicated in every stage except
in the low typhus state of the fever when it would be too debilitating.
Epispastics & irritants are useful in the progress of the
disease, to translate action from parts essential to life & in 
the last stage also perhaps to keep up the action of the system. They 
may be applied to the abdomen if it is much swollen to the
head behind the ears where there is danger of hydrocephalus & 



Avoid too much heat to prevent tumefaction of the
bowels.
Terebinthinates a [illegible] oil may be needed proper 
If pneumonic symptoms blister etc.
“If the lungs are much affected, apply a blister to the
chest, give expectorants, and pursue the treatment required
in pneumonia. Senega & squills are good, but
are too stimulating for the earlier stages liquorice anise”
By this disease it is sometimes proper to do nothing 
and omit all medicines in mania etc. In those cases
as I have had difficulty to persuade parent to do nothing.
I have applied aloetic plasters 
to the bowels I think they have produced evacuations
injections also can sometimes be given
Case of a very [illegible] child
[furious] parents passed in review before him with 
roasted apples pears etc. after 26 hours he snatched
an apple relapsed in 26 hours they probably had over 
loaded his stomach however the same management 
finally succeeded afterwards of the patient recovered. vide p. [20?]
The same season I had 3 or 4 more such 
cases of mania which required to be cured by fasting


59
a large one to the chest if the lungs are affected.
“This disease is sometimes followed by thrush
when an emetic of ipecac will have a good effect. If the stools
are fetid charcoal should be given. If in the latter stages
there should be tumefaction and pain in the bowels, the
abdomen should be supported by a bandage. In the latter
stages also a decoction of the inner bark of the white
pine be useful. It possesses some tonic properties”
Sometimes in diseases of children the mind is 
affected, the patient will take neither solids nor liquids & struggle
till it is exhausted whenever an attempt is made to administer
any thing. If that is the case in this disease we must use
the tepid bath & we may a apply for purpose of moving
the bowels, a large plaister of aloes and ginger to the 
abdomen Frequently this derangement & morbid revengeful
disposition (according to Dr Rush an affection of the moral
faculty is so great that we must wait even for 24 
hours or more without administering any thing. It may 
require great prudence and judgment in such cases, to 
satisfy the parents.
Before leaving the subject I may observe,
with respect to the propriety of the course I have directed
in the commencement of the disease, that if the cathartic which 
we administer first produces emesis we may be sure that
the alimentary will be operated on, & also that we often 
require a remedy more powerful than the disease, just
as in croup.
“As to diet meat must be forbidden but sometimes salt food is craved. The weak chicken broth is good.



The dis. is something very rapid & violent
Fever as violent as the constitution could bear
Collapse from the violence of action
Parents considered the patient & dead
After the mustard was applied as soon as the
skin was reddened a blister was applied, which 
produced a sore 2 or 3 months in healing
“In one hour pat. revived”
Nervous system affected
Irregular action such as after collapse of
cholera Strong clonic spasms once in 15 min.
“Pat. kept under a constant [narcosis]”
Antispasmodics & tonics finally In two or three weeks [illegible] recovered some strength
It was called the child that died & returned to life again
The above is account of the disease as it
most commonly appears. It is different however in 
different years sometimes effecting one part of the system
sometimes another A practitioner keeps this [illegible] [illegible]


60
Case of a female child 2 yrs of age. The disease ran
the most rapid course I ever witnessed. 
The whole system became
affected; the pulse was full & frequent, the skin hot & the
tongue furred. In 24 hours the disease came to a crisis
and exhausted the excitability of the system; the pulse
grew faint, the skin cold and the respiration languid
the patient became insensible & was apparently dying
sinapisms were applied to the abdomen, ankles & wrists & 
heated bodies put into the bed, to restore warmth. After
the sinapisms had been on an hour and excited some
redness, epispastics were applied in their stead.
Ammonia & ether were put into the mouth & caustic ammonia
was applied to the nostrils to excite 
Inflammation so as to blister. Ether was also put into the mouth
In about two hours the system was resuscitated. Immediately a train of most violent nervous
symptoms followed the chill became convulsed
almost instantly. After trying antispasmodics in vain 
the convulsions were checked by laudanum, 6 drops,
every two hours. The laudanum lost its effect in 
two hours & needed to be repeated. The blister on the 
chest produced a deep ulcer which was difficult to cure
Finally tonic solution was administered. The child recovered
Child of Mrs “Moulth???]
Child of N. Beers’s vide p. 208
diseases and consequently meets with no new disease
For they do not make sudden transition as in botany plants
he is guided by symptoms & by the operation of remedies



Appendix to Mes. fever acute marasmus
This disease sometimes appears in an acute form
with great irritation Sometimes terminates in hectic Patient will run down
very rapidly [illegible] appearances enlargement
& [illegible] of mesenteric glands “Called” consumption 
of the bowels” or Marasmus”
Mesenteric fever is thought to terminate
in hectic Probably it does especially in scrofulous
patient and in those bad cases where the tubercles with a mesentery ulcerate
“The pain in the bowels is no usually very severe 
but of a continued aching kind generally better
removed by [camomile] injections than by anodynes”



61
Mesenteric Fever
Marasmus tabes [illegible] [illegible]
This disease arises from obstructed glands in the mesentery 
& is accompanied with morbid secretions of the stomach & 
liver bowels. It is sometimes the consequence of some other
fever. It is often connected with scrofula, & it is apt 
to be attributed to worms. The disease attacks children
of from two to ten years of age.
Symptoms. The fever is of the intermitting remitting kind, with 
irregular paroxysms attended with tumefaction of the abdomen, 
costiveness, indigestion, loss of appetite & very irregular
appetite & with paroxysms of pain in the bowels. The patient
complains much of its bowels, but the affection seems to be rather 
distress then sharp pain & is neither constant nor regular. The 
countenance is very pale except when the cheeks are flushed with 
fever & the limbs are emaciated
This is generally a chronic disease, but 
sometimes it is acute, & exhibits strong marks of irritation in 
the system. It may terminate in hectic. Dissections exhibit
an enlargement of the mesenteric glands.
Causes. It is sometimes as has been said above, the effect of
another fever. Among the poor, with whom it is most frequent,
it is caused by coarse and unwholesome diet. Children 
born of scrofulous or gouty parents are more subject to it
& hard labor by the mother during the period of gestation 
may have some influence in predisposing to causing this disease in the 
child.



Patients in this disease are subject to paroxysms
of pain


62
The indications are 1st to empty the bowels and to keep 
up a gentle peristaltic motion in them 2nd to change the
secretion of the chylopoeitic viscera.
3d to remove paroxysms of pain
4th to remove the obstruction in the lymphatics.
5th to impose the digestion & to invigorate the system generally 
1at To move the bowels and keep up a gentle
peristaltic motion mild mercurials as blue pill or calomel & chalk should be given & at
the [illegible] time friction as in almost all chronic [illegible] complaint should be employed, upon the
abdomen, and persevered in by the attendants. A very good
mercurial preparation, will be a pill of four parts gr. blue
mass and one 1 or ½ gr of ipecac adding a little opium ½ or 1/8 gr of the bowels
are very irritable. If this preparation 
is not sufficient calomel may be substituted in 
a dose of 4 to 6 grains. The tincture of rhubarb has 
in some cases answered well as a laxative & corrector
combined with neutral salts and aromatics
2nd For changing the secretions, we must rely 
upon the articles just mentioned, and also upon those
to be mentioned under the 4th head
3d For alleviating sudden paroxysms of pain injections
of a gill or a half pint of camomile tea have been found serviceable.
If these fail give a camphor injection
The pain is relieved by opium plaister



There is but a small quantity of iodine and [illegible]
effect appears to be produced than shd result from 
the small quantity of iodine
Neutral salts in connexion with tonics have
undoubtedly [illegible] deobstruent powers


63
4th For removing obstructions of the mesenteric fluids
burnt sponge has been thought very efficacious. I formerly 
questioned whether it had any superiority over soda.
Now it is supposed that all the virtues of the article are
owing to the iodine continued in it. It would probably be [illegible] better
better to give tincture of iodine in doses of 2 or 3 drops.
Still the burnt sponge containing carbon & alkaline matters
may have peculiar properties The neutral salts given
with tonics have some influence in removing these obstruction 
It has been proposed to use mercury by injection for this purpose.
I know not that it has ever been tried
For the indication I have been in the habit of
employing the muriate of lime & here given it in connexion 
with the mercurial pills mentioned under the first head 
It may be made by adding muriatic acid to chalk 
or marble & the dose for a child of 3 or 4 years, should 
be from 5 to 50 drops, given in tea coffee or milk.
It is best to begin with a small quantity, say 3 drops & increase 
by one drop at every dose until the stomach
is offended remembering that the stomach bears the article
best if much diluted. The muriate of barytes might be 
used; also the carbonate of barytes is used in dose of but
2 or 3 grains, it being a powerful article. But iodine is
probably the best article that we know of
Other articles containing iodine, have been 
used besides burnt sponge, as [fucus] [nodasus] & vesiculosus
[reckoned] vide scrofula



mur. [illegible] dose 4 or 5 drops in milk & water for a child of
3 or 4 years increasing to 50 even 100 perhaps
This [illegible] is not to [illegible] [illegible] it iodine as to be substituted
by the latter We are apt to neglect an old remedy as 
a new one comes on
The tepid bath shd not be used when the system
is too much debilitated
It excites the action of the mucous membrane
and of the skin not affecting particularly the blood vessel 
add a little spirit to make the opium 
[illegible] if necessary 


64
Muriate of lime has the important advantage of exciting
the action of the skin which is generally torpid.
Hence also the tepid bath has been used with 
success in this disease The flesh brush too if thoroughly 
applied several times a day will have a powerful effect.
5. To improve the digestion and invigorate the general system
Carbonic acid is a most grateful stimulant to the stomachs 
of patients in this disease. Hence soda water and other effervescing
mixtures, may be recommended spruce bar also & 
similar articles, if they agree well with the stomach. Aromatics 
as ginger & spice may often be added to them with advantage 
Among the tonics which are used to invigorate
the system. Iron is very often employed & frequently with good
success. The mildest preparations least irritating are the best, such as 
the tincture of the muriate, the martial flowers & the
alkaline solution. Still iron is apt to cause irritation
Cold bathing is a good remedy for invigorating
the system but if the patient is much debilitated, a cordial
should be administered previous to using it
When the patient is much debilitated I have found
anodyne plaisters upon the abdomen
give great relief (where opium did not agree) I have 
used Noel’s plaister (similar to dyachylon) with soap mix
opium zii with zfs of this plaister & spread it sufficiently
large to dover the whole abdomen


Children are very fond of potatoes but they should 
not be allowed, unless cooked so as to be dry and [illegible]
and then thoroughly mashed
Some vegetables as spinach, [illegible] & asparagus
may be allowed but only in moderate qualities
Preparations of meal of [illegible], especially fried, are bad
Rx dough roll it in flour and then cut
into thin slips, twist & bake them for [some] hours An excellent preparation
for dyspeptic batter than crackers called twisted bread
In making broth avoid adding rice, flour, etc. which 
will make the compound approach the nature of pastry 
and be more indigestible. Make broths as simple as possible
& season with pepper & salt


65
Under this head may be ranked the use of the terebinthinates
which have a valuable effect upon the mucous membrane of the alimentary canal
The best article is a decoction of white pine bark, which is
milder than any preparation of the turpentine of the shops
Regimen. Flannel should be constantly worn next the skin
to keep up an action in it. The patient should take exercise in 
the open air whenever the weather is good & damp
easterly winds should be carefully voided as they have great
influence in all chronic affections particularly glandular of the bowels. Friction & 
cold bathing have been already mentioned.
Diet. This should be carefully attended to Raw fruits, 
potatoes and other garden vegetables, corned beef & in short all 
articles which are not of the easiest digestion or which have any 
tendency to ferment & become acescent in the stomach should be 
forbidden & caution should be enjoined that the stomach
be not distended with liquids, so as to interrupt digestion.
The diet should be dry consisting of toasted bread & farinaceous
vegetable substance, as arrow root etc. well boiled & seasoned
with a little wine & spice. If meat be given it should 
be broiled & eaten, with condiments. In some cases a piece of 
lean beef that has been partly broiled & then boiled, makes
a broth that is grateful & sits well on the stomach. But if
there is much dyspepsia, broth of any kind a not good
If this fever terminates in hectic the mineral acid shd be used 



Undoubtedly however the affection may be produced 
by excessive purging vide next page
low states of fever in adults also for the 
state of the bowels occurs much oftener than some phys. are
aware of
“The gases may arise from the ingestion, from a 
fermentation of the natural secretions, or, as I think from a
direct secretion of gas by the intestines. this alone would see
to account for the rapidity of its production”
sometimes small watery stools


66
Tympanitis
In diarrhoea dysentery & constipation with fever & typhus fever
after these diseases have passed the first stage, the bowels of 
children affected with them, are liable to be affected with 
tympanitis. a troublesome symptom This state of the bowels may occur of itself about
the time the febrile action begins to subside, or it may be brought
on at an early period by the use of astringents, or by heat
produced, either by too many bed clothes or by hot articles
applied to the body for the purpose of exciting perspiration
it is important to examine daily the state of the abdomen in 
children affected with bowel complaints, that a tympanitic
state may be obviated, as soon as it begins to appear
The abdomen is [swollen] and elastic to the touch
feeling tense like a drum head under the fingers
We can tell as soon as the hand is applied whether the
swelling proceeds from inflammation, or from imprisoned
air, for in the former case the pressure will cause pain
The proximate cause of this state of the bowels 
I believe always to be a relaxation of the villous coat of the
intestines & a deficiency of peristaltic motion in consequence
of both which the villous coat falls down & forms a 
valve which confines the gas, while at the same time there
is a morbid secretion of all the chylopoeitic viscera 
which [illegible] the evolution of the gas
In the first stages of tympanitis, the alvine
discharge usually cease even if there had been diarrhea
& dysentery before & the little patients exhibit signs
constant [illegible] not acute pain
of great uneasiness from the unusual distention of the 



“It is thought by some that tympanitis is always 
occasioned by bad treatment in not giving cathartics enough at
the common [illegible] Such persons probably do not examine
the abdomen of their patients with sequels of severe bowel
complaints. Tympanitis comes on whether cathartics have
been used or not and nothing is more likely to bring it on 
than an excessive of cathartics at the commencement of the
disease”
The temperature had been raised above it
secreting [illegible] & the child might have died
“I am very partial to diaphoretic measures in general
but must confess it is often abused If carried to excess 
it rapidly exhausts the patient also if excessive heat as aplied
and the pat. does not sweat.” 


67
bowels. In the progress of the disease tympanitis the child frequently 
comatose. The tympany is not always to be regarded as 
a dangerous symptom it sometimes indicates a favorable
crisis, yet if it is accompanied with coma, there is danger
that the brain may become seriously affected. If symptoms 
of congestion in the thorax exist, the disease of the thorax
should claim our first attention, and the tympanitic
state of the bowels be treated as a [illegible] complaint
Treatment. The indications are to evacuate the flatus 
and excite healthy action of the viscera of the abdomen
If the disease has been produced or aggravated by heating
applications too many bed clothes or too 
confined an atmosphere, the heated substances should 
be removed, the bed clothes thrown off & air admitted
freely to the patient. In the summer of 1814 I was
called to a child sick with dysentery whose bowels became
extremely inflated in consequence of filling with 
the steam of boiled potatoes in [illegible] the bed in which he lay
The child because if much [illegible] & [illegible] was so difficult that it 
was thought to be dying; but upon removing
the potatoes throwing off the bed clothes & opening the
doors, the symptoms were at once amended & in the
end the disease was completely removed by the use of a little [cajeput] 
oil in water and laxatives
For removing the flatus of the bowels 
we may use enemata of the decoctions of aromatic plants or 
suds, such as catnip, camomile; the seed of fennel caraway 
or masterwort seeds or the essential oil of such suds may 


I prefer camphor to any other articles 3 or 4 [illegible]
IN colicky complaints etc. I have known more benefit [illegible]
injections of camphor in milk & water than from any [illegible]
articles and that too after the most violent purgatives
had vailed. I know of no article which operates
so well in relieving irritation of the pelvic viscera
[Anodyne] balsam Rx vol. [lin] zi [illegible] camph
“Sometimes blister the abdomen”


68
be injected in milk and water. But I think I have experienced 
the greatest benefit in the case of children from the 
injection of a teaspoonful 2 or 3 of the tincture of asafoetida in a 
gill of warm water. It unites more readily with the water
of a little milk is added
A pipe of ivory or the pipe of a common 
injecting syringe may be introduced into the rectum as is
recommended in hysteria, for the purpose of evacuating the
flatus. I have sometimes used an elastic catheter with success
The peristaltic motion of the intestines is
to be excited and healthy secretions induced For this purpose
we are to apply friction with dry flannel to the abdomen
and mild cathartics are to be given. The latter may be jalap
aloes rhubarb etc. with castor oil to work them off
If frictions do not succeed, we may apply volatile liniment
camphor, oil of origanum & finally epispastics
We may likewise give internally cajeput oil in 3 or 4 in sugar oil 
of mint, oil of caraway, asafetida zfs to si etc. which is [illegible]
to offer [illegible] its stomach & is not offensive to the taste
and magnesia with [illegible] & cubebs [illegible] [illegible]
or guaiacum 


Dr Good classifies [worms] according to their locality
yet he makes mistakes as to their locality
Much has been under the subject, and the
remedies are almost innumerable. It is rather difficult to select 
the most important parts of the subject


69
Worms
This subject naturally follows that of bowel complaints
From testimony which cannot be invalidated it appears that worms
of various sizes and forms have been found in almost every 
part of the human body. It is only in the alimentary canal
however, that they occur with any frequency and give rise
to symptoms, from which we are led to infer their presence
Those worms which are of anomalous kinds, or
are found in anomalous situations (oftenest perhaps in the lungs
& frontal sinuses) as they are of rare occurrence & as the indications
of their presence were either very obscure or altogether unknown wanting 
are interesting only as curiosities and will be passed over,
without any notice, except an occasional reference to 
the fact known with regard to them
“Worms in the alimentary canal are so 
common, as to have given rise to a class of diseases called
verminous & a class of therapeutic agents called anthelmintics.
The kinds of likewise of worms which occur in 
this part of the body have been thoroughly investigated & we
are in possession of a large mass of information upon the 
subject
I shall consider this subject under the following
heads 1st The kinds of worms found in the al. canal
2nd their origin & that of worms in general, found in the body
3d the general effect they produce on the system & the general symp
5th the morbid effects produced by each species, with their treatment
4th the general treatment of verminous diseases




70
II. The genera of the common intestinal worms are three; toenia ascaris & tricephalus
Of the tania there are two species. Tania solum or cucurbitana
& t. lata or vulgaris. Of the ascaris there are also 
two specis of a. vermicularis & a. lumbricoides.
1st Tania This a long flat worm varying much in breadth
and thickness which is formed by a chain of flat articulations,
united by a border or edge. The accounts of the length 
of this worm are almost incredible from thirty to a hundred
feet. Taenia solum (called also cucurbitina
or gourd seed worm & the armed taenia) is distinguished
by having the head forked and surrounded
with papillae or long fangs (holders) by which it fastens
itself to the mucous membrane. The broken off joints have
when discharged the appearance of gourd seeds. hence 
its name of gourd seed worm.
Taenia bata (or vulgaris the unarmed taenia) has an 
external form like a ribbon joints scarcely perceptible
& is white and seen transparent. The head is
narrower & smaller & the papillae not elongated
2nd Ascaris vermicularis & a lumbricoides
The first, a. vermicularis (thread worm, pin worm & when
existing in number called ascarides) is filiform, slender at
both ends & from half an inch to an inch in length & of the diameter of a small thread found
generally in the rectum & though not confined to that part of
the intestines. It feeds on the mucus of the intestines & produce
its young in immense quantities. It is found in the stomach 
& called maw worm





71
Ascaris lumbricoides (or [illegible] long round worm) is perfectly 
round & from four to ten inches in length bearing a striking 
resemblance to the common earth worm It is said sometimes to perforate 
the intestine with its mouth 
3 The trichocephalus now called [tric???] is a small capillary worm from 
an inch to an inch & a half or two inches in length. The body 
is about half an inch in length & Is terminated a tail which 
is twice as long & end in a fine hair-like point
In addition to these worms have been reckoned
two others the vesicularis & the gordius. The former is a 
small vesicle found in the brain (sometimes in great numbers)
& containing many small worms. It is now considered a 
hydatid & is excluded from the subject of worms & verminous diseases The gordius (horse hair worm) is found in soft
stagnant waters from four to six inches long & twisted into 
various knots & contortions” Good. They are sometimes found
in the earth in great numbers they turn black on exposure
to the air & resemble horsehair, hence their name
of horsehair worm They are very common in our vicinity They are rarely found in the human
stomach. I have known them coughed up in abundance from the 
lungs; when they had probably come from an abscess in the
liver. It gives rise to a severe disease among the [lapladens]. Vide Good. 
The maggots of the common house fly & the’
larvae of many other insects, have occasionally been met
with in the alimentary canal of the human body vide Good
What were formerly called vesicular worms
are now considered as hydatids. [Brera] or worms recommended 



An attempt has lately been made to revive the doctrine
of [equivocan] generation. The learned advocate has
attempted to fortify his opinion by the analogy of 
vegetables. But where the experiment has been made the 
seeds of the forest trees that come up as [illegible] may 
be found at the roots of the young trees
Hyoscyamus formerly was common here
but is not now However when the gourd is broken in the 
college yard Hyoscyamus springs up. It has also in the
soil brought from a cellar in Chapel St.
Leeches & a variety of insect are undoubtedly taken in in water etc.
In Duncans [illegible] we shall find an account of
a number of caterpillars [illegible] by a child produced by eating cabbage leaves
I think I have never known an instance of worms
in children while nursing


72
II II. The origin of worms in the human body
Worms arise from eggs. Some multiply by depositing
their eggs to be afterwards fecundated by the 
male. Others are propagated by copulation between the 
two sexes While a third kind of the taenia fecundate themselves.
I have spent much time in investigating
the origin of worms in the human body but must confess
that I cannot satisfy myself upon the subject.
It has been supposed that worms found in the human 
body are produced from eggs deposited by flies about 
the rectum, at the time of going to stool. Were this the
fact, they ought to be more abundant in summer 
than in winter, while the reverse is the fact. I am 
inclined to think that the rudiments of worms are 
contained in certain kinds of food as apples pears, cider
water & unboiled fruits and vegetables. In infer this
from the fact that worms make their appearance, oftenest
when such articles have been taken & disappear
when they are avoided. If confirmation of this view 
of their origin we find that children are rarely if ever affected
by then when under three months of age & seldom
while they are nourished from the breast. For though
some have asserted that they have seen worms in the
bowels of children within the mouth & even before birth 
yet the fact is not well ascertained.


Breras opinions, also adopted by Good speaking of the
fluke worm
There is no doubt of the fact of worms within [fetus in uteri]


73
Brera thinks that the minute eggs of worms are absorbed 
into the circulation He says “when we consider that the
eggs of worms are so small that they are not perceptible by 
the microscope of Hoffman and these eggs themselves are masses
of small eggs, nothing is more probable than that the eggs of worms
are absorbed by the lymphatic vessels, pass in to the circulation
pervade the system with the blood & are deposited in the various
parts of the body, where they enlarge and unfold themselves when 
circumstances favour their development.”
If worms are found in the foetus, the fact
will favour this idea that the eggs of worms are carried 
into the circulation. It may be remarked also that
the parts of the body which favour the development of their eggs
are those abounding with mucous
The hypothesis of equivocal generation 
is neither specious nor probable. It derives no support
from analogy aid from reason, nor countenance from fact
In its operation it is worse than useless as it tends to obscure
truth by substituting conjecture while it disregards with 
the most vague and licentious imagination the boundaries
between the animal and numeral kingdom & ascribes 
to chemistry what pertains only to animal life
When the creator first gave being to 
the natural world, every part of the vegetable and animal
system was brought into existence by 
an extraordinary exertion of productive power. They  were
not moulded by the slow operation of time & the cooperation 





74
of mechanical and physical forces, but he spake and it 
was done. But since that first act of creative power, we
find are that these creatures are propagated and perfected by processes
more gradual successive and [operose], many of
which may be traced by human wisdom and admit
of being regulated and controlled by human culture & ability
Rosenstein says “from the eggs of a fly proceeds 
a fly, from the egg of a hen a pullet and not a 
serpent, from the egg of a goose, a goose and not a fish
So from one worm is produced a worm and nothing else”
II II II. The effects of the presence of worms in the body
When the seed of worms are once developed in the human 
body, the health is more or less affected, and the morbid
symptoms which then appear are in proportion to 
the number of size of the worms the sensibility of the part
they occupy and the general morbid diathese which
takes place at the time, whether the cause or the effect of
the worms
Worms in the alimentary canal are less
frequently the original cause of diseases than is generally 
supposed, inasmuch as in many cases of disease where 
they exist, the disease was merely aggravated & not originated
by the worms & all the symptoms of worms from which it is 
common to infer their presence, may be occasioned by 





75
undigestible substances for a diseased state of the bowels
Worms are often also found to have existed & that too in 
great numbers, where the general health has been apparently 
good. I well recollect the case of a child in 
North Milford who fell from a height & was taken up in 
a state of coma from the concussion. A dose of calomel was
given him which brought away twenty or thirty large
worms. The child had been healthy to all appearance previous
to the accident.
Some physicians go so far as to say that worms
are necessary for the health of vigorous children that they 
are nature’s scavengers a natural provision to destroy the
superabundance of food taken into the stomach. Dr Rush
was of this opinion. The opinion supported by Dr [Parr] It is a fact beyond controversy that
very healthy children have worms with out manifesting
any symptoms of their presence until the supervention
of some other disease causes them to make disturbance 
in the system. It is but seldom that they are the excit. cause of dis.
The following are some of the ways in which 
worms are injurious to the system. They may be injurious
from their number obstructing the bowels and consuming
too much food. They are particularly hurtful by 
the irritation which they produce when the irritability
of the bowels is excited by fever. They sometimes threaten
suffocation by rising in the oesophagus & in one instance 
a single worm I have known to lie in the fold of a volvulus 
of the intestines so as completely to obstruct the passage 





76
Linneus attributed the dysentery to a worm or insect [illegible] dysenterical
[languis] the measles to a similar origin. Various
authors the itch, sigler, petechiae lusitanus the syphilis
martin the elephantiasis nyander, eruptive
& contagious diseases in general lancissi, plague, remitting & 
intermitting fever considering miasm [it] being a collection of insects # some authors, toothache Dr [Adam]
observes cancer itself is nothing more than an animalcule 
a worm or an insect. It would seem from 
such speculations, that a great part of the diseases
which flesh is [illegible] to result from a superabundance
of vitality and that as Good remarks in his [illegible] corruption is no longer the triumph 
of death over life, but of life in one form 
over life in another. Such fancies lead into the 
wildest speculations of equivocal generation & relinquish 
all principles & all limits in natural 
history.
# Vide N.Y. Rep. about the year 1815




77
Symptoms of worms. Those children are most frequently 
troubled with worms whose powers of digestion are weak.
The symptoms of the presence of worms in the alimentary canal
are very equivocal, for they may all proceed from other
causes. They are countenance pale or flushed sad and dejected 
livid around the eyes, eyes sunken
eyelids swelled pupils dilated itchings in the nostrils, head
ache after taking food, mouth water [illegible] filled with saliva, breath
fetid, great thirst, grinding of the teeth in sleep, starting
in sleep fainting vertigo, palpitation of the heart, irregular
pulse & cold abdomen bowels flatulent
costive or loose colic throbbing in the bowels severe from [illegible] the small [intestines & umbilicus] appetite irregular
& craving loss of appetite pain in the stomach when empty, which is relieved
by food urine increased or diminished turbid and milky, stools irregular,
containing much mucus nausea & vomiting Sleepiness particularly
after eating, bloated countenance swelled nose & upper
lip, paleness of the lips, irritation about the mouth, rubbing
the nose, itching at the anus irritation about the neck of the bladder dry & convulsive cough
difficult respiration sense of suffocation paroxysms 
of suffocation body emaciated frequent flushings of fever with irregular pulse convulsions, epilepsy
and partial palsy. Of course these are not all present
at any one time
Chorea catalepsy & epilepsy are produced
sometimes, by worms
Dry convulsive cough Diff respiration
In addition to the other symptoms there may be these of irritation
of the lungs producing cough also irritation of the brain




[772]



It will be impossible to class all the articles inasmuch
as we do not certainly know the modus operandi of many 
articles which yet have sustained their reputation for [illegible]
Much stress has been laid upon the operation of cathartics
in evacuating the [illegible] which the worms generate by their irritation, 
just as irritation in the lungs produces [illegible]. But then
the [mucus] although it forms [illegible] for them, an effect more 
than a cause, and the worms will make [mucus] enough for themselves
Probably many caths act by their acrimony upon the worms
themselves. Others by the violence of their operation dislodges 
them. “Aloes are beneficial in mild cases as a tonic
when there is no excessive irritation. If there is excessive sensibility
& irritability they are improper as they irritate the
rectum they may be given by injection When there are
symptoms of worms though no worms exist aloes are serviceable
in the form of elxiir prop.”


77:a.
IV.
[general
treatment]
In the treatment of patients afflicted with worms two 
general objects seem to have been pursued both in popular
practice & in that of physicians 1st to destroy & 
expel the worms themselves & 2d to obviate their effects
upon the system & at the same time by the improvement
of the general health of the patient, prevent their recurrence
and increase This second indication will often coincide 
with the first, inasmuch as a diseased state of 
the body is the most favorable for the multiplation of
worms
Of those remedies which destroy or expel 
the worms themselves we have three kinds
1st those that expel them by strong cathartic operation
2nd those that act mechanically upon them
3d those that are prisoners to them.
1st Although strong & even violent
purges may be used to drive out an accumulation of 
worms in the bowels yet they should not be often repeated
as they would increase the weakness & irritability of the 
stomach & bowels to such a degree as to favour this increase.
In general calomel will be the best cathartic 
inasmuch as it will tend to promote a flow of healthy bile 
& to restore healthy secretions. In Europe the gall of 
animals has been administered. One of the best forms 
for the administration of cathartics is that of alkoholic
tincture, for the sake of the joint effect of the alcohol
hence elixir proprietalis in teaspoonful doses & the tinct.


“The bark of the button wood taken from the north
side of the tree has been recommended. It is a nauseous bitter
& a cathartic good” #
“It is a question whether cowhage acts mechanically 
or whether it contains an acrid principle like that which 
exists in the nettle”
# One of the remedies that I have most 
reliance on for ascaride in tinct [illegible]. Fill a
bottle with the young inner bark fill the interstices
with [prosp] spirit & give I to zfs night & morning
It is an old remedy and better than tinct aloes
It is tonic & deobstruent”
Some of the acids to be narcotic, are more probably active
merely by their pungency, odour etc.



77:b.
of hickory bark or buds have been found very serviceable
Podophyllum peltatum is much used but is probably not better
than other cathartics. The best form would be that of a tincture
2 Mechanical remedies are not now used. Cut hair
has been given cowhage though some doubt whether the operation 
of this is wholly mechanical. I have thought that the root of
osmunda given in pieces acted mechanically The filings of
tin, formerly were much employed as was also an amalgam
of tin & mercury. There is a curious account in one of our
journals of a man in Kentucky who took a pound of the 
amalgam & was unable to expel it from the bowels The 
mass lodged in a part of the intestines & could be felt externally
It was very troublesome to him when riding.
Oil has been given with the intent that it should fill the 
respiratory pores of the tape worms & thereby destroy its
life. In Madame Nouffeurs recipe The supper of
panada is intended to act mechanically by its bulk.
3d The remedies which destroy the worms seem generally 
to be narcotics All articles of this class however do not
have this effect opium for instance. Particular animals
are sensible only to particular narcotics as for instance
swine are poisoned by stromonium while sheep eat it with
impunity. The most valuable article of this class
are the two species of spigelia s. [ma??ndica] & s. anthelmia



A strange notion has existed about a little innocent [illegible]
was considered as the narcotic agent
Similar reasoning has been used with respect
to denarcotising the opium Opium denarcotised would
be not better than bread
Spigelia zii in ¼ pt water to a child may be given in divided
doses. It is better to give a cath. e.g. cal. or ruhb
Spegelia from zfs to zf for an adult
Sometimes but rarely it operates itself as a cathartic
Sometimes convulsions are produced
Our pink is bad because it is gathered by [illegible]
packed in hogsheads & the rotten saved & the rest [illegible]
The emigrants from St. [Illegible] brought what they 
called worm syrup which they said shd be given in the
night because it affected the eyes
S. [anth.] is [illegible] S. [illegible]
about zi if S. anth.
“Pink is given more especially for the [round worm] & sometimes
for the tape worm”
[illegible] [illegible] & [areca] [oleacea] zii to zfs
“The French use the syrup of peach flowers & seeds 
They first give sulph either zi in [illegible] decoction male
form & an injection of the same. They probably act by 
their prussic acid”


77:c.
The former is the one commonly used in this country
and in England It is called Carolina Pink. This is a most
valuable article and is useful not only for its operation 
upon the worms but for its effects upon the system, in allaying
the irritation which they occasion. I have prescribed it for 
a cough & other symptoms of irritation where I had no reason 
to suspect the existence of worms Then given for its effect
upon the worm from half an ounce to two ounces should be 
given in decoction in the course of the night, accompanied with rhubarb
or some other cathartic to drive the worm off while in a state
of intoxication. It may be given in powder in a dose of from 
10 to 20 grs The French W. Indies s. anthelmia is used
& called wormgrass. It is a stronger article than ours
The French use the article in form of a syrup & give a 
teaspoonful at a dose.
Veratrum subadilla & helleborus [fetidis]
belong to this class and have been given in doses of 2 to 6 grs for
children In Europe the most famous article
of this description has been the Felix mas
Other articles of this class are camphor, prussic acid & tobacco
The bark of the cabbage tree (of which there are two species
vide Good) is found highly valuable in this way by the
West India physicians
Other articles which have been said
to be successful in cases of worms owe their success apparently 
to their acrimony in whole or in part, such as
the terebinthinate oils Oil of turpentine is the one commonly 


Various aromatics have been used, as chenopodium 
[illegible], rue tansy
“The leaves of cedar juniper & [illegible] powdered
20 grs They are acrid stimulating and tonic & may have
a mechanical action. It might be used to add to the
powdered leaves some aromatic as rue ol. tansy [worm]
wood etc.”
“Melia [azidurach] bark of root or plant
zfi to zi act as emetic cathartic & narcotic. Acts
more effectually at the south where the recent article is
used”



77:d.
employed should be given in large doses, when it will
prove cathartic. A concentrated solution of salt has been
strongly recommended given by the mouth or by injection 
Ether is much used by the French & perhaps has an effect
upon the worms. Some of the other antispasmodics 
which have been popular may also have some effect upon 
them such as asafoetida, petroleum the essential oil of
the chenopodium etc. Perhaps arsenic poison intestinal
worms I have known it cure. Ammonia may perhaps act on them
2 Of the remedies which are designed to have an effect
upon the system. In severe affections from worms our first
attention must often be directed toward quieting the excessive
irritation of the system, by antispasmodics. Various popular
remedies for worms seem to have little other virtue
The chenopodium anthelminticus & c. ambrosioides called 
worm seed & the c. botrys. or [juris]
oak ar probably valuable, mainly if not entirely a
nervine. They may be given in decoction or the essential
oil may be used. The garlics are used in syrup or decoction they are nervine
7 have considerable effect as condiments upon the intestinal canal. The 
ictodes fetidus is of this class & so are the empyreumatic
oils, petroleum given in a dose of 10 to 40 drops barbadoes tar etc.
For giving tone to the digestive organs
and exciting their sluggish action the tonics
the bitters & the aromatics are indicated while mercurial


[Artemesia] ][santonica] is no better probably than the
other bitter tonics Some confusion results from the appellation 
worm seed being applied both to this and to [illegible] botrys
c. anthel. & “Indeed anything which tends to [procure]
healthy secretions of the viscera. Of this kind are the
mercurial which produce healthy bile which is especially [illegible] 
to [illegible]”
# “Indian corn or maize has been supposed to 
favour the generation of worms in the body. The aborigines
of this country have been peculiarly subject to them perhaps
from this cause”
Worms are far less common now as are also colic dysentery et. than formerly when cold
water & cider were drunk instead of tea and coffee AT the
south likewise the negroes who feed more upon crude and raw
articles are more subject [illegible] of the plantations it is a 
rule to give a decoction of melia to the black children once
in 3 months #
Though you can cure worms generally by calomel
yet sometimes they will resist all treatment
Eupatrium perfoliatum is used for worms
Flowers of [zinc] are antispasmodic so also sulph zinc 
Dr Rush thought well of [sugar] especially when given in the
morning
Petroleum seems to be a valuable article a substitute
for turpentine It may be supposed dangerous, but I have
used it for many years without inconvenience I began with 
small quantities from fear of danger, but now I give 10 30 or 60 grs
It very often to produce no violent effects. Yet we must not conclude
hence that it is useless. Asafoetidae for instance produces 
nothing but a little [illegible] in healthy persons


77:e.
preparations & other deobstruents will be valuable 
adjuvants. The metallic tonics as the preparations of iron
& of zinc, the mineral acids, myrrh, bark, the various bitters 
& the astringents have been found useful I have used alum whey with advantage. Among us the geraniums
& all the indigenous aromatics & bitters have been given
in popular practice. Alcohol from its stimulating effect
upon the digestive organs will be a useful vehicle, for the
exhibition of medicines. Condiments used freely with the
food, will answer to the same indication
The diet of patient troubled with worms
should be dry & stimulating, rather than liquid & cold
raw fruit, acids cold water & all indigestible articles
should be avoided & in extreme cases I would advise that
neither food nor drink be taken but which has not been
subjected to heat. I have apparently cured patients by this
means. “[illegible] toasted bread [illegible] [illegible] vegetable
[illegible] though they occasion [illegible] dyspepsia”
A multitude of heterogeneous articles have been 
used as anthelmentics, besides those already mentioned; some of 
them are sugar; worm-wood; rue; peach flowers; bark’
of prunus virg; valeriana selequa used by the French; muriate of
barytes; injections of mur. of tin (Alibert); oxide of tin grs iii with
etr. of juniper (Alibert) mur. of amm. of linseed; mur. of amm.
[illegible]I with jal. or rhub 10 gr.; all the forms of ammonia; crude
mercury; merc. boiled in water; aethiops mineral; artemisia
[illegible] [illegible] ([illegible] [illegible]) & a. [illegible] [illegible]
[s?tonica] worm seed bitter & of some value; melia azedarach much
used at the south; butternut bark intensely bitter dose a tablesp. full of decoct cathartic & said to be narcotic;
allows asclepiadis I think I have seen the a. [illegible] then beneficial; etc. etc. 


Garlics seem to do well how it is difficult to 
say perhaps operate upon the worms. Garlic also 
will relieve the eruptions of worms. It is though also
that garlic prevents worms
I have a very good opinion of sulph ether
introduced into the rectum used by the Germans, Italians
nervine & antirritant. It is valuable both in cases for worms 
& in those of irritation & affections of liver severe pain in bowels etc.”
½ oz or 1 oz. iron filings taste by [illegible]
remedy worse than disease
Wherever leaves of [illegible] are recommended
you may give our common juniper For the imported [illegible]
loses its strength by keeping & drying
Rosenstein recommends cold water during the
operation of a cathartic He recommends effervescing mixtures
to destroy the worms by carb. acid
An old remedy of the tonic kind is alum whey
Rx milk & water equal quantities & put in [illegible] [alum] to [illegible]
give the whey [illegible] children takes it pretty freely; It is a 
given in cases of relaxation of bowels and for ascarides & round worm
It is of consequence often to have a remedy [illegible] and not require
to be forced down


77:f.
Various external applications have been prescribed
Oxgall & venice soap aa zi made into a liniment with 
oil of tansy or wormwood;
Aloetic plaisters; ether oz vi, bruised garlic zi, camphor 
zi (used by the German Brera) for a liniment; petroleum mixed with gall;
Most of the patent medicines for worms [illegible] or both contain calomel,
Storr’s lozenges are calomel with sugar & gum. These
are his white lozenges. His brown are resin of jalap,
gum tragacanth & calomel.
Good on the authority of the Germans recommends 
[illegible] milk
Electricity 
A popular article (cath.?) is decoction of [plantanus]
occidentalis strong bitter
For ascarides I rely as much as any thing upon a saturated
tincture of the juglans [illegible] & [illegible]
All the indigenous bitters as cherry bark [illegible]
melia [azedarach] zii of recent root is divided
doses ½ pt water. When dried & long kept it is apt to 
disappoint here.
It is acrid [as the] narcotic & cathartic
a powerful article The berries are also narcotic causing
lard to fall down not from [choking] as has been thought
The [planters] think it too powerful for [white] children!


Tape worms frequently produce headache 
[illegible] about the umbilicus
yet generally produce a sense of weight. Yet I have known 
persons evacuate them when they had not been suspected
Case of a man who had kept taking remedies for a catarrh
Finally a medicine ? brought away to his own surprise 
and that of his physician a tapeworm
Perhaps vomiting occurs oftener from tape worm
than from any other species
# “When the worms are very numerous, there is a sensation 
of something falling from side to side on a change 
of posture”


78
V. Symptoms of each of the kinds of worms with the treatment.
1st taenia solum. This worm generally inhabits the upper
part of the intestines & adheres so firmly as to be removed
with difficulty It is sometimes solitary but commonly in 
considerable numbers. When brought away from the bowels
many of the joints are separate & have the appearance of gourd
seeds hence the name. 2 T. lata or vulgaris This likewise
inhabits the upper part of the intestines and is usually in families
of three or four
Both are called by the common name of tapeworm
They may exist without any apparent symptoms of worms
or they may give rise to the severest affections In general 
they are attended by severer pain in the bowels & more violent
symptoms in general than the other worms. The diagnostic 
marks of their presence in great quantities, are
sense of weight in the abdomen, # irritation of the stomach
nausea & vomiting loss of appetite, irregular appetite
weakness of the chylopoietic viscera, bloated countenance
emaciation of the body etc. All these symptoms however 
may arise from mere irritation of the stomach of a child
Adults are more generally affected with
tape worms but children sometimes have them.
For the taeina solum t. lata or vulgaris or cucurbitina the
gourd seed worm the spirits of turpentine has been 
very successful. Though not prescribed by the physicians
it has been used as a popular remedy here for more than
T. lata
fifty years. I have known a man of intemperate habits 


No cautions are given about the use of the article (so far as I know)
But if it does not act as a cathartic immediately, it will produce
great irritation especially of the urinary organs
I recollect the case of a lady who had been treated
with aph turp. in N.Y. taking 2 or 3 ounces Violent vomiting
& catharsis had been produced and the tone of the 
stomach and bowels seemed to have been permanently destroyed
Worry had indeed been brough away, but then they would 
come away themselves & the relieve was fallacious
In delicate cases it had better be combined
with castor or sweet oil
In the case of the lady cath seemed to do no 
good, they would indeed bring away large quantities but
they would return in a few days. I put her upon arsenic 
but she left town and I have not heard from her
It is difficult to tell how arsenic operates whether 
upon the worms or producing healthy bile
For the t. lata the spts turp. seems to do 
better


79
take a wine glass full of spirits of turpentine to expell a
tape worm Though an habitual inebriate, he said he never
had been so drunk in his life & large tape worm of this kind? came
away # It is said sometimes to intoxicate & sometimes to produce irritation
T. solum
2d The t. lata is the most difficult of all 
worms to manage. Spts of turpentine do no good at
least in those cases in which I have tried the article In
T. solum
one case I gave zfs. In another I gave it in teaspoonful
doses. In the latter it operates freely as a cathartic
a single teaspoonful procuring as many as ten stools 
Worms were evacuated but they would make their appearance
again in as large quantities as before. Indeed
any medicine may bring them away for the bowels
are sometimes so filled with them that they come away 
T. solum
when the patient is walking, or is asleep. I have known
two quarts to be brought away in a day, & then a fresh
supply in a few days after!
T. solum
# Arsenic has succeeded better for this kind? with me than any other
remedy, which I have used. In the case of a child
5 or 6 years of age who had both the round & the gourd
seed worm the common cathartics were given with some
advantage, as some worms were brought away; but the
symptoms still continued and the worms passed occasionally
with the stools. Fowler’s solution of arsenic was 
administered in doses of four drops three times a day. In a 
few days worms ceased to be evacuated the symptoms 
disappeared & the child has once had no recurrence of the worms



[Osmunda] cinnamonea is bitter, subastringent
and perhaps deobstruent. So is polypodium vulgare
and perhaps more decidedly so
The polypodium vulgare & felix mas They 
are used in chronic affections of the stomach & bowels & thought 
they have not obtained much reputation for worry in 
this country yet they have sustained their reputation for
2000 years. It was used by Galen
“The [form] is tonic”


80
I recollect case of one patient, a woman, who kept 
passing tapeworms, in great quantities, for months. After failing
with medicines I threw them all aside & tried diet
All the food taken was roasted or boiled even the water
used for drink was boiled. She was cured. It must be 
remembered the healthy bile & gastric fluid will destroy 
those worms & from this fact results an important indication,
which I shall presently dwell upon.
Felix mas the male form has been considered
in Europe, as a specific for this worm. With us the
osmunda cinnamonea [illegible] ([hog brake]) has been used as a substitute for 
it. It is bitter, astringent & sweet. The polypodium vulgare,
which is tonic & deobstruent, & other forms may 
probably be used also
The famous fern remedy bought by the king of France of Madame [Nouffleur]
is as follows. Take a super of the following panada
Rx water lbi [illegible] fresh butter z 2 or 3 bread cut into small pieces
zii add salt zi & boil thoroughly. If the patient is costive
give an injection of water lb is in the evening olive oil zii salt gr. s.
The next morning eight or nine hours after the supper the
specific is to be given viz. Felix mas ziii in powder, mixed 
with 4 to 6 z of the distilled water of the fern or the
flowers of the linden tree the whole to be swallowed at a
dose. In children the dose is reduced to zi of the fern
Two hours after the fern is taken the patient is to swallow 
the following bolus R. cal. & scamm. aa grs xii
Gamboge grs V powdered fine & made into a bolus to be 
given at one dose to a person of vigorous constitutiokn


Ether acts especially upon the nervous system
on which account it has been used as an anthelmintic 
Alibert for taenia gives about zi in a glass of the
decoction of the male form in the [illegible] an hour
after his doze zi of the ol. ricini are to be given
in syrup or in composition the dose to be 
repeated twice & sometime three times a day
The worm is usually evacuated after the first doses 
Mr [Bonadier] directs an injection of the decoction 
of the male form to which zii of ether are 
to be added Mat. Med. art. ether


81
Mathieu adds to Mad. Nouffleur’s remedy the filings
of tine & the sulphate of potash
The French & German add ether to the same
remedy
Rothier’s method is Rx powdered savin grs xx
seeds of rue 15 cab. grs x oil of tansy gtts xii syrup 
of peach gr. s. make a bolus Take half in the morning 
& half after dinner, drinking with each dose a glass of 
vin. tincture of peach kernels
Dr Baurdier gives the following 
Rx sulph. ether zi decoct felix mas 1 gill taken fasting
4 or 5 an injection of the same decoction with 
zfs of ether an hour after zii ol ricini or zi of
the syrup of peach blossom the worm is discharged 
half organiz
Oil is used in order to kill the tape worms
by filling their respiratory foramina. Ol ricini has
been given for taenia & other worms in doses of 3 or 4 z
Liquid carb. amm. might be given for taenia
The German physicians are fond of giving 3 or 4 
ounces of castor oil They are fond likewise of peach flowers
Within 5 or 6 years the bark of pomegranate has
been recommended. Paris says bark of the root [illegible] probable
however the office preparation is meant viz rind of 
the fruit which is the most astringent substance to 
the [illegible] which we have [illegible] also cathartic! I have
not [illegible]
N.B. The male form is astringent, and is given
to enable the bowels by the tone it gives, to bear the [strong]
cathartic afterwards. Hence the union of these give in [illegible] [illegible] may be useful



I have seen the worm occasionally in rain water
I recollection one man of 60 who informed me he had been
troubled with then nearly all his life until he removed his [illegible] Change of place
may effect a cure by change of water
Probably [illegible] of our cholera are
troubled with this worm delicate children only suffering much
children troubled with them will be faint, have
turns of colic etc. you will be called [illegible] Give an injection, and no worms will 
come [illegible] yet give afterwards a strong cath. & or repeat
the injection and worms will come away proof that they 
were not in the rectum They probably breed in the duodenum
I have known but one case in which they were vomited
up. The subsequent cath. will bring away 
smaller worms 
More is done by diet int his worm than by 
any thing else
Alcohol in this morning especially its bitter
tinctures. Condiments are useful. Worms are less common 
now because condiments are more used. It is said that
the aborigines when they cannot get salt used potash ashes
by a condiment The aborigines are said to be very subject 
to worms
# Ascarides sometimes produce severe pain at the 
umbilicus and colic
# “Ascarides though often found in the rectum
are generated in the stomach & small intestines. Hence they 
are sometimes no discharged till the second or third operation
Hence they are sometimes thrown up by vomiting. I have examined this point carefully 


82
3d Ascaris vermicularis. This worm is always troublesome
when it exists in considerable numbers though it is but seldom
that they exist in healthy persons in such numbers as to 
give rise to morbid symptoms. They are very common in 
children, and not rare in adults & are called by the
generic name ascarides
These worms are commonly found in 
the rectum & hence are often said to inhabit that part 
This is a mistake they multiply abundantly & lodge in 
the rectum as they daily pass void by sphincter. Sometimes
they exist in the stomach in vast numbers (hence called
maw worms) so as ever to threaten suffocation by rising
in a ball into the esophagus & sometimes they 
cause severe griping pains by their presence in the 
small intestines #
They pass in the stools & sometimes come
away spontaneously at night, they are said even to 
make their way to the vagina & urethra of females producing
troublesome symptoms X Ascarides are most troublesome
in the latter part of the day & the first of the 
night, when they excite an intolerable itching 
at night [illegible] probably than feeding They give rise to symptoms of general irritation
& sometimes to a cough # Ascarides are particularly 
injurious to dyspeptic patients & they themselves may give 
rise to the symptoms of severe dyspepsia such as craving
appetite, indigestion, faintings. Flatulence, cold
extremities pale & sallow countenance, cough etc. The irri


“They are attended with violent itching
about the rectum general irritation convulsions
irregular appetite pale urine flatulence want
of vigorous action of chylopoietic viscera increase of mucous
secretion darting pains in the abdomen stomach 
& chest faintness cold extremities the symptoms of
dyspepsia sporadic cough”
Tobacco injections & tobacco smoke injected are
very useful and will often cure. It is not safe for children
I have seen great prostration produced in children & I have
known an adult killed by a tobacco injection #
A physician who had been much troubled
with ascarides told me he had tried merc. oint. externally 
with advantage. “I have used it but was rather disappointed
# When the ascarides are in the small intestines, tobacco
smoke will do not good & by its debilitating effect will
favour their existence
“Injections of camphor and milk 
have done more to remove ascarides
than all other remedies I have used. The injection 
immediately removes the irritation produced 
by the ascarides & the ascarides themselves. It
may be made of milk ziv to spts camph. zi
This is the form in which I have used it, probably 
an emulsion is as good, perhaps a
better form” M. M. 


83
which they cause sometimes, in children brings on convulsions
Whenever, finally, they exist, in the alimentary canal
they are accompanied with great quantities of mucus in 
this part. They feed on the mucus of the intestines, the flow
of which they excite by punctuating the mucus membrane
Treatment It is very difficult to cure a patient
troubled with ascarides. The most immediate relief is
given by injection. If the worms are in great quantities & too much 
“Tobacco smoke is one of the most powerful means we possess for the
involved in mucus, they may be completely removed by 
cure of these troublesome worms”
injecting tobacco smoke. Injections of warm water or milk & water will
relieve for the time being by washing out the rectum & if
a quantity of aloes zis to ½ pt is added a still better effect may 
be expected though camphor being a nervine & a poison to the 
worms would be a still better addition. Injections of milk 	
and water, with camphor zii tinct camph to ½ pint, 
will if preserved [illegible] destroy them 15 grs of [illegible] [saladilla] have been injected. Still the frequent injection,
required in bad cases may debilitate the bowels
& consequently invite the return of the worms.
For internal administration. I have found
a tincture of the buds or bark of the hickory given in doses
from a tea to a tablespoonful one of the best articles both
for removing the worms & for preventing their return
Drastic cathartics should not be depended upon 
for they weaken the bowels & increase their irritability & 
hence favour the production of the worms. On the contrary 
calomel & tonics should be given to restore healthy secretion
Aloes if given should not be in large doses, for that will
irritate the rectum still further, but in smaller ones as a tonic


Oily articles shd be avoided as butter, because
they relax the [illegible] of the intestines Potatoes, vegetables 
All kinds of pastry avoided
All the metallic tonics are useful as tonics
They are thought also to be unfriendly to the worms
It is said that forth ascarides a pint or a quart
of sea water has been drunk with advantage, producing
vomiting & purging. Salt is a good remedy. Dr Rush proscribed
a teaspoonful of salt in the morning to a gentler one
much troubled with ascarides. He told him after trial than 
the remedy would not do. Dr Rush gave him, then, for worm
powders # 
For the worm the [illegible] the pink shd be the remedy vide [illegible]
“Rhub & cal. are the best cath. but all are useful For children Rx
tinct. [illegible] Fowlers solut. cold water” 
“Common salt ground up with cochineal to colour & disguise
the article. The gentleman reported that the last prescription 
had answered well. Dr Rush also believed
in sugar. This more doubtful
The asclepiasis have been much used especially 
for this worm especially A. incarnata called wild hemp It is 
dried pounded to a fine powder mixed with molasses & given in doses of a teaspoonful
Or [illegible] down and make a strong decoction [illegible] the [illegible] with it
molasses and give freely until it moves the bowels
This much used by the practitioners of the state more than any 
other article after calomel. it is an article which may always
be obtained growing in clayey situation and is safe
The other asclepians are similar & may be used S syriaca
is the most laxative


84
To prevent the return of ascarides, condiments should be freely used
such as pepper, ginger etc. in short all warming and bitter things
In extreme cases let the diet be so regulated that nothing shall be 
received into the stomach which as not been subjected
to heat. Mercurial ointment has fasted in my 
hands.
4. Ascaris lumbricoides the long round worm is perhaps
more commonly found in the alimentary canal than any other
This worm more than any other is found to have existed in 
the stomach or intestines while the general health has been good
is the presence of worms not suspected.
Strong purges may be used to remove
them & alcoholic tonic tinctures given to prevent their increasing.
For this latter object the carbonic acid has been recommended 
in the London Med. & Phys. Journ. & in confirmation 
of the idea I have used soda water with advantage
Melia azedorach or pride of India a decoction of the bark
is much depended on at the south for their young negroes
who are much subject to worms. It loses much of its virtue when dried. The spigelia is also
sued but of this I shall speak under the head of general 
treatment.
I recollect with an aff. of the liver
wh often vomited up dark [gravous] blood, which had evidently been 
long in collecting. Finally he was said to have thrown at 
a snake. Many eyewitness testified to the snake & to its eyes 
& teeth. I saw it. It was a very large round worm of the kind


To be distinguished only by the violence of the
symptoms. The same itching at the arms will exist as of the
ascarides, but non violent etc.
“Treatment similar to that for ascarides. It
is more common than is generally supposed. Many 
of disease & death by irritation from an unknown cause, are probably 
owing to this worm. In examination the contents of 
the bowels should be placed upon linen cloth and then
this worm can be seen.”
For the gordius Linnaeus recommended the angelica
Archangelica (not our viz the [atropur????])



85
5. The tricocephalus is but seldom met with 
The irritation produced it may be so great as even to bring
on delirium & will be manifested by screaming
throwing of the hands & [fat] etc. I have found this worm in a 
fold of the volvulus of the intestines vide Volvulus.
I should try narcotics for this worm, but 
cannot speak from my own experience. I should recommend
also an injection of a table spoonful of ether in a gill of
water or mucilage. Ether given in this way will undoubtedly 
pass the valves of the intestines in a state of vapour 
Vesicular worms, according to the old division of verminous
diseases, are met with commonly in the brains of adults & 
are attended with the symptoms of vertigo, convulsions
apoplexy & hydrocephalus.
Cases of worms & of colic are much less frequent with 
us than formerly; owing to the change in our mode o f
living. They are said to be very common among the 
aborigines of this country



One volvulus may be received within another
a second, a third and fourth time & [illegible]. The whole may 
then become inflamed, the vessels may run
from one to another, and the whole become one complete mass 
of organised matter or sometimes [illegible]
“It may occur in any part of the intestines except the rectum
though the colon is often received into the rectum”
The symptoms of the two kinds [illegible] [illegible]
owing to the different susceptibility of these two portions of the 
al. canal, and the diff. ages of the subjects of each
Nor located in books vide Ed. med. & surg. J
where the best account of it is given. Good merely mentions it
as an accident that is found sometimes to have occurred in ileac
passion
“Predisposing of exciting causes”
The cavity of the natural stricture may not be large than a goose quill, & such 
children will be very liable to an occurrence of volvulus
This is not a primary disease. It occurs more
in some families of [illegible] fibre & [illegible] phlegmatic
temperament
It may occur from debility of constitutional
or that of the bowels [illegible] by bowel complaints etc.
Local violence One instance, in here the child 
was apparently thrown into it by being carried over the shoulders


86
Volvulus or Introsusception
This is a disease with which I was at first very much perplexed
especially as I derived little satisfaction from the books
Volvulus or introsusception is the reception of one portion of
intestine within another. It doubtless exists often in a 
slight degree, when there is a strong action of the bowels
& are inverted peristaltic motion & the bowels disengage
themselves. Sometimes there is a double involution, or one
involution within another. In some cases likewise the 
cavity of that portion of the intestine is entirely obliterated by 
the tumefaction of the coats. I have always found in post 
mortem examinations, that the upper portion of intestine was
received into the lower & not vice versa the involution having been caused apparently 
by inverted peristaltic action
This affection of the intestines occurs oftenest
in children though adults are liable to it. It would seem also 
that some families of a leucophlegmatic temperament & 
delicate constitution are particularly liable.
It may be caused by a natural stricture
of a portion of the intestinal tube when it will be incurable
It may arise from extreme irritability; local violence
& injury may occasion it, & the irritation of worms may 
bring it on. Drastic cathartics may bring on volvulus
& hence should be cautiously avoided where there is a liability
to it. Bowel complaints, as colic, cholera, dysentery
etc. sometimes terminate in one or more volvuli of the
small intestines. The disease is more frequent in the 
summer, when debility is greater & bowel complaints prevail 


“Symptoms incessant irritation one or two copious evacuations
but usually these have ceased entirely before the physician 
arrives constant efforts to vomit, resembling hicup constant
efforts to pass stools & nothing passes but mucus streaked with blood
Generally mistaken for hydrocephalus
In bowels complaint of delicate children look out
for volvulus It is much more common in some seasons than 
in others. About 10 years ago they were quite common. I had
many letters from our students, who met with the disease
& disagreed with the phys & gained [reputation]. They 
frequently sent me such accounts.
Sometimes there will be a partial involution of the
large intestines [illegible] to relaxation of inner membrane what descends
like a funnel & may be felt by the finger #
In the large intestines there is not very much irritation
than is torpor of al. can. not much vomiting except upon 
the administration. There is no purging
You may sometimes determine that of the
large intestine by heaving the peristaltic action discard
& stop at the [illegible]
This is most common in adults. The symptoms
are more mile
# It occurs in females who have had long continued effetion
of uterus, occurring in females about cessation of [catamen]
and from long continued bowel complaints. The [inner] membrane
will descend like a funnel An injection will perhaps 



87
Symptoms These will be different according as the 
affection is of the small or of the large intestines
1st Where the small intestines have one
or more volvuli the symptoms [illegible] vomiting or
Symptoms like those of violent injury to abdomen vide case 1st 6.89
a constant endeavour to vomit as often as once in ten 
or fifteen minutes the matter thrown up being a greenish 
fluid or simply mucus. In severe cases the vomiting is 
attended with a discharge from the rectum at the same 
time. The stools are fecal at first & copious but afterward 
they are small in quantity & consist principally of white mucus streaked with blood
the blood not being diffused throughout the mucus as
“no fecal smell generally”
in dysentery, but in streaks or specks. These symptoms 
are attended by others which indicate great inquietude or irritation
such as throwing the h ands & feet, rolling the 
head paleness of coutenance This set of symptoms resemble those of hydrocephalus
& hence volvulus is often mistaken 
for this disease. The pulse is small and frequent
“[illegible] usually occurs in 24 or 36 hours”
2 A volvulus of the colon or rectum 
is not usually attended with much vomiting unless this
is excited by cathartics. It is attended with the ordinary 
symptom of constipation. There is no evacuation 
from the bowels unless at times a little blood and
mucus. If the passage be not completely closed, an 
enema thrown-up will remain & not come away if
completely closed. it either cannot be thrown up 
or it returns immediately. Blood often follows the introduction 
of the pipe. Indeed the inflamed part is often 
so low as to be reached by the pipe & admit of being felt
by the finger.



come away immediately. [Schyl?la] of feces may come away 
And large quantities of mucus may come away sometimes 
½ a pint. This is not apt to be fatal. Treat by a strong
inject prescribe for the [illegible] with conium [illegible] etc. mechanical 
means
The more cath. you give the more the unsolution is
increased therefore give more
Give mucilaginous injection, in involution of the 
small intestines, sufficient to fill the intestines. If it is
said that the injection will not pass the valves. I answer 
that whether by sympathy or in whatever manner, I am satisfied
of its utility # 
Give [illegible] enough to allay irritation 
I have treated # patients for 8 or 10 days without 
evacuation & cured them 
Not long since I had a case in what
I suppose there was such a volvulus, for the attendants
could not make the child receive injection. “thought
the bowels were swelled” The child was suffered to 
get 8 or 10 days without evacuation & eventually died
of another disease with which this was connected
# In the incipient stages, filling the intestines
with warm water [illegible] recovered. I was led to it from 
its [illegible] strang. hernia I am satisfied it acts well as a 
local nervine etc.
I would recommend the injection of ether 
in cold water table sp. to a gill warm wat. will make it fly off. The inject of it
is practised by the French & Germans. Other antispas. might be [injec??]
is asaf. petroleum etc.


88
We may often hear a rumbling noise proceed as far as 
the stricture & then stop.
Treatment The indications of cure are principally,
to relieve the excessive irritation both constitutional & 
local & to attempt the restoration of the involved intestine
chiefly by mechanical means
When the small intestines are affected we
must give opium and aromatics & depend mainly upon
these as internal remedies, until the intestine restores 
itself. As an adjuvant the warm-bath will be valuable
& fomentations or irritants, as mustard & horse radish
leaves may be applied to the abdomen. Soothing injections 
also may be copiously given. The quantity of opium 
which will be safe at a dose may vary from half a drop to 30 
None but the mildest cathartics are safe, as blue pill
and aromatic tincture of rhubarb I have succeeded in giving 
only a decoction of senna & the blue pill [Savage]
When volvulus is in the large intestines
all our remedies must be given by injection. The 
warm bath etc. may be used & we may also attempt
the restoration mechanically, by means of copious 
injection repeatedly given & thrown up with force
Two cases are related of young men cured by inserting
into the rectum & keeping these for a considerable time 
as spermacete candle with a quantity of opium at 
its extremity.




The first case which I had I treated for constipation 
with repeated cathartics, which are thrown up etc. The
attendants complained that they could not give the injections when
I ordered I was ignorant of this case Tried warm bath & 
every remedy for colic constipation etc.
Upon examination at first the colon was
apparently wasting at the sigmoid flexure where there
was a large tumour which we thought to be a malformation
It proved to be a repeated & insolution of the intestines Inflammation 
had taken place & the whole was adherent, some
[illegible]
Afterwards I was called too late, to a similar
case which upon an examination showed circular appearance
Afterwards called in consultation to a child
said to have hydrocephalus all the children of which family 
had died in a strange way. I pronounced the disease
not hydroc. but some could not say what was the matter.
No treatment was serviceable. Examin showed volv.
of small intest. Symptom is above. vide p. 204
The children of the family were subject to 
diarrhoea & were leucophlegmatic. I afterwards 
[illegible] the family and was very cautious about cath.
giving nothing stronger than blue pill or tinct. rhub. The
family raised 5 or 6 children afterwards
Case of a student [unaccountable]
Dr Munson & Dr Smith at a loss. [Cath.] retained & yet
not thrown off by vomiting Sitting by him I observed
a rumbling noise Which he said upon my enquiry, he
felt & which stopped. I felt the stricture. Spermacite 
candle, sharpened, opium at [end]. kept up about a [illegible]
[renewed] afterwards injection passed up 
Case of a gentleman on the wharf similar cured


89
Cases. A man over whom a cart had passed without
leaving any external injury, died with all the symptoms 
of volvulus of the small intestines. On dissection the duodenum 
was found cut entirely in two. One remarkable
physiological fact occurred in this case; a cathartic
was given by the mouth & produced a regular 
evacuation from the anus, although the intestine
was completely severed.
An interesting case occurred to me
in which the worm ascaris tricocephalus was found
to be the cause The worm lay in this fold of the intestine. Grace Linsey, a delict schoolgirl
on was taken with slight in disposition for 3 or 
4 days the rejected her food by vomiting then came
on constipation with vomiting attended with great
restlessness & throwing off the bed clothes, cold extremities,
low & small pulse the tongue not much furred,
little or no thirst, no tumefaction of the abdomen
no determination to the head. She was visited on 
Tuesday and died on Saturday. A blue pill was
given & followed by 15 or 20 grs. of calomel in divided
doses No effect was produced though they were 
not rejected. Opium and stimulant were tried but
were not retained. There is no pain but faintness & 
an uneasiness about the alvine & urinary passages.
Both copious and small injection pass up well but
produce no evacuation. On Wednesday injections produce
stools which are clay coloured. Black vomit came
on two days before death. P.m ex. liver very pale
little bile in the gall bladder no marks of inflammation cavity 
containing the intestines very dry as in cholera. Two volvuli were found one in the
ileum which was disengaged with difficulty, & one in the jejunum 


In other cases with similar symptoms I have had supposed 
there was volv. caused by worms, but have had no opportunity 
to examine Vide p. 204
[illegible] Lindsay’s case continued. After the examination 
we accidentally observed some of these worms minute 
& coiled up among the mucus on the cloths. The worms seem
more calculated to irritate the bowel than any other “If it
could have been known that the worm was there, perhaps tobacco should aught have
succeeded
# It is called leg ache in slight affections 
alluded to by DR Rush
Affects the legs, calves of the legs
[illegible] continues extends up to the [illegible]
coats” It is a disease manageable in its commencement
Being a severe disease it calls for 
decisive remedies
The indications are to allay pain 
equalize excitement & promote peristaltic action
by opium by diaphoretics by cath.
Cal. in full doses some would call 5 grs a
full dose some 10 But if 5 gr. should be given
every hour it would amount to a full dose. You 
may give 10 gr. 2 or 3 times repeated. AT the
same time apply warm bath & fomentations
not regarding your giving cath. Put drafts
at the feet. Follow the cal. with senna, salts etc.
But do not be too anxious about the calomel’s operating
immediately It is better that it shd lie sometimes in 
[illegible] vessels
With the cal give opium also guiacum 
& guaicum with dovers powder the latter
to act on the skin and the whole to produce a 
decided [nerve] action affect on the al. can. and on the whole system


89:a.
Nervous Rheumatism
Infantile neuralgia
This is a disease which has never to my knowledge
been described in the books, though it may have existed unnoticed
I first met with it some years ago, but it is [not] some years
since I have seen of a case. It may occur again
It occurs in the winter and spring mouths & 
occurs after exposure to cold especially after the feet have
been in snow water.
Children are the only persons that I have
known attacked # 
This disease is in its symptoms allied to neuralgia
acuta. The affection leg ache is probably allied
The attack is sudden after exposure to cold 
with excruciating pain in the inferior extremities sometimes
rigidity of the whole muscular system more or less disorder
of the digestive passages (apparently the muscular coat of the
intestines is affected) abdomen frequently tense
and full stomach sometimes irritable. If the disease advances
there is nausea, vomiting, tumefaction of abdomen
(appearance of tetanus?_ (coma?) etc. and the patient dies
in 4 or 5 days
The indications of treatment are to equalize
excitement by acting upon the whole surface of the alimentary
canal and skin at the same time introduce new action in the system
commence with a full dose of calomel 5 to 10 grs or 20 & follow
it by senna and manna, or castor oil and enemata
“I do not expect that cal. [illegible] I as above will operate at 8 years therefore follow it.


Immediately after administering the calomel I put the patient
into the warm bath or the feet in to the tepid bath,
wrapping them afterwards in flannel or boil cedar boughs
in water, roll them in cloths and apply them to the body & 
feet. Irritants also may be applied to the extremities and
to the abdomen
Sometimes it will be best to repeat the cal
in the course of 2 hours. The stools will be fetid and
dark but this must not be considered as an indication 
for further evacuations as the appearance may be caused by 
the calomel, and is a sign that secretion is beginning to take
place. After producing free evacuations by your cathartic
you must keep up a regular course of exciting the secretion 
by cal. & guaicum with Dover’s powders, especially if 
pain continues & keep up a diaphoretic action by Dover’s
powders calomel and camphor alternately increasing 
doses if necessary. Calomel and gum arabic, as an emulcent, 
& calomel and decoction of cedar twigs, as a diaphoretic
may be given
Give the calomel first in divided doses
If cold applications are made to the extremities, to 
discuss the inflammation the disease is translated to the
stomach and death is the consequence
I called in the first stages, & am always successful in effecting
a speedy cure



The irritation of the system is so great that secretion 
is prevented hence the production of
secretion
I have been called to patients with [illegible]
where little had been done the abdomen was
swollen the patient went into a comatose state
& died and that too where the disease
was not of the most violent form
After the bowels are thoroughly evacuated
depend upon diaphoretics camphor guaiacum and 
[illegible] etc. giving so as not to offend the stomach 
and beginning gradually 
It is a violent and excessively 
painful disease and it is a great satisfaction to the 
phys. to cure it
Dark stools [illegible], satisfied
“The pain usually begins in the calf of the
leg and extends to the contiguous parts. Sometimes it is attended
with tetanic spasms & a constant rigidity of the abdominal
muscles. The stomach becomes in these cases irritable,
and nausea & vomiting prevail. In the progress
of the disease the abdomen becomes full and tense, with 
constipation.”
“It should be our leading object to make the
muc. men. of al. can. & the cutaneous system active [concert]
After the operation of cathartics, if the pain is severe give diaphoretics 
with opium, as Dover’s powders. Camphor & cal.
in small doses as an alterative. If the stools are watery & fetid
give opium ¼ gr. guaiacum 1 or 2 grs. camph. 1 gr. Ipecac ½ gr.
with cal. repeated till some effect is produced not to salivate, but
to this children are not so liable as adults”


Young physicians are often called in a case of convulsions
as their first case The neighbors & friends (women) have assembled
in great numbers and their sympathies are excited. Hence
an impression is made with respect to a young physician’s talents which 
will be of great service or detriment
Morbid condition to brain so that ordinary stimuli
produce convulsive action
Convulsion fits may continue 5 m or from 1 to 2 hrs


90
Convulsions vide costiveness 12:a
This is a very common disease of infants. The mortality from 
it is truly appalling nearly one seventh part of the whole
number or deaths of patients under the age of puberty
by the bills of mort. in Phil in 20 years
Medical writers commonly make two 
kinds of convulsions idiopathic and symptomatic, the
former arising from some morbid condition of the brain 
and nerves and the latter from some other disease, or from 
irritation. Children are subject to both kinds & most
of the diseases of children may be expected when they prove mortal
to terminate in convulsions
The causes of symptomatic convulsions
are as various as the agent capable of producing irritation
though the causes of convulsions in one child will not 
necessarily produce them in another. The susceptibility to 
them varies with the age of the child and the peculiarity 
and degree of delicacy of the constitution.
Convulsions may arise from the sudden suppression 
of evacuations to which the system has become
habituated. Irritation from teething is a very common 
cause. Worms in the alimentary canal may excite convulsions.
But perhaps the most frequent cause is the 
presence of indigestible substances in the primae viae.
irritating the nerves of the stomach & through them those of
the whole system. Over distention of the stomach, even with 
food of a healthy quality interrupt the progress of digestion
& the food undergoing action [illegible] fermentation 


“Or the excessive quantity of food may produce
convulsions from the mere stimulus of distention”
“Dyspepsia is a cause”
This is an important maxim in the first children of 
young mothers Their anxiety of mind will often affect their
milk


91
in the stomach, becomes noxious matter & excites convulsions
In the season of fruit we may always suspect this as a 
cause in children old enough to eat it. Calomel has been
known to be so irritating to the system as to bring on convulsions
Costiveness also is a cause of convulsions in children
A change in the quality of the milk of the
mother or nurse, produced by improper food or
by strong affections of the mind, in some instances
is the cause of convulsions in young children. Hence 
not only the diet of nurses should be regulated, but their
minds kept tranquil. It may be observed also that the 
countenance of the mother or nurse as also those of the bystanders
has more influence upon children than is commonly 
supposed. Even a child but 3 weeks old, will be strongly affected.
In some families there is said to be an hereditary 
predisposition to convulsion among the children.
For the treatment we have two indications
1st to remove the exciting cause where this is local & 
2nd to relieve the irritation of the system
1st We must enquire into the causes with 
with care. If evacuations are found to have
suddenly ceased they must be restored. The guns should
be lanced. Anthelmintics should be given if there are worms
If improper food is suspected we must be particular 
in our enquiries, or we may be misled by a [vague] & 
general answer. When the convulsions have been brought
on by improper food or by food in large quantities
recently taken the stomach should be evacuated by an
emetic of 5 or 6 grs 4 to 8 of sulph of zinc or of ipecac.


# How long should we wait after giving one cathartic
before we try another? the child being in convulsions 
all the while?
The equilization of temperature will do a great deal
to remove convulsive action Besides the soothing of the [nerves] etrc.
Some rely on one and [illegible] or another
Oil of a amber is not in my opinion better than many others
The oil of amber apparently is the [illegible] the oil of [capal] brought from its E. [illegible]
It is recommended to dissolve the oxyg oil in [illegible]
[but] it is slow of solution It dissolves readily in either


92
If the offending substances have probably passed the stomach
& the irritation is in the bowels, these must be evacuated as
speedily as possible giving and injection to begin with [illegible] it to [illegible] cathartic. Sometime
it will perhaps be best to give a dose of calomel
large enough as to operate both as an emetic & cathartic.
Frequently large & repeated doses of cathartics
will be needed in order to overcome the torpor produced
by an excessive quantity of food. The food also diminishes
the cathartic operation is the case with the French
[dinner] pill. We may give calomel, 5 to 10 grs. or scammony 
3 to 4 gr. jalap 2 to 3 gr. senna & manna, castor
oil, neutral salts etc. If dry cathartics fail to produce
the desired effect, the liquid should be tried. Sometimes
will be acted on by one kind when they will not by the 
other # If one fails after 3 doses try another & assist with injections
Begin with cal. & follow with the others
2. If the convulsions continue after the removal of the cause we must
rely upon antispasmodics or even at the commencement. Of these the warm bath must
be considered the most powerful remedy in convulsions
of children always [illegible] & often efficacious. Its influence is immediate and extensive.
Antispasmodics, as pearl ashes or aromatic herbs, may be
put in to the water of the bath
Of antispasmodic articles a great variety are 
used. Oil of amber Dr Rush called his sheet anchor in 
spasmodic diseases. It is useful internally, and applied
as an external irritant along the spine. The artificial
musk a preparation of amber is in my opinion a better
article than amber itself, for all cases where amber is 


“# Seneca oil is more limpid & pure & approaches nearer to naphtha”
Soot is a [illegible]
Soot is efficient as a nervine tonic & deobstruent
It is sometimes very efficacious in jaundice & dyspepsia It was
very popular in Philadelphia with ashes for stomach complaints
“The British oil is manufactured in this country from 
Barbadoes ter & spts turpentine”
The nostrils may be rubbed & it may be given
internally “also rubbed on the skin”
Though so offensive to the small yet children taking 
the tinct readily
potash [illegible] & [illegible]
All the alkalies & alkaline earths are antispasmodic.
They are not nervine properly. There yet
seems to be abundant testimony to their antispasmodic
properties. They are to a certain degree tonics. i.e. they 
have a specific action on the mucus membranes. I have maintained [illegible]
they operated by generating excitability a view supported by Jobe
vide Hufeland’s Journal in Lond. Med. & Phys.


93
indicated. The mineral oils from whatever source obtained,
such as petroleum, seneca oil, British oil, are
little inferior to the oil of amber I prefer the seneca oil 5 to 30 drops #. The eympreumatic oils
are useful antispasmodic and soot is often given by nurses in 
decoction
Ammoniae in any form is a good antispasmodic 
A solution of ammonia in spirits often contains an empyreumatic
oil of this solution we may give to a child from 2 to 
6 drops in an ounce of water. Either the spirt, the carbonate
or the aqua ammoniae will be useful in alleviating spasms 
in children either applied to the nostrils, rubbed
upon the skin or given internally. Dippel’s animal oil, a
very fetid substance distilled from bones in a state of putrefaction owes to antispasmodic
virtue to the presence of ammonia. It is too disgusting
Castor and valerian are good articles
of this class, but in cases of children they are too bulky & a sufficient quantity
cannot be introduced into the stomach. A more
powerful article than these is the asafoetida fetid gum 10 or 20 40 
drops of the tincture. This is a very valuable remedy to 
give by injection using for this purpose either the tincture zii
or a decoction
all the alkalies are antispasmodic & 
are proper for children. The most powerful is 
pearlash given by injection, zi to zii in lbis of water 
I have seen more sudden and permanent effects in cases
of spasm produced by injection of this kind, than by any 
other remedy. It has been successful in cases both of 



In for [illegible] who have [resumed] in convulsion 2 or 3 days
when a variety of narcotics had been given. I have seen
surprising effects produced by the injection
These applications sometimes fail & we 
cannot tell to what sort of cases they are Yet we must have
a variety of resources if we would be able practitioners
Opium is powerful, but though it
frequently relieves, yet it sometimes aggravates the symptoms
I have given it with great success in paroxysmal convulsions
anticipating the paroxysms yet in these it will sometimes
fail



94
infants and of adults. Sometimes however this remedy 
fails & I am not able to point out in what particular
“We are compelled sometime to practice [illegible]”
instances it is indicated. All the narcotics
are antispasmodic. Opium is a powerful antispasmodic
and may be given to patients of any age when the condition
of the system does not contraindicate it vid. lect on m. m
I have given opium
where the convulsions were violent & returned
at stated periods with fever preceding. When the
convulsions appear at regular intervals, as once in an
hour, or day, opium in repeated doses may be considered
a specific.
Counter irritation may be valuable adjuvant
in the treatment of convulsions. Oil of [origanum]
& similar articles may be rubbed along the spine
 drafts may be applied to the feet and wrists & mustard
horse radish leaves etc. to the abdomen.
When the convulsions are frequently repeated
in children and become in any degree periodical, a
cathartic of calomel given once or twice a week, rarely 
fails to prevent their recurrence. If this fails I give
stramonium or other narcotics
If convulsions arise from organic affections
we can expect to effect more than to palliate
instead of curing the disease.
“Counterirritation by mustard, horseradish etc. may be
useful”


An injection can do no harm can always be administered
and if one cannot administer articles by the mouth
Irritants may be applied immediately e.g. mustard
horseradish garlic N.B. we do not need powerful vesication
for the tender skin of infants. Even garlic sometimes vesicates
Ammoniae to nostrils & in mouth
Be sure that you have [water] enough to [illegible]
the child completely for the nerves are apt to think that it 
is sufficient to half [illegible] child & then sprinkle
or scatter water over producing an equal excitement
Friction may be applied while in the bath & after
coming out [illegible] with dry flannel
If the irritants have been applied before
the bath taken then off when [illegible] about to immerse in the
bath & put them on again if necessary after coming out
If the child seems to be in a state of asphyxia 
the emetic may not take effect; then irritate the fauces
the child being lard on its abdomen supported by the
hand of the nurse



95
When you are called to a child in convulsions, without 
previous sickness, direct an injection to be immediately
administered and the warm bath to be prepared. if the
injection does not relieve, put the child in the warm bath 
previously adding pearl ash in proportion of zfs to a gall.
of water. Let the child remain from 5 to 15 minutes taking
it out when it begins to grow exhausted. When taken out
of the bath let it be wrapped in flannel & put into a 
warm bed. Then apply irritants as mustard, horseradish
garlic, or aqua ammonia to the abdomen feet and wrists
Apply aqua ammonia to the nostrils and temples
As soon as the child can swallow give a dose of calomel;
If the countenance is pale or livid the
cause may be suspected to be some offending matter in the 
stomach & an emetic ipecac not [illegible] generally should be given. We may often
succeed in exciting vomiting by irritating the throat with 
the finger or a feather & this method should be tried
when the patient cannot swallow & is known to have taken
improper food or when it is desirable to hasten the 
operation of an emetic. The child will vomit with much
more ease if it is held lying with its belly upon 
the nurses’ hand, which this supports the abdominal 
muscles
If the child is much agitated at the 
sight of the water which it is to be immersed, let
the tub be covered with a blanket & the patient gradually 
lowered into the water there will then be 
no difficulty




96
Epileptic fits are very frequent among children
Epilepsy is defined by Good A “spasmodic agitation & 
distortion, chiefly of the muscles of the face; without sensation
or consciousness; recurring at periods more or less
regular.” One side is generally more affected than the opposite
The limbs may be fixed and rigid with twitching 
of particular parts. The pupils may be contracted or dilated
& the attack may be followed by coma. The attack may 
be abrupt and without warming or may be preceded by 
hilarity, or a giddiness or other unpleasant sensation.
Sometimes there is what is called the Aura epileptica, a
sort of formication, creeping up the body for which the 
ligature may be applied
The fits may be kept up by the constant 
presence of the cause such as malformation of the brain etc.
or, by habit & while in the former case the disease
will be incurable, in the latter habit will be very 
difficult to break up.
The causes of epilepsy may be, malformation 
of the brain tumours of the brain derangement of the system 
produced before birth by syphilis & rickets or the same
causes as those which produce the rickets & in children oftener than after preventing the disease
may also arise though more rarely from mere excessive irritability of the system, even’
without any exciting cause of irritation such as indigestible substances
in the alimentary canal or suppressed evacuations
Among children however epileptic fits are
most commonly excited by teething, suppressed evacuations
& the irritation of a morbid condition of the bowels or of 


In scrophulous children remedies for scrofula
may be given. [illegible] rickets I have often
found advantage from blisters behind the [ears]
I have found the cath mode of treat successful 
for children within the year especially calomel
In some cases the most powerful cathartics are
required
If there is acidity of the passages so that cal. seems
to gripe much [illegible] chalk any quantity from 5 to 10 
It is immaterial whether the action is chem. or certainly 
the effect is good
The system being very irritable ordinary stimuli
or rather a little more than ordinary brings on [illegible]
Hence improper articles improper exertions of mind & body
etc. Careful management & [illegible]


97
indigestible substances in them.
The treatment of epilepsy must vary
with the causes which produce it but does not differ materially 
in the case of children from that of convulsion fits
In epilepsy from rickets I have used the
cold bath with advantage. In children our attention 
in the treatment of epilepsy must more especially be directed 
to the alimentary canal. Cathartics are far more valuable
with them than for adults. I have almost always succeeded
by means of a course of mild cathartics & 
joined with one of tonics, such as the tonic solution 
& the different preparation of iron
When called to an attack brought on 
by offending matter in the stomach and bowels, we should
commence the treatment with a strong cathartic in 
order to thoroughly clear the alimentary canal
calomel is the best article but if the bowels are loaded with 
mucus so that calomel fails to operate we may conjoin 
1 or 2 gr. of gamboge & of scammony & 5 of jalap & this
though powerful, will yet operate kindly. In 
the subsequent treatment calomel should be given 3 or 4 
times a week; though if there is a deficiency of mucus
in the bowels an abrasion as it were the blue pill will
be preferable or chalk may be conjoined.
Among infants most cases are curable
by careful management, both of the physician of nurse
The diet should be regulated with great care Generally 
however there is a morbid appetite, & a sub-[insanity]


There is often a difficult, particular waywardness
[illegible] like into [illegible] etc.
In children more than a year old I have given stramonium
so far as to dilate the pupils keeping the child under
the operation of it I have not prescribed it to children
under 2 yrs or 18 m. I recollect one case in which 
the convulsion begun to subside as soon as the pupils began to 
dilate
I would not prescribe to [illegible] but to [all]
symptoms e.g. tonics all the nat. ton. tinc irr. cap.
lead
I would give the lead where cathartics, from 
the excessive irritability of the al. can. aggravate all the 
symptoms Lead will produce a torpor or sub paresis
contrary to this Narcotics also will meet this condition
Opium will occasionally, but not generally 
Why it is we know not but the fact is that phys. do 
not depend on [illegible] ep. seems to cause a determination
to the head


98
with regard to food. This subderangement of the mind
manifests itself also in other ways by oddity of appearance
gesture & action. A strange propensity for climbing for
instance is met with & epileptic children will often be so 
active & so artful as to be very difficult to manage
For more particular treatment see my 
lecture on m. medical articles stramonium & nit. silver
[illegible] turpentine from 10 gtts to zi diluted
stramonium, camphor, opium atropa belladonna
& most of the more powerful narcotics Arsenic
zinc is one of the best of the metallic tonics
Actual cautery, [moxa] etc. have been highly extolled
“In epilepsy caused by rickets or by the same
causes as those which produce ricketts. I have used the 
cold bath with advantage”
“Mercurials followed by mild cathartics
[Seontod??] etc.”


The child will be still breathing languidly
The parents think it dead If you look at it carefully 
you will perceive as languid treating & looking at
the eyes you will often perceive a little convulsive motions of 
the balls pulse not much disturbed
The child continues a few [illegible]
with paroxysm & comes out with a scream like
an adult from nightmare
Not dangerous
In a few instances [somerset]
Case adult patient [illegible] a chair stands fixed eyes fixed
come out with a stare irritable & sub derangement
for a few days Afterwards [somersets] “asleep
once a sleep twice”
Case a girl last year gather up [illegible]
[somerset], even 50 times than cataleptic then exhausted
This case changed from chorea to catalepsy Repeated
bleedings did not change the emaciation etc.


99
Catalepsy
This affection when it affects children, is called in 
poular language still convulsions. It is a very rare disease 
among adults, but among children I have met with several
cases of it
In catalepsy the muscles are universally 
or partially affected with a tonic spasm. The patient remains
fixed in the position in which it happened to be
when seized appears asleep, is insensible and scarcely 
breathes. The eyes are commonly fixed, but sometimes have
a little motion. The paroxysm may terminate with common 
convulsions. The length of the paroxysms I have known
vary from a few minutes to three hours & in some cases
they are frequently repeated
The disease arises from the same causes
in general & requires the same treatment
as epilepsy & convulsions. Cataleptic convulsions 
sometimes follow other convulsions & in some instances
have been brought on by drastic cathartics
In adults catalepsy is often followed by irritability 
& a degree of mental derangement.
“Catalepsy arises from the same causes and
requires the same treatment as epilepsy chiefly 
by cath. & antispasm. Sometimes children are
affected with catalepsy without it being observed
When I commenced practice I thought the notion of
still convulsions a mere whim”


Dancing before the [illegible] of St. Vitus
Dance [illegible] 3 or 4 well persons
Comes on gradually parents complain that
their children are getting into bad habits Awkward
motions
The dis. is not benefit. by [illegible]
I recollect a gentlem. 40 or 50 yrs told
me he had chorea when a child & recollects perfectly 
the indignation, horror & disgust when so long as to be 
unable to speak [illegible]
Hand carried not to the mouth
Sometimes the motions finally become regular
“The dancing master” feet blind [illegible] then 
hands then body then stop like a statue then begin 
one foot like a [falling] [illegible]


100
Chorea Sancti Viti
This is a disease not to be mistaken in its ordinary appearance
the voluntary muscles are but partially subject to the well
and their motion is convulsive. It occurs oftenest in 
females of relaxed habit & about the age of puberty
especially if they have grown rapidly or been much 
confined to the needle or to study.
In children this disease is often caused
by irritation in the primae viae Chorea also arises in 
some cases from a peculiar irritability of the system in 
which ordinary stimuli produce convulsive action
This irritability may be accompanied with 
relaxation, or with increased action together with a
determination to the head. Indeed it is said sometimes
to be connected with inflammation of the brain 
 & hydrocephalus. With those who are predisposed
to this disease, particularly if they are females
about the age of puberty affections of the mind may bring it or
epilepsy sometimes runs into chorea, or alternates with 
it. Finally, the disease may come on in a very gradual
manner, so as not to be suspected, causing a strangeness
in the gestures walk etc. which at first is attributed 
by the friends to the formation of bad habits.
This disease is rarely fatal and is not
difficult to cure in patients under the age of puberty after
that period it is seldom cured. When the disease is
of long continuance a great variety of remedies are generally 


“When I give cathartics in chorea it is not for the 
evacuation but to produce a new action. All cath.
will not act favorably. Hamilton’s views in prescribing 
cath. are not generally correct.”
There sometimes irritation of al. can. from accumulation
of feces about the coecum. Hence Hamilton’s
plan of purgatives Purgatives will cure but [general]
by impression on system
It is said to arise from a tonic infl. of 
brain I have read periodicals have not so
I have seen all kinds of treatment tonics, cath
narcot. electric. galvan. cold bath etc. etc.
Perhaps no disease prescribed for more [illegible] periodically
We find one and another article fails and are obliged 
to go the whole [illegible] off [illegible] narcotic etc.
# “In one case of chorea I tried the arnica until the
head became affected. The patient began with a decoction of zii
the flowers & increased to zfs without any abatement of the disease”
Prof T’s [illegible] [illegible]
Nux vomica has been used with success in many 
cases but there are other narcotics which act more powerfully 
& more certainly I have not used it deterred by [Ba??]
[Surrey] who found it injurious for some convulsive cases 
“Stramonium succeeded in a case following
epilepsy”



101
tried and the one last given is apt to be considered
as having effected the cure; but I am inclined to think that 
in many of these cases the disease instead of being cut
short by the treatment and run its course and then ceased 
of itself
The most common indications are [for] narcotics
and tonics with antispasmodics as palliatives & 
permanent counterirritation along the spine in some cases.
In children however cathartics are commonly indicated; though
in general the plan of treating chorea by cathartics, has not
succeeded very well in my practice. Dr Hamilton however
depended upon cathartics and had better success, though it may be remarked that those who act on that treatment are also the metallic [illegible]
When there are symptoms are symptoms of worms, of hydrocephalus, or of
inflammation, of the brain or when the disease follows epilepsy
we must treat as for those diseases; & if it the chorea
is the result exclusively of the peculiar irritability above
alluded to, narcotics must be our chief dependance. 
The principal articles which I have employed
in my practice are conium, conium & iron
sulphate of zinc, sulphate of iron & other metallic
tonics. Various narcotics are used, as the nux
vomica in doses of 1 or 2 grs of the seed in pill or 15 or
20 drops of the alcoholic tincture; and antispasmodics
as valerian musk etc. may be used as palliatives
Cullen’s favorite tonic was the ammoniuret of copper 1 to 4 gr.
I have lately used it with advantage in pill 2-3 hours in creasing
other tonics are mineral acids, nitrate of silver, bark
& the arnica montana #, which is a narcotic & tonic & 
was successfully used by Dr [Monsen] in chorea” Dr. T’s copy [M. ?]




“Sulph zinc 1 gr. may be given 3 or 4 times a day
nit. sil. 1/6 to ¼ gr. succeeds best in relaxation of the blood-vessels”
“Evacuate the first passages and restore the healthy
secretions & irritability of the system by tonics & antispasmodic
“I have rarely effected a cure by cathartics though I generally 
begin with them The cure with antisp. & tonic is slow 2-3 [illegible]
with narcotics more speedy but uncertain”
A good deal may depend upon the careful management
of the patient keeping him quiet & amusing him especially 
avoiding the irritation of the [pressure] and the impertinent
curiosity of strangers
The young man in a debilitated 
“So camphor has sometimes been given in mania to 
such an extend as to produce epilepsy & sub-apoplexy & this 
sometimes cures the mania”


103
double the quantity, when the head began to be affected still
there was no considerable relief The patient was finally cured
by taking the bark in substance zi a day.
One case which came on in the gradual
manner above described & was brought to a high degree
by a dysentery proceeded so far at least as to present
the peculiar symptoms of hydrophobia such as horror of
water etc. convulsives perfectly [like] that frothing of the mouth etc. died in coma exhausted
narcotics tonics etc. no effect excitability exhausted by [illegible]
This disease may affect the mind causing
it to run upon particular subjects especially upon that
of numbers & calculation. I once travelled a short
time with a book pedlar who had the odd gestures of 
chorea & had also this facility in calculation, being
in this respect fully equal to the famous [Serah] [Colbourn]
[Serah] [Colbourn] though furnished in Europe with 
the best advantages for education never improved
and this result I ventured to predict, when I first
heard that he was to be educated. I have seen several
such cases. # They have a peculiar articulation & expression
of countenance; and are deficient in memory and
judgment. Vide [illegible] 12 [illegible] for [Serah] [Colbourn]
Case girl at stool good talents studied
hard [stand] out of schools [illegible] Cal. narc. cath. tonics
operated but
[Elateri.] 1/16 gr. once 4 hr in about 24 
hours deadly sick nausea prostration vom. purg.
disease broken up. It may be diff. to class this
A year after similar causes brought on a second attack #


Connected with acidity gives great pain not
dangerous
“This is a troublesome and not unfrequent 
complaint, arising often from improper food 
and that stab of the stomach which causes acidity. In 
a torpid state of the stomach when the healthy action 
ceases or is feeble, chemical action commences, and
the acetous or putrefactive fermentation, prevails according
to the contents of the stomach”
“If our remedy fails try another for there are no two
exactly alike & the judicious physician will discriminate as
they are indicated”
Among the astringents should be mentioned the rose
willow It is one of the pleasantest astringents & is a popular 
remedy in canker It seems to combine a mucilage
Almost any of our wild willows may be used
Nitrate of silver may be used It is often however
difficult to touch the ulcers and we may then use astringent
washes.
Rhus glabra and R [typhina] are good astringents
vide hosp. [illegible] sub. [illegible]
The poison of R [vernex] I have more than once known
communicated in more than one instances by using the wood as
fuel. I recollect a man’s [illegible] to me on account of an eruption 
on his legs. I told him he was poisoned. He replied that
there could be no cause for it but a pair of the pantaloons
lately dyed black. Upon investigation I found that
the poison species of sumack had been used by the dyer
by mistake for the common one. Young persons are more 



102
Cold bathing is sometimes advantageous tepid is seldom proper
Electricity has been used. I have seen little benefit from it
Setons, issues, tartartar emetic ointment along the spine & 
other modes of counterirritation, are employed & may be advantageous
but where the irritability is great they do injury
If the disease is not translatable it is made worse by counterirritation
In the treatment of patients affected with 
this disease, we should bear in mind, that they are the
subjects of great mental sensitiveness & irritability
The presence of strangers in injurious & the remarks of bystanders
upon the patient may cause an amount of mental
irritation little suspected.
I have succeeded in curing chorea by 
elaterium though this is an article not mentioned by writers
as applicable to this disease. A young man debilitated
by confinement as a clerk in N. York was thrown into
convulsions and derangement of mind, by a sight of distress
while on board the packet for this place Elaterium was
given to prostrate the system & break up the habit. It was
successful & this led to its employment in chorea. I have
completely broken up the latter disease by an eighth of a grain
of elaterium & this is the only case which I have broken up
vide end of this article
Case a female delicate 14 yrs of age had not menstruated had been
treated with cathartics, epispasmodics and narcotics, which 
palliated the symptom. The patient then took arnica for
10 or 12 days beginning with moderate doses (zii to a pint
of boiling water being given in 24 hours) & increasing to 


I have found [illegible] which however was Dr [Rush’s]
favorite remedy in females about the cessation of the [illegible]
useful
Friction antispas. electricity etc. had merely palliated
The case then [illegible] to indicate tonics
[illegible] the other remedies had [illegible] effect or not recovery
rapidly upon bark
Sometimes connected with pneumonic affected
or with [organic] eff. of the heart In some of these cases 
[illegible] of copper 1 to 3 gr. rarely more than 2 gr. nauseating article [illegible] in such cases more
especially
As the [disease] advances sometimes [illegilble]
difficult [illegible] swallowing dark [tongue]
# [illegible] of them the book pedlar and [Minot]
[Sheri] [illegible] [illegible] Both these had this facility in [calculating]
# At this time there was not excitability enough left to enable
the elat. treat. El. shd not be cont. more than 


103:a
Ulceration of the mouth in children
This is sometimes a troublesome complaint and one that
does not readily yield to remedies. It is commonly called
canker. The complaint consists of one or more ulcers, which 
commence with an inflamed point or with a white slough
situated commonly near the frenum but sometimes extending
over the whole inside of the mouth. The edges of the ulcers are
inflamed & elevated & their surfaces excavated, as if they had
been eaten out with caustic. The child drools much
and nursing is evidently very painful to it. A febricula
attends the first stage. The bowels are slow and digestion
not vigorous indeed the complaint often arises from improper
food and is connected with that state of the stomach
which causes acidity
Treatment. First excite action of the bowels by magnesia, 
if there is acidity, blue pill, if there is torpor, or calomel grii & chalk grvi. After this give
tonics & astringents as Moseley’s tonic solution 3 to 12 2 to 10 gtts 4 to 6 brak compound
tinct. vitriol 4 to 5 gtts & the vegetable astringents as geranium in a [ter] spoonful of water
statici spriaea cornus etc. a little laudanum may be added
For topical applications we may use the
vegetable astringents just mentioned, catechu, kino etc. or
the following which has been recommended as very efficacious RX sulph. cupri grs x, cort. peruv. zii acad. gum zi
mellis et aquae aa zii make a soft paste to be applied to the ulcers with a 
pencil. A weak wash of corrosive sublimate may be used
Sometimes a mild caustic is serviceable, as nitrate of silver
A wash of opium or of opium & corr. sub. is sometimes the best
viola pedata makes a valuable wash. Asclepias tuberosa is
escharotic. [Post] [illegible] case


affected by this poison than old. When young I have often
been poisoned myself by boing near the plant
merely. Now I can brush past it with impunity provided
it does not touch my hands or face. Some
persons are not affected at all. The uncertainty of its
operation is the only reason why it is not used in 
medicine. Corrosive sublimate is a good application
for the affection of the skin. Yet the disease is
a specific one and must generate run through its
regular course. A similar disease is produced by 
the oil of the shell? of the cashew nut
Ulceration of the mouth continued “The disease
sometimes attended with severe pains, as severe as in tooth ach
in which case opium is serviceable. Case of an adult use
veg. astring. copper, zinc, opium, nit. silv. & at last corros.
sublimate. This last would not be safe in the case of children.
Intense pain was produced, which was remedied by holding
it in the mouth There was a profuse salivation but it soon 
ceased and the disease was entirely removed. The surface of the
ulcer was destroyed by the sub. & the dis. being local this effected a cure
# I have turned my attention particularly to the question whether
cal. produces it. I have known the dis. to allow dysentery
It was an old notion that cal. broke down the crasus of the
blood and it produced a tendency to gangrene. But 
in the venereal wards of hospitals you will see patients 
with sloughs all over the mouths and yet no gangrene 



104
Gangrene of the mouth
This is not a primary disease but a termination of other
diseases making its appearance soon after their abatement
I have known it follow dysentery and other affections of the
bowels, but not any disease in which the blood vessels
have exhibited an inflammatory action. It seems to follow
diseases of the nerves rather than of the vascular system
Children are generally subject of it.
This disease is sometimes accompanied 
with much pain & at others with none ordinarily with little or more. One of the first
symptoms is a constant inclination in the child to pick
some part of the mouth with the fingers where the gangrene
first commences either the teeth gums, less or cheek 
That part becomes spongy & has a fungous appearance in 
the course of a few days discharges a [illegible] matter, has
 a livid appearance & finally becomes black and dry 
the adjoining parts of the face become tumefied and indurated
and the disease continues until a considerable part
of the face becomes completely [sphacelated] when the 
patient dies It may continue sphacelatal in [illegible] etc.
the sphacelus being hard dry & black like a piece of leather
This disease has been attributed to the 
use of calomel, but it is entirely unlike that produced 
by this article, and occurs also in cases where no 
calomel has been given. # In those cases where calomel has been freely 
given the disease is not so apt to occur vide case 4th
I have known a similar affection occur
in the leg of a child, & an irritative fever preceded by rheumatism.
Commencing with a spongy and orange coloured spot
which afterwards become hard & black, the gangrene 


livid purpled as though the blood had settled
pulse small not much disturbance of the circ. syst. except that it was large
# & Prof. Smith & myself could not get down much medicine 
and were obliged to [illegible] [illegible] with external applications
We [illegible] injections and a great variety of external application 
blisters
“When the disease appears with tumefaction I think
leeches might be of service. This was called by Dr Smith congestive
inflammation. In other cases of gangrene, leeches would not be of service
It is not easy to [class] the operation of charcoal It
has been called a tonic, but it does not much resemble peruv.
bark and we do not gain much by classing it with it
It seems to act by generating an excitability
Charcoal shd be made of soft wood or of lamp black 
burned over again in crucible, as is sometimes done by the
apothecaries


105
extended up the leg and the child above the knees on both sides died [illegible] No applications 
seemed to have any effect. The child was irritable &
The disease under consideration is nearly allied to 
that called swelled tongue, but the latter oftener attacks
quadrupeds 
The treatment should be stimulant & antiseptic.
Acrids as capsicum may be used & the arum 
triphyllum accidentally has been known to cure.
In one case which I shall relate charcoal appears to have
effected the cure.
Case 1st The first patient that I saw affected
with gangrene of the mouth was an adult female who had the typhus 
fever. The gangrene commenced on the inside of the 
cheek & when I first visited the patient a portion of the
cheek as large as a dollar had sloughed off out? Great
part of the food taken into the mouth passed out at the
hole in the cheek. The patient continued in this state
for eight or ten days & then died The attending physicians
informed me that she has received the ordinary
treatment for typhus fever.
Case 2nd The next patient affected in a similar
manner was a girl seven years of age. Previous to the
gangrenous affection she had had a most excruciating
disease, which affected the knees legs and bowels I have
called it nervous rheumatism & shall notice it in another 
place. For this she had taken large doses of purgatives




106
calomel & opium, with diaphoretics & tonics. In three
or four days the pain ceased and the fever almost
entirely disappeared. The guns presented no symptoms
of salivation & there was no increase of saliva.
In five or six days after the fever subsided 
the patient complained of severe pain situated in the right temple
& extending down to the shoulder like that which had been in the extremities. This was removed by opium
to complain of the teeth
Soon after she began to work at the molar teeth of the upper
jaw, on the right side, at the same time she had a cough
which was accompanied with an expectoration of white
viscid mucus, and the breath became very offensive, resembling
the effluvia of an anatomical room where 
subjects have been kept a long time. The appetite
was tolerable, however the patient took animal food, with 
relish, and the bowels were easily moved with a little
rhubarb
the patient world at the teeth until she had removed two 
of the molar teeth with her fingers, she still continued
to pick at the gums. The cheek of the side affected
became hard, swollen & red. In forty eight hours a 
black spot appeared in the centre of the swelling. This 
spot the patient immediately began to rub with her fingers & 
soon made a hole through her cheek. The gangrene 
continued to extend, for a week & at the end of that period
had proceeded as far back as the angle of the jaw
affected the throat & perhaps the aesophagus The patient then died, having taken
food and medicine will until within forty eight hours
of her death.




107
Peruvian and oak bark, opium & camphor were
very freely given the affected side of the mouth between the 
teeth & the cheek was filled with superfine bark & poultices
of bark were applied to the face In the last stage affected
perhaps the lungs
Case 3rd Another case occurred in [illegible] subject a child etc.
A female child, about 5 years of age was attacked,
in the winter of 1813 with “constipation with fever”
the complaint being principally confined to the bowels The 
attending physician gave a dose of calomel and worked
it off with senna and manna. A considerable quantity 
of matter was discharged from the bowels, but from its appearance
further evacuations were deemed necessary, and several
doses of castor oil were given. On the fourth day I was
invited to see the patient. I found her with considerable fever 
of the typhoid grade, attended with pain in the bowels and
head. There was also some swelling of one cheek & the child
complained of one or two of the double teeth of the upper jaw
on that side. These she frequently attempted to pull out
with her fingers & finally succeeded in extracting one of them
The cheek afterwards became swollen, inflamed, and hard to the touch
& in a short time an orange coloured spot, appeared, upon
the outside near the centre, which soon became livid,
and the gangrene spreading rapidly, the child died, in 
eight days from my first visit. She became delirious previously 
to the cheek becoming livid & afterwards, was comatose.
In this case the disease seemed to affect the brain 
as it does in some cases
Bark, opium and camphor were truly given & antiseptic





108
poultice applied to the face as bark [illegible] [fermenting] [poultice]
Prof. Smith saw this patient
soon after my first visit & agreed with me in the opinion 
that the case would terminate fatally. He informed
me that he had seen but one case of the kind before & 
that he had attributed that case to an injudicious
use of calomel After seeing this patient however, he considered 
his former opinion as incorrect since in this case
there were no marks of the effects of calomel & there was no 
probability that the single dose of calomel, given in the
commencement of the illness, could have produced such 
an effect, especially when repeated doses of other
cathartics, had subsequently been given & 
had operated freely 
4th Case. The next case which I met with was that
of a female 12 or 13 years of age, who had the dysentery,
in the summer of 1815, accompanied with much typhoid
fever & rather a larger discharge of blood by stool than 
is common in dysentery.
The child had been sick for some days
before a physician was called. I did not succeed in 
my attempts to determine the diseased action from the
bowels to the surface by diaphoretics & the warm bath, & 
the disease ran its course and nearly exhausted the patient
When it began to decline, the stools to present a fecal appearance
& the appetite to return, the friends were 


There had been some aphthae and I was on a 
careful watch


109
much encouraged I, however, began to expect a fatal
result for I observed, between the anterior incisors of the
lower jaw, a fungous enlargement of the gum, the apex of merely a slight discoloration [illegible] & swollen between two teeth 
which had a purplish appearance somewhat as appears in salivation sometimes. I apprehended gangrene
in the case (perhaps from the countenance) and on the first
symptoms of it informed the parents, who however, could see 
nothing alarming in the small swelling between two of
the front teeth. I began early with oak & peruvian 
bark, and at the same time gave freely of brandy and
porter. As this course had no effect I applied 
bark and diluted sulphuric acid to the part affected
& also covered with the lunar caustic. Still the treatment
had no good effect the gangrene extended under lip and chin became
black and the child died
Case 5th A child about 3 yrs of age cousin of the previous one [illegible] had a dysentery,
in the summer of 1815 [illegible] as there was another
member of the family sick in oil uncommon & interesting
manner viz the case of chorea resembling hydrophobia was much neglected Her fever was typhoid
& the stools sometimes bloody and sometimes of a 
green mucus. After a course of 15 days and amendment
in the symptoms took place the stools
became less bloody, the green stools more rare & though
the patient was extremely weak but no reduced low as the previous one, the appetite returne
After convalescing gradually for six or eight days, there
came on a samous discharge from the nose, small in quantity
but very fetid which reminded me of gangrene


# In this case I examined the gums to see if there
was any appearance of salivation and found the gums etc.
Two teeth and a piece of the alveolar process came out
The disease did not spread so rapidly as the other ones
In addition to bark, tonic solution etc.
I gave charcoal


110
of the mouth which I had not been on the look out for AT this period the patient inclined to 
keep her fingers I her mouth. # The gums were very clear
and bright & adhered firmly to the teeth, except on the 
left side of the upper jaw, where the gums of the biscupides
appeared discolored and discharged a samous
matter. I declared the parents that in my opinion 
the case would terminate fatally. The child complained
of pain in the face and teeth. The cheek opposite the teeth 
became swelled and hard and of an orange colour. I declared to the friends
that mortification had taken place 7 pointed to a black
spot on that cheek which happened however to be accidental. I was mistaken for the next day
it was found that the black spot was produced by a piece
of burnt apple skin, which was washed off This encouraged
the friends; yet within 24 hours sphacelus took place 
the apple skin was
in the very spot where I had supposed that I had seen
it. This gangrene ceased to spread after 
the spot became as large as the end of the little finger
 A circular piece sloughed out and left a hole in through
the cheek of about a quarter of an inch diameter
The disease abated, the affected teeth and a piece of the alveolar
process came away the lips of the wound produced by the sphacelus
healed up & the child recovered
I recommended the same treatment in this case as in 
the preceding, but having no confidence in it, & abandoned
it and gave charcoal to the amount of perhaps a pound
or a pound & a half a day I h ad pudding made of 
half charcoal & half flour, sweetened with molasses & sugar
& fed to the child for the appetite was good. Tonic solution 



When the disease commences of itself
# At the time when the disease called the scalled
tongue was very prevalent affecting cattle principally with 
swelling of the tongue & salivation but to some extent human 
beings with swelling of tongue cheeks etc. It was found that
acrids as [arum] were the best remedies
pulse 120 tongue then [brown] fur, considerable pain



111
and compd tinct. vitr. were also given & I commenced
the treatment with white oak & peruvian barks & yeast
poultice. I attribute the cure, however, to charcoal.
Case 6th This was an idiopathic affection. Martha Denison
a delicate constitution about 12 yrs of age was attacked in 1819 with symptoms of gangrene
of the mouth. There was severe pain in the teeth and jaws
oppression at the stomach and symptoms of fever. I discovered
the purplish spot in the cheek & “the gums soon put
on a spongy appearance” In this case I commenced
the treatment with an emetic, which operated favorably 
I gave it to [illegible] the excitability of the system
& gave relief. I then gave stimulants, bark, brandy & 
opium & kept in the mouth between the gums and cheek a paste made of powdered
bark wet with brandy and laudanum. The patient
recovered, but the two front teeth of the lower jaw became
very loose and there was occasional pain & 
suppuration for nearly a year. It was about a year before
the teeth became firm. [Superfine] bark was occasionally 
used.
Case 7th In 1820 I visited a black child in the last
stages of this complaint. At the time when I saw it, it
could not swallow. It lived however in this situation for several days
I have seen several children in the latter stages 
Even if there is no chance for a cure it si desirable to be able
to give a correct prognosis Trouble has sometimes arisen
from the opinion that such cases were produced by calomel
A student of this school in [Litch.] cty from notes of 
my lectures



It is known by an [illegible] swelling in the throat
some fever etc. etc. 
In some seasons it prevails extensively & 
affects persons of all ages. In some seasons these diseases
which are called contagious affects one description 
of persons in another another owing to mode
of life etc. “It rarely affects a person the second time. It is said
that if it affects the parotid of one side only it may occur again”
I have treated cases of this disease with 
great anxiety. I have never known cases of greater 
irritation than from this disease
“It is milder in children than in adults & is
seldom translated to the mammae or testicles till after puberty”
“Sometimes the swelling of the testicle is simultaneous
with that of the parotid gland or [previous] I have seen
several such cases”
“The first symptom observed is sometimes
a soreness of the testicles. They at length become 4 or 6 times
their natural size a suspensory bandage will be 
necessary”
“In some cases there arises suddenly, [illegible]
pain in the head pulse full and tense eyes red & all 
symptoms of phrenitis”


112
Cynanche parotidea Mumps
This disease is an inflammation of the parotid glands & is generally 
moderate in its symptoms Sometimes however it is translated
to other parts & is then a severe disease endangering life. It is milder
in youth than in adults & in general it is only after the age of puberty 
that it is translated. The parts to which it is translated 
occasionally, are the testicles & the prostate gland in males
the mammae of females more rarely & sometimes the brain or stomach
I have never myself seen a case in which the inflammation was
transferred to the mammae but do not doubt the fact
Sometimes it appears first in the testicle or at least simultaneously in that
& the gland This disease has been considered contagious
In my opinion it is not, but on the contrary is liable to be
epidemic. When its prevailed in college, the students who 
left in order to avoid the contagion were attacked as early 
and is certainly as those who remained. I have noticed 
that it made its appearance pretty regularly once 
in seven or fourteen years
The fever which accompanies the severer
forms is either of the inflammatory or the typhus grade or may be merely irritative & 
should be treated accordingly When the testicles are affected
they are painful swollen sometimes to an excessive degree & 
sometimes so highly inflamed as to indicate venesection 
When the stomach is affected “it puts on crythomatic inflammation”
and there is hiccough, subsultus tendinum, irritability
of stomach and frequent vomiting. # When the brain is affected
there is pain of the head & eyes, with hard and tense pulse
When the parotid glands only are affected the
# These symptoms may come on after the affect of test. [illegible] continued, some
[illegible] begin to subside.


Dr Rush observes that applying a blister
directly on the infl. prevents the system from being
affected. I do think blisters keep the aff.
in one part “In some seasons an emetic at the commencement
or a blister will prevent a translation”
Having [learned] the importance of attempting 
the breaking up of diseases I cast about
one year for means to interrupt it & found emetics
quite efficacious
Stramonium
After the testicles have been affected some time 
and the affection begins to subside the symptoms sometimes change 
There is subsultus tendinum the stomach become affected 
vomiting is frequent with hiccough etc. In this case apply 
mustard to the stomach & feet etc.


113
a generally mild and more inconvenient than painful
A translation makes it worse; more so when the translation is
to the stomach than to the testicles & most of all when to the
brain. Sometimes the complaint is very severe, the fever lasts
three or four weeks and the patients are many years in recovering
from the disease
Treatment. The disease is often broken up by an emetic
in the commencement It is best to stop it in the first stages
if possible. Mild applications to the inflamed parotids
we generally sufficient, such as ammonia or volatile
liniment. Dr Rush however recommends blisters to the parts
affected, in order to prevent a translation.
When the disease effects the testicles & give emetics
and apply discutients to the local affection. I also 
apply blisters to the inside of the thighs. They relieve the 
testicles when they are swollen & prevent translation to the 
stomach For a discutient was we may take the following
Rx mur. amm. ziii; camph zi; brandy or vinegar 1 gill;
water 3 gills. When the inflammatory action is high, bleeding
may be practised. It will be well also to use a suspensory 
bandage.
If the stomach is affected in the manner above
described
we have a difficult case to manage. Epispastics must be
applied to the scrotum, counterirritants to the epigastrium
to ally vomiting, with effervescing mixtures internally for the 


Ether is best given in effervescing mixture (carb amm. & 
lemon juice) Carbon ac. makes stimulants more diffusible
& hence causes them to be [used] gratefully and often to be well borne when 
otherwise the would not be
Case 18 grs plethoric parot. gland & testicles swollen
head affected Relieved by bleeding decidedly entonic
the only entonic case which occurred In the 
progress of his case stom. became very irritable abdomen
sore & tender excessive irritability Did not 
recover his health completely for years was left dyspeptic
& with nervous irritability.
To correct irritability of stom. lem. juice
[illegible] is most grateful add [doses] of aromatics
lime water also external blistering etc.
Tonics or metallic tonics myrrh 
asafoetida (nervine also) hops lettuce
These cases are so obstinate and will 
give you an opportunity to try a great variety of
remedies cajeput oil on sugar ol. valerian
Though the cases may be apparently alike
yet you may find one article best for one & another for [another]
A very distressing hiccup, accompanied
with spasms might have been mentioned in connection 
with the vomiting give ether lavender cajeput
oil also & valerian which are called terebinthinates 


114
same purpose diffusible stimuli as ether given
to rouse the system opium ipecac, as tonic stimulant, diaphoretic
& nervine 7 finally to allay irritation of the system 
in general antispasmodics as castor & counterirritants to the
extremities effervescing mixtures absorbents, also, as chalk & magnesia, cathartics
cantheride & occasionally emetics may be indicated.
When the brain becomes affected, the lancet
should be freely used, cupping, leeches & blisters, applied
to the head of the neutral salt given as cathartics
Antimonials nit. [illegible] cal. & neutral salts # 
Some cases will require a vigorous antiphlogistic 
course of treatment, others with typhoid fever
will require in the [illegible] a stimulating & supporting one, while others
again will have symptoms of irritation chiefly & require 
a corresponding treatment
In the progress of the disease uniform
perspiration will be valuable
Angostura serpentaria, qualified
with cardamom or cubebs The old writers
recommend also [contrayerva] I have much used it
atonics of a peculiar character resembles much 
agrimonia eupatoria which I have used for it
in the country where it is easily obtained the latter is non 
astringent
# “Cold to the head and warmth to the feet avoid mental
irritation recovery is usually speedy adults most
liable to this translation”



I consider [quinsy] an affection of the mucus membranes
and [tonsils] nearly allied to catarrhal aff. There
is a catarrh aff. nearly allied in which there is a
thickening of the membrane. This diathesis may also 
run into croup
Good classes angina maligna with 
quinsy Here is the evil of nosology For scarlet
fever gradually runs into quinsy. We must have
science and nosology but still we ought to 
know the errors which nosology is apt to lend [illegible] & 
the imperfection of science
I have the advantage of not [illegible]
having seen the disease but of having had it myself
often
[illegible] with an unpleasant sensation
a relaxation a disposition to hawk and throw off
[illegible] In this stage it may certainly be cured
After the symptoms comes on swelling, or moderately 
succeeding to this a chill then swelling with 
pain perhaps extending to the [illegible] The tonsils enlarge
The fever is considered enteric or a common but
unless among the labouring men in the country it is 
more usually subacute
One tonsil is perhaps more enlarged
than the other perhaps one goes on to suppurate & 
the other becomes of the natural size and appearance 
The uvula and fauces swell and respiration and deglutition 
are prevented. Sometimes ulcers from at first
upon the tonsils. Examine each case and do not be
too positive in calling it quinsy for this & scarlet
fever do blend
These symptoms continue 2 to 36 or 48 hours
I do not know that I have ever seen a fatal case of 


115
Cynanche Tonsillaris Quinsy
This diseases has been called
“I include also under the term quinsy all effections of the upper
part of the aesophagus and pharynx which resemble quinsy in 
their grade of action”
Quinsy is an inflammation seated in the larynx glottis & fauces
The characteristic symptoms is swelling of the tonsils
Sometimes it is seated lower down in the pharynx than the tonsils, but this 
does not alter the nature of the disease
In some cases it is complicated with catarrh. Those who have once had this disease are very liable to a return of it
“The disease common at the age of puberty that before or after”
Quinsy may be divided into two stages
1st Predisposing debility indicated by relaxation of the uvula
and tonsil, irritation about the fauces, weak deglutition,
general languor, with cold chills and uncommon sensibility
to cold. This usually continues from 3 or 4 to 12 hours
the progress of the disease being sometime rapid and sometimes
slow
2nd As the disease advances we find, soreness, pain, redness
and swelling of one or both of the tonsils & an inflammation 
of the mucous membrane of the pharynx; deglutition
in exceedingly difficult; there is a severe cough & especially 
a spasmodic one upon taking food or drink, there is
much heat about the throat and about the head & sometimes
pain in the head, with a pulse so full and tense as to 
indicate bleeding. Sometimes there is an excruciating
pain in the ear. “rarely cough unless complicated with catarrh”
This stage may continue three or four
3 to 7 days days. It terminates either in resolution, or suppuration.


of quinsy though I have seen many that I thought 
would prove fatal. I have known a patient
continue unable to swallow for 3 days and yet recover
When however it is in the form of swelled tongue it may 
prove fatal. “An entonic fever may attend, with fullness
of pulse much headache excruciating pain extending to the 
ear; but for more commonly at least in my practice, the pulse
is little affected, and the disease is almost not entirely local”
# riding on horseback and having the snow melt on 
his throat & [conduct] off the [caloric] rapidly
# and shd carry a piece of alum in the pocket
“It is important to distinguish this disease from 
roseola (scarlet fever) There is an erythema of the fauces
distinct from both which yet may terminate in either
[illegible] The diagnosis is generally easy but there are cases
where it is extremely difficult & indeed there is no definite
line believed the two especially in the first stages
We must bear in mind that quinsy is commonly 
more inflammatory that it is not apt to ulcerate
& we must be guided somewhat by the prescribing epidemic


116
The suppuration is generally in the tonsils, but in some cases
where the disease is seated lower down, a part of the aesophagus
suppurates. “The tonsils often remain permanently enlarged”
Causes. Quinsy occurs must often in the latter part of autumn
& in winter. It is caused like catarrh by alternations of heat
and cold by exposure to cold & especially by exposure
to cold storms of rain or snow. # Sometimes it is connected
with dyspepsia & it may be brought on by irritating 
substances, as acids, acting upon the mucous membrane
of the stomach. I recollect a case of a young man who 
was attacked with a severe quinsy in consequence of drinking
freely of cider made cold with ice
Persons who are subject to quinsy should be very cautious 
about exposing themselves to the alternative of heat and cold # 
Diagnosis. This disease has sometimes been mistaken for 
scarlet fever. It is not difficult however to discriminate
between them by attending to their prominent symptoms the
quinsy being as inflammation of the mucous membrane etc.
The first stages however of scarlet fever, resemble those of
quinsy, and the difficulty of discriminating between them 
is at that period much greater. In deciding upon any 
particular case we must be governed by somewhat by the nature
of the prevailing epidemics


Chewing camphor will also but not so well break up quinsy
in the forming stage but chewing this article
is apt to produce pleasant symptoms in the stomach 
and head Other stimulating applications 
would probably answer as [guaiacum] & any 
alcoholic tincture “The prophylactic plan of carrying
alum in the pocket etc. has succeeded in hundreds of cases. Indeed
when called in the latter stages I often tall them I can do 
little except to prevent it in future”
When the dis is fully formed and when 
there is much pain in 
the neck running up into the [illegible] fomentations
and the vapour of warm water, the steam bath 
by throwing over the patients head a blanket and
having a teapot of warm water
A blister also in the above circumstances
will relieve the pain and give great relief 
An emetic also will be often very 
beneficial in the commencement of the second stage
There is often an excessive quantity of acid in the stomach 
Case A young man in very hot weather [illegible]
a large quantity of cider made very cold with ice was taken at night
with great pain and difficulty of swallowing
The patient was very anxious to be cured that night
A large quantity of tartar emetic was given in excessive
doses until a severe orgasm was produced then seeing
to [illegible] stricture of the upper orifice of the stomach the 
[illegible] & secreted from every pore from the violence of
the action of the system finally he [illegible] away, and
continue in syncope for 10 or 15 mins came out of his 
fainting fit, the tart. ant. acted as a cath. and the patient
was entirely relieved of the difficulty of swallowing [illegible]
was merely feeble and exhausted from the prostration of the [tart]




117
Treatment In the first or forming stage. Quinsy may 
be easily broken up by keeping a small piece of alum say 
of the size of half a pea in the mouth, and swallowing the 
saliva until the symptoms have left. Various other astringents
may be useful in the first stage. I have given the astringent
barks and bitter roots, catechu etc. & have also combined
with them the mineral acids chlorine etc. “But all these things will be injurious in the 2nd stage”
When the disease if farther advanced a more
energetic treatment is necessary. If the tonsils are largely swelled astringents will merely aggravate. IN this stage it may often
be broken up by a strong impression made by nausea
and vomiting. A strong emetic 3 grs tartar emetic with 8 grs of ipecac # may be given & when the 
disease arises from a chronic affection of the mucous membrane
& acidity of the stomach, an emetic will remove it. In one
case I gave half a grain of tartar emetic once in 15 min. 
until the system was affected, I succeeded in conquering
the disease. The patient was in extreme pain & exhausted 
he fainted previous to fainting he was unable
to swallow after coming to, he could swallow & the
disease was removed. “But if the case has advanced a 
little farther, emetic will do no good”s
Gargles will in general do harm 
rather than good, where there is much inflammation.
If the irritability is extreme mucilages may be given, and 
when there is great difficulty in swallowing a cloth wet with 
spirit and water ay be applied over the mouth and 
nostrils. Cold water applied externally & internally has
been recommended but is dangerous. It may be used however
as a preventive.
# Eupatorium etc.


I have known some phys. generally successful [illegible] breaking
up quinsy with cold water but as I predicted
there was danger of the translation to the brain he lost
one patient in this way “It may be used as a preventive”
When the trails are much enlarged it is
customary to bleed I would bleed it there was
much fullness and strength of the pulse I have often bled
and seen it done without the beast benefit still however 
without any injury as I could perceive “V. S. is important
when there is danger of affection of the brain”
Scarifying is generally practised. It is
sometimes beneficial but often it increases the disease
as is the case when a boil is scarifyed I do no t
know that I can point out the circumstances
which it is beneficial but if there is much irritation 
I think I would not scarify I have often
had my own throat scarifyed without benefit
Perhaps it is as often as once in 20 cases
that the disease proceeds to suppuration. But if 
you puncture the swelling be careful 
to see where you introduce your lancet Case of [young]
an opening was made which subsequently caused a troublesome sore the
swelling burst of itself
In various cases astringents was useful 
Lister’s [scoriae] (devils bit button snake root) it acts 
a little like seneka stimulating the fauces it operates considerably 
in a decoction It has been much used not of
much consequence
I have not much confidence in gargles
The patient cannot gargle
But you will give great relief
by washing out the mouth with warm water or with 
mucilages or with a little old spirits and water which 
is very grateful to the patient Wash off the [illegible]
which [illegible] Great advantage is derived from 
injecting with considerable force with a syringe & washing on 
the parts Spirits & water will be grateful & reviving


118
When there is redness and swelling but not extreme
irritability, scarification is beneficial. If there is irritating
soreness or inflammation scarifying will aggravate it
After the inflammatory stage is past, blisters
may be used I have not been successful in scarifying
Bleeding may be necessary, if so it will 
be indicated by pain in the head and a full & tense
pulse.
When suppuration is about to take place
poultice may be applied externally & vapor inhaled The 
latter remedy may be administered, very well in 
the following manner. Put a vessel of hot water in the
bed, by the side of the patient & cover him with a sheet. # 
Touching the tonsils with nitrate of silver, is 
highly useful
If the ear is affected, wet a piece of cotton 
with strong ammonia and apply it to the dear. it produces
a pungent sensation and often gives relief
The [liatris] scariosa is used in quinsy
in the form of a decoction of the root. It is expectorant, diaphoretic
& diuretic. It is called “devils bit”
“After the inflammatory stage is established
apply blisters”
“If the irritability is extreme apply mucilages”
“[illegible] & diaphoretics have been used 
in the early stages and are undoubtedly serviceable”
# If you cannot well distinguish where suppuration has
taken place, you had better not attempt to open the tonsils 


When the swelling is great poultices are very beneficial
Dove’s [Dury] poultice Devils dung asafoetica
Album graicum blown through a quill!! much used
by my predecessors in this place
Cathartics are proper early in the disease
neutral salts if the fever if phlogistic
Diet & regimen
Give while the patient can drink, nitrous
ether & water or a acidulated drink etc. Feed
with arrow root etc. for the diet
When the inability to swallow has 
continued sometimes the action is not enteric & the
patient shd not be bled nor exhausted by cath.
The disease is at this time principally local & 
from want of food etc. the pulse becomes feeble spirit
and water injected into the throat will bring grateful and 
reviving [illegible] exhausted patient “Apply poultices keep the bowels
open with enemata” “Inhale vapour of ether”
Various gargles are recommended
such as chlorine muriatic acid & water etc.
but when there is much action they are apt to irritate
Camphorated gargle vapour of camphor
etc. There are a variety of these things which are
mere palliatives
The difficulty of swallowing is not caused 
so much by the swelling as by the soreness and pain 
for I have seen patients declare themselves much relieved
and able to swallow when upon looking into the throat
I could perceive no change in its appearance



119
“Scarification is recommended but I could never succeed
with it. If the disease were pure inf. scarif. would be of service 
but it is an irritation infl. & scarific. increases the pain & 
infl.” In [illegible] case a free scarific. made the case worse in 
every respect” There is a stage when scarifying is beneficial
when there is redness & swelling but not extreme irritability”
“Leeches have been applied in the inflammatory
stage externally and to the tonsils. It is difficult to make
them take hold on the mucous membrane, but they would
be more effectual there”
“Suppuration does not take place in one 
tenth part of the cases. There is free secretion but no solution 
of continuity upon extermination” “When suppuration
is likely to take place use poultices and inhalations of vapour 
poultices of bread and milk with stramonium are serviceable
Gargle or syringe the mouth with spirits & water or
camphor”
“When the disease is seated farther down 
in the larynx it is essentially the same”
“White dry pigeon’s dung in a poultice with 
bread and milk was used by Dr [Monson] He thought the
phosphate of lime of service” I prescribed it in one
case and they mistook for it devils dung (asafoetida) 
& it did wonders. I did not tell them of their mistake”



[illegible] state of fever is a better
classification than Good’s. Good separates the disease
under different classes making one part are [illegible]
disease another an aff. of the blood vessels
“Scarlatina & angina are sometimes considered 
as separate diseases, but they seem to be only different forms
of the same disease”


120
Scarlet Fever
This disease has been called by various names, among
medical writers, though the popular English appellation
has been scarlet fever with little or no change. Canker
rash however has been its common popular appellation in 
New England, until of late. Under the name scarlet fever 
I include both scarlatina mitis & S. maligna & likewise the
paristhmitis maligna or ulcerated sore throat called also malignant
sore throat & malignant quins. Other names that
have been given are Scarlatina mitis & maligna 
cynanche maligna paristhmitis maligna 
scarlatina anginosa 
Enanthesis rosalia is defined by Good
Rush a scarlet flush appearing about the second day 
on the face neck or fauces; spreading progressively over
the body; and terminating about the seventh day; fever
a typhus. This author divides rosalia into two varieties
simples or mild scarlet fever which he considers as
being slightly contagious & paristhmitica with an ulcerated
throat & a rash not so regular
as that of the other variety. This he calls highly contagious
Under the name scarlet fever I included
both the common mild scarlet fever with a rash & nothing more and the most malignant forms
of ulcerated sore throat with the intermediate varieties
considering them all as being but different degrees of the same
disease
This disease with its varieties a naturally associated 
with pneumonia quinsy influenza etc.



Quinsy is an exception persons who have had
it are more liable to another attack
So too in tropical climates even have what
is called a seasoning
As a matter of fact this disease is theoretically 
considered contagious practically not so no precautions being
taken the patient not being separated nor the friends and
neighbors refraining from coming “The notion of contagion
may sometimes be useful in keeping away idle visitors
case in Guilford”


121
Scarlet fever often appears as a sporadic and
sometimes as an epidemic disease. In general it affects children
and women more than men. Dr. Rush’s opinion Some say that the disease never 
persons over 40 years of age. When epidemic however it attacks 
persons of all ages, though even then the majority of cases
are among children and persons of delicate constitution.
In general persons who have once had the 
scarlet fever are not attacked with it again, still this
rule is liable to many exceptions for I have known repeated 
instances of a second appearance of the disease in the
same person. This partial security from a second attack
is met with in various epidemics & we may say in general 
that a person who has had any one of several different
diseases the same general diathesis is less liable to have another
Scarlet fever is said to be contagious especially 
in its severer forms The fact is disputed but this is 
the general opinion. Some fevers are perhaps contagion & among
them some forms of this may be so. It certainly, however
appears to follow the laws of epidemics and I am inclined
to think that the facts which have led to the opinion 
that it is contagion are better explained by reference
to those laws. It is said sometimes to go through the country 
like the influenza.
Like other epidemics, those of scarlet
fever exhibit appearances
in different seasons, being sometimes milk and
harmless & at others highly malignant & dangerous
It has occasionally been as 



# And because blisters applied produced
mortification
It swept off whole families
The fever considered a typhus It is not always
so It is sometimes [sub-entonic] always however
of a typhous grade



122
as the plague. About a century ago this disease prevailed
in this state in its most malignant form, sweeping off whole
families. It was called the black canker because the sloughs
in the throat turned black & this name, though the influence
of tradition, inspires terror in this town even to the present day
Since that period the disease has probably been growing 
milder up to the present time. In 1794 however it
was very severe in this town in Litchfield county & over the state more malignant than it has
been since. Subsequently to that period adult males have
been less affected. The last severe epidemic in this town was in 1803.
Though sometimes attended with inflammatory 
symptom. Scarlet fever as a general rule, is of the typhoid
or typhus grade & when malignant puts on the form of typhus 
gravior or gangrenous state of fever
Symptoms. This disorder, when not malignant, nor
irregular, commences with ordinary febrile symptoms general
disturbance of the functions of the system, chills alternated
with flashes of heat & pulse in most cases frequent and soft
In severe attacks there is much nausea, sometimes
vomiting, pain in the head back and limbs & great prostration 
The tongue
of strength. In 1803 the disease frequently commenced
with pain in the teeth or in the ear is the first symptoms
In the progress of the disease there is more
or less tendency in proportion to the violence of the
disorder. In severe cases there is often great heat and dryness
of the skin & perhaps the color mordax. In such cases also 
we frequently with an acrid discharge from the eyes & 


“When delirium is present it arises rather from inanition 
than repletion IT is accompanied with subsultus”
Swelling of the tonsils is rather a favorable
symptom Swelling and suppuration of the
glands in the neck
haemorrhage for the [illegible] & petechiae
may occur


123
nose which excoriates the skin wherever it touches.
Irritability of the stomach & vomiting are common & sometimes there
is a troublesome diarrhoea. Petechiae may make their appearance.
Case at [Hotchk??] town Haemorrhages sometimes take place; & in case of 
heat on the surface and what Armstrong calls congestive state
of the system, a slight haemorrhage from the nose will be
beneficial. Finally in the ordinary malignant forms of the disease 
the breath is very fetid.
The epidemic of 1803 was characterised by 
great irritability of the stomach vomiting & diarrhoea pulse
very low and feeble. In this epidemic after obviating the
inverted action (of the stomach) stimulants were indicated.
The throat is more or less affected from a 
slight redness to a deep slough. Sometimes there is a high degree 
of inflammation of the uvula & tonsils at others a relaxation 
indicating astringents both conditions accompanied
with a high degree of tumefaction.
A common appearance, in the commencement of the severe form
of the disease is that of a white coat upon a part of the tonsils
In the progress of scarlet fever, the affection of the throat 
may be more or less troublesome. It often terminates in ulceration
& sometimes in gangrene
In three or four days from the first appearance
of febrile symptoms or rather on the second day of 
the fever the eruption appears in the form of a fine rash
as described in the definition. In about as many days from 
its appearance about the seventh day of the disease it disappears 


Peculiar dulness of the eyes hollow sound
of the voice patient appearing much like a night walker
The first case of the kind which I saw I had no doubt 
about The friends had doubted whether he was sick enough
to send for a phys. I declared at once that he probably 
would die. This was a case of pneumonia notha
Most resembles measles Ordinarily distinguished 
readily sometimes with difficulty
If scarlet fever is accompanied with 
a running of the discharges from nose with catarrhal symptoms, and is somewhat 
distinct in its eruption (hard under the touch under
the skin) and such cases occur it cannot be distinguished 
from measles except by the general character of the epidemic
I used to notice in the first commencement of my practice
that on the first breaking out of the epidemic the older phys. used to 
wait and observe several cases before they decided upon the name 


124
with branny scales & in ordinary cases the patient is then
out of danger. The eruptions, however may vary much & even
be altogether wanting the local morbid action being determined 
wholly to the throat. Ataxic cases will have no eruption.
The worst cases of scarlet fever are those
which transcend ordinary febrile action. In these the patient 
is scarcely sensible of being ill, appears dull and languid, his
countenance indicates torpor of mind, he has little irritability of 
mind and is indifferent to surrounding object, his extremities
are cold & his pulse small frequent and feeble & 
perhaps intermitting. Upon examining the throat ash coloured
sloughs are found upon the tonsils and uvula. In these
cases life is extinguished without any reaction 
of the system in the course of 24 or 48 hours, unless the tendency 
to death is obviated by the most powerful treatment.
These ataxic cases resemble the ataxic cases of yellow fever
pneumonia typhodes etc. which have sometimes been called 
walking cases
The scarlet fever is liable to be confounded with 
measles, the disease which it most resembles. The marks of 
discrimination are these. In measles the eruption is less diffused
is in pimples or circular dots more pointed & partly distinct & partly in clusters & the pimples produce a palpable
roughness of the skin. In scarlet fever the eruption is diffused
like erysipelas & consists of innumerable points or specks under 
the cuticle, intermixed with minute pupulae In some
cases the eruption is in irregular patches & in others are uniform flush 


“Symptoms of pneumonia rarely attend scarlatina”
This is one of a series of epidemics. It is usually followed
or succeeded by measles & is followed by hooping cough
For only it probably existed only as an epidemic now
we meet with sporadic cases continually 


125
while no roughness is felt, except in a slight degree upon 
the arm. The two diseases differ also in the time at which 
the eruption appears. In scarlet fever it shows itself
upon the face and arms on the second day, but in measles
it is not seen upon the arms till the fourth day.
The scarlet fever is distinguished also by the absence of the
catarrh, cough & determination to the lungs, suffusion
of the eyes & the red and swollen state of the eyelids, which generally 
attend upon the measles. The latter disease also
is generally accompanied by an inflammatory fever instead
of the typhus which characterises the former.
Still these two diseases of ten blend together
so as to make the discrimination very difficult. It is barely 
 possible that they are the same disease, though it may 
be objected to this view, that scarlet fever likewise is occasionally 
seen to blend with influenza # 
Epidemics of influenza are followed by [measles & scarlet]
The prognosis in this disease will be obvious
upon attending to the malignancy or the severity of the 
symptoms. In its severer forms it is always a dangerous
disease & in its highest malignancy one of the most fatal
while in its milder forms there is but little danger.
# It is sometimes difficult to determine whether a particular 
case should be considered as one of scarlet fever, or of quinsy
A case of scarlet fever in which there is no eruption & the
tonsils are inflamed &swollen can be distinguished from one
of quinsy only by attending to the state of the pulse, the prevailing epidemic etc.


I have known it appear as an epidemic
when it required nothing more than nursing
One idea which I wish to impress particularly 
upon your mind, is that you must investigate the particular
epidemic which you have to treat for no previous one
will probably have been similar


126
The treatment of this disease must vary according
to the diathesis. Epidemics of scarlet fever will differ
widely in different seasons & different places & require very different treatment
In a country where intermittent prevail the treatment will 
be different
This has been some dispute about using the
lancet in this disease. This will depend the degree of inflammatory 
diathesis. As a general rule emetics are indicated, 
but not always. Cathartics are generally improper 
but sometimes are required. In short indiscriminate treatment
is as improper in this diseases as in any other.
In this milder forms of scarlet fever, we
may employ the usual treatment for typhoid fever, & administer 
those remedies which translate & keep up action 
and equalise excitement, as diaphoretics, the warm
bath etc. For the mildest form it will be sufficient to 
give mild diaphoretics such as wine whey & elder flower
tea, with perhaps a little antimony, acidulated drinks
& gentle laxatives
As the fever is generally of a typhoid or
typhus grade, emetics are of especial importance in its 
treatment. They affect particularly the mucous membranes
and may be repeated in the course of the disease, for the
purpose of throwing off the accumulated mucus. The violence
of the disease may often be completely broken by an emetic 


“In some epidemics when there is considerable action cath. of cal. are
important especially in intermittent districts Rx cal. & 
jal. as for remittent bilious fever”
“When there is tremor paleness, cold sweats, vomiting
diarrhoea, cathartics might destroy the patient We must
rouse the patient by counterirritants etc. and then we may go on 
with the treatment by emetics of ipecac etc.
“Dr Rush bled but f.s. is very rarely indicated 
and in such cases as approach to A.  tonsillaris” “Still it
[illegible] all forms entonic atonic etc.
“If malignant give bark & the min. 
acids. If the system does not respond give cantharides 
& capsicum oil of cinnamon cloves or cajeput”



127
at the commencement. All writers agree in recommending
them. [Witherin] advises ipecac grs vi & tart. ant. gri for
an adult followed by a strong decoction of senna
Dr Rush recommends the turpenth mineral 2 to 6 grs with the view
of strangling the disease in its birth. Sulphate of zinc is a
good emetic & is preferable in the latter stage. It is local
in its action & tonic in its effect. It operates speedily and
produces less exhaustion. Vomiting by snake root has
been practised
In the irregular forms of scarlet fever, this
practice is more questionable & if emetics are given they must
be preceded by stimulants to rouse the powers of the system
Cathartics are sometimes needed & calomel
is to be preferred The judgment of the physician however 
must be exercised & the character of the epidemic studied, 
for great caution must be exercised that the system be not weakened 
by them & in extreme debility they should be preceded
by stimulants. In some epidemics they will destroy the pat.”
In some epidemics bleeding may be 
proper, but the apparent indications for it will generally 
be better answered by leeches about the throats and [temples]
In malignant cases where the powers of life
are very feeble no evacuations are to be used. External 
irritants are to be applied to rouse the system such as ginger
mustard brandy a paste of mustard spts. turpentine & 
aqua ammoniae etc. Internal stimulants must be given 


Ammonia with bark opium etc.”
“Tinct. canth 20 drops once in 2 hours till
there is some effect.”
“Serpentaria with ammonia acts as a tonic
and diaphoretic”
Where there is a prejudice against cold affusion
with water alone spirits or [illegible] or camphor
may be added


128
[illegible] to 4 [illegible] 3 or 4
such as capsicum Capsicum especially when the stomach is debilitated 4 to 5 grs [illegible] Cantharides in 20 drop doses. Ammonia
camphor quinine, mineral acids etc. Carb. amm. & cantharides 
may be given to excite the system & be followed by 
bark and brandy to keep up the excitement.
Diffusible stimulants also may be required, such as chloric
or sulphuric ether 20 gtts to a teaspoonful of water
for a child. In small children if there is difficulty in getting down
medicines the bark may be given by injection, or the body covered 
with it, by means of a bark jacket.
In severe cases, not of the most malignant
form, the heat and dryness of the skin are often very 
great & calor mordax may exist. Cold applications to the 
skin, especially those of stimulating kind will then be beneficial. The cold bath
cold affusion, or sponging with vinegar & water or spirits
& water may be used according to circumstances. The cold 
bath or affusion of cold water may be superseded in case of 
prejudices on the part of the [illegible] or objections from other
causes, may be superseded by sponging the body with vinegar
& water If the case is attended with extreme debility 
and relaxation of the system or if
any chills are present sponging must be used
& [illegible] with caution. If the cold applications produce a chill or
if the eruption comes out irregularly. I should advise 
the tepid bath to determine to the surface. In the advanced
stages of the disease when debility & relaxation are
great the vinegar & water should be made tepid & spirits
may be added. The rules with respect to these applications 
are the same as in typhus. In the atonic form of 


“In children with disturbance of the stomach
and pain in the bowels at the same time the eruption not
coming out well use the tepid bath It obviates the tendency
to convulsions and makes the disease regular In the most
malignant forms it is inadmissible”
“If there is irritability of the stomach give chloride [illegible]
4 grs 2-3 hours absorbents counterirritants”
“In the latter stage of protracted cases emetics of 
sulphur zinc or copper are very useful”
“Withering advises in the typhoid state, after evacuating
the stomach & bowels to give senega freely This 
would be injurious in a malignant case”


129
scarlet fever, the cold bath or cold affusion must not be used
IN 1803 I used sponging with vinegar and gave internal
stimulants at the same time as min. ac. alc. brandy
For children the tepid bath is invaluable in scarlitina 
particularly in the early stages of the disease and 
when the eruption is not fully out, or where the eruption is 
irregular. It is questionable however, how it would succeed
in the most malignant form of the disease
If there is great irritability of the stomach
with vomiting, absorbents and counterirritants are to be used
& in malignant cases capsicum, tinct. canth. & care to be given
In cases of vomiting saffron & snakeroot
If there is much diarrhoea we may 
give # white decoction with opium, injections of laudanum
etc. astringents etc.
In ordinary cases, when the eruption has been 
regular & ends with branny scales, about the seventh day
the case is out of danger But when the disease is protracted
sulphate of zinc or Moseleys tonic solution is
to be given as a tonic. The latter article in a dose from 
a teaspoonful to a tablespoonful is an emetic in cases 
of great morbid action. Emetics of sulph. zinc & sulph.
of copper have been recommended also of acetate of copper 
The latter article is also escharotic tonic & caustic. The chlorides chlorates are adapted 
to this stage of the disease
[illegible] [chlorate of potassa]
grii to vii


“In those cases that require stimulants blisters
may occasion gangrenes”
“When there is tumefaction of the tonsils use
blisters paediluvium & gargle with the mur. ac.
especially the [oxymorestic] diluted with 6 parts water”


130
The treatment of the local affection of the throat is of two
kinds, external & internal When there is much inflammation 
about the throat, with the uvula elongated, the
tonsils enlarged an inflamed & the pulse full I apply 
epispastics externally. Blisters, mustard, oil of origanum 
ol. monard punct. etc. may be applied to the throat
Gargles are injurious in bad cases & perhaps
of little use in most. Still in ordinary forms of the disease
from four to six ounces of any mild astringent acidulated
perhaps with muriatic acid may be thrown in by 
a syringe. The marsh rosemary is considered better than 
any other astringent. The alum root (henchera amer.) is
useful both as a gargle & given internally. For the latter
purpose sweeten it & add a little brandy
When there is not much tumefaction & 
considerable relaxation of the parts stimulating garbles
are good, as capsicum & brandy astringents may be 
added. In gangrenous cases quinine is good if it can
be got down. In the latter stages of the disease it may 
be useful to touch the ulcers in the throat with nit. silv.
“Vinegar & lemon juice may be 
used as a gargle”
“If the ulcers are thick and leathery
apply nit. sil.”



“I have seen the brain affected and much spasmodic
action subderangement pain in the head 
and all the symptoms of hydrocephalus with a bloating
of the whole cellular membrane pulse frequent & extremely 
quick and all the marks of irritative actions
For 3 or 4 years I have used tinct. dose in 4-5 & sat. tinct.
canth. in 10 3 or 4 times a day giving also the tonic
solution and keeping the bowels open”
“It produces eruptions on the skin, heat dryness & 
soreness of the fauces febrile action & if continued 8 or 10 
days I think it would be useful. I would try it were the
disease severe and epidemic, whether I thought it contagious 
or not”


131
The sequel of scarlet fever is dropsy. In children
especially an anasarca and sometimes an universal
dropsy comes on after the disease has subsided. The 
first two cases which I met with were in the severe epidemic
of 1803. I treated them according to the direction 
of the books, with bark & brandy opium & lost my patients 
Considering this as an affection of the absorbent and nervous
system I treated the subsequent cases which fell
upon my hands with tinct. cantharides & tinct. digitalis
The digitalis allayed the morbid action of the exhalents 
& absorbents & the cantharides acted as a diuretic.
“Give of each 
2 or 6 drops every 3 or 4 hours It [opens] [illegible] in these cases the
effect of irritative action hence the propriety of digitalis
Hanneman proposes to prevent the recurrence
of scarlet fever by the administration of moderate
quantities of atropia belladonna an article which produces an
eruption upon the skin, similar to the rash of scarlet
fever. The influence of belladonna, upon this hypothesis
is similar to that of vaccination in preventing small 
pox.



The termination of the chain of actions in health
in some diseases & if we say nature cures the disease
then we may say when the tendency is [inevitably] to death
that nature commits suicide. The latter is true
of this disease Yet if this chain of morbid actions is 
broken up by a powerful impression the constitution
will take on its ordinary action
Scarce any disease is more curable
when taken in season yet it would not be proper
for a physician to say he could cure all cases
then pretending infallibility
I shd doubt whether Good had ever
seen the progress of a single case. He says nothing 
about the first stage.
The tendency of the disease is to destroy 
the patient not by infl. or irritation but by 
suffocation from a foreign body in the trachea
The stages run into one another, and 
yet a phys. watching the progress would naturally 
divide it into three stages
Always curable in the first stage unless complicated with some other disease
rarely in the second almost never in the last yet
I have known cases cured in the last stage
The peculiar sound of the cough is 
alarming (in the first stage) even to those who have never
before heard it
Dr [Hesark] I have been told divides the
disease as I have done into 3 stages and directs to give
2 grs. tart. ant. combined with ipecac. I shd give
for the effect not according to the quantity. I put out 3 or 4 gr
and give till the effect is produced
rarely over 10 grs


132
Croup
This disease has been called in America by the popular name
of hives which is probably a corruption of heaves called rattles
The name given it by Good is empresmia bronchitis. The 
most common scientific appellation has been cynanche
trachealis or angina trachealis
The persons attacked by croup are
I have never [illegible] 3 and [illegible]
almost exclusively children from 3 months to 12 years 
old # in one instance I have known it attack
a person 60 years of age When it occurs in adults it
succeeds other diseases I have known 2 or 3 cups of [illegible]
“Croup sometimes though less frequently than most diseases, blends with
other diseases as catarrh” Some have considered the disease as
contagious, but though a few facts appear to favour the
supposition, they are not numerous enough to establish a 
general law.
Croup usually occurs in the winter
and spring, when it is brough on by exposure to a cold
and damp atmosphere. Children upon the sea coast are
more subject than in the interior of the country, because
exposed to more variable weather and more frequent [thaws]
& notwithstanding the greater warmth of the climate on 
the seacoast For when the air is filled with 
vapour, the caloric of the body is conducted off with 
more rapidity than in a dry atmosphere, even if the
temperature of the latter is colder.
# It is principally confined to persons under 5 years of age
though it sometimes attacks persons of all ages, and 


It is not precisely entonic or atonic & hence
might be called specific in peculiar
It is said that in croup the exhalent
arteries are affected & in catarrh this [illegible]
vessels Whether the different vessels are affected or not there 
is certainly a different action
“I have thought croup might destroy life by 
coating the entire surface of the lungs with a mucous
or membranous coat thus preventing the decarbonization 
of the blood”
“I have never seen croup without more
or less spasm; & probably in fatal cases it is always a 
spasmodic contraction that closes the passage to the lungs 
which is only diminished by the membrane. I never
saw a case on the other hand of what is called
spasmodic croup which did not if neglected put on the
membranous & inflammatory form”
A similar [membranific] inflammation
exists in the duodenum


133
Croup is a specific disease of a peculiar kind and
is never malignant. It comes on with all the symptoms
of pyrexia and consist in an inflammatory affection of
the mucous membrane of the larynx and trachea, which
causes a remarkable shrill sound in breathing & a ringing
cough by which those who have seen the complaint
cannot fail to recognise it. The proximate cause is a 
peculiar inflammatory action of the system, 
determined to the exhalent vessels arteries of the trachea
and bronchial vessels, where there is produced an exudation 
of coagulable lymph similar to that which forms
on the membranes of closed cavities from inflammation & 
entirely different from secretion of the mucous glands
whether healthy or unhealthy. This coagulable lymph 
which is thus exuded, always forms a membrane which 
lines the larynx and trachea, if the disease proceeds
to a fatal termination, and causes death by suffocation. 
This appearance is always found in the
tracheae of those who have died of the disease.
The membranific inflammation distinguishes 
croup in its nature, from catarrh which is in all its
varieties, an affection of the mucous glands



Most diseases attack in the night
“Diseases are cowards, they mostly attack in the
night” Rush.
“The peculiar ringing sound of croup is made in 
[expiration] that of hooping cough is inspiration”
# As is the case when respiration is impeded
by any foreign body there is a great deal of
irritation
# when the nose discharges [illegible] [illegible] it
bronchial vessels secrete mucus and a new
action takes place the patient will be apt
to recover
# The patient was subject to asthma
and the croup was neglected until the latter 
stages finally died
+ “I have known this to happen only once
In this case the friends were not alarmed because the
child had been subject to catarrhal affections & the symptoms 
received no attention till the last stage”
# Frequently appears to be [illegible] in the
very commencement of the disease


134
This disease sometimes come on like a
catarrh and continues two or three days without any 
alarming symptoms, until suddenly, & often in the night
the peculiar symptoms of croup appear. At other times 
the first symptom of the disease is a severe paroxysm of 
suffocation attended with the hoarse & shrill ringing noise made
during expiration like air through a broken tube & the peculiar ringing cough. The cough
in its progress is attended with more or less of spasmodic
action. # It is always dry; and when it becomes loose
or when mucus is expectorated the disease is broken up 
and there is no further danger # It rarely continues so long as five
days and is sometimes fatal in twenty four hours. Sometimes,
though rarely the membrane of coagulated lymph is
coughed up. I have met with but one case + In this the 
membrane was thrown up three times, at each subsequent
time forming lower down than before # 
No disease resembles croup so much as
suffocating catarrh yet there are obvious marks of discrimination
The latter disease as I have seen it is not attended
with much cough and the difficulty of respiration is
not in paroxysms but constant & commence with the disease. The pulse is often quickened
and when the system is prostrated may be low. #  In suffocating 
catarrh the powers of life are to be raised by external
irritants & excitement equalized by the inhalation of the vapor
of [illegible] of warm water etc. “Mustard” “If pulse tense
bleed”



From the earliest of my practice I 
have been in the habit of dividing it into 3 stages
[illegible] that they are perfectly distinct, but [illegible]
person would naturally take this view
Quiet between the [per.] apparently 
not much affected during the paroxysms Between the paroxysms pulse natural & eyes bright. You will 
know this disease in this stage only during the par.
Parents in this place know the disease in this stage
and send forth phys. 
In this first stage, the disease 
must be broken up by a powerful impression 
upon the system This may be done many ways
Some are partial to a [illegible] & some to another 
“That which is best administered is best” A local
effect upon the stomach will not answer
I have relied more upon tart. ant.
than any other & found it answer all reasonable
expectations. I have preferred it to any other
I have occasionally used other [illegible]
I have found seneka better as an auxiliary
than as a commanding [remedy]



135
Croup may be divided into three stages each 
of them requiring different treatment. 1st The forming stage
2nd The inflammatory stage & 3d The last or suffocating
stage
1st In the forming stage, the cough
is severe & hoarse & occurs in paroxysms of from five minutes 
to have an hour in interval. “There is little or no fever” The
pulse is regular and small, & sometimes trembling. The patient
is often chilly. In this stage the disease may with
certainty be cured
“I have not lost a patient & have not saved one
in [illegible] when not called till the second paroxysm 
had commenced”
In the treatment of this stage we must depend
upon emetics. Large doses must be given moderate
ones do no good. A dose should be administered sufficiently 
powerful to affect the whole system and call into action 
every muscle. We must be regulated not by the quantity 
but the effect for we must calculate to overcome the diseased
action completely by the operator of our remedy.
I have given three grains of tartar emetic to a child three
months old, & kept up the action by the large doses of seneka
repeated every half hour for six or eight hours
Tartrate of antimony is the best emetic to 
commence with and may be given in a dose of from 3 to
six grains of strong tart em. After its operation a constant nausea must
be kept up by seneka or some similar article, for some
time in order to prevent a return of the disease. The seneka
excites a new action in the system. It may be given
in decoction. Take zfs or zi of bruised seneka to half a pint of
water, & boil away a quarter. Give a table spoonful for a 



It has so happened that with us the [serpentaria]
has not answered so well as tart ant. It acts 
on the fauces perhaps more [illegible] than tart. ant. 
but does not affect the system act upon the skin 
& determines to the surface so well as tart. ant. We have 
not used it however except in the latter stages & perhaps have
not given it a thorough trial
Sanguinaria vide p. 212 has been used 50 perhaps
a hundred years. Three generations of physicians
in one locality have used it and relied on it
in croup with as much success as upon other articles
These mode of using it was in strong decoction 
without weight & give a table spoonful until 
the desired effect is produced till vomiting is excited
or the disease is broken up There are however
forms of the disease where it fails even in [illegible]
“Much has been said of the good effects of calomel
Give in large doses 20 – 30 [illegible] acting as an emetic it is
serviceable but when catharsis is produced, the emetics 
would fall in with the catharsis. I never could in such a 
case make the strong impression on the system what I 
[illegible]”


136
does once in half an hour or as much as the stomach
will bear. Seneka has been relied upon by some as
a specific in croup, but it is inefficacious when inflammation 
is present, being a stimulant, and it is too slow in its operation
for the first remedy. After giving it as the first
article, other emetics seem to lose their influence; acting
as cathartics; but after the violence of the disease has
been broken up by other emetics, you may avail yourself
of the nauseating & deobstruent effects of the seneka & effect
a cure. Dr Rush preferred the turpeth mineral 2 to 6 grs
as the first emetic. The physicians in Wallingford for 5 years
make a strong decoction of sanguinaria, and give it
until emesis or a cure is effected. This article may be
used instead of seneka in the way above directed
In connexion with these means the warm
bath and fomentations may be used as adjuvants. Much 
has been said of the good effects of calomel in this disease
You cannot rely upon calomel for the cure of the disease
It is too slow in its operation. Never give calomel until 
you have broken the violence of the disease 
After emetics have operated and you have availed your 
self of the operation of seneca & sanguinaria and the disease
still exists, give from 5 to 10 grs of calomel
By this producing an orgasm in the 
system more powerful than the disease & continuing it until 
the latter be overcome, croup may be cured with more certainty
than most other diseases. All diseases should be attended



I know that there are some very respectable physicians who rely
upon calomel For this purpose they 
give very large doses and produce [illegible] & [illegible]
I should prefer it as an auxiliar. I have often 
used it but after the emetic or with the
emetic or before the emetic
A variety of other men [illegible]
India tobacco which though not allied in 
botany are so in their operations The common 
tobacco is generally applied eternally to the pit of the 
stomach. Lobelia acrid & emetic loses some of its virtues by drying
In its recent state 1 gr will often excite full vom.
Indeed I have known vom. prod. by merely 
chewing the capsules & [illegible] without swallowing
by the impression upon the mouth	
Dose of tinct. 20 drops to a t. sp. according to age
Other acrid narcotics as veratrum & colchicum
may be used
In this forming stage bleeding is not
indicative by the pulse, nor by state of the
system and you will obstruct your efforts to excite
a powerful effort of the system if you bleed
2nd stage
In this acrid emetics are injurious
seneka is too stimulating Sanguinaria had I have
seen all the symptoms aggravated by bloodroot in [illegible]
the high entonic stage
# “If the disease is complicated with a similar
affection of the stomach & duodenum give calomel & other
cathartics”



137
to in the beginning & it is owing to the imperfection of 
or our art that every disease is not broken up in 
its first stages. When however croup supervenes upon other
diseases, it is more dangerous. “Those who practice in the
country rarely see the disease in the forming stage. I had one
winter 20 cases of croup all in town recovered most of the in the country died”
2nd Country practitioners however seldom see
this first stage which I have just been treating of when the 
tongue is not discoloured, the fauces have a natural appearance
the pulse is unaffected respiration natural & ordinarily 
no inflammation about the tonsils. On the contrary 
they too generally arrive when the disease is in the
second or inflammatory stage the disease has effected in which the bloodvessels the skin is hot and 
dry, the face flushed, the pulse tense & sometimes full the
tongue furred, respiration between the paroxysms difficult
tongue furred, respiration between the paroxysms difficult
and the cough so severe as to threaten immediate death vide p. 213. In this stage 
we should immediately bleed from freely from a large orifice the arm or jugular vein
freely, even until syncope is produced put the patient
in the warm bath & let him also inhale the steam of warm
water, and give calomel and other cathartics. # Never
give emetics in this stage until after depletion by V.S. 
when we may give 4 grs. of tart. ant. in a table spoonful
of warm water & apply epispastics to the throat” in the commencement 
apply a blister” I dread to be called in this stage of 
the disease, for it is the almost always fatal venesection 
sometimes succeeds but very seldom. I would not apply 
leeches cupping would be better & perhaps friction might be serviceable.
Digitalis has been recommended, but 



In this stage inhale the vapour cover
the child & nurse in a chair with a blanket
In this stage cal. & cath. may be given
In the first stages I have conserved it very unfortunate
to find my patient under the operation of a
cathartic It feels as if my hands were tied
The excitement is of a different kind from what is wanted
And emetics are apt to produce hyper cathartics
Where the dis tends to the [illegible] the
[illegible] a specific. This is known by the
cough being less hoarse, by fever, by constipation 
fever more intestinal membrane
will pass off from the duodenum I was formerly 
disposed to cure this form of the disease [illegible]
& described it as such
In the second stage epispastics
over the whole chest also diaphoretics
and tepid bath When the cough is milder
and beginning to be loos after being principally 
broken up in the first stage give cal. in 2 or 3 gr
doses once in 2 or 3 hours
In the 2nd stage remedies have been
given to obviate the fever & digitalis has been used
with good effect It was used as a depressing agent
It operates by its narcotic power however. here refrigerants
are of little efficacy
In what may be seen to be the last


138
I have not used it. It is at best but a doubtful remedy
in inflammatory effections though calculate to remove more irritations. Sanguinaria diminished arterial
action like digitalis and operates powerfully as an
emetic. I have not succeeded with it in the last stages of
croup & have not used it in the first. [?ronchotomy] has
been proposed, but does not promise much benefit, as the
disease is seated below the place for operating. “Dr Smith did not recommend it”
After depletion and especially after the disease assumes
a bilious form you may give powerful cathartics
The pt. begins to thrown his head back death may happen any moment
3d IN the last or suffocating stage* you may give emetics
of turpeth mineral sulphate of zinc or even
corrosive sublimate to throw off the membrane. Something may depend upon changing
the emetics & sulphate of zinc may be tried. The cold bath
is said to have been successful in this stage, but the fact is
not well authenticated. I have used calomel and the
warm bath with advantage.
Child of Mr Culver
[last] in chronic stage
“I regret that I have not tried 
affusion of cold water in the last stage. It is 
said to cause the membrane to be thrown off & to procure
relief even in the very article of death”
vide p. 182
*”In the last stage respiration is constantly laborious
head thrown back pulse often irregular
& intermittent sometimes strong”
Chronic form “Sometimes though rarely the disease is only partially 
subdued I [illegible] on in a chronic form. Calomel
vapour best tepid bath are the appropriate remedies”




139
Angina Laryngea
Empresma Laryngitis of Good, q.v. for a definition & 
an account of the disease
In this disease the symptoms differ somewhat
from those of croup, though the cough is similar
The disease is seated in the larynx glottis and fauces & the
characteristic symptoms is swelling of the tonsils. The cough
is spasmodic and is excited by taking food with drink in this respect also indistinguished from croup. The
disease is more violent and rapid than croup, as the inflammation 
being seated in the narrow part about the glottis
produce suffocation sooner. The respiration is more difficult
than it croup particularly between the paroxysms
This disease more commonly affect adults
The first case that I saw was that of an old man in whom
the disease was brought on by exposure to cold after a pneumonia
From a relation of his symptoms I prescribed
seneca which only exasperated the disease, so that when 
I saw the patient he was unable to speak or swallow. A 
small red spot appeared on the tonsils. venesection, epispastics,
pediluvium, inhalation of vapor etc. were resorted to with 
no abatement of the symptoms. Venesection was performed a second
time & as soon as the patient was able to swallow, 4 grs. of 
tartar emetic were administered. Some nausea and vomiting
with considerable catharsis followed. The vesication 


“Angina laryngea is mor apt than croup
to recur several nights in succession”
“The slough were thick and leathery. Sloughing
even under blisters. In one instance blisters did not
heal in 4 mo. Lunar caustic applied to the tonsils & 
uvula & inflamed parts proved serviceable
# “In one case of A. laryngea I gave sanguinaria 
It was too acrid and increased the cough etc. It might 
do good if we could avoid the local effect of its
acrimony”



140
was extensively returned & the patient recovered.
Much the same treatment is required
as in croup but it should be more prompt and with earlier
venesection. For the inflammatory stage comes on earlier
and the disease runs a more rapid course
Last year this diseases differed in its appearance
from the former years
It has often followed certain affections
of the tonsils called black canker. The tonsils are inflamed
in black canker and sometime covered with a leathery
crust. This comes off and leaves an ulcer. If the inflammation 
extends to the larynx, symptoms of croup 
supervene
Case of black canker. Two called in the
last stage gave blood root with disadvantage # Still at 
this late period calomel and other cathartics in large
doses produced free evacuations and the child recovered 
Cathartics appear to do better than emetics. In one case after 
giving cathartics I used the vapour bath and applied 
a large epispastic over the whole sternum. Though at
so late a period the disease abated. A large slough however
was produced by the blister which required three 
months to heal. The morbid action on the skin being
similar to that of the tonsils
Vie p. 187


Sometimes comes on with a sudden paroxysm of
suffocation sometimes gradually 
“Distinguished in its commencement
from croup by the quantity of mucus in the bronchial
vessels”
“in the case which I have attended, 
not much febrile action attended the disease”
Proximate cause a morbid action of the lining
membrane of the lungs accompanied with a viscid secretion 
of [mucus]
By vomiting the disease may be relieved & apparently 
cured but may appear again in the course of 
an hour
The quantity of mucus is greater than in 
any other catarrhal affection”


141
Catarrhal epidemic resembling croup
Peculiar catarrhal affection resembling croup suffocating
catarrh
This disease is characterised by a severe hoarse 
cough, much resembling that of croup. The disease is distinguished 
in its commencement from croup by the excessive quantity of
mucus in the bronchial vessels which causes the suffocation 
The disease resembles croup likewise in the mode of its attack
which is sometimes sudden with symptoms of suffocation, and at
other times gradual with paroxysms of coughing and intervals
of perfect ease The turns of coughing are so violent in this
disease as to produce a livid colour of the face. The extremities
evident determination to the head
are cold and the head is hot from the quantity of blood
thrown into the vessel of the head by coughing. The evacuation 
from the bowels are healthy and among children with no disease which I am acquainted
affect the bowels so little ass this.
The proximate cause of the disease is a morbid
secretion of mucus on the lining membrane of the lungs & 
trachaea with obstructed perspiration. The quantity of
mucus thrown out by this membrane in this disease is astonishing After
the disease is fully formed, great quantities of viscid mucus
may be brought away by vomiting, to the great relief of the
patient for a short time, and yet within an hour the patient
will appear to be suffocating from the the quantity again 
collected in the bronchial vessels
In the commencement of this disease, the indication
is to break it up at once by a powerful emetic, of
tart. ant. unless the system 


The principal indication is to break up the disease
by a powerful action on the skin on the stomach
the duodenum and the fauces It is best affected by 
tart. ant. which is more difficult in its action than
[ipecac] though is very delicate constitutions ipecac 
may be practicable
# prevent accumulation of [mucus]
The bowels shd be evacuated not for the purpose
of curing the disease but for the prevention of an
accumulation of feces which would be irritating
In all diseases of the lungs examine
the state of the skin and particularly that of the lower
extremities for perspiration upon the upper extremities 
[only] may be a part of the disease
I have known the lives of several patients saved
by the use of the vapour bath
I formerly [illegible] and used [illegible]
for transmitting vapour by transmitting air through
boiling water
It was old practice to apply cat-skins
fowls split open (to the feet) etc. with the intention of
communicating vitality


142
is too much weakened to bear this treatment. This is a 
general principle viz, if possible to break a disease in its
commencement by means of a strong orgasm. Often the
emetic is to be repeated, and it may ever be necessary to give
four or five emetics 1 gr [illegible] tart. emet. each in the course of a day. After the disease 
is somewhat broken up, and epispastic applied upon the 
breast will assist much in allaying its violence #
If the disease still continues or if when first
called we find it fully formed and powerful emetics inadmissible
the primary indication will be to open the pores of the skin and
keep up a gentle perspiration, by small doses of antimonial wine
to which may be added in all quantities of camphor by elix. [illegible] & in 
some cases tinct opii by fomentations and especially by 
the warm bath and the inhalation of vapour. To affect the 
latter object the child may be placed in the warm bath & 
a blanket thrown both over it and the nurse, so as to keep
the child in an atmosphere of vapour. Long continued 
perspiration invariably relieves the symptoms. I have known
an instance in which the skin of a sheep warm from the animals
body was wrapped round the naked body
of the child with beneficial effect.
In small children when the stomach ceases
to be excited by emetics the throat should be irritated 
by a feather or the finger, when we wish to produce vomiting 
For we must never rest satisfied with merely endeavoring
to palliate the symptoms. In small children also the
mucus should be wiped out of the mouth by the finger or a cloth 
This disease prevails most in the winter and spring months & does not
occur every year. The first patient that I treated for the disease suffered
from it a year. I gave mercurials & finally the silver pill (nit sil)





143
I was puzzled with the first cases of this disease
which I met with. Some of them continued for weeks
and months I was obliged to use perspiration,
by warm bath to vapour bath emetics etc. I determined
to break up the next cases in the commencement
with tartar emetic repeated until full vomiting
was produced walking my patients. This 
plan was more successful
A s a general rule break up 
all diseases if you can
“The complaint is epidemic or rather
endemic. It has been mistaken for croup, but it
differs As croup formerly occurred no mucus was raised
in the earlier stages, and when there was an excretion
of mucus we considered the disease cured
But of late years the two complaints are somewhat blended.
Mucus is thrown off sometimes without permanent
relief”
“There is often in this disease a disturbance of 
the brain and nervous system resembling epilepsy or chorea
produced by the cough”


A distinction was formerly made by some
writers and some practitioners, between hooping cough
and [chin] cough the latter being a spasmodic cough
without the hoop. Such a distinction will not hold
good there is no difference
“Linneas and Rosenstein attributed it to an insect
others to malaria”
There had been a very severe winter & no one
had left the island for months


144
Hooping Cough Pertussis
Called also chincough
This is a disease which generally attacks children
yet occasionally, adults are the subjects. I have known persons
of 60 years of age affected with it. As a general rule also it
does not affect persons a second time. I have known about 
20 or 30 exceptions & among them was the late president Dwight at 60 years
Hooping cough generally appears as an epidemic.
With respect to its origin there is considerable difficulty 
in making up an opinion. It is said to be contagious 
to arise from a specific
contagion which affects a person but once. Dr [Dewers], however,
says “We confess that we are inclined to believe that it depends upon 
causes of a more general and pervading influence that 
contagion.” Dr Cullen asserts that he has said a disease which 
though evidently arising from chincough contagion never put on 
any other form than that of common catarrh. In the tenth
volume of the medical commentaries DR Willey gives an account of
the breaking out of the disease on Block Island under such 
circumstances that it would seem that it could not have originated
from contagion. When the disease prevails many become effected
where every precaution is taken” When the disease has been extensively 
prevalent I have not been particular about keeping patients
apart, perhaps however it is best for prudence’ sake to consider the disease
as contagious and to treat it as such. One fact I have noticed
that in particular seasons may have the disease who have had it
before.” Some suppose that it is contagious only in the first stage 
others in the second “Some think it caused by malaria or
animalcular”


“The stricture may be overcome by not
attempting to inspire, but to expire till the lungs are
emptied the pat. can then inspire without difficulty
I have known persons subject to this kind of hooping
without cough Adults are sometimes attacked in the night
with paroxysms of suffocation they start from bed when 
the recover their breath there is hooping but no cough, at
least at first The more they struggle to catch breath 
the greater the difficulty there seems to be a spasm of the
glottis Let them make no effort to inspire but expire 
the little air remaining in the lungs & they will bye relieved at
once. The disease is liable to recur bathe the feet at night 
give paregoric wine whey diluents The disease is not described


145
Some suppose this disease a peculiar inflammation of the
mucous membrane of the trachea and lungs, others that it arises
in the bowels
This disease often commences with the 
symptoms of ordinary catarrh & continues without alteration for
some days.  Sometimes the peculiar mark which gives this
cough the appellation of hooping & distinguishes this disease
from every other does not appear until the 3d or 4th week
It is impossible however to distinguish the disease until this
peculiar hooping makes its appearance. When the disease
is prevalent it will be safe to treat every severe case of catarrh
among children as one of this disease
The phenomena peculiar to this disease may 
be the described. Several frequent expirations are made in 
succession by spasmodic coughing, and a full inspiration is
then necessary to restore air to the lungs. The air as it passes
rapidly into the lungs produces a loud sound called whooping
The sound however is made more by the structure of the passage 
than by the rapidity with which the air is drawn into the lungs
I have known persons subject to this kind of whooping, without
having a cough caused by a spasm of the muscles of the trachea 
larynx? to which adults are sometimes subject. (Goods laryngismus?) 
A similar sound is also made in croup, when 
the air is expired after the passage becomes constricted
The patient is aware of the coming on of a 
paroxysm of coughing by an unpleasant sensation in the throat, & 



The cough is violent in proportion to the shortness of 
the paroxysm


146
it is common for children support themselves during its continuance
by changing to a chair or other support near them. During the
paroxysm the blood is returned with such violence to the head as to 
produce a livid colour of the face & often in 
bleeding at the nose. Very violent paroxysm sometimes
in young children terminate in convulsions or death The paroxysms continue
until a quantity of mucus is thrown up from the
lungs or the contents of the stomach are evacuated by vomiting
They are short in proportion to the facility with which the mucus
is brought up or rather in proportion to the rapidity with which it is secreted
It is the secretion of mucus, not its removal
which gives relief to the irritation of the lungs 
Many suppose that this mucus which is generally in considerable
quantity is the cause of the paroxysm of coughing instead 
of the effect of it. The peculiar irritation of membrane in 
a paroxysm of coughing produces a secretion of [illegible], and 
when a sufficient quantity has been secreted it is coughed up 
like the secretion of tears from an irritated eye
and the paroxysm is relieved “The mucus sheaths the part & the ceases”
The disease continues from one to six
months It is often kept up by habit. The cough is usually more violent by night than
by day. Violent cases are often attended with considerable fever
and in the worst cases respiration is laborious between the fits of
coughing. The disease may terminate by apoplexy or suffocation
or by ulceration of the lungs and hectic & sometimes by 
permanent visceral obstruction “or apoplexy or suffocation”
Whooping cough is not dangerous to adults
and I have never known a child over two years of age die
with it. It is most dangerous to infants and the younger the 


It is usually dangerous to children within the mouth
It is apt to wear out very young children especially 
if they are of a scrofulous tendency
It is frequently accompanied with a morbid sensibility
and irritability of mind and hence in the latter
stages a change of air and of place is salutary as in 
cholera infantum The same despondency of mind takes place
as in chol. inf. q.v.
The disease is a fever spending itself upon the
lungs and trachea, and affecting also the glandular
system
Some phys. think this dis. like common
catarrh, is always inflammatory in its commencement, and 
requires antiphlogistic treatment. But we know that
pneumonia may be highly typhoid & require treatment
opposite to [enteric] pneumonia. If infl. of the lungs exists
the antiphlogistic treatment shd be adopted in its fullest
extent I have seen antimony as efficacious in this dis
as in pneumonia. In general perhaps mild
antiphlogistic diet & treatment will be proper.
In some cases I have thought the
veins lost their power, and in such cases the
blood [illegible] has been prescribed & with advantage
It is a catarrhal fever at first and to be
treated as such


147
child the greater danger in children under the age two years
The anger, to be apprehended from the disease will also depend
upon the debility of the child when attacked. The cough may be
violent and attended with frequent vomiting yet of the patient’s
appetite be good there will not be much danger
to be apprehended. A moderate hemorrhage from the nose
is often salutary
Treatment. If the disease is mild and the constitution
good little need be done with the way of treatment. But if inflammatory 
symptoms supervene with a tendency to pneumonia
the antiphlogistic treatment must be adopted. Bleeding
will often be advisable. A small quantity of blood
taken from the arm proves serviceable. In general greater 
effects may be expected from the application of a few 
leeches to the breast or neck than from bleeding at the arm
but when decided symptoms of pneumonia appear, & the blood 
seems to be transmitted with difficulty through the lungs.
I would recommend venesection. In this case also the 
bloodroot will be the best article for internal administration
In most cases the disease comes on like
a catarrh, and should be treated as such, with mild 
antiphlogistic regiment [illegible] important part of the
antiphlogistic treatment of this disease is the keeping 
the bowels open. Costiveness frequently attends the disease & should
be carefully avoided. In general it is better to obviate 
this symptom by diet as far as it can be done 



Begin with antimony in small doses 1l or 2 drops ant wine & 
in [illegible]
For very delicate children however it may be better
to give ipecac
Almost all the writers recommend vomiting [Best]


148
rather than by medicine. The best cathartics for the
indication are those which excite the secretions of the stomach
and liver. Sometimes the disease has a tendency to produce
congestion of the liver and obstruction of the mesenteric glands
and in that case also mild mercurials should be given 
and their use continued as long as any symptoms of congestion 
exist.
All the medical writers on this disease recommended
vomiting in the first stage
Tart. ant. is in ordinary cases the best emetic. Sometimes
for a child from two to six months old two drops of antimonial
wine will be an emetic dose while for another
of the same age 20 or 3o drops may be required. In 
affections of the lungs children will bear antimony better
than in those of the stomach and duodenum. In some
constitutions antimonial emetics produce (in this disease)
a sort of spasmodic stricture other emetics also may produce
this effect a symptom which must be relieved by diluents 
and opium
In general antimony in small doses
may be given to children of any age, either by itself or combined
with a small quantity of paregoric or any other mild preparations
of opium. Given in this way it removes febrile action and 
congestion of the lungs, and determines to the surface
When the disease has proceeded with 


You may see the fontanelles swell in such 
cases. I recollect a child in the whooping cough going
into the country I told the parents not to suffer the child
to be vomited. A physician in the country said the child 
must be vomited of course all the books directed it
in whooping cough He vomited the child. It went into
convulsions and died
# Here insert the recipe for hire syrup or 
compd sys. of squills p. 150
I have known the lives of some patients saved 
by 
this antimony internally had lost its power produced no effect


149
violence for some time and there is much determination of
blood to the head, threatening convulsions or apoplexy from 
distention of the blood vessels, or when the patient has become
debilitated vomiting by emetics should not be practises
or but cautiously.
When the system and particularly the
stomach has become debilitated. Ipecac is preferable to 
antimony, given in emetic doses, or in small quantities 
as an alterative diaphoretic and antispasmodic. And in the
latter stages likewise on account of the debility, sulph. tinc. is a good
emetic using 5 or 6 grs. with as much of ipecac
If there is not much febrile heat, and there is much 
viscid mucus in the stomach and lungs, and emetic of
squills is often serviceable # particularly I [illegible] phlegmatic temperaments syrup of squills vinegar of [illegible]
In this disease if there is danger of convulsions 
from vomiting, blood root and similar articles should
be given. The hive syrup or compd tinct. of squills may be used
In children under three 6 months, whooping
cough may be much relieved (respiration being promoted)
by vesication on the breast. A blistering plaster may be applied but
I have more generally used the following. Rx common or mild
tinct. canth zi targ. ant zi Dissolve the ant. in the 
tinct. & apply a linen cloth with the mixture till [illegible] or partial vesication 
is produce & then dress with simple cerate In this way we have the vesicating & irritating
qualities combined. This external use of tart. em. was
recommended 20 years ago, in the Lon. med. & ph. Journ.


This disease may be cured in its first stage but it
ordinarily runs a regular course & the treatment is generally palliative 
brown mixture
You will perceive that this is a strong decoction
of seneka and squills, with a large proportion 
of tart ant. shd be given cautiously 4 to 30 drops 
Narcotics have been strongly recommended
e.g. atropa belladonna & hydrogen of the former
for 2 gr of the leaves in powder Alibert recommends
the fresh bruised root


150
A popular remedy in whooping cough in Godfrey’s cordial, made
of molasses and water with a little laudanum and oil of [illegible]
“Hive syrup” (or compd syr [illegible]) is made as follows Rx bruised seneka root & 
squills zz z8 water lb 8 boil and evaporate one half
strain and add honey 4 pts boil to lb 6 Add tart.
ant. gr.i to every ounce Give for an emetic 8 or 10 20 drops
to a child 4 mo. old & repeat the dose every 15 or 20 minutes
until vomiting is produced
The “brown mixture” is as follows elix. pareg. zi; ant. wine zfs;
ext. glyc ziii pul. gum ar. zii wat. zvi trit. & boil 
dose from ½ teaspoonful to tablespoonful
This has been very extensively used
This disease has been prescribed for more 
empirically than most others; a fact which proves the
difficulty of curing it It is a popular notion that it must
“run its course” & under the influence of this many parents
object to its being prescribed for. Undoubtedly this
like every other disease must “run its course,” if it is not
cured; but this is no reason why the cure should not be 
attempted.
Ammoniae asafoetida (especially if
the cough is kept up from habit)


1st antispasmodics 2nd tonics
# An emetic is occasionally administered with advantage 
“I have prepared this from seneca oil also
from gun copal”



151
2nd In the second or chronic stage tonics & 
antispasmodics are indicated. Sulph. of copper or of zinc
tinct canth. cinchona, arsenical solution etc. may be required 
to rouse and support the system & as antispasmodic
tinct. asafoet. petroleum Artificial musk etc. and also
the narcotics, as hyoscyamus, conium, stramonium, belladona arnica, opium etc.
When the cough is kept up by habit, # asafoet.
is often administered to children with advantage. It may 
be given in tinct. or decoct. & if it cannot be given by 
the mouth it may be thrown up in an enema, using 10, 20, or 
30 drops of the tinct. It is a valuable [illegible] the taste is less
unpleasant than the [illegible]
Artificial musk or oxygenated oil of 
amber was first introduced by Prof Hufeland of Jena
as a specific for whooping cough and has since been found 
very useful in other spasmodic diseases vid. Lon. M of ph. J.
vol. 1: p.181 van Swieten’s comm. etc. Rx nit. ac ziiifs
cl. succini zi. And the acid gradually, ina temperature 
of 100 [degrees] or in the sun. Prof. Hufeland triturated
x or xii grs. in a mortar with a few almonds & diluted with 
z 5 or 6 of water & gave a teaspoonful every 2 hours to 
a child a year old. This preparation was very celebrated 
and very effectual, for a time, but afterwards fail 
was thought to be ill prepared. The truth was the diathesis had 
changed. Probably it will be as affectual at [illegible] time
I have given the above article in tinct. Rx zii 
of the oxyg. [illegible] [illegible] lbfs alcohol dose 10 to 12 20 gtts
It is much more soluble in ether. I frequently dissolve zi 
of oxygenated amb. in zi of ether dose 1 to 2 drops on sugar 





152
It may be prepared indeed of any strength, to suit the
convenience of the physician. Probably gum copal oxygenated would
answer the same purpose as amber as there is every reason 
to suppose that the two are essentially the same
amber being gum copal mineralised Case of a vein of 
olibanum or Frankincense found in S. America.
Opium is not indicated in this disease
except when it is qualified and its action determined to the
skin by antimony ipecac or camphor. Hyoscyamus
is better than opium for in the cough it produces no constipation
and the tincture is very pleasant. I have not
however used it in this disease. Conium has been recommended
by writers of the first respectability, but later authors do not 
speak of it with much confidence. It deserves a trial
when other things fail. Alibert recommends atropa belladonna 
1/6 gr. of the root or leaves powdered & given in milk
I have used I have more confidence however stramonium in the [illegible] & think it preferable
most of the narcotics
to any other narcotic It is peculiarly calculated
to remove spasmodic action depending upon irritability 
of the system or kept up by habit From the relief obtained
by its use in asthma I was led to employ it in this disease
and from those cases in which I have tried it I am of opinion 
that it is a very valuable remedy in it 
The ripe seeds of the stramonium are best the full dose of 
these for adults is gr. ii for a child  1/10 gr. or more according 
to the age



Mercurials occasionally blue pill rhub & 
ipecac enough to keep up a gentle excitement in the 
bowels
Not unpleasant to the taste
An old [illegible] Chalmers ([illegible] of silver) recommends sulph. cop. & 
tinct canth in wh. cough
# [ago] more used than any other Lately the ox. bis.
has taken its place dose the same used  for irritating
cough & irrit. of stomach


153
Carb. potash is a good antispasmodic used externally 
and internally. It is not only antacid & antispasmodic but it appears to 
me to produce a peculiar excitement upon the stomach
and aesophagus, which makes the more susceptible to 
the impression of other articles. Pearlash zfs & water z8 with 
cochineal enough to colour the solution has been considered
relied on by some physicians
a specific. The cochineal merely colours the solution.
is an article from which I never could perceive
any medicinal effects when used alone. I have tried the
experiment & could perceive no medicinal effect from it
Tonics. I have given the sulphate of zinc
more than any other tonic in this disease, and have experienced 
the greatest benefit. Sulph. tinc given by itself,
sometimes produces spasmodic action, the effect I attribute
to its being used in substance & hence I always
give it in the form of Moseley’s tonic solution. This 
preparation is both conic and antispasmodic is easily 
taken and retained on the stomach of very small children
Sulph. copper possesses properties similar 
to those of sulphate of zinc. It is administered in the 
low stage of whooping cough. In this place the preparation
of it called compd tinct vitr has been used
according to the recipe in the 10th vol. Duncan’s Commentaries
in doses of 3 to 30 drops according to the age of the patient
The oxide (or flowers) of zinc & also bismuth 
formerly much used in spasmodic cough 30 grs
have been occasionally used 1 to 3 grs 1 to 10 to an adult
The Peruvian bark is a good remedy in 
the last stages. The only objection to it lies on the difficulty 


It sometimes happens that the physician is 
not called in until the latter stages. As one resort we
may have recourse to irritate along the spine
It is an opinion very extensively prevalent to that
it is of no consequence what kind of food a child takes
when he has the whooping cough But great attention 
shd be given
Removal from sea side to country 
and [illegible] country to sea side either is beneficial


154
of administering to small children, a quantity sufficient
to produce any considerable effect. This difficulty may 
now more be overcome by using sulph. quinine ¼ gr to 1 gr Dr Chalmers of 
South Carolina recommends a combustion of bark, sulphate
of copper and cantharides
Tinct. cantharides has been long since
recommended for whooping cough. It is useful when the system
requires an inflammatory diathesis to be produced. Its action on the stomach 
is probably similar to that which it has in cases 
of gleet and leucorrhoea the stomach being in a relaxed
state & requiring to be excited to a healthy inflammatory 
action
Irritants, as oil of capsicum canth. [illegible] or ol. orig.
or vol. lin. rubbed along the spine have been used in 
the latter stages. They should be tried when you have reason 
to suspect that the spinal marrow or the nerves proceeding 
from it are affected.
Attention should be paid to the diet of children
in the whooping cough avoiding potatoes, oily foods etc.
Change of scene & change of air especially by 
riding should be resorted to in bad cases, to tranquillise 
the patient & furnish mental excitement. Sometimes the little
sufferers will be excessively irritable constantly worrying and teasing until 
this is done requesting first one thing & the other to be done. It is the worst of such cases, medicine does
little good, even the irritation produced by administering 
it may counteract its beneficial effects.


violent palpitation throbbing of the heart
a soft flowing pulse and a jarring feel of the pulse under
the finger ([illegible]) (The French call an enlarged heart
hypertrophy I object to the [name])
For this I have given nit. sil. 1 or 2? gr.
(in the chronic stage of [illegible]) Digitalis & also
[languinaria] (tinct. 2 or 3 gtts.) This article is dangerous for
children because it accumulates in the system
Lead has been recommended 
I have been doubtful with respect to its propriety in affection 
of the lungs etc.
# Pneumonia typhoides 1815 the system seeming to lose the
power of [illegible] the blood and the bloodroot was
given to promote venous absorption The digitalis
might probably be given in such cases but is not as
well adapted. I used the blood root and found
as much benefit as could or [expected] from any article


155
If the patient having the whooping cough happen to be teething
the treatment recommended for dentition should be employed
The patients are very liable to have an 
inflammation of the lungs from taking cold in any stage
of the disease & in such cases the remedies for pneumonia
should be administered, such as antimony bleeding
epispastics, bath etc.
The disease I think sometimes determines to the
head & produce a relaxation of the sinuses & 
[illegible] likewise produces a relaxation of the ventricles of the 
heart the immediate cause being the violence of the cough
In such cases I have used lead, but not in sufficient
quantities to enable me to recommend it Iodine has been
recommended 2 or 3 doses 3 times a day Nit. sil. languinaria & digitalis
When in the progress of the disease
the circulation becomes much affected the pulse frequent,
soft, flowing with occasional intermission
respiration high frequent and laborious, with a bloated
and sometimes analogous to # a livid countenance, the blood root has
done more than any other remedy not failing in any 
instance to give relief & palliate sympt & in some cases the relief has been
permanent. I gave the bloodroot repeatedly, the last
spring, 1815 to my patients in the whooping cough. To a
child a year old 5 to 10 or 20 grs of the dried root, according
to the urgency of the case, infused in 6 or 8 teaspoonful of
boiling water. Give a teaspoonful every hour, until 
vomiting is produced or the patient relieved. Children 


Sometimes the dis. will be very mild and yet leave 
the system in such a state that a slight subsequent disease
will carry off the patient e.g. in 1815 the dysentery
attacking children would often be very slight and yet
would carry off every one who had had the whoop. c.
in the spring. The attack would be mild and insignificant
of dysentery and yet the pat. would go into 
a [illegible] very speedily like cholera
Elaterium has been recommended I shd
be cautious in trying it except in very vigorous children
I can speak with confidence of arsenic. Excepting
occasionally prussic ac. I know of no remedy which 
so completely cures the wh. cough except prussic acid in 
some cases.
Case child 2 gtts night & a [illegible] in a
weak countenance pale, eyes dull face bloated muscular
strength weak muscles soft & flabby Parents
much [illegible] cough gone recovered colour & 
strength upon bark I have known several such 
cases and have known no ultimate injury result from this practice
Yet parents are afraid


156
who had the whooping cough that spring were very liable
to be carried off by the dysentery of the following summer
none died in 1815 of the disease but many in consequence
of it, with hydrocephalus and dysentery
Prussic acid dose 1/3 of a drop to begin with and arsenic
occasionally cut this disease entirely short; and these are 
the only articles which I have known do so, without leaving
a vestige of the disease behind. The former is a dangerous
article to use, from its want of uniformity and strength
Fowler’s solution of arsenic gtt more [illegible] is safe but does not answer
so well in the first stages. If it makes the patient feeble
livid bloated & with swollen lips etc. it must be stopped & perhaps
bark administered. It has cured the cough in the 
second stage. Dose 1 drop 1 or 2 drops twice a day. Sometimes is only palliates
Case. June 1815. A child of Capt. Totten’s a boy 
of 5 yrs of age rather full habit had been affected
with the cough for a fortnight before I saw him 
I found his pulse very frequent soft convulsive & with intermissions
face swollen and livid, circulation much increased on 
slight palpitative [illegible] motion of the body in the symptoms aggravated to an
alarming degree by a paroxysm of coughing. Previous t the
disease a remarkably even tempered and pleasant child he
was not on the contrary very irritable. Trifles irritated his
mind, and when irritated, all the symptoms of his disease
were aggravated. He took an emetic of ipecac, with 


The sequels of this disease are numerous
Sometimes the heart is affected as above and continues
so for years. Sometimes the glandular system
is affection. Sometimes the lungs. There is a lady in 
Philadelphia who had (under my care) suppuration of
the lungs whoop. cough now healthy hence never despair
The stomach and abd. visc. are
sometimes affected in a chronic way requiring 
dandelion mercurials hop [illegible] etc.
It is very tedious to attend children in the 
chronic stage an account of the excessive irritability
When bath recommended
Cold bath doubtful. I have known patients killed
by being brought from the country and plunged in the
sea bath
“Good speaks highly of rhus [illegible]. It is
given to produce a distinct action on the system which shall
overcome the diseased action. It determines powerfully to 
the surface and has a powerful exciting effect on the
blood vessels while it does not produce a determination
to the brain. I should not recommend this article and 
it is so uncertain in its effect. On one person it will
have no effect at all, when in another it will cause
swelling of the eyes, blindness, fever, & great irritation


157
but inconsiderable & temporary relief. He was directed
to take the bloodroot every hour, as much as the stomach
In relieved the violent symptoms
would bear. It was continued for two or three days, and the
palpitation of the heart was much abated, the circulation
was less irritated, & the livid colour of the face was gone still did not cure
When costive he was benefitted by full doses of cathartics.
because the system was [illegible] deranged heart lungs etc.
I considered the case a fatal one and expressed that opinion 
to the parents. The cough and other symptoms continued
though in a less violent degree disease chronic an epispastic was applied
to the chest very irritating (changed clothes often in the day [child] run upon various subjects)
Patients strength began to fail and tonics were given
white vitriol bark cantharides Finally the patient refused
to take any medicine and was left to his own appetite
called obstinately for it took cake for food for several days then baked pears then [illegible]
Afterwards recovered but was unable to run “for some years”
without a palpitation
If this disease should again prevail
I think I should atropa belladonna as a prophylactic.
As the disease continues the stomach
may become very much debilitation and require 
compd powd of [contragerva] cat carilla etc. etc.
“Ledus palustra are narcotic”


It is not certain that the dis. did not exist before
It may have existed before but no general account
given of it. It may have been known in diff. places by 
diff. varies and it [illegible] have been known than the 
diff names meant the same disease Diseases are not
apt to appear suddenly. Still at this period, there
[illegible] cause operating for the increase of the dis.
Belly usually large and limbs small
Joints unusually large
Often morbid cravings of appetite
Yet the same causes operating in a higher degree
produce cretinism
There is no difficulty in recognizing the disease
You will be struck at first sight with the large size of the
head the blue [veins] of the forehead paleness of countenance as you cast your eyes
down you will notice the large joints


158
Ricketts
This disease according to Underwood was first noticed
in England in the year 1628. It is said to have immediately 
succeeded the increase of manufactures, when people left the villages
to settle in large towns, where they wanted exercise and a
pure atmosphere
Children are rarely attacked with this disease
earlier than the sixth month and not usually until after
that period. The symptoms are soft flesh muscles & cell. sub. relaxed general relaxation 
of the system paleness of the countenance unless the face
is flushed with fever, which when it exists is of the hectic kind a fever of irritation
pulse, usually quick and feeble,
tumefaction of the abdomen appetite and digestion bad tendency to acidity
veins of the head [illegible] and blue the sutures of the head not firmly closed head large fontanells unusually 
open joints large in bad cases all the bones of the system enlarged & softened
One effect of the disease is that the teeth are cut later than 
usual. Ricketty children are usually precocious in 
intellect. Their mental faculties are developped more early 
but are not capable however of so much improvement, as
those of others. Evolution of the mental faculties does not
proceed with the tardy progress of the assimilating function 
The child learns to [illegible] very early and exhibits an acuteness
of intellect beyond his years with the exception however of those
cases so severe as to have a tendency to cretinism It is a common 
saying that very forward children are not likely to live long
and the precocity of scrofulous & rickety children may have contributed
much to the production of this impression.


Too much heat may produce an indirect
debility
Undoubtedly aff. the brain & nervous system
Give mercurials occasionally Do not produce salivation
and do debilitate by mercury
Frictions are very efficacious exciting the skin
The reasons why friction are not more successful is that they are not perservered 
[illegible] the al. can. etc.
The cold bath is the only strengthening remedy which 
acts suddenly
No effect can be produced by any medicine
equal to the astonishing effect of exercise & amusement in many 
cases of chronic aff. of stomach & bowel.


159
The causes of this disease as in some instances a predisposition
transmitted from debilitated parents sometimes
a syphilitic taint of the parents In others bad nursing
the children being kept wet and dirty and confined in 
close & damp apartments or if the child has been carefully 
fed and kept clean debility produced by confined air
too great warmth, too great variety of food and as some think
too much saccharine matter in its diet. Inanition may be
a cause. The disease prevails among the Alps
and is perhaps there caused by the combined influence of 
cold and moisture
This is a disease of debility nearly allied to 
scrofula & cretinism affecting the viscera of the abdomen generally, the
lymphatics and the [isseous] system. The chylopoietic viscera
are probably first and afterwards the mesenteric & lymphatic glands generally 
the indications are to give tone to the system 
and excite healthy secretions
The diet should be dry and nutritious
and such as is not only easy of digestion but rather stimulating
and the bowels kept open by cathartics which act on the
secretions. A dose of calomel with a little ipecac will 
be useful. The cold bath should be used every day Take the child out of bed in themorning bathe & return. If the
Cold bath of salt water is [illegible] tonic
patient be very feeble it should be begun with at of a temperature 
of about 80 [degrees] and gradually used colder
The child bath is equal to all other remedies It is more tonic if made of salt water 
As a substitute for exercise, frictions will be very useful
But exercise in the open air should be like whenever the
weather is good in a carriage or on horseback and exercise
should be so managed as to afford amusement and mental 



The [guephalin] [polyapt] & also the gr. marg.
(which is less odorous) are also used Their agreeable odor
if there is no other advantage will prove grateful
stimulus & promote healthy secretions
Take the child out of bed and plunge him
in water (about 70 at first) and replace him in bed
Yet in exhaustion of fever the cold bath
gives a shock from which the system will not react but
yet in the debility the cold bath is highly beneficial whether
we can explain it or not.
It may be necessary to vary the tonic And 
it is desirable to have a variety of tonics to [chorea] from 
also carb iron & tinct. carb. iron ac. fer. alkaline solut
The sulph. zinc is not inferior to iron and is not subject
to the inconveniences of iron not producing inconveniences Mosely’s sol.
The compd tinct vitr. although apparently [illegible] is yet
certain in operation and has been long used in this vicinity
A tinct. of potash is thought very useful to 
rub the body with. It is a popular remedy & has sustained
its reputation in this neighborhood for many years
Lime water made of caustic lime is more tonic
than the carbonate That made of shells is thought better being
pleasanter than that made for stores probably not as pure
but containing muriate of lime. Be careful to see that the
shells are thoroughly burnt so as to fall in powder when 


160
stimulus by the sight of scenery vegetations, flowers etrc. The patient
may even be benefitted by being carried in the arms into the garden
and amused in this manner. It must not be forgotten
that this cheerful excitement has a powerful effect on the secretions.
Feather beds should be prohibited. They are too 
enervating, and hard ones should be used in their stead.
Beds made of the sweet fern (comptonia [asph??folia]) are
popular & do very well. They not only from their hardness
check the profuse perspiration of the hectic diathesis, but correct
the acid smell of the sweat which is very common. IN general 
heat should be avoided as too relaxing
I have rarely failed of curing the disease by 
the cold bath as the principal remedy, using tonics however as
occasion may require. The tonics which we may use are sulphates 
Phosp. & mur [illegible] 3-10 grs
of zinc & of iron muriate of iron martial flowers of iron
etc. and the plan has been tried of applying finely powdered bark eternally in a 
quilted jacket of flannel. It is difficult to give bark in substance to small children. Astringents may be indicated & 
there is often a degree of acidity so great as to indicate a free use
of absorbents
The alkalies as pearlash may be beneficial internally
& frictions with pearlash & water zfs to a pint may be recommended.
Of late iodine has been given in doses of from 
2 to 4 drops of the alcoholic tincture 3 or 4 times a day, given
mucilage or other convenient vehicle. This article when persevered
in has cured a great many cases. It should be [given] at first
in small doses & the quantity be gradually increased or 
a disgust towards it may be created


Phosphate of [illegible] was popular
Forgetting that the deficiency of [osseous]
matter may be defect in the action of the secretions
Though the theory was wrong yet the practice
was found beneficial absorbents
Give a solution of the acid of about the strength
of lemonade The phosporus is preferred to the phosphoric
quenches in the water you will then have, not as is
too commonly the case merely smoky water but lime 
water of full strength These preparations are called
tonics by Good called stimulants (too loose as use of the
word) Long before I had any explanation in [illegible]
I thought I observed that these articles created a susceptibility
to the operation of tonics apparently as generating excitability


161
It has been supposed that the proximate cause of this disease
is a deficiency of phosphate of lime with bones but 
this is an effect, caused by want of action as those vessels which 
secrete this substance. The proximate cause, as it is called, is in 
this case the disease itself. In consequence of this notion 
burnt bones have been much prescribed. They are probably 
useful not as supplying the matter of bone but as an 
absorbent & perhaps as a tonic
Acids especially the phosphoric have
been given. Phosphate of lime has been used with benefit
muriate of [illegible] and barytes were
formerly much prescribed.
The worst cases are those of children
born of syphilitic parents for these tonics mercurials and 
the cold bath will also be the treatment.
I give them corr. subl. 1/30 gr with
no injurious effect


Nearly allied to ricketts and often as sequel
of it ricketts often running into it Sometimes appears
with ricketts sometimes afterward Ricketts occur with 
the year. Scrofula occurs later. Ricketts children
are more generally of a scrofulous temperament
The tendency may exist in the parents and yet
be developed only in the children from the causes of 
bad food [illegible] pain etc.
These swellings may continue
in children of 5 or 6 [illegible] or within the year with little or
no change but increasing of size in spite of poultices filling the whole neck
I have found poultices apparently injurious promoting the
relaxation but blisters would stimulate and bring on 
a suppuration. The pus will not be healthy but curdy 
and whey like The edges will be ragged, not unite
readily, and will leave a bad scar. Scrofula,
ulcers are said to be distinguished by a smooth overlapping
margin. the disease may continue for months
and years with little or no change of it does not attack
a part essential to life as the lungs, producing tubercular
consumption attacking the liver producing a peculiar
atonic infl.
I have seen cases of scrofula that were [entonic]
They were injured by tonics and benefitted by cal. and ant. They 
would have borne bleeding



162
Scrofula
This is a disease of the lymphatics and affects persons of a peculiar
temperament this temperament is characterized by a fair, thin, translucent
skin, light hair, blue eyes, sometimes black hair and eyes delicate 
fullness of lips & nostrils usually texture of skin and cellular substance general laxity of
muscular fibre usually delicate organization mental faculties 
developed early on in ricketts. Person who have been affected with ricketts
in infancy are after affected with scrofula in after life.
This peculiarity of constitution, when a morbid action 
is superadded, gives rise to the following symptoms
First small swellings appear about the neck, slow in their 
progress & with an imperfect suppuration. Small holes
form in the swelling and discharge a subpurulent,
watery and flocculent fluid. These scrofulus 
ulcers when fully formed are distinguished by smooth spongy 
and overlapping margins & by very lax granulations. The disease forms tubercles upon the lungs, liver
kidnies & ovaria & causes a great enlargement of the mesenteric
glands
This morbid condition and action may 
be transmitted from parents to children. It prevails especially in cold and variable climates exists most in 
large manufacturing towns where it is caused by bad food
and air, want of cleanliness all of them debilitating causes
It is sometimes also in persons predisposed, a sequel of other
diseases particularly of small pox, hooping cough & measles
Treatment. more may be accomplished in 
the treatment of scrofula by diet, exercise, sea air etc. than
by remedies. Scrofulous swellings should be treated by 



Avoid cold vegetables & watery diet give animal 
food articles containing nitrogen as infants are said to 
abound more in albumen and adults to be [illegible]
“Iron zinc copper silver tonics & antispas. are useful”
“Conium 2, 3, 4 grs with carb. fer. 10-20 grs”
# “I have used with advantage mur. lime 3-4 drops increased 
to a tablespoonful & also mur. [illegible] 3-30 drops given
in milk & water or in coffee. They are tonic & act on the lymph. & gland. syst.”
Articles containing [illegible]
In [anthelmint???] vesicular [illegible]
F. idealis ([illegible]) (sea cabbage) has been given for worms and
some families learn their children to cut it
A mucilage may be made F [vesiculosis]
[illegible] which with bran has constituted a popular poultice
for scrofulous tumours
When there is loss of tone & an ill conditioned discharge 
cantharides with opium is a valuable excitant
Never continue any remedy after it debilitates
by exciting disgust and nausea
Mercurial plaister of the shops (gum ammoniac 
& blue ointment equal parts) has been much used 
especially for scrof. [swell.] of the joints In these [illegible]
become extensively effective and become spongy
A man at the westward was very celebrated for 
curing scrofula. He used wild violets but was not particular
as to which species he used



163
blistering van Heuvel’s child a round of remedies had been tried [illegible]
Occasional purging with calomel and rhubarb
and ipecac in a pill will be useful
Preparation of iron, carbonate of iron with conium etc.
muriate of [illegible] 3 drops or 6 and barytes in [illegible] you give a teaspoonful iodine
scrophularia mar. [Cistus] Canadensis uva ursi
Mr Daggett Havanna Dublin Eliza Collis
Vide p. 209
Iron no prep. perhaps are better than myrrh
mixture or Jenkins’ pills (carb. per. [illegible] camph.)
“Bark & quinine”
Different preparations of [illegible] & barytes # Now
superseded by iodine. I have seen more powerful
affects produced by 4 dr. tinct. iod. persevered 
in a long “5 to 20 gtts within the year 2-3 gtts ter in die”
Various vegetable articles I think very highly 
Rock rose or Cistus Can. (Helia [illegible] [pity] it is changed)
Some years since a person went to Long Island to be cured
of scrofula to a family famous for curing scrofula returned much benefitted should his remedies
they [illegible] [illegible] & [illegible] always used than 
afterwards, when [illegible]
[illegible] from Havan. neck filled up 
cured by [illegible] had been salivated W. I. without benefit
Eliza Collis scrofulous cough much [illegible]
cured by [cistis] vide p. 209.
Scroph. maril. has been popular has been
much used by empirics I have seen it sold at a great price 
brought from the west a very common plant It has been 
celebrated for accelerating parturition probably with out foundation
The article has probably little or no power. Yet it is advantageous
to know such articles in order to [illegible] [illegible]



Two entirely different diseases but are classed
together and may be treated together
“H. externus is correctly named hydrocephalus”
“No fever ordinarily attends. The disease
consists in loss of town in the absorbents”
Of late iodine has been recommended 
[illegible] two years since I was called to a patient with 
had enormously distended [illegible] [upon] gr. cal. & 
2 drops tinct. iod. [illegible] recovered
Tinct. canth. Face pale and bloated child sleepy and [illegible]
I know one child who recovered, but at at the ages of 5 or 6 years died of H. 
internus. If the patient recovers he is more liable to the acute disease
afterwards. Puncturing the membrane has been tried with success,
and the application of bandages then supporting the 
child. It is said that puncturing of the pressure
has [illegible]



164
Hydrocephalus
Divided into two species externus and internus
In H. externus the water is formed between the membranes
of the brain (between the brain and its membranes?) In H.
internus it is in the ventricles of the brain
H. externus make its appearance at birth
and is usually born with the child. # In its ordinary form
it is fatal (It is almost always fatal when it makes its appearance
immediately after birth and always so if born 
with the child)
Stimulating and discutient applications
to the head have been recommended. Epispastics are 
said to be serviceable. (Blisters have been found serviceable
they should be kept up for a length of time) Mild mercurials
cal. or blue pill & the muriate of lime or sometimes [illegible] pressure by bandaging . If
the disease is accompanied by rickets the cold bath 
is indicated and has been found serviceable
I have known one child recover from 
this disease and other who has been mending under
medical treatment for 2 years past. I do not know whether it recovered
# H. externus appears to be nearly allied
to those watery tumours which affect the spine.
In consequence of a partial opening of the sutures of the
cranium, or the absence of a portion of one of the
bones the dura mater and scalp are protruded by the
pressure of the contained water & form a swelling on the
outside of the head. Puncturing this tumour is suddenly 
fatal (is as fatal as the same operation performed on the tumor
of the spine.


Arachnoid inflammation, arachnitis, apoplexia hydrocephalica 
(Cullen) encephalitis phrenicula of Rush
cephalitis profundu of Good We might multiply 
[illegible] but perhaps this is sufficient
The disease different in different cases
A great deal has been written and great deal
of confusion exists
“In this species of hydrocephalus the effusion 
of serum is into the ventricles of the brain. This
serous effusion is the effect of the disease and not the
disease itself & hence it may follow diseases of
various kinds. I consider the name very improper”
# “The vomiting if it cannot be ascribed to improper 
food in the stomach is an important symptom in 
the diagnosis”



165
Hydrocephalus Internus acutus
Under this unfortunate name I propose to treat of all
those cephalic diseases which are less violent in their action
than phrenitis (or are less inflammatory). I shall 
principally confine myself to the disease as it appears 
in children
“Symptoms different in different cases”
The disease commences with the following
symptoms (one form of the disease is well described by Dr
Quin) vide [illegible] vol 2 p. 315 The patient is languid inactive and drowsy 
more or less feverish at times apparently free from any 
complaint (drowsy & peevish at intervals easy and
apparently free from any complaint) The appetite is
poor and irregular (week) & (Nausea &) in many 
cases vomiting # occurs once or twice a day. The skin
“Exacerbation towards [illegible]” 
is generally hot and dry (towards evening) and if a perspiration 
occurs it is partial. Soon after these symptoms. The 
patient is troubled with a headach. The seat of the pain 
varies in different cases, sometimes it is confined to one
side of the head (Soon after these symptoms commence
the patient is affected with a sharp headach either 
in the fore part or crown) It is a common observation 
that the headache alternates with the affection of the 
stomach, the vomiting being less troublesome when the pain 
in the head is most violent. The pain occasionally 
attacks other parts of the body (& sometimes principally confined
to the back of the neck and the space between the scapulae)
At this period the patient is averse to the light, cries
much & sleeps little While asleep the patient shows 



# “The tongue is commonly clean & in this respect this
aff. differs from remittent bilious fever, in which the vomiting
& febricula are attended with a yellow fur upon the 
tongue”
One side of the face body one arm or one leg more affected or moved often is perhaps
a severe a pathogen sump. as any other. This is an
indication of paralysis I have known [illegible]
patient recover from paralysis 


166
signs of uneasiness grating grinding the teeth. starting
and screaming in sleep as if terrified. The bowels are usually 
constipated though sometimes relaxed. The pulse in this early 
stage does not indicate much danger (These symptoms 
however are subject to great variations). These symptoms
are succeeded by affections of the eyes. One eye is turned
in ward to the nose its pupil is dilated The pupil contracted in this early & dilated in the latter stages. Sometimes both
eyes at the same time are affected in this way both turned
inwards & both pupils dilated. In this stage the 
vomiting becomes more constant and the headache
more excruciating, the pulse is frequent and the breathing
quick. # If these symptoms supervene to typhus fever,
the pulse becomes more slow Exacerbations of fever
take place towards evening. There is often a flush upon 
one cheek (flushing is usually confined to one cheek)
Perspiration if it appears is usually confined to the
head and chest. A discharge of blood from the nose
at this time relieves the symptoms of fever (& removes the
flush from the cheek) for a time & any favorable symptoms. Delirium often takes
place at this time and is violent in proportion to the age 
of the patient All this time the disease is undergoing a change. As the disease advances the pulse becomes
more slow and unequal & the patient becomes 
less sensible to (the pain in the head) his sufferings 
Lethargy succeeds the disturbed sleep and restlessness
of the early part of the disease. The strabismus and
dilatation of the pupils increase & the eye loses its sensibility
Loss of vision (The patient after sleeps with one or both eyes half
closed) The patient in this stage often takes medicine & 


# “Even in this stage patients have been cured
by the strong impression on the system made by tartar em.
pushed so far as to produce colic” vide infra
Sometimes when hemiplegia takes place the 
disease puts on a chronic form
In the


167
sometimes food will sometimes however
he obstinately refuses to take any thing. The bowels for
the most part continue costive. #
To these symptoms succeed a quick small
pulse (almost imperceptible) bad symptoms in 
the last stage sure forerunners of a speedy dissolution 
(a difficulty of breathing in many cases the flushing of the
face is succeeded by extreme paleness sometimes in this 
stage petechial eruptions appear on various parts of the
body & the patient dies in convulsions or sometimes a hemiplegia
takes place two or three days before death
The disease sometimes runs through its stage in 4 or 5 days
at other times it requires as many weeks. The dilatation 
of the pupils in some cases does not take place until 
the last stages & perhaps sometimes not at all. In 
all cases the proper treatment should have been 
pursued before strabismus, blindness or coma
takes place, because very little is to be done afterwards.
A constant rolling of the head & moving one
arm and one leg are among the most important 
early symptoms which indicate a dangerous affection
of the brain)
The disease sometimes puts on the form
of an intermittent. When the disease has terminated
in effusion the case is probably always fatal.


much dissatisfaction after
existed When an ordinary fever terminated in hydrocephalus 
thinking that the phys. was mistaken at first
“I think this disease is rarely an idiopathic
affection. It supervenes upon other diseases & generally 
depends on disease of the stomach & bowels”
The disease when from ext. violence may 
exist without any [pathognomic] symptom


168
Causes external violence teething worms
Other fevers forming a crisis by effusion into the ventricles 
of the brain. Typh. fev. & dysent. in children terminate in [illegible]
I have known more than one instance in which it followed [illegible] of hip joiont
This is very rarely an idiopathic affection 
unless it may be considered so when it arises from external
violence Vide L. J Pringle on dis. of [illegible] When it does arise from external violence
it rarely puts on the same symptoms or the same appearances 
after death
All the diseases of children from infancy are
liable to terminate by hydrocephalus & hence it is important
to examine all the symptoms which may indicate
a determination to the brain & check the tendency
if possible
Case A girl 14 years of age, had symptoms
of affection of the brain from a fall upon the occiput she complained
of pain in her head for two or three months before she died 
& occasionally had regular epileptic fits [illegible] [mouth] The pain 
the head was relieved by cupping and epispastics to 
the head, but she finally died in an epileptic fit
On dissection the dura mater under the cranium, where 
the injury had been received was thickened and the vessels
were injected with blood. The ventricles contained half a
pint of water. Dropsy in the brain Yet the
pat. had no dilatation of pupils etc. The dis. put
on the appearance of epilepsy occurring once a month.


More common in some families than 
in others 


169
Causes. Hydrocephalus is a disease nearly allied to with scrofula
& like that seems to run in families. Delicate children
in whom the mental faculties are more early developed
are more subject to it. Hence the common observation 
that the child is [illegible] forward that it will not live
long I think persons of a scrofulous habit 
are more subject to this disease & that of the hip joint
When there has been no local injury to the brain, the
disease commences with affection of the bowels, or it is a 
sympathetic affection from disease of the bowels
In the progress of bowel complaints in children, the
[illegible] and the small veins become turgid. This enlargement
of the vessels seems to invite the blood to that 
part. In consequence of this child may die
with symptoms of hydrocephalus, from the turgescence
of the vessels, without any effusion into the ventricles
In typhus fever, in dysentery and in
other bowel complaints of children it is not uncommon 
for children to die with symptoms of hydrocephalus


It is a good symptom in hydro. to have a 
discharge from the [sch??der???] membrane


170
Diagnosis “In its early stage, this disease is scarcely 
to be distinguished from remitting fever When 
from the anxiety of relatives & of the physician, a
diagnosis is eagerly desired, the following circumstances
may perhaps assist in forming a judgment
If there is occasional vomiting, with febricula
the tongue at the same time remaining [illegible], there is
reason to apprehend that the primary irritation has
its seat in the brain and that it will prove a fatal
case of hydrocephalus. But if along with the fever 
and vomiting the tongue is covered with a thick
yellow fur, we may hope that the complaint is confined
to the digestive organs and that the disease is
nothing more than coler or remittent fever.”
Ed.reviewer
Diagnostic symptoms between idiopathic
arachnitis or cerebral fever, and infantile remittent
or fever from intestinal irritation choler
In cerebral fever the abdomen is
flattened, not tumefied but in intestinal fever it 
is tumefied. In idiopathic cerebral fever 
the secretions of saliva and that form the schneideran membrane are diminished. Unless complicated with aff. of muc. m. which is rare. In cerebral
fever the tip and edges of the tongue are red 
In intestinal covered with a thick fur. In cerebral
fever the pain in the head is severe and excruciating; 
in fever from intestinal irritation it is obtuse.


# the sides of the head, back of the head on 
the forehead
Perhaps a constant rolling of the head & 
movement of an arm & leg are among the most important
symptoms
Different opinion ben entertained
about the nature of the disease Some 
have been so anxious about determining the exact
nosological nature of it disease as to refrain
from prescribing until the first stage has gone
by. Prescribe for the symptoms at all events
and make up your mind about the nature of the
affection as fast as you can. Too much discrimination 
cannot be exercised & cultivated yet where 
we cannot determine the exact nature of the disease
we had better treat the existing symptoms & the obvious 
indications
# It varies in scrofulous constit. there is 
no such state It may approximate in some cases
And I might cite the opinion of 20 others
The [illegible] it is sometimes entonic & sometimes 
tonic. It more frequently [illegible] determined 
Why shd not fevers terminate in the brain as well as [illegible]


171
In intestinal fever the patient more frequently directs 
his hand to the nose & about the face in cerebral puts his hand to his head # 
In cerebral affections the head is hotter than the abdomen;
but if the disease originates from the bowels
the abdomen is the hottest. “There in a very few cases seen
picking at the nose in cerebral fever but in general the rule
holds good” “The state of the bowels is not pathognomic”
Dr Beddoes thinks the disease belongs to 
inflammations & that at an early period he should be
inclined to bleed as largely as in pneumonia #
Dr Withering observes “in a great many 
cases if not in all, congestion or slight inflammation are
the precursors of aqueous accumulation
Dr Rush thinks that instead of being 
considered an idiopathic dropsy, it should be regarded 
only as an affect of primary inflammation or congestion
of the brain
“Dr Rush says” It appears that the disease in its first
stage is the effect of causes which produce a less degree of 
that inflammation which constitutes phrenitis & that its
second stage is a less degree of that effusion which produces
serous apoplexy of the brain
Dr Darwin supposes torpor or inactivity
of the absorbent vessels of the brain to be the cause of 
H. internus
Dr Whytt in his treatise on the disease
observes that this and every kind of dropsy depends
upon the fact that more fluids are thrown out by the exhalants
than [illegible] the absorbents take up



I chiefly depend upon calomel for a cure if it cause
too much evacuation check it with opium
There is no evacuation from the brain therefore
the disease must be overcome by altering the secretions
counterirritation etc.
Bleeding with leeches from the temples
seems to translate to the surface and give relief vide
John Hunter.
Case young man apparently as
desperate a cure as ever I saw not scrofulous we
concluded to try tart. emet. gave it without
much weight in about 8 or 16 hours he complained
of violent pain ion the bowels and all the
symptoms of the head were relieved
[illegible] “Irritant to the schneiderian
membrane in the last stages are recommended
by Dr Malachi Foote of N. Y. in the Med. Rep. 
for about 1810. Turpenth min. 1 gr. with liquorice 20 grs 
[apreynum] [myrici] ipecac etc. are the best [stermentatories]” 



172
Treatment Evacuants Bleeding general & local
cathartics calomel and jalap gamboge
Counterirritation local bleeding cupping epispastics
behind the ears and to the whole surface of the head
Salivation should be induced but cal. often
relieves without altering the secretions
There has been a difference of opinion as to 
the application of epispastics to the head. If venesection 
be indicated they should not be applied until after 
bleeding. I prefer cupping and blisters to the back
of the neck and behind the ears
I think some advantage may be derived from applying
to the spine ol. orig. ol. capsc. etc.
Where considerable entonic action has existed 
I have cured this disease by giving tartar emetic until 
colic was produced. give perhaps a grain 
& continue its exhibition until the symptoms abate #
“gr doses every 2 or 3 hours”
Sneiderian membrane dry snuff
malachi root Irritants applied to the schneiderian
membrane have cured the disease in its last stages
Rx 1 part turpenth mineral & 10 parts powdered liquorice 
for a [ster??tatory]
Green tea is sometimes given



In the progress of the bowel complaints of
children the sinuses may become enlarged & a determination 
of blood [illegible] to the brain and 
produce symptoms of hydr. I have known
pat. apparently die of hyd. & yet upon dissection
no water be found in the [ventricles] in this
case some say that the water was absorbed in death 
this is entirely improbably. Certainly many of
the symptoms of hydr may be prod. by other
causes e.g. excessive doses of narcotics is stramonium
belladonna
It shd be remarked that many 
cases supposed to terminate in hydr. in cases
of [termination] in volvulus
“All the diseases of children are peculiarly 
liable to terminate in hydrocephalus. Hence
the importance of caution on the part of the 
physician. He should examine all the symptoms to check
the first beginning of determination of diseases
action to the head V.S. keep the bowels open 
blisters behind the ears cupping leeches”


173
Hydrocephalus from bowel complaints
If in the progress of any of the bowel complaints of children
morbid action should be determined to the brain, Epispastics
should be applied behind the ears and irritants to the feet
Cathartics are useful to obviate this determination. #
In some cases perhaps the determination 
[marise] from nervous irritation. In such cases the 
tepid bath gives relief “Strong green tea” Some
physicians of respectability have in formed one that they have used digitalis
in hydrocephalus with very good success. I have not used
it myself but should consider more adapted for that
form of the disease which arises from irritation, than 
any other
Hydrocephalus from disease of hip joint.
Child of Ezra Hotchkiss child of Horace Edwards.
“I have known hyd. alternate with disease of hip 
joint Case Narcotics etc. till suppuration”
Afterwards died of hydrocephalus
# I have cured a patient by giving him calomel and lemon 
juice in sufficient quantity to move the bowels. It increases the
secretions and improves the tone of the bowels


“I have seen a case in which the child
fell 8 or 10 feet upon a pavement & broke his skull
like a squash shell yet he recovered in 2 weeks and
did well. When the fracture is so extensive there is 
less danger of compression of the brain” The same case?
Hyd. from injury by a fall is not common 
in young children the sutures are not firmly 
closed (the bones are softer & more yielding)(
# He had other severe wounds as a compd
fract. of the radius yet he never suffered 
his head


174
When the disease is produced by violence
Depressions of the cranium in children
from blows or falls are not of course fatal though dangerous. A child
four months old fell head foremost upon the hearth striking
upon the vertex. The head was much flattened & the
parietal bones bulged out on each side. The child did 
not suffer much from the injury. The bowels were kept open 
by mild mercurial purgatives. In these the head assumed
very nearly its natural shape. A boy of eight years fell 
six or eight feet and struck his head against a stone
A depression of the cranium was made larger than the bowl
of a spoon. He suffered very little inconvenience from 
the injury #
There is less danger when the skull is so 
much fractured as not to cause pressure upon the brain 
If a child has received a fall we may apprehend
danger from the following circumstances. If the
fall has been upon the occiput the brain is more commonly 
injured than if the face is upon the os frontis. If the child
vomits after the fall and is very sleepy there is danger that
the brain will suffer.
Treatment If the child vomits or is
comatose after the fall upon the head and there is no
wound that bleeds the patient should lose blood and
take a dose of calomel, one or both according to the urgency
of the symptoms & the death of the patient. All the exciting causes of fever should
be avoided and the patient kept as quiet as maybe.
The symptoms should be carefully watched and if at
anytime there should appear to be a tendency to an affectation 


# for local bleeding is as important a general
bleeding
“[illegible] all causes of irritation, as light noise
heat, food. Keep the pat. perfectly quiet”
“Apply an epispastic behind the ear, or
better upon the injured part.” “Blisters are very 
useful” “Use counterirritation & the tepid bath”
# In torpor of the br. [illegible] al. can excite the latter
may excite the former and excessive action in 
the former may be translated by it act on the 
latter “Give strong cath. cal. gamboge jalap etc.”
“Afterwards give cal. in small doses as an
alterative If it causes too much evacuation check
it with opium”
“In N. Haven we have followed 
Abernethy’s plan of treating infl. of brain for 
40 years”



175
of the brain the patient ought to be bled & leeches or cupped. #
The bowels should be opened with calomel and small doses
of the same remedy frequently given as an alterative
After depletion epispastics may be applied behind the
ears and upon the part of the head where the injury 
was received. 
There is no outlet to the brain & 
consequently more evacuants are needed than in most diseases 
Frequent cathartics are useful as evacuants and 
also to translate action from the brain # 
When effusion has taken place the 
case is probably always fatal Yet I have had 
a pat. with dil. of pupils, who cont. so & paralytic
for months & finally recover
Vide p. 200


The treatment consists of local applications
A variety are used One of the best is [illegible] zii alc. zi
An equally good or a better application is seneka oil but the
smell is disagreeable. Cold water is applied but
though it relieves the pain and the insupportable itching
it is doubtful whether it is of any permanent benefit
Basilicon [illegible] [illegible]
absorbents to ulcers


176
Chilblains Pernio
This is a local affection to which children and old people
are most subject. Some are much more liable than
others. [illegible] [illegible] more liable. The parts affected are the toes heels fingers, hands
face, ears and with ladies who wear short sleeves
in winter. It is caused by exposure to extreme cold & to cold & damp air
& on the feet, more especially by walking through 
melting snow. It is most common in the early part of winter
This affection should be prevented by avoiding
an exposure of the parts to the air, by keeping the hands
warm with soft leather gloves & by keeping the feet warm 
with stockings and shoes
The skin of the part affected becomes tumefied
and hard & of a deep purple colour, there is a 
pungent pain in the part accompanied with an insupportable
itching; & these are often so great as to prevent the patient from 
sleeping. If the disease advances, the cuticle breaks and
discharges a thin fluid. Sometimes a deep ulcer is formed
The treatment for the first stage should consist
of stimulating application as if for a burn. I prefer oil of origanum
alcohol & seneca oil are good applications. Spirits of 
turpentine will ordinarily do well, though in some idiosyncrasies
it acts as a poison. Cologne water may be 
applied or alcohol two parts with one of ol. orig. #
For the ulcers you may use the oxygenated
ointment ointment of red precip. citrine oint.
# or apply a plaister Dyachylon or Noel’s 


Not being able to have any fire on board
for some days
[illegible] to pain of a neuralgic kind as [illegible] were a toothache
One of the best applications is a cataplasm of stramonium
seeds give internally opium narcotics & 
stimulants
Apply [illegible] & narcotics
Followed by no infl. to supp. etc.



177
Painful affection from cold
We sometimes meet with a painful affection of the feet 
without discoloration, or any other visible mark, which 
has been brought on by long exposure to cold without
freezing. Sailors coming upon our coast from the I. in winter, from 
a warmer climate are liable to it.  The affection may 
be a very painful one and give great uneasiness both
night and day
It is relieved by the external application 
of stramonium & epispastics or rubefacients, and fomentations
Cathartics and opium may also be given internally.
Singular effect of cold in Wm Daggett 


Burns are dangerous in proportion to their extent
[illegible] young physicians are called to prescribe for
burns it is important for them to treat them in the best manner
About 30 years ago a great controversy existed in England
between those who advocated [stimulating]
In recent cases stimulating or exciting applications are 
the best provided the burn is not very deep. About 30 years since 
spts turp. were much used. It in some case and these are 
not very rare
Case myself [water] boiled over into my shoe
I immediately poured spts tupr upon the stocking then 
took off the stocking applied a cloth dipped in spts turp. put
on a dry stock. & boot rode out of town and suffered My father
was a man of florid complex. & thin skin He was burned in n
a similar manner
Ol. orig.
Linseed oil is smooth mixed with limewater
alcohol or proof spts good when the skin is [illegible] off
Others use camphor Others stramonium in ointment contain
what [illegible] when the article s off
Carrot poultices etc. exclude the air
Cotton does well except when the cuticle is off if it is
used then you had better smear it with oil


178
Burns
This subject belongs more particularly to surgery, yet as
burns occur most frequently among children, and you may 
be suddenly called in on such an occasion, when it is important
that a remedy be speedily applied. I have thought
proper to make some remarks on the subject.
For the treatment of burns very different 
modes have been recommended. A long controversy was
carried on in one of the English journals with respect to the
phlogistic or antiphlogistic treatment, one party being in 
favour of cold applications in cold water and the other of
stimulating ones as spirits of turpentine The truth seems
to be that in adults where the injury is not extensive and
the powers of life are strong cold applications do well, but 
they are dangerous for children especially if the injury is extensive.
Burns upon the abdomen will not admit
of cold application even in adults
It is necessary that reaction take place
If there be no reaction of the system, no pain, no inflammation
the child dies. The cause of its death is the irritation of 
the nervous system, extended to the stomach, & hence
the death is preceded by cold extremities and vomiting
Where cold application are proper such
applications may be made as scraped potatoes, cloths
wrung out in cold water etc. But if it is necessary 
to produce reaction and inflammatory action stimulating
remedies must be used. And we know from 
experience that these remedies do effect a speedier cure 




Cold applications may do well if immediately
e.g. dip a burnt arm immediately into cold
water. But stim. app. are better. I have tried
both. Cold applic. very dang. in extensive burns
of children Case scarped potatoes no infl. livid
appearance of the burn extrem. cold [illegible] death
In such cases apply stim. app. & give ether, elix.
[illegible] etc. etc. In these cases the child dies of irritation
not infl. It seems to be necessary for a regular [course]
of continuity of action in infl. & suppuration
The best and mildest application as has
been proved by experience is petroleum or seneca oil
In one case I tried the experiment of applying seneca
oil upon one hand & ol. orig. upon another (both being known
alike) one hand was easy the whole night the other painful 
(the burn was a very extensive from the clothes taking fire)
In the suppurating stage use 1 part seneca oil
& 3 parts cerate
These cases are very troublesome to treat
In the above case the system was exhausted by the extensive
suppuration the bowels had to be kept open & 
large quantities of opium to be given. I gave columbo
bark and various tonics and aromatics
Turner’s cerate is a good application
chalk may be sprinkled over it
In the progress of the suppuration a pale
flabby fungus almost like a blister and is difficult to 
manage I have applied a sol. nit. sil. also nit.
sil. & laudanum [illegible] cop. sometimes after these
I have succeeded with ac. op. in ointment green basilicon
i.e. verdigris ground fine & mixed with basilicon
But if you apply only applications after these caustics 


179
The reason is that we apply to the part a stimulus
less powerful than that which produced the injury
and thus render the diminution of the excessive excitement
gradual. On this principle holding the injured part near the
fire is beneficial
Another important indication in the treatment
of burns is to exclude the irritation of the external
air Hence the popularity of some applications as cotton.
sweet oil etc.
1st Of stimulating applications. Spirits of turpentine
will answer for a robust and healthy person but not
for a slender & feeble one; and it must be remembered
that from a peculiar idiosyncracy it is a poison to some 
persons. In general spirits of turpentine is liable
to cause irritation and may be suspended by better 
articles. Being burnt myself a complete cure was effected
without the least appearance of inflammation, by this article
but in the case of my father such violent irritation was
produced as to oblige him to desist from applying it
A common remedy in this town is the oil
of the origanum majorarum called burn oil
mix ol. orig. zii with ol. oliv. zi or mix it with
alcohol or cerate. Cloths may be dipped in the diluted oil
and kept constantly applied
Of late years I have used seneca oil
and prefer it to either of the two already mentioned. In 
several cases I have tried both this and the ol orig. & 
found that the seneca oil relieved more speedily & 
with less irritation. I usually apply the seneca oil & 



the fungus [illegible] Apply rather chalk or fine alabaster
or scorched flour
The sooner you apply stim. appl. the
better ol. turp. produces [illegible] etc. seneca oil
does not
Case a woman thief etc. etc.
we rolled immediately in the snow was thrown by it into a state
of syncope life almost extinguished was burnt universally 
except on the legs covered by the stockings was wrapped
in sheets dipped in a mixture of ol. orig. & 
spirits


180
then cover the part with cotton to exclude the air. I let them
remain till suppuration takes place, particularly if the skin
is broken. When suppuration takes place, apply a poultice
to the loose dressings and then apply simple cerate
or a cerate made by melting together beeswax and lard
and stirring in seneca oil while the mixture is cooling 
This last is an admirable application for burns Dr
[Mons??] said he knew none so wild. It protects the raw 
surface from the cold air and keeps in the animal heat
In the latter stages of the cure, the oxygenated ointment will 
be a soothing application
A popular remedy is stramonium, used
in the form of a plaister of the seeds or leaves. It answers 
well and I have known no ill consequences to happen from 
its use though it is said that in extensive burns it is dangerous
Cotton is a popular application, used by itself
For slight burns it will answer but if they are so
extensive that suppuration is to take place, it should
not be applied in this way
Other remedies that are useful upon the
principle of excluding the air, are the oils as sweet oil & 
lamp oil. Linseed oil mixed with one third part lime
water, is especially recommended
When suppuration takes place and 
the cicatrices do not form well, oily application should 
be laid aside and if there is considerable discharge
apply absorbents, as plaister of paris, chalk & chalk & cerate
i.e. apply chalk first & cover with cerate.


Note from Dr Woodward of Wethersfield extracted
from Dr A. Talcotts notes “Apply immediately spts turpentine
to the inflamed parts and cerate of limewater & 
linseed oil equal parts on cotton to the vesications
2nd If pain & irritation ointment of stramonium
3d To prevent fungus Rx white lead a teaspoonful
lard 2 tablespnfl. ft. ung. Orgrate or
chalk and apply simple cerate over it.
I have seen a metastasis at the end of a week to the bowels
with diarrhoea & tumefaction or the bronchia with 
croup Treat with opium & bark Dr S. B. Woodward”
N. B. I extracted this principally on account
of the definite direction about the difficult treatment
required according on the burned part is vesicated or
not a point on which the above notes of DR Ives
do not seem to be sufficiently precise


181
Should there be a fetid discharge from the burn, it may be
remedied by pulverised charcoal. Sometimes the ulcers are 
very difficult to heal and repeatedly break out afresh
A fungus may arise upon the part if so it should be touched
with caustic. The eager of the ulcers may be touched
with sulph. copper or nit. sil. chalk then applied
and the whole covered with cerate.
If the burn is on parts liable to unite in 
healing, as between the fingers and toes, care should be
taken to prevent the union. A bad cicatrix is often
formed which it is difficult to prevent or cure.
Internal Treat When the constitution has received a severe 
shock and the extremities become cold and the powers
of life being to fail, the system must be supported by 
stimulants & cordials & the excessive irritation relieved 
by opiates. Laudanum ammonia, spirits, alcohol
ether are all good. To a child from 5 to 10 years 
old 15 drops of laudanum may be given; warm-applications
may be made & warm aromatics drinks as ginger tea & 
mint water administered. Elixir paregoric is one
of the best preparations of opium in such cases
In a case in which a large quantity of
sulphuric acid had been drunk by a boy who immediately
afterward, ran to a brook
and drank of the water. I merely give mild mucilaginous 
drinks & the patient being of a strong constitution
recovered





182
Croup from p. 138
In what may seem to be the second type of patient
may go off suddenly. If he throw his head back
in order to enlarge the chest it is a bad sign
I have found the treat. by tart. ant. so 
infallible in the first stage & in general so useful that I have not been tempted
to desert it. If I am called rather late and
find ext. ant. acting locally upon the stomach, I seldom
succeed in curing the patient.
Other emetics may be used when the excitability is worm out for [illegible]
Calomel is proper in the latter stages, [illegible]
the disease is partly broke up by antimony
If the first stage is not interrupted
[illegible] the child may be playful between the paroxysms 
and though the pulse is not affected, yet the second will 
surely come on
In the second stage bleeding is to be first 
resorted to in order to prepare for emetics bleed even to fainting
conjoining the warm bath for the same etc.
Exciting and irritability [illegible] in this 
second stage do mischief. I have seen sanguinaria do much
mischief. Even after bleeding purges is not advisable
for as has been remarked there is a constant tendency 
in the system to the return of this inflammatory symptom
Cal. may be given though if it act by 
the bowels it will be useless. I have seen bleeding and the 
vapour bath palliate the symptoms. Scarcely ever
will the patient recover



183
Croup
In the latter part of the last stage the child
throws its head back. This is a dangerous symptom.
Now the patient goes into the last or suffocating
stage. The patient lies on its back struggles
violently for breath countenance livid appears apoplectic and often goes into convulsions
and in these convulsions sometimes dies
Sometimes in this stage you may hear a
flapping of the false membrane. This is sometimes
thrown up and great relief is afforded and 
the friends think that all is over. Soon however 
in most even of those cases a membrane is formed
lower down & the patient ultimately dies
In this stage the metallic emetics
have in a few cases succeeded The sulph. 
cupri & the sulph. zinc have each
cured Cal. is recommended & may be used 
The cold both has been recommended It may be tried
as a dernier resort.
In the second stage after bleeding blisters
shd be applied over the whole neck & chest
Dr Hosack recommends bleeding from 
the back of the hand immersed in warm water
After bleeding has succeeded in 
subduing the symptoms cal. & the warm bath shd be
used


184
Croup
This disease has been divided into acute & 
chronic but without much propriety
Sometimes it continues for some time. I have
known one case which continued 3 or 4 weeks
In some seasons a different mode o f
practice is better. I have known seasons in which 
cath. & diaph. were the best treatment Although
for the first 15 years of my practice I considered nothing
more unfortunate than to find the child under the 
operation of a cathartic. In these cases, it was the
form in which the duodenum is also affected in a similar manner
Case Wallingford [emet.]
failed & cal. & diaph [illegible] Others that season 
occurred which required the same treatment
Bronchotomy has been recommended
I have seen it performed but never with success
It has sometimes succeeded But in the cases 
which I saw the membrane form lower down, and 
the patient die


186
You will see by looking into the throat
the tonsils perhaps red & the epiglottis certainly inflamed



187
Angina Laryngia
Another form of the croup has been called
angina laryngia [illegible] the croup you can see nothing
by looking into the throat In this the epiglottis & 
the [illegible] glottidis are affected From the larynx 
being affected, the actions & more spasmodic
Frequently comes on while eating
Case of my child While apparently well was taken while
eating with the peculiar croup & respiration of croup 
& became alarmed & treated
This is the form which attacks old people 
probably Geo. Wash. died of it
Case The first time I saw this disease the pat. had had pneumonia & may nearly recover when he went into the cold open air
without stockings. I was informed that he was taken
with difficult respir. & without seeing him prescribed seneka injurious ultimately refused
to swallow anything as the act brought on a spasm
I tried bleeding, blisters, vapour
& after awhile persuaded him to swallow when I gave him 4 gr. tart. ant.
in a cable spoonful of water


188
Angina Laryngea
The dis. is brought on by eating
And if you examine the throat you will see a redness
perhaps upon the tonsils, and will certainly see the
epiglottis inflamed
Bronchotomy promises more in this
form of croup
Readily distinguished for the other by 
difficult deglutition paroxysms being brought
on by an attempt to swallow
This firm 
It is not of much consequence to 
distinguish the forms except that laryngea is 
more rapid And you must avoid acrids
in this form as they irritate the fauces & produce
spasmodic action
For the spasmodic symptoms give
in the latter stages of it asafoetida which also acts upon 
the secretion tinct. ant. & opium
It must be remembered that this disease
cannot be cured by bleeding alone. It is too far out
of the circulation. But by reducing the system very 


189
Croup concluded
When croup follows other diseases it is more
rapid and dangerous they are very apt to die
particularly when following ulcerated sore throat
You may treat by emetics blisters metallic
emetics etc. but you have not so much 
strength left in the system to act upon 
In the latter stage where we wish to 
throw up the membrane the stomach may lose
its excitability to a particular emetic then you are 
to change the em. I have succeeded in throwing 
up
Upon dissection a membrane is 
found formed But sometimes it is wanting and in 
A laryngea then probably is not [time] for a 
membrane to form 
Vide p. 211
low and suspending the functions you may change the secretions 
perhaps 


190


191
Scarlet Fever
Withering in his first edition separated ulcerated sore throat
from scarlet fever. In the second he changed his opinion
Where there is much heat and fullness of the
pulse I would much prefer a strong dose of cal.
followed by antimonials [to] commencing with emetics
Or is Dr Rush & the elder DR Barton thought best turpeth
mineral
Epispastics are to be used with caution
& adopted this rule viz to apply them where there
is much tumefaction [illegible] & enlargement approaching the
quinsy. Scarlet fever after resembling quinsy and
is with difficulty distinguished except from the previous
affections of the family and neighborhood
Mineral acids have been considered
specifics Chlorine was much used in this town
in [1801] etc. as a fumigator. You may give it internally 
with advantage
A great variety of gargles are
used generally stimulating ones are better as those
of capsicum (with salt say in cider water)
In some cases capsicum does not do well
If the patient is too weak to gargle use a syringe


192
Scarlet Fever
Chlorate of potash was used with advantage
to quiet the stomach. It allayed irritation etc.
Ammonia and amm. with camphor
& gum arabic
In the progress of the disease mineral emetics, 
as sulphate zinc will be useful to excite the system 
acting speedily they do not exhaust sul. zinc 5 to 20 grs 
mosely’s solution was the form most used
Sulph. copper 2 to 5 gr. also as an emetic
Acetate of copper was formerly kept as a nostrum in 
some families ½ to 1 t. sp. of sat. sol. of common verdigris
2 to 3 gr.
In some cases and seasons cath. are
required. I have treated children without a
single cath & yet in the same family I have given ant.
followed by cal. & worked off by salts and senna
If a diarrhoea occurs early it must
be attended to white decoction



193
Scarlet Fever
Dr With. lays great [illegible] upon diuretics
particularly senega giving it throughout the 
disease. In moderate fevers diuretics eliminate morbid action will
Serpentaria may be given freely throughout 
the disease adding bark alcohol ether 
or wine Diuretics & diaphoretics
Irritable state of the stomach is to be
counteracted by irritants by aromatics white decoction
etc. etc. a little alcohol upon the fauces voiding a great
bulk of liquid
Case of a boy in delirium his father 
was forcing down articles which he was puking up 
I put into his mouth spoon dipped in brandy 20 or 30 drops his eyes opened immediately 
said it was good continued it in tspfl doses through the night
saved his life
Scarlet fever occasionally passed by insensible
gradations into quinsy and is of an inflammatory 
character. No one character will distinguish them
No one mode of practice will answer in all 
cases though if any indiscriminate mode of practice is
to be followed that by emetics and stimulants will be best
In many cases no evacuations at all are to be
used if this you must judge by the symptoms
In the same family I have lately treated one or two patients
with antimonial and nitre and another who had been
worn down by fatigue and watching with feeble pulses vomiting
coldness etc. was treated by external heat, brandy in moderate


194
Scarlet Fever
quantities, counterirritants spiced tea etc. to stop the vomiting #
(One of the best articles in fevers of a low grade
is spiced tea or hot spiced wine or brandy. The strength is apt
to give out first, and an excitement kept up in the mucous
membrane of the stomach will have a beneficial effect)
# The first patients in this family I had evacuated freely
both by vom.  & purging etc. while this patient had no evacuation 
goodness & was supported throughout the whole progress 
of the disease
After I had seen the disease in 3 or 4 epidemics
I thought I had seen the disease in all its forms but I
found oftenwards that I met with different forms still 
Not only different epidemics differ, but different cases during
the same epidemic may require widely different treatment 
In the malignant epidemic of ’94 I was informed by some
physicians that they met with cases in which there was increased 
action though the many cases of the epidemic ran rapidly in the [illegible] gangrenous
state
In 1803 we generally gave emetics
It is said that in the malignant form the eruption 
is a bad symptom. I do not think so. I think it better
for a general eruption to come out the action is less unequal than 
if a scanty or no eruption appears
I hesitated in 1803 much about the application 
of blisters & I finally found that the rule was a safe and
beneficial one to apply them where there was swelling
of the tonsils
In this epidemic I gave bark, the mineral
acids, alcohol, wine, and (for the first time) tinct. canth
Tinct. cant. [illegible] zi to pt. give 20 gtts once in 2 hours ½ as much to a child


195
In many cases [illegible] requires to be qualified & corrected
by serpentaria or carb. amm. If wine injures
the stomach and [illegible] too locally continue carb. amm.
which will render it diffusible with white vinegar
will have somewhat of an effervescing mixture Use also
effervescing mixtures, as soda water, with brandy
or ether, or aromatics tincture. It is no objection that
you thus combine stimulants and refrigerants, for you 
thus get diffusible action and obviate unequal excitement.
The min. acids may be given in form of 
punch The sugar will be grateful & useful
A diarrhoea is apt to take place in the 
commencement of the disease. Use white decoction 
laudanum & injections of starch & laudanum RX
starch 3 bal. sp. SS. 30 gtts to 2 t.sp.
Pay great attention to cleanliness of the 
patient
Where there is fainting apply ammonia and ether 
& spirits at the nostrils keep them applied to the nostrils
to prevent fainting, I have never known any injury 
done by over excitement by these articles thus applied
Capsicum is used in tropical [illegible]
in very strong decoction. Salts and vinegar has been 
much used as an antiseptic gargle?
For the diarrhoea use tonics, bark,
contrayerva has been though valuable. Avoid injuring
the stomach by distention


196
A variety of garbles (or injections by a small syringe) are
used. [illegible] rosemary has been thought a specific & carried
hundreds of miles into the country Use others when pat. is disgusted
with one # 
Sulph. cop. ac. cop. nit. sil. ([touched])
apply these with a swab
What is called the leathery inflammation 
is sometimes met with. in which the skin dies at first and
afterwards comes off & then a discharge follows. This affection
sometimes extends down the throat. In such cases
apply blisters to the sternum Touch the part with
nit. sil. in such cases. IN one of these the blister on the
sternum produced an ulcer which was 3 mo. in healing
and in another though the affection with throat was relieved
the ulcer for the blister destroyed the little patient
# [illegible] oak bark etc. pomegranate combine brandy 
aromatics etc.
It might to be remembered that in the
latter stages of ulcerated sore throat where there is an
accumulation of [many] a phagedenic ulcer, 
emetics of sulph. zinc give tone
and excite action also when
Acetate copper in the latter stages
used in an emetic as a tonic or locally
applied as a caustic
When the stomach fails in the latter
stages we give capsicum in pill or strong 
infusion (2 tab. sp. to the pt makes a strong infusion give 
to an adult a tablespoonful also acrid oils
There seems to be an erythematic infl. of the mucous


197
membrane of the stomach hence acrids are indicated to excite action
Bark jacket also it seems to 
have some effect
In the latter stages also a cath. will
frequently be beneficial an accumulation
of feces may exist given mild cath. as castor
oil or perhaps a dose of cal. an
emetic also may be needed
One thing to be guarded against
in young children is the supervention of dropsy
In 1803 I had 3 cases all the writers
considered the disease as one of weak [illegible]
action and requiring tonics bark etc. Not
successful Bark does not generally do well when there
is unequal action
I have known in such cases the brain
& nervous system apparently much affected I have
given in such cases digitalis and cantharides to
produce as new excitement and ally this irritation in 
the nervous system
Case related patient very low from a disease digitalis
was given and elaterium being advised was given
when the patient died upon the second evacuation
In general treat these cases with diuretics 
a moderate use of cath. narcotics & remedies
etc. Digitalis is the best narcotic but be cautious 
giving it to children
In ordinary cases of such dropsy 
a cath. will remove it and frictions & exercise 
in the open air. Various articles are popular as ol. [mor]


[199]
[illegible] ol. gaultheria various irritants etc. and to 
encourage the attendants to persevere in rubbing
you may suffer friction to be made with these mere
dry friction though probably just as good does
not seem to them like giving medicine
Various astringents may be 


200
Hydrocephalus
The management of the pat. is equally important with
the medication avoiding in proper diet alternatives
of temperature, and all debilitating irritating and exciting
agents all the exciting causes of disaster. Sometimes
a patient may (after a fall perhaps) continue one
two or 3 years not entirely [illegible] and yet not quite sick
and finally die of eff. of the brain
Sometimes in strumous habits canth. internally 
may be advantageous
Blisters translate action 
The applications of remedies to the 
Schneiderian has been thoroughly treated by Dr Malachi
[Foot] in the N.Y. Rep. about 20 years ago.
The subject has not bee sufficiently attended to Give in 
the way turpenth wine (mixed with liquorice) verat.
vir. apreyn. [illegible] myrica cerifera etc.
If a discharge can be excited relief is afforded
Salivation can rarely be produced in children
In some cases where there is paralysis
the acrids and some of the narcotics as strychnos
Blisters are applied by some to extreme
parts of the body I sometimes change the place of
the blister to the back of the neck etc. But the back of 



201
ears is more efficacious. It seems to have a grater
affect upon the constitution to excite a discharge from 
this part
If the symptoms indicate bleeding
bleed leech also. If there is much infl. about the
mouth scarify the gums as a depleting measure
“In grade of action the fever of hydroceph
may vary from high entonic inflammation or phrenitis
to low strumous fever. If the action is too high or too
low counterirritation will fall in with the morbid
action We must first bring it to the “blistering point” 
(Rush)
“Blisters to the head are thought by some to be 
dangerous and the ears or neck preferred”
“In irritable cases and scrofulous habits, strong
cathartics are hurtful. Give blue pill especially when 
the bowels are primarily affected. But in entonic
phrenetic fever, use the drastic cath. & tart. ant.
ut supra after depletion”
“Scrophulous predisposed mesenteria
glands generally affected the fever analogous to hectic
never entonic pulse soft, frequent, quick I have
tinct. cantharides with advantage in this variety”




[204]
Volvulus continued from p. 89:a:1/2
“Cases I was called to a child 2 years old which 
had symptoms of irritation and was obstinately constipated
It had been carried on the belly upon the shoulders
of another person Gave a cathartic Ordered an
injection but the attendant said it would not [illegible]
The cathartic was thrown up patient died
Upon examination after death no color could be
found. In the upper [illegible] rectum there was a tumor
which seemed of solid flesh as large as the doubled fist
inflamed. The color had been completely removed from 
its place”
“I was called to another family 
where the children had died when 5 or 6 months old as was supposed
of an affection of the brain. This child appeared well when born
but was very costive etc. Upon p.m. [illegible] 2 inches of the
small intestine were found contracted
to the size of a goose quill the coats were thickened & 
the course the cavity must have been extremely small This
contraction undoubtedly existed at birth. This contracted
part was received into the part below it, and no
[illegible] could have availed”
from p. 99 ½ “In another family they 
had lost all their children at about such an age. They 
supposed the disease to be hydrocephalus. The older physicians
called it so. I told them I could not tell what 
the disease was but it was not hydrocephalus I had
then seen no case of volvulus. There were strong 


205
marks of irritation the face was pale and much distress
was depicted with countenance the head was rolled
back and hands tossed violently. There was vomiting and
tenesmus and a discharge of mucus streaked with blood
Cathartics had been given under the impression that the disease 
was an affection of the head The cathartics aggravated the
disease which ran a rapid course and the child
died. The small intestine was found received into itself
and its cavity obliterated. This obliteration of the cavity
would not of itself cause death; for a patient may 
continue several days with perfect torpor of the bowel.
It is the irritation as in cholera morbus which is the
immediate cause of death which [illegible] death usually 
occurs within 24 or 36 hours”
“Called to a child one year old
constant vomiting stool, mucus streaked with blood
Directed mucilaginous injections & fomentations combined with opium
Gave opium freely internally 10-15 minims to allay 
vomiting. The symptoms subsided gradually & in 
3 or 4 days the feces passed off without any cathartic”
“Was called to an Academical student
had given cathartics and they did no good. Called
in older physicians. They were in doubt respecting the
case and advised not to do any thing as we might do
hurt. As I was sitting by his side I heard a motion 
in his bowels. I noticed that it passed down to a certain 
point and then stopped. Upon examination I could 
distinctly feel the involution. I tried injections and 
some [illegible] of them would stay. Ordered a spermacetic
candle with opium upon its extremity to be passed up 
the rectum and allowed to remain. It was s


206
passed in to the length of 10 inches. The opium allayed irritation
and the application by repetition replaced the part & the 
patient recovered another case cured
by a bougie”
“Opium by taking off the spasm and
restoring the natural function of the bowels may be
said to act as a cathartic just as in spasmodic
colic”
From p. 56 “I have given when I 
could obtain it, the [resin] of Mandrake podophyllum peltatum It operates
kindly, and more certainly than any other article. If
the western gentlemen who have so much mandrake
and whiskey, would furnish a supply. I think it [will]
supersede every other article”
“If there is torpor & a stuffing or infarction 
of the bowels we must use injections to assist
cathartics repeating them every 2 or 3 hours. If other
cathartics do not operate give castor oil which will 
promote their operation”
“The particular kind of injection 
is not important and may be left to parents
Thoroughwort, camomile, mayweed 
catnip, dandelion, weak soap suds salt
& water a tablespoonful to ½ pint water


207
Continued from p. 57 “The stools resemble
meconium. In the progress of the disease they exhibit
small pieces of a membrane of a dark green colours,
about the size of the petals of peach blossoms 
floating in a dark green fluid. The membrane of 
coagulable lymph, resembles that formed in angina
trachealis and sometimes as in that disease
it is formed in such quantities as to cause obstructions 
Still in this case it may not destroy life
the action of this part not being so immediately
essential to life. Stools of this kind sometimes
attend the bilious colic of adults. They are an
indication that farther evacuation is needed
Continue the 
calomel or combine it with magnesia or soluble
tartar, or phosphate of soda or other neutral salts


208
Infantile remittent continued from p. 60
“Cases A child had violent fever gave calomel & cathartics
warm bath symptoms abated. In 2 or 3 weeks the
regular symptoms of hydrocephalus appeared; & the patient
seised in the greatest danger. In a short time these
symptoms were relieved by a violent and dangerous
attack of thrush The patient was very much exhausted
lay several days very low gradually emerged and 
after a long course recovered.
“Case of a small little boy
5 or 6 years of age After 5 or 6 days head affected
& became maniacal very irritable and cross swore
profanely would bite and strike all who came 
near him. If any thing was attempted to be administered
he would shut his mouth. If his mouth was pried
open he would close his throat with his tongue Advised 
his parents not to trouble him nor notice him to pass by 
him with drink roasted apples etc. but not to offer
him any thing. The first day to he took nothing second
day took roasted apples etc. readily but ate too 
much mania returned, but soon went off & 
patient recovered” 
“In one case the pat. took 
nothing for a length of time. Recovered by use of 
[even ato] & external applications as aloetic plaisters
to the bowels etc.”



Scrofula continued from p. 163.
“Scrofulous swellings are very difficult to excite
to suppuration I have however then poulticed without
effect for 2 or 4 months Of late I have disused poultices
& have applied blisters as soon as may be to excite invigorate the
absorbents and act as discutients. They do not disturb the
system. If there is suppuration the relaxed state
requires stimulating applications lunar caustic vegetable
astringents etc.”
“Case of a young act 18 with bad cough
swelled neck scrofulous temperament Gave laxatives
blue pill afterwards rub & spec. Then gave decoction 
of [cistus] [canadensis] for several weeks and pat. recovered
“ A physician (Smith) on Long Island (from an
old recipe) has acquired reputation by the use of cistus
canadensis combined with uva ursi at the same time
enjoining a strict & spare diet as in dyspepsia”
“I have given with cist. canat. 1/8 gr. corr.
sub. & also decoct. scroph. maril. which is thought 
by the vulgar to be a specific It has been sold as a nostrum
to facilitate parturition called nerve root.) I
think it useful in scrofula”
“I have known the comptonia [illegible] folia
given internally. It is tonic & has balsamic rpoperties”



“The remedies particularly indicated are tonics & 
deobstruents such as will not produce congestion 
such as uva ursi cistus scrophuloria contrayerva 
agrimonia (entire plant or root angostura etc.”
Sea bathing is recommended, but if the
lungs are affected, it will not be advantageous. A 
sea voyage to the eastward has been of service the constant
motion of the vessel stimulating all the vital organs
to healthy action The change of air is beneficial & at a
distance from the shore there is no danger of taking cold
In chronic complaints attended with a want of vital
energy I direct a voyage to the east rather than to the
south



Croup continued from p. 189
“Vapour bath Inhalation of warm water in 
a [pour] blow a current of air through hot water upon the pate & 
by means of a coffee pot with two spouts”
“Tobacco or snuff applied to the patient”
“Croup is an epidemic disease & of course it will vary 
at the different periods of its appearance We must take
into account the prevailing diathesis I have described the
disease as it has usually occurred in my practice”
“The proxim. cause of the dis. is a
peculiar morbid action translated to the traches for
the disease arises from general causes acting on the system. 
In catarrh diseased action is seated primarily 
with mucous membrane.
The exciting causes of croup act on 
the surface and with different diathesis the same
crises might produce pneumonia, dysentery enteritis
or cephalitis “Disease determines to the weaker part
as the rod attracts lightning” Rush Water & snow
cold damp air a [illegible] & low situation sudden 
changes as when the wind blows from Canada or the
gulf stream are the exciting causes



“In the treatment sanguinaria, if given early in strong
decoction very freely, so that enough of it shall be
given & still it vomits or relieves the symptoms, in very 
efficient practice adopted by Drs Jared Potter & 
Kirtland
“But if inflammation has taken place
& the second stage has arrived seneca and sanguinaria
are both too stimulating and I have seen them do hurt
sanguinaria is less stimulating than seneka
For p. 137 “Some authors state that the 
disease is entirely inflammatory not regarding
the forming stage. If the forming stage is wanting
we must rely solely on the antiphlogistic treatment”
“This disease has a direct tender eye to death 
The physician must take it out of the hands of nature”
“When croup supervenes upon catarrh as it
frequently does of late year the mucous secretion and expectoration
usually cease suddenly
“When croup follows diseases that prostrate
the system powerfully as angina maligna, there 
is little chance for recovery. The sympathies of the
system are broken down and Archimedes can find
no fulcrum for his lever”



“I used tart. ant. at the commencement of 
my practice and succeeded with it as well as I
could wish I therefore contained it, but only in
the early stages & to produce a powerful orgasm. If it
acts upon the stomach only it aggravates the disease
Other practitioners rely upon different
articles & probably with equal success bearing in 
mind however that a powerful impression must be
made Decoct. sang. to prostration & vomiting
seneca or lobelia inflam with the same view”
“Sulph. copper & zinc & acetate
copper useful to assist in the latter stages or when 
other emetics are worn our. So also hives syrup 
which is much used at the south.”
“For six or 8 years past croup has been 
occasionally different from the pure inflammatory.
It affects the lungs and duodenum& calomel and cathartics
are the remedies to overcome this form. The cough is more
frequent and loose the paroxysms less distinct there
is pain in the epigastrium vomiting & a membrane
is formed in the duodenum which passes off.
I have called it angina duodenitis.
The same year ulcerated sore throat came on with it
the slough leathery & like a burn it seems to 
be intermediate between A. tonsillaris & A. maligna


The application of lunar caustic by a pencil or brush would
prevent croup Blisters to the throat & chin were
useful yet a blister would produce the same action as
existed in the throat, forming an ulcer very difficult 
to heal Slough ¼ in. deep 3 mo. in healing. In 
one case the blister cured the croup and the ulcer
killed the patient It is desirable to translate
action to parts less essential to life. Cal. & carth.
would translate it to the duodenum Emetics & 
powerful treatment do hurt here. The vapour
bark is good.
“Croup sometimes recurs several nights in 
succession A. Laryngea is more apt to do so”
“When crop assumes a chronic form
emetics irritate inhalation of vapour blisters
opium diaphoretics & expectorants”
“In chronic croup the inflammation 
in erythematic and not membranific. The 
vapour bark often does wonders Tartrate of 
sanguinaria in ¼ gr. doses Tinct. hyoscyamus
gtts x
N.B. Dr Woodwd treat of subacute ([S?bertonic]) & typhoid croup the latter contraindicating
tart. em. & requiring sanguin. turp. mer. calom. etc. & sometimes
capsicum, ammonia & even perhaps wine & alcohol.




“One of the most extraordinary examples
on record however of the effect of disease in 
developing of perceiving a certain class of relations
is that of [Zerab] Colburn His history 
is well known When quite a child in his sixth
year, without any previous instruction, he
could by mere intuition perceive the relations 
of numbers with so much readiness and
precision, as to solve almost without reflection
questions in arithmetic which would
require a long calculation to enable others 
to answer. How he obtained this result
he could not tell. The answer seemed to 
present itself to his mind with the same
readiness and conviction of its truth, that
the proposition tow and two make four
does to us. These facts I saw are well
known, but it is not so well known, that
this power was the effect of disease. That
such was the case I have very little doubt
This was the opinion of a very distinguished
physician who saw him at the time, and
who ascertained that he was then affected with 
a peculiar nervous disease the same
(chorea) which Jane had a few years 
since. In conversing with Mr Colburn 


about a year ago I asked him if he
retained the power of calculation which 
he possessed in his childhood. He said
no, and attributed the loss to the want
of its exercise. But why should exercise
sustain a faculty in existence which 
was spontaneously developed?”
“Account of Jane C. Rider the
Springfield somnambulist; by S 
W Belden MD. Springfield 1834”
p. 108
“The discovery of Zerah’s power 
of calculation was purely accidental 
Zerah not having yet completed his 
sixth year was overheard by his father, as
he repeated to himself in his play, parts
of the multiplication table. The father
surprised proceeded to examine him & 
[found] etc.


























































1 Diseases of children




[B illegible 31]
Proposed plan
name – history symptoms & causes
[Regar] plan of treatment minutely described
Other modes of treatment
Miscellaneous remedies
N.B. Collect all his remarks on 
art of practising medicine


Contents page
Introduction
Tumour of the head from difficult parturition 5
Cutting the frenum linguae 5
Congenital hydrocele 5
Management of children – as to 
Particular appetites – Preventive medicine 5
General nature of the diseases of children 6
General operation of remedies in children
Diseases within the month
Retention of the meconium 8
Jaundice 11
Acidity, Flatulence, Hiccough etc. 12
mothers milk & cows milk 12
Costiveness & its consequences 12:a
Vomiting 12:d
Diarrhoea 12:f
Prolapsus ani 12:l.
Aphthae 13
Eruptions in general 19
Strophilus interlinctus or Red gum 19
Strophilus candidus 21
Crusta Sactea 22



Eruptions of Dentition 24
Eruption resembling the itch 24
Venereal Eruptions 25
Infantile Erysipelas (Rose rash) 27
Sore ears (Intertrigo) 30
Tinea capitis 
[???phlicus]- [illegible] [illegible] on [illegible] [1821-2] 32
Dentition 34
Cholera Infantum 40
Infantile Remittent 55
Mesenteric Fever 61
Tympanitis 66
Worms 69
Volvulus 86
Nervous Rheumatism Infantile [remedy] 89:a.
Convulsions 90
Epilepsy 96
Catalepsy 99
Chorea 100
Ulcerated mouth 103:a.
Gangrene of the mouth 104
Parotitis or mumps 112
Tonsillitis or Quinsy 115
Rosalia or Scarlet fever 120


Croup or Bronchitis 132
Laryngitis 139
Epidemic catarrh resembling croup 141
Whooping cough or Pertussis 144
Rickets 158
Scrofula 162
Mesenteric fever
Hydrocephalus 164
Chilblains 176
Painful aff. from cold without
discoloration 177
Burns 177
The cause either is to be found in [???uctural] [illegible] for the 
[illegible] This will [illegible] men to trust their lives to 
unknown men, or to fictitious names in the newspapers, where
they would not trust property even to a small amount
# Formerly prescription of an experienced physician
very often set aside for that of the nurse or a 
negro woman


1
Diseases of children
1  In this part of our course I direct your attention 
to the history of man in relation to his habits, diseases, & their
remedies in his infant state
That this subject has occupied the attention of the 
learned less than any other branch of the medical
profession, is universally acknowledged
2 – It is unnecessary for me to enforce
the importance of the subject, by any remarks which 
might be made concerning the evil to society from 
a neglect of a part of the practice in which the community 
is so deeply interested
3 – I need but advert to the evils which must
result from the practice of committing the
management of the diseases of infants to a class in society
which is the lowest in point of intelligence
6* [the opinion of the nurse is sometimes taken 
in opposition to that of the physician – On this subject
the world seems to desert its principles of reasoning
on other subjects. If a point of law is to be decided men 
will not trust to a petty of the court, in 
preference to that of an experienced
If a text of scripture is to be explained, men 
apply to a learned divine in preference to the mere
servant of the church & on the subject of wearing apparel
it prefers the opinion of the master to that of the 
apprentice.]



4 – That this subject has occupied the attention of
the learned less than any other branch of our profession 
is universally acknowledged. (The French & Germans
however, have neglected it less than the English;
and the American physicians have been in the 
habit of paying more attention to diseases of children
than the Europeans)
8 Great attention has been paid to diseases of children
within the last 30 or 40 years
It has been most neglected in Europe, but less by 
the French & Germans than by the English
17 European practice differs from ours – but less so 
at present than formerly because the constitution 
of our countrymen are coming to resemble those
of Europeans
12 It is also the case that European diseases differ from ours on account 
Disease, here is [illegible] more violent owing probably to the greater
of climate etc. Angina [Trachealis] is much 
milder with them & requires much milder treatment
# vicissitudes of the weather



2
5 - The causes which have excluded physicians
from the treatment of [infantile] diseases infants, having ceased to exist
the subject is now receiving the attention which its
importance demands
6 – These causes may be enumerated in few
words – viz. the exclusion of the faculty from the
practice of midwifery – from the difficulty of
obtaining correct ideas upon the subject from its
obscurity – the prejudices of the public on this subject – 
attributing as they do intuitive skill to nurses 
and matrons * vid. page [illegible] & perhaps also the indifference
of the profession
7 – At the present period, however, the enlightened
physician watches the mother during the
whole period of gestation, receives the child upon its 
first introduction to the light, & prescribes for its
diseases from infancy to old age
9 – As knowledge however must on this subject, as
on every other, be progressive, it follows that this
part of the profession having but recently received 
the attention of physicians, has not attained
the perfection of the other branches
10 – American physicians need American treatises on this as on other medical subjectds
13 – European practice, as exhibited in 
their works, is too slow and mild to meet and
overcome the morbid excitement of acute diseases in 
our climate. [Chronic diseases may be treated 



They practice no deceit


3
with mild remedies, but acute diseases are made
worse by remedies if those remedies are not sufficient
to overcome the disease The action 
of the remedy falls in with the diseased action
and aggravates all the symptoms if it is not 
powerful enough to overcome the diseased action
IN such cases disease is to be taken out of the 
hands of nature. The powerful [enemy] is not to
be irritated unless there is a prospect of overcoming 
him]
14 – The difficulty of acquiring a knowledge
of the seat of the diseases of children, on account 
of their being unable to communicate their
sensations by language, has been made an excuse
by some physicians for neglecting the
subject of infantile diseases We may 
remark however that the difficulty of attaining a correct 
knowledge of a subject, cannot be given
as a reason why it should not be committed to 
men of intellect & science
15 – Though children cannot communicate their
sensations by language, yet the other symptoms by 
which we determine the seat of their diseases are more uniform
in their appearance & more certain in their indications than 
those of adults
16 Children are under no restraint from feeling
fear, [delicacy] or from false modesty In the infant, the 


mind does not react upon the stomach & destroy 
its function 
When Dr Harris published his essay on the
acute diseases of children Sydenham said to him
“you are the first man I ever envied and it is
my firm belief that your little book will be more
useful to mankind than 
# Adult patients also will often deny the existence of
dangerous symptoms; for fear they shall be considered as
very sick
The subject has not yet been thoroughly 
investigated. No regular course on it has been [illegible] until 
quite recently in [illegible] of the European schools. I recollect
the embarrassment under which I laboured under
at the commencement of my practice Cases frequently 
occurred which were not described in any of the books [&]
I was obliged to acquire all my knowledge on the subject from 
older physicians or from experience. My students have often
expressed to me the satisfaction they experience from an examination 
of my notes and they have often quieted the anxieties
of parents by reading extracts from them
# In my embarrassment upon being first called to a sick child
though familiar with the treatment of adults & having attended the first schools in the country I found my information 
& in books as to [illegible] nature or treatment and was
obliged to have recourse to the older physicians
29 [Dewers] is popular addressed to mothers, very prolix
& not intended for a text book but perhaps able [work] & is the
30 [illegible]
# Parents think a young physician will do well enough for a young 
children and are much more apt to call one in for such patients


4
mind does not react upon the stomach & destroy
its function We are at no loss how much to attribute to disease & how much to [illegible] #
17 – Still with all these advantages & notwithstanding the importance of the subject
it has been neglected & has received less attention than any other branch
18 – When Dr Harris published his essay on the 
acute diseases of children Sydenham said to him, you 
are the first man I ever envied, and it is my firm belief
that your little book will be more useful to mankind
all I have written” This opinion was not founded
upon the merits of the book but upon the fact that the attention 
of physicians would be drawn to this part of their
profession, not the least useful though the most neglected
25 Authors on this subject & their merits
26 Underwood 
Still the department has received less attention than
any other branches of our profession
27 Dr Rush in his works, has many remarks
28 Periodicals contain more or less upon the subject
21 – No courses in any of the schools
19 – Some physicians of the first respectability have acknowledged
their ignorance & given up to nurses
20 – I recollect the embarrassment I suffered upon 
this subject # It is a common complaint
22 Since I have lectured upon this subject, our students
at parting have expressed their satisfaction.
23 Young physicians are first called to children
because the older ones neglect them # hence its importance to them
24 Parents however seem, as a matter of fact, to prefer
a young physician, for a young patient! #



34 – I shall first remark upon a few surgical cases 
which occur to the young physician soon after the birth 
of the child
[illegible] cutting the frenum. I have never seen a case in which this operation 
was necessary. It is very common for nurses to insist that 
children are tongue tied. Dr [Eneas Munser] was called in such 
circumstances he remonstrated the nurse was instant until 
finally he drew the back of a knife across the frenum & the child
he told [illegible] [illegible] hurting and this with this [result]
was relieved to the great satisfaction of the nurse. If there is
a false frenum it may be divided.” this [illegible] [frenum] is never 
so short as to confine the tongue & cutting it is a dangerous operation
# They will tell you that this particular appetite is indicated
by the natural crying of the child
The mother will set herself to recollect some former
longing of her own
[illegible] 6 Hydrocele
Young physicians are often called on to prescribe for congenital 
hydrocele in young children The complaint is apt to excite alarm but
neither troublesome nor dangerous. It is readily distinguished from [illegible]
by its transparency, insensibility, & not yielding to pressure. In the course 
of my practice I have had to operate in but one case in children. Dr [Dewers] recommends
pouring considerable quantities of cold water on the part. I myself
have frequently cured it by washing the part with cold water in the morning
and applying camphorated spts in the course of the day. You [illegible]
direct the application of spirt & water, camphorated spirits, [muria??]
of ammonia, [opium], spirits of nitre, in short every discutient
Or you may direct astringent lotion, as a strong decoction of
maple bark, spriaea Fomentosa Geranum, Rhei etc.
Case in which I had to operate year old  probably neglected 2 or 3 inches long 
about as large as a small egg. Operate without a cannula  - with a lancet & catheter
& injecting syringe – water 1/6 or 1/8 port wine – children more irritable - vomiting



5
Tumor on the head
35 Children are sometimes born with a tumour
on the head occasioned by difficult labour
This may be distinguished from a tumor caused by 
a deficiency in the bones of the cranium, by a uniform 
hardness. “We may apply mur. amm. or spt & water”
36 – Cutting the Frenum
37. Hydrocele
31 Management
Appetites 32 A prejudice prevails in some classes of society 
with respect to a point in the management of children
Some children are thought to be born with a strong
appetite for some particular kind of food, which 
was possessed by the mother previous to the birth of the
child & inherited from her. It is thought that the child will [pine] & ultimately 
die, if this [illegible] appetite be not gratified #
It is probable that a belief in this doctrine has caused
many children to be killed by the administration 
of improper food A fact of this kind occurred
in Humphreysville, which nearly proved fatal to 
the child. Vide next page
Preventive
medicine 33 As a general rule medicine is not to 
be given to children in health for fear they should be 
sick. Some are nursed to death, while some die for want
of nursing. Some are fed to death while others are starved
Some are physicked to death while others die for
want of medication
injection immediately with [draw] healed [illegible] with swelling


The child cried much # - a council of females was
called who set themselves to make out what the
child needed Finally the 
mince pie was concluded to be
the article the child sucked down the inside & the 
report was that this effected a cure & saved the life of
the infant. Prof. I inquired of the attending physician who 
informed him that the child was indeed alive and well at
present but that it was made very 8ll by the mince pie
& came near losing its life. The crying of the child in 
this case was probably nothing more than a trifling increase
of the ordinary crying of very young infants, which 
is a natural and wholesome exercise # 
The al. can is large in proportion to the [illegible] of the whole 
system
# The above is a good example of the various prejudices
which have prevailed among [nurses] respecting the management
of children. Owing to the influence of enlightened physicians 
these are no disappearing. (examples to be given)


6
38 – Diseases requiring medical treatment
General considerations
39 – In investigating the causes and seat of the
diseases in infants the mucous membranes claim
particular attention
40 The action of this membrane is greater in 
the infant than in the adult constitution
Its secretions are often morbidly increased & are sometimes
diminished. It is subject to spasmodic action 
and to inflammation [illegible] with [illegible] or decomposed with effusion of 
coagulable lymph. “It is subject to turpidity & to
spasmodic action which by sympathy extend to the whole system 
41 The liver is much larger in proportion to the body the infants than in adults “& its secretions are much of [illegible] as to quality & quantity than in adults”
42 The secretions are much concerned in 
their diseases. They are changed as to quantity 
and quality
# Prescott child no ducts lived 3 or 4 
months and was excessively emaciated – there was no bile
in the stools There was no [previous] duct for the gall bladder
into the disorder



# There is greater susceptibility to action & tendency
to conversion
# Just as emetics are given to a stomach [complaint]
from excessive quantity of food


7
42 The nervous system of infants is more easily excited,
and more affected by the various causes of irritation
such as dentition worms acrid substances in the 
first primae via passages etc.
43 – The blood vessels are more rarely the seat o f
disease in infants than in adults – particularly, primarily 
so much as irritative
[acid] if they were affected the action is not [illegible]
44 – Consequently their fevers are fevers of irritation, rarely 
enteric or those of inflammation 
45 Operation of medicines
Children bear evacuation better than adults
witness the long continued diarrhoea without much 
debility following, or the salivation for mouths during 
dentition without a waste of vital energy
In operating upon the abdominal viscera it should be [illegible] it is
not for the purpose of mere evacuation, it is to produce
an excitement for the purpose of overcoming a morbid
excitement also to produce healthy excitement a case of 
torpor # The milder purgatives should be used, the
drastic being irritative.
Emetics
Bleeding
Do not bear narcotics vide p. 11


2 – In general the evacuation of the meconium should be
effected by the [colostrium] or first milk of the mother
which has a laxative property # The child should be
put to the breast within 2 or 3 hours from birth # unless [illegible]
Instead of suffering the nurse to feed the child for the
first 2 or 3 days the breast should soon be presented
for if the child feeds it is in danger of losing the 
instinct to suck If the [colostrium] does not bring
away the meconium we may begin with soda as
mentioned below or with cold sweetened water 
Some give a little cold water at first vide [infra]
5 – In strong children cold bathing may be employed
with advantage, but the bath should be made
tepid for weak ones & gradually used colder as the 
child can bear it
# “If from the exhaustion of parturition the mother be unable
to suckle let the nurse commence feeding at the end of 3 hours” vide infra
Give a grain of carborate of soda in a teaspoonful
of water until iii qts [have] given
# The meconium is frequently evacuated during parturition.
After birth also the al. canal is set in notion by the crying
and mother of the child and the stimulus of the
air upon it vide p. 10 skin. # Colostrium is of a yellowish colour
probably contains bile & is cathartic
# It was formerly supposed that the child
should not suck at first. The consequence often was
that the child lost the interest to suck



8
Retention of Meconium
1 – The first diseases of infants which claim the attention 
of the physician are those which arise from retention of the 
meconium. The meconium is a matter always existing
in the bowels at birth & having a dark green colour
when evacuated. It resembles tea but is more mucilaginous # 
It will ordinarily be sufficient to give a little molasses 
and water to the child until it receives the [illegible] or first
milk from the mother which has a laxative quality 
6 – If it is suffered to remain a train of diseases may 
follow. In the diseases which occur within the 
first moth after birth the retention of the meconium 
is always to be suspected as the cause
7 – The diseases caused by retention of the meconium 
are Severe paroxysms of pain in the bowels
indicated by crying & writhing – Tumefaction of the
bowels. Convulsions. Epileptic fits. Trismus
nascertium or Locked Jaw This last disease is
very common in some of the West Indian islands, but
I have never seen it in this place
8 – Whatever disease may arise from 
retention of the meconium the principal indication 
will be to remove the irritation by evacuating the 
bowels. This is effected by cathartics. A teaspoonful
of castor oil is generally sufficient. If [illegible] necessary


1st indic to remove meconium
2nd obviate effects
# IT will be sufficient to pour on boiling water instead of boiling
the materials in the water The strength however is of little consequence
Sometimes the most powerful remedies are to 
be used beginning with mild. These used
full doses of calomel, scammony 2 to 4 yrs – [illegible]
assisted by injection, & warm bath until the bowels
were moved Wait how long for the operation of each?
# By emollient injection, irritation is allayed, and if the
lower part of the bowels is excited the rest will be
Dose 2 to 6 pills each pill containing 1 gr. of 
(calomel)
# Chalk & calomel is a substitute for blue pill – perhaps
the chalk qualifies the cal & at least it
corrects acidity
Antimony should scarcely ever given to children
within the mouth
# A great part of the calomel has no effect
[illegible] it does not come in contact with the coats 
covered with mucus In cases where there was great
quantities of [mucus] I have given full doses of cal.


9
the dose may be repeated every 4th or 5 hours 
until half an ounce has been given
8 – If the oil is rejected from the stomach Senna & Manna 
may be given – zi of the former to zss of the latter
boiled in gill of water # & administered freely until 
the bowels are moved once in ¼ or ½ hour
“ Rx Sennae zi [illegible] ferv. 1 gill 1 or 2 teaspf every ½ hour”
9 – The operation of the cathartic
should be assisted by emollient injection #
10 – Fomentations to the bowels will assist the 
operation of cathartics & if spasms exist, will always
be needed for their relief
11 Cathartics of various kinds
12 The best cathartic which I have used
for infants within the first month after birth is the blue
pill (or [mellated] pill It rarely offends the stomach
and never produces griping By it the action of the 
liver & the secretions from the mucous membrane
of the intestines are excited more than by any other
cathartic except perhaps calomel. In my 
practice I have never known an infant salivated
by it. # 
13 In severe cases where the blue
pill is insufficient we must have recourse to 
calomel, which may be given in doses of from two 
to 10 grains. It is often necessary to give as large 
doses of calomel to children as to adults owing to the 
great quantity of mucus in the intestines by which 
they are defended from its action. # The meconium 


scammony or jalap as a laxative & had them
operate mildly If the cots were [naked] [illegible]
a dose would prove fatal for irritation
# This is a mild cathartic and supposed to act chemically.
# “Evaporate the [illegible] over the fire stirring it until 
thick then add chalk till it is of a consistence suitable
for pilling Each pill may contain 1 or 2 gr. of
Dose from 2 to 5 gr. Or it may be dissolved in herb
Fish, gall has been recommended [illegible] gall 
Rattlesnake has been thought to have specific
properties especially in fevers. This article
is bitter, tonic [illegible], laxative, & [illegible]
Continued from page 8
“The infant may be put to the
breast in one or tow hours from birth This course will 
produce permanent contraction of the [uterus] & tend to stop [hemorrhage]
& prevent milk fever” When an infant is first
born it is well to wet its mouth with half a teaspoonful
of coldwater and give it nothing else until it is applied
to the breat


10
while retained will likewise prevent the operation 
of the remedy by involving it in its viscid substance
14 Chalk & calomel may be used in doses
of 1 gr. cal. to 4 or 5 chalk repeated once in 2 or 3 
hours
15 Other cathartics which may be used are
or as recommended by Dewers
1 gr. carb. sod. to a teaspoonful of water repeated every 
“it operates”
15 minutes until 10 gr have been given. # Decoction 
of the flowers of the dandelion & the mullein 
Senna 2 dr. to with 4 dr. of aromatic herbs or seeds 
The bile of animals (ox gall) is a good cathartic
Perhaps we may consider it as acting as a substitute
for the childs own bile. It may be given in 
[catnap] tea milk etc. # 16 An injection of bitter or 
16 aromatic herbs will allways assist the operation of 
whatever cathartic you use & in mild cases frequently will be 
sufficient of themselves – superceding the necessity
of giving anything by the mouth
Continued from p. 8 The stimulus of sound upon 
the child, crying, irritation of the air upon the
skin, and especially muscular motion, excites the peristaltic motion 
of the child. The influence of muscular motion upon the
peristaltic action of the bowels, is considerable, as is seen in horses
while travelling, the costiveness of sedentary persons etc.


“The warm bath at the temperature of 98 or 100 assists the 
operation of cathartics renders their action more mild 
equalises the action of the system and nervous irritation
It is especially useful when convulsions are present and may 
be used at any period except in cases of extreme exhaustion”
# It is the most powerful antispasmodic for children
[have] acting upon the extremities of so many nerves
Jaundice
“Jaundice sometimes appears at birth indicated
by the yellow colour of the countenance and arising from obstruction
of the liver etc. Such cases are generally incurable.
The first remedies are the mild deobstructant 
plant, small doses of calomel etc.”



11
When convulsions are present the warm bath should
be used to assist the operation of whatever cathartic
is used, to render the operation mor mild, to equalise 
excitement and to remove irritation. This remedy
may be safely used at any period after birth #
After the cause which excited the convulsions has been
removed, if the morbid irritation of the
nerves continues, the bath will again be serviceable
18 Antispasmodics may likewise be used
such as valerian, aqua ammoniae, elix. asth.
artificial musk infusions of catnip etc.
We may use aqua amm. 3 or 4 drops
or carb. amm 3 or 4 gr.
or asafoetida a teaspoonful of the tinct.
in milk & water, or camphor by enema
Be [cautious] of giving narcotics to children
Some are more susceptible than others. And some children
are accustomed to [them] from birth. Case of 
a mother who had inured a child of 3 m. to bear
30 dr. of SS. I proposed to give paregoric, beginning
with 8 or 10 drops, and found that the child had often
taken with impunity 31 dr. of SS. to produce sleep



4 – “Child bed women are generally to be treated with 
mild diet for the first week after delivery, unless their
strength has been much reduced by parturition, when 
they may take port wine in moderate doses”
# “If light stools indicate a deficiency of bile the administration 
of oxgall will be found very serviceable 
vide [illegible]
If acidity is produced, add limewater, 
If diarrhoea is produced, use arrow root
instead of the water, or any other [fecula]
Children are apt to receive too much food; hence cow’s
milk should be diluted with water. Milk may sometimes coagulate
in the stomach of children, in large quantities and occasion much
uneasiness Meat should not be given under 6 mo. unless in 
particular cases which are exceptions to the general rule, where
milk disagrees or perhaps in the case of some scrofulous children


12
Acidity Flatulence Hiccough
1 – Very young children are often troubled with 
acidity, flatulence & hiccough These affections 
may be removed by a free use of magnesia, lime
water, or aqua ammoniae
2 – It will not always be sufficient safe? to 
administer these articles to the child alone. The 
mother or nurse must often take them likewise
3 – Sometimes the mothers milk disagrees
with the child. This will be known by the constant
disorder of the bowels of the child. by the evacuation 
and pain suffering after nursing both child
and [illegible] mother may seem to suffer without a cause
The stools may be slimy# The child may cry obstinately
5 – If the mother’s milk continues to 
disagree we may use cow’s milk diluted with one
third or one half water & “sweetened” or with arrow root mixed
first with a table spoonful of cold & then with one of hot
water, in order to make a homogeneous mixture 
6 – Children fed on cow’s milk are more apt 
to be costive. To prevent this give a little magnesia, decoct.
of dandelion etc. Peach tree blossoms are much 
used, but are too violent in their operation 


The injection will start the machine again 
The injection may be made of Eupatorium, catnep,
elderflowers mallows etc. etc.
Apply first whatever can be first prepared
counterirritants for instance. Spirit or 
mustard to the fat ammonia etc. ammonia to the mouth
and nostrils etc. endeavouring to rouse the patient
4 – [A young physician should be careful to know what to do in 
sudden cases (much depends on a favorable impression 
at first) Neighbors and friends usually assemble around
a child and the expect the physician will be able to prescribe
at the moment. In such cases set some of the bystanders 
to preparing a warm or tepid bath – no matter if 
eventually if it should not be used. Set others to preparing 
some other thing and so on. Thus while the attendants are
all employed he will be able to devise some course to 
pursue] I recollect an old physician in this situation
who was pressed what to do & replied “stop 
let us think about it”


12:a.
Costiveness & its consequences
1 – Physicians are frequently called upon to prescribe for
infants who are in health except that they are costive
Children fed from a spoon or bottle are mor to be thus affected
than those who are nourished from the breast. If costiveness
is produced by improper quantity or quality of the 
food as is sometimes the case, the diet must be changed
2 – Costiveness if not attended to in time produces
flatulence, watchfulness, startings, hiccough, diarrhoea
vomiting & convulsions
3 – A physician is frequently called to children
I fits, who have been apparently well until the convulsions
come on The safest and most efficacious prescription 
that can be made, is an injection & indeed is 
all the treatment that most cases will require. Let
a warm bath be immediately prepared & the patient put in 
it if the enema does not relieve. While the convulsions
continue the mouth is closed & we can operate on the system
mainly by the rectum & the skin
5 Be careful to make your directions for administering an
enema very definite, unless you know that the family are 
familiar with injections Case of a mason’s man hands & 
knees shooting somewhat off fright rolling over murder
The enema may consist of simple warm water, or milk 
& water, or of tea of thoroughwort or catnep etc. a table 
spoonful of salt may be added finally castor or other
oils may be thrown up in extreme cases the rectum has been filled with lard The water for the tepid 





12:b.
bath should be about blood warm. Be careful 
to bathe the child, & not merely to scatter or sprinkle
water on it. The length of time during which the child
may be kept in the bath may be from 5 to 20 min.
While the patient is in the bath if it is
sufficiently relieved to be capable of swallowing give a 
dose of calomel for a child of 6 months 6, 8 or even
10 gr. If improper food is the cause 20 gr. are not 
dangerous, for infants will bear full doses of cathartics
though very small ones of narcotics
In bad cases of convulsions the means to which 
we have it in our power to resort, are external irritants
such as garlic draughts to the feet, injections of [nervines]
the most powerful of which will be a teaspoonful 
of tinct. camphor thrown up in a gill of milk & water & the
warm bath until we can administer articles by the
mouth
“If the child be feeble & exhausted upon coming 
out of the bath give cordials or tonics”
Any quantity of food in the stomach & bowels
which is not congenial, interrupts the process of digestion 
& the peristaltic motion functions whose importance is 
second on ly to that of respiration. When these functions 
are interrupted the muscles are brought into convulsive 
action to relieve the system



Be particular in your enquiries about food for those who 
have the care of children are very careless and children
will swallow whatever is put into the mouth. I recollect
being called to see a very strange worm which a child 
had voided. The imagination of the attending physician 
& parent were excited. To me whose imagination was
cooler the worm appeared to be a piece of bark I enquired
if the child had had no slippery elm bark & found that it
had been chewing some. Then the supposed worm was accounted for
Rye flour is more apt to become acid than 
oatmeal
# Cal. sometimes by its irritation produces convulsions I have
known a family, all the children of which were thrown into convulsion 
by cal. & I was obliged to be very cautious & use blue pill injections etc.
There are several milk remedies such as dandelion
which is tonic laxative, & deobstrument acting on the 
liver, mullein fl. elder [blo??] tea
“The pollens of most plants has a laxative quality”
I have seen no danger from the prussic acid of the
[illegible] flower & it is much used [illegible] from [illegible]
also among the French they hold a place the French Pharm.
Wild liquorice [gal??] [Circa???] resemble
the dandelion
Moderate friction excites the bowels
Sometimes alkalie or chalk, though generally they are
rather constipating, prove laxative probably on account
of the acid combining


12:c.
II II Where is a tendency to costiveness, the use of oatmeal gruel
or porridge will be beneficial or a porridge made of wheat
flour with the bran, strained through a cloth & mixed with 
the milk with which the child is fed also rye meal gruel or 
rye bran gruel
If the health is not affected by the constipation 
be cautious about giving much medicine. It is always better
to cure this affection by food than by medicine. #
Castor oil from a teaspoonful to a table spoonful
is the best cathartic magnesia given with the milk is a good
remedy but not always sufficient. Elixir salutis is one of the 
most common family medicines. This article with castile soap
dissolved in it has been found very serviceable. The gall of 
animals may be recommended. The blue pill operates gently 
as a cathartic & is useful in changing the habitual disposition 
to costiveness. I have prescribed with advantage decoction 
of the flowers of the dandelion, or mullein. The flowers of the 
peach tree are much used for the same purpose but
“are rather too powerful for ordinary cases” “They are powerful even for adults”
& sometimes gripe unless combined with aromatics
Calomel may be used with safety # “In severe cases
mustard and ginger may be applied to the abdomen”
Mechanical manes in the form of suppositories 
are much used by nurses such as a piece of molasses 
candy or a roll of paper moistened with oil. They are
beneficial.
# If the child has been weaned pay particular 
attention to its food. Nurses are very careless.



# “No serious evil will arise unless young & anxious
mothers should give medicines and thus make the
child sick”
“If vomiting arises from dentition we must
remove the irritation Give laxatives, as magnesia, & 
narcotic
Children should be early accustomed to the reception of 
enemata to prevent subsequent prejudices upon the subject.
I recollect the case of a child about 12 who was suffering
from an obstinate constipation caused by an affection of
the lower spinal nerves which produced a partial paralysis 
of the rectum and bladder so that a catheter had to be introduced
& injections were [illegible] demanded. But all the
efforts of the nurses (women) were unable to administer an 
enema Calomel had been given until the mouth was affected, yet
without producing an evacuation. Finally the patient went
into an insensible state, and injections were given & 
produced free evacuation. I have heard adults say they 
would die before submitting to receive an enema.



12:d.
Vomiting
Spontaneous vomiting in infants arises from over distention of the
stomach. The discharge is made without nausea & almost without
effort, & consists of pure milk or milk coagulated. The mother
should simply be cautioned not to allow the child to nurse
so long at a time. # Children and old people vomit with 
more facility than the middle aged
If vomiting arises from the sympathy of the
stomach with some other part of the system which is in a morbid
state, the primary disease must be first cured & used for the irr. of stom.
For the vomiting itself in palliative we may prescribe lime water & 
milk. a teaspoonful of each; soda water, or any 
liquid affording an abundance of carbonic acid.
Vomiting from irritability of the stomach
or free [illegible] requires particular attention. The attendant symptoms will 
be paleness of the countenance, quick & feeble pulse, & cold
extremities. Irritants must be applied over the region 
of the stomach. They may consist of ginger, mustard, horseradish 
leaves, mint etc. aqu. amm. [illegible] essent oil dissolved in alcohol” The alkalies such as pearl ash, also 
soda water “lime water” may be given internally. Excite a discharge
from the bowels by injection or a calomel cathartic to remedy the irritated action of the stomach “[illegible] counterirritation”
The warm bath will be very serviceable, soothing the nerves
of the skin & by sympathy producing the same effect upon 
those of the stomach nervines also may be given We may try putting a little brandy
into the mouth or a small quantity of capsicum tea. Hot
cloths & fomentations may also be applied externally.
A large bulk of warm water water may be thrown up the rectum
in obstinate cases, use stimulating injections..


One of the most convenient modes of administering a large
injection is by a pipe fastened to a large ox bladder
Press the fingers against the end of the pipe which 
the bladder is fastened so as to make a valve and
prevent the escape of the fluid contained in the bladder,
until after the pipe has been completely introduced
into the rectum
# I used to carry this recipe about me when I practiced in the country
Frequently irr. of stom. is overcome by irr. o f
the rectum by an enema of salt & water or by a large
injection to produce a peristaltic motion downwards


12:e.
Ren “Remove the cause, which is frequently 
indigestion. If it proceeds from the teeth, lance the gums
The following is an excellent recipe # in these cases
Rx Cret. ppt zii sem. card. zi bi carb. potas. zfs grind
aqua bullientis 0 fs Give a tablespoonful every half hour
I am inclined to the opinion that the alkalis, such 
as pearlast act by creating an excitability
Emetics are particularly safe for children
much more so than for adults. Ipecac is generally 
the best unless the disease in which the emetic is indicated
is very threatening, when antimony should be used
Squills are indicated in emetic doses in complaints of the
chest “with [illegible] [illegible] but should not be administered when there 
is much inflammatory action in the system.
“Warwick’s powder a preparation of antimony,
was once popular and often administered without 
the advice of a physician. I have known it endanger
life Nurses should never prescribe antimony”


Some situations are more liable – low situations
[seashore]
Children shut up in low dark apartments suffer
from want of amusement.
If a diarrhoea from teething is suddenly stopped
the brain is apt to be affected. This affection of the brain 
is peculiarly liable to occur in children. There is no 
outlet to the brain


12:f.
Diarrhoea
This complaint sometimes affects children for months & even
years Some families are more subject to it than others & I
have known those in which all the children would be affected 
with diarrhoea from a period soon after birth until they 
were three or foru years old. The children who have this predisposition 
to the disease are born with diseased liver and bowels
& have indeed all the chylopoietic viscera in a disordered 
condition. Hence among the causes of diarrhoea we may 
rank a bad constitution. Other causes are want of 
cleanliness, bad food “want of sufficient clothing” bad air damp rooms, confinement
& want of exercise. Exposure to cold & moisture
A bad air probably causes diarrhoea mainly by 
its depressing influence. The effect of confinement and want
of exercise is very great. Young animals suffer in the same way 
Even vegetables seem to need motion for I think I have observed
a great deficiency of fruit & a sickly appearance of 
fruit trees after a season uncommonly free from wind. Confinement
is injurious in another manner Children need
mental stimulus from a variety of external objects. I have
known surprising cures effected apparently by the operation 
of this very principle.
Teething is a frequent cause & whenever
it is we must palliate & check, but may not stop the diarrhoea
From the sudden stoppage of a diarrhoea during dentition you may 
expect an affection of the brain to follow. The discharge from the 
bowels in this case is similar to that of tears from an irritated 



This will be convenient in many cases as in travelling
Other mints may be used spearmint is most agreeable
I have given this in the latter stages of the diarrhoea of
adults with advantage
Almost any cath. will often check a diarrh. Cal or 
blue pill is generally best
Judgment is to be exercised whether to prescribe an
emetic or a cathartic & as to the choice of a catheter
Ipecac however is almost always safe children bear
emetics well
Put the parents & the nurse upon investigating as
to [diet] Persons are apt to very careless about giving
things to children And they may have wrong notions as 
to particular articles
Prohibit solid oily food, crude
vegetables and esculent roots. Potatoes are very 
bad in diarrhoea so are the analogous roots. They 
contain indeed much fecula, but also much 


12:g.
eye, or of mucus from the lungs
The expressed juice of mentha vulgaris, boiled
skimmed and mixed with white sugar is an agreeable, & useful
article for the cure of a diarrhoea, which has continued but a 
short time & is not severe.
In the early stages of a diarrhoea, which 
is sufficiently severe to demand the attention of a physician
it will generally be best to commence the treatment with a
cathartic; though if fever accompanies it an emetic of ipecacuanha 
should be the first article administered.
Judgement must be exercised in the choice of a cathartic. Calomel
will be best if the child be not particularly feeble or of a very 
delicate constitution & for a feeble child the blue poll. I myself
was for formerly many years unable to take any other cathartic than the 
blue pill without being griped. Generally it will be best to combine
chalk with the calomel, as the latter is indicated for its deobstruent, 
rather than for its purgative effect. The dose may be about
2 gr. cal. with 5 or 6 of chalk
If improper diet is the cause the food must
be changed; & it will generally be necessary to be particular in 
our enquiries with regard to the diet for the parents may 
consider many things a safe which would be strictly forbidden
by the physician. Especially will it be necessary to attend to 
the diet if the child feeds instead of sucking. Every thing 
hard of digestion, such as salted & oil food should be prohibited
The diet should be arrow root and in case of diarrhoea this 
article will be improved if prepared with a little laudanum 
or wine sago taipica, which is probably a hydrate of 



besides They are apt to become acids & acrid in 
the bowels. In the Polyn. islands The inhabitants
living upon taro are very liable to diarrh.
West of the Rocky Mts Lewis & Clark found the 
inhab. subject to diarrhoea for living on a root [illegible] [illegible] men suffered in the
same way after they arrived among them
In the evacuations & the evacuations of children shd always be exam
[may] [illegible] that potatoes remain undigested
Cullen & Rush thought different of potatoes
The evac. of chil. should always be [illegible]
Pies cakes articles containing much sugar
hot bread should be prohibited Bread shd be toasted
The juice of meat will often be beneficial
No gravy (i.e. artificial or carbonized fat with flour etc.)
Potatoe starch, pure, is perhaps not 
inferior to the tapioca etc.
Boiled flour becomes s hard as stone
almost hydrate It is an old practice It is an
excellent preparation make a porrige of it grated
Tapioca I suppose is made by sprinkling
casserva root, powdered, with water & baking it
making a preparation what appears like gum arabic. I have not 
been able to learn how it is made, but have made
it this way a similar substance of arrow root
Arrow root & the tapioca are cooked
by first dissolving them with a small quantity of cold water
& then adding hot water. In this way [illegible] are avoided


12:h.
flour or roasted or baked flour made into a
porridge with equal parts of milk and lime water. The bread
should be toasted and butter should be used very sparingly 
gravy not at all. Casserva sago etc.
An article similar to tapioca, if not the same 
may be made in the following manner. Tie up a quantity of 
wheat flour tightly in a clean cloth & boil it for 5 or 6 hours
The result will be a hard substance which is to be grated &
“[illegible] milk & water or with lime water” 
made into a porridge this will be palatable & good Rice
in gruel, or thoroughly cooked by boiling 
The worst cases of diarrhoea are attended
with feeble pulse, cold extremities, dry skin, & 
generally a rise of fever once or twice in the 24 hours. Soften
the skin by the tepid bath which is [illegible] etc. and keep up an action on it by 
flannel unless there is fever & in such cases use also absorbents freely with 
tonics & aromatics. The chalk julep or white decoction will 
be as good a preparation as any. Rx Chalk [illegible] zfs to zi pul. cinnam. to zii
zii, bum arab zi carb. potas. zi water lb I. boil ½ hour Sometimes
[illegible] a similar recipe shd be used” The Europeans add [illegible] use [illegible]”
a little laudanum may be added. Of this feed freely, giving
say a table spoonful from ½ tab sp. to I once in an hour sometimes. As a tonic the
vitriolic or tonic solution of Moseley is inferior to none in such
cases Rx zinci sulph ziii alum zi water lbi Give from 
four to twenty drops. Tonics must sometimes be combined
with absorbents
Opium is always safe in cases where the 
bowels have been thoroughly evacuated. It is generally 
better to combine it with ipecac, which will determine its
action to the skin and act as a gentle tonic & laxative


The tepid bath is [illegible] as it may be called) 
relieves the irritation of the bowels through the 
skin
Chalk does not act mechanically or chemically it
has a specific action upon the stomach as much as
bark
Make white decoction in various ways if cinnamon
offends use some other spice Sometimes add
astringents or [illegible]
Tonic sol. sulph [illegible] ziii al. zi Mosely sometimes
used al. zii In 3 or 4 gtt it is anti emetic
In larger doses it may be emetic & cathartic
This is a state of the system similar to the collapse
of cholera Asiatica It is a collapse taking place
during diarrhoea. I have found advantage from
stimulating or acrid injections as salt & water, mustard
In chronic diarrhoea opium is often
invaluable. Some families are obliged to give it 2 or
3 times a day for along time to their children until they are so 
old as not to be liable to continual diarrhoea
The stools may be green clayey from deficiency of bile sour curdled [illegible] or very
fetid, so much so as to be very offensive turning the
stomach of the attendants.


12:i.
In cases of chronic diarrhoea where there is attending it
much sensibility and irritability of the bowels opium combined
with diaphoretics cathartics or tonics is an invaluable
remedy
Sometimes violent symptoms supervene vomiting supervenes & the diarrhoea 
stops the patients hands & feet grow cold his pulse
grows small, & if the most active measures are not
take used the patient dies in 24 hours. When this change
of symptoms take place we must resort to the most
powerful means of exciting counterirritation such as application 
to the epigastrium of mustard, horse radish leaves
ol. monardae punctulae, ol. turpent. etc. Such articles 
as pimento will be grateful and stimulating given internally
We may give calomel, opium & the carbon. acid, and use 
stimulating injections. “Effervescing mixture with SS. [illegible] appt”
Particular attention should be paid to the
kind of They may be sour & curdled, or mucousy, [illegible] clay colored, water
stools for much may be learned from their inspection.
Acid is often formed in the whole alimentary canal, producing 
sour and curdled stools which will indicate lime water
or other absorbents, with aromatics. The acid may 
arise from fermentation or more probably from secretion 
Such cases I have often cured by the expressed juice of the
spear mint prepared as above mentioned & given freely.
When the stools are green white, or clayey, give
opium to allay irritation. Ipecac to equalise excitement, & 
the blue pill as a deobstruent, the latter in small doses so as 
to move the bowels, but once or twice in the 24 hours. 
Alkalis are useful as 


# Noel’s plaister was made of white lead red lead castile
soap and olive oil, boiled till the red lead was so far decomposed
by the oil that the mixture was of a cream colour It is a 
smooth plaister and is less stimulating than [illegible]
Use soft charcoal by burning cork, which is
the popular kind or cedar Dose teaspoonful
to a tablespoonful in a convenient liquid
Lime water & other alkalies may always
be given They may be mixed with the food
without [injurious] the taste
When the disease has continued long & 
patient is [illegible] phlegmatic temperament we may 
bandage the bowels, to give mechanical support 
[Opium] also will be useful applied externally in this way
Adults from the Wt. I. with chronic
diarrhoea will look like a mummy
Bog water is a very soft water & contains
carb. hyd.
Astringents [illegible] tinct. vitriol
decoct. of oak bark with milk & sugar & spice
Bandaging & plaisters Take any adhesive
plaster and mix about ½ opium Or soap and opium
Acetate of lead is not a new remedy 1 2 or 3 gr a day
1 gr at a time continued as long as the relaxed state of the bowels
continues as long as they last lead [cholic] cannot take place for 


12:j.
are also enemata formed by dissolving castile soap
in mallows or catnip tea. If there is much griping with 
tumefaction of the bowels injections of camomile tea give
great relief. In diarrhoea of this kind the following is also 
a good stimulating & correcting laxative Rx castile soap zi
elix. sal. zi dissolve & give it 3 or 4 times a day of teaspoonful or ½ teaspoonful doses.
If the stools are fetid give charcoal
internally. It will correct the fetor & it sometimes cures
the disease. For sour stools vie last paragraph of this lecture
During the long continuance of chronic
diarrhoea it will of ten be advisable to apply mechanical
support to the abdomen. We may apply a plaister of
white diachylon [illegible] plaister alone or with opium or of lead and soap & a bandage.
In chronic diarrhoea the skin becomes 
brown, of a dark & dirty appearance, & very dry and husky
If the tepid bath does not relieve this symptom, we may apply 
water from peat swamps, which contains carburetted
hydrogen. Vide Duncan’s commentaries
In the last stages of diarrhoea we must 
resort to tonic solution to astringents, absorbents & aromatics
we may also use opium with cathartics, emetics & absorbents
& If we met with a great craving for salt food it should be 
gratified. The gratification of such an appetite will prove 
a stimulus, especially to the mind & consequently the more
powerful. We meet with similar cases among adults also. Case
of a man who could retain no medicines upon his stomach & 
finally recovered upon bread & cheese, given at his request
In the latter stages also of chronic diarrhoea, acetate of lead 



the [illegible] [become] very lax and there is generally a prolapsus ani
patient being [semiphlegmatic] I saw this article
much used in this way when a young man and though expecting
bad colic no injury resulted.
Prof. Smith was very fond of chocolate [illegible]
It sometimes acts like a charm
Spiraea may be given in decoction or
extract. [illegible][illegible] is not so good being unpleasant
having a fishy taste & offending the stomach Ger. mac. & [illegible]
[arom.] are pure astringents & unobjectionable on 
this score. I have prescribed sometimes one, or another,
according to convenience of locality where I 
happened to be
The root of typh. latif. is used as food by the aborigines
European physicians give [althea] [illegible] which 
is the true marshmallows
Usually when diarrhoea has continued 
long the kidneys become affected. Mucilage will then 
prove diuretic probably by their [illegible] affect. The terebinthinates 
will then be useful. The most common practice in 
this neighborhood is a decoction of white pine bark especially 
with a little milk it is called healing to the bowels. There is
also nutriment in it for the aborigines, sometimes live on it
When mucilages to wear out we may resort to terebinth.
The species of [polygnomic] knot grass are 



12:k.
may be given internally. There will be no danger
of the production of colic, by this remedy, for the bowels are
too much relaxed.
The astringents just mentioned may be various 
We have at least fifty indigenous vegetables, which may be used
given in decoction of milk or water such as the bark of the
currant, the raspberry, the various species of oak, of viburnum
chocolate of acorns etc. white pine bark in milk etc.
the roots of the [illegible] of the [geranium] etc. The viburnum
Especially deserving of recommendation are the spiraea tomentosa
& cornus circinata. The latter of which equalises excitement
Of mucilages we may have occasion to 
use a variety for irritation for any one article may become worn out & another be more grateful
We have typha latifolia, twigs of sassafras, hibiscus, malva
bran, flax seed, slippery elm, gum arabic etc. all the mallows, all the [illegible] marshmallows hibiscus palustris
called rose of [illegible] in the gardens root is [illegible] [illegible] & sub astringent 
Sour stools Be particular in forbidding the use of animal
food. If there be want of bile, give ox gall, lactescent plants
dandelion etc. with mild mercurials; e.g. calomel 2 gr. with 
6 gr. chalk. Aromatics also may be combined. Astringents
elg. [illegible] speraea cornus & geranium do well. Also the following
Rx calc. magn. zfs rhei palm. gr. 8 acaciae zi ol. anisi gtt vi
aquae purae zi Give a teaspoonful at a dose. “once in 2 hours”
In bowel complaints with griping attended with green
or sour stools Rx magn. ust zfs pulv. rhei grs viii pulv. gum ar. zi
ess. menth pip. gtts vi water zi dose, teaspoonful Spiraea & cornus




used – they are mucilaginous sub astringent & diuretic
Articles of a stimulating kind are often needed in 
the latter stages especially erigeron canadande (colt tail) [illegible]
The bitter [illegible] which grows in similar situations (ambrosia [elatio??]
is also used as a bitter apparently nervine in diarrhoea
Roman wormwood) [Cupron] is acrid, sub astringent & diuretic much 
used in the middle states improper when there is entonic action
case of cholerine cured last summer by this garden young
man called etc. chewing the plant etc. The other species
of erigeron have similar properties espec. E. phil.
Various recipes are given for diarrhoea in 
children Ex mag. zfs rhei gr. 8 [illegible] zi ess. pep. gtts 6 gum ar. zi
The popular remedies are generally absorbent [illegible] mucilaginous
astringent etc.
Much benefit may often be derived from 
copious mucilaginous injections mutton broth is the most popular
probably other broth (fat meat) would answer still mutton 
suet is less apt to become rancid. It is thought to be 
useful also as nourishment I have not though much 
of this may of nourishing
Laudanum may be added Also
laudanum & starch injections may be advisable to check the
excess of the discharge It will generally be best to begin with 
about 10 drops of SS. though a teaspoonful may be required
vide p. 2 [illegible] 2



12:l.
Prolapsis Ani
This is a troublesome symptom which sometimes occurs in 
diarrhoea. The protruded intestine should be immediately 
replaced. Most writers recommend to do this with a 
dry cloth, but this will irritate the sphincter ani & make
it contract. The smoothest and least irritating article
within my knowledge, is the crop of a fowl, or the neck
of a bladder, turned inside out & filled with warm water # 
Afterwards we may apply astringent washes & injections
of white oak bark or other similar articles, or
of acetate of lead. The latter article may also be given 
internally in doses of from 1 to 2 grains. It will 
have a tendency to overcome the relaxation.
Astringents are multitudinous
& have had a specific [illegible], which proved to be the
bark of [?strea] virginica At another time I had a specific
sent me which proved to be viburnum sentago all
the vib. are astringent
Prolapsus ani “The part is relaxed
and passes down and is then strangulated by the sphincter. For a
permanent cure we must resort to astringents & tonics, but the
part must be [illegible] by mechanical means If 
the intestine is not replaced, [illegible] or suppuration 
will be the consequence” “Take 1 bladder, cut
off the neck, turn it inside out, fill it half full of 
warm water, and tie up the neck”


“This disease was very common at the commencement
of my practice but is now rare. The change has arisen in a great
degree from the more correct notions respecting the proper management
of the mother and child which now prevail. It is possible
however that it may appear in [epidemics] and that case we
should expect that it would appear for a time and the disappear
# It frequently follows other diseases both in children
and adults
# According to the law of contagious diseases and
that it is of no use to prevent it
# Heat is a stimulus but too much of it produces a 
debility which may be [illegible] perhaps in direct debility
“Since a free ventilation of nurseries has been practical the
disease has been rare. laying aside the use of the preparations 
of alcohol has also been beneficial.” 


13
Aphthae or Thrush
White thrush from [illegible] (to inflame)
This disease often appears within the mouth 
is then generally unaccompanied with fever. In some
cases it is idiopathic but it more generally is a 
consequence of morbid affection of the primae viae #
It is frequently found in adults of robust constitution 
which have been very much debilitated by previous that disease
infancy and old age are most subject to it & in infants,
as was just mentioned it is often an idiopathic affection
In some families every infant is several with this
affection. The vulgar error however, which very generally prevails
that all children have the thrush at some sooner or late period other #
is contradicted by the fact that many children as I have
known never have the least appearance of it 
at any time “and it may probably in all cases, be prevented”
The most feeble and delicate children are affected with the most violence, hence & from the fact of
its being an affection of old age & a frequent sequel of other disease
in adults, it may be inferred that this is a disease of 
debility & this [illegible] will be confirmed by the predisposing
causes which we find to be, confined air, a
very hot room & improper food# It is caused among
the poor by bad air & among the rich by too great warmth 
& confinement. The fever likewise which accompanies it
in many cases is of a typhoid character.
# “Caused by neglect of the nurse by want of cleanliness
& is often the effect of costiveness”


# And have been led to prescribe remedies to prevent 
the thrush
“commences on the inner part of the lower lip & corners of the
mouth & extends over the tongue & inside of the cheeks & gums
sometimes all these parts are affected & sometimes only one of
them”
“It appears in small eruptions or vesicles containing a whitish
fluid resembling a coagulum of milk these vesicles
often coalesce so as to form patches”
“extend down the oesophagus to the cardia & here in all
known cases it has stopped”
Prof. Tully has seen p.m. [illegible] which the thrush the al canal [illegible]
“The feces are sometimes covered with aphthous sloughs”
“in its severest the eruptions are of a dark brown
or deep red colour”
“The alvine discharges are very acrid”


14
Symptoms – The disease is preceded by languor and sleeping
This is so generally the case that it is common for nurses to 
say that the child is sleeping for the sore mouth
In adults I have observed the same fact, & have predicted
the appearance of thrush from the drowsiness of my patient #
The symptoms of thrush are very obvious. It commences
with white specks upon the lips #, angles of the mouth, & 
tongue effervescence. # In severe cases the specks in crease in number
and size until they cover the whole inside of the mouth
the throat & are found indeed upon the 
stomach x & throughout the whole intestinal canal
though this is disputed. One thing is certain, whether these
specks or flocculi extend throughout whole alimentary 
canal or not, viz. that they are found upon the rectum,
agreeably the law that the orifices of tubes are
most affected The white crust will 
fall off and be succeeded by one of a darker colour.
The coats of thrush are often many times renewed
& in this case the formation of a new one is preceded
by unusually protracted sleep. A typhoid fever
may accompany.
It seems to be an eruptive disease
determined [illegible] the al. canal.


“In its milder form it is confined to some particular
part of the mouth or to the mouth itself. The eruption is
white & the mouth appears “as if a stratum of coagulated
milk were spread over it” & but one separation of
the curd like crust will take place. The general health
will be but little disturbed”
“In severer cases two or three successive crop
are formed & the habit being unhealthy, the food innutrient,
& the frame weak and atrophous, the under [surface] ulcerates
and spreads & a low typhoid fever ensues”
# “Your principal object should be to produce an
excitement in the bowels by some mild medicine”
# Because it is an eruptive disease however diaphoretic
seen to be indicated & those which [illegible]
action “The treatment is ordinarily a gentle laxative
but there is a choice in the kind of laxative. Some practitioners 
recommend oily medicines, as butter, goose oil, pigs foot oil
etc. But these articles do mischief As the vital powers of the stomach 
are weak, these oils will become rancid”
# In such circumstances the oils become rancid & 
consequently irritate. I never allow oils to be
given, yet it is a common practice to swab the
mouth with oils, especially goose oil (or [illegible]?)
# Chalk shd generally be preferred the other articles
dissolve more slowly & may act in part
mechanically”


15
It is thought that this disease has often
been prevented, by giving soon after birth a teaspoonful
of cold water & repeating the remedy every
morning, for some time taking care also that the bowels
be kept open There may be some foundation for
this belief inasmuch as the disease is brought on 
by heat and debility. “In families where the children
have uniformly been subject to this disease. I have recommended
cold water as directed that the room should be well ventilated
and the child not covered with too much clothing”
In mild cases & where the constitution 
of the child is robust, a gentle laxative will be sufficient
to remove the complaint # 
Castor oil is very often prescribed for it
& it may be proper to five it to assist the operation 
of other cathartics But there are several objections to 
this article. It does not affect the secretions so much 
as other cathartics. It does not evacuate the contents of
the bowels so thoroughly as others & it tends to 
# relax the coasts of the intestines, already in a state of 
morbid relaxation “It will not remove the mucus of the intestines”
For mild cases magnesia is the best laxative 
where it can be given in sufficient quantities. If the
bowels should not need a cathartic chalk or some one
of the other testacious powders may be given “as [illegible]
oyster shells, crabs eyes, crabs claws etc.” #
Because it is an eruptive disease however, diaphoretics 
and articles which translate action seem to be indicated 



# “Give at first the clear liquor of this infusion and if this does
not operate stir it up and give the substance
(1) “After the stomach and bowels have been evacuated the
ipecac should be given in small doses ¼ to 1/6 of a grain, to 
keep the bowels open, to produce a tonic effect, to determine
to the surface & to prevent convulsion Ipecac has
more claim to be considered as a specific than any thing
else. It obviates the morbid secretions of the bowels it acts as
a tonic never produces unequal excitement or other tonics
& it does not like astrigents produce constrictions Whenever
there is a tendency to unequal excitement it must be
obviated or tonics will do no good”
# I rely upon the ipecac though I use [illegible]
sometimes especially white root asc. tul.
# Indeed “if diarrhoea is present, prepared chalk is a
good remedy as is also charcoal: the best form of which 
is burnt oak for this can do no mechanical injury”
# “I have found this almost a specific” Since I have
used this treatment I have not lost an infant by 
this disease” Ipecac in small doses as an alteration 
approaches as near to a specific in any remedy can
# which is not to be expected
# Astringents must be avoided, though tonics are indicated
because they produce unequal & local excitement & 
stricture they must be given in the latter stages after excitement
has been [equalised]
A little borax may be given
Moseley’s solut. zinc ziii al. zi [illegible] 1 pt


16
In the commencement of the disease if the symptoms do 
not indicate the probability of a severe case an emetic
of ipecac is the best remedy Antimony has been recommended
but it is not a safe emetic for children within
the mouth Infuse [illegible] of ipecac in 6 teaspoonfuls
of warm water & give a teaspoonful every half hour
until the patient vomits or purges. # Ipecac has the advantage
over antimony in its tonic and antispasmodic
properties & in the mildness of its operation, never producing
alarming symptoms # 
If the ipecac empties the stomach and not
the bowels, a blue pill should be given of the size of
from 2 to 8 grains. If this be found insufficient, it may 
be assisted by a dose of calomel, or magnesia or an enema 
(1) After the bowels have been thoroughly cleansed
the ipecac should be given in small quantities a fourth or 
a sixth of a grain to determine to the surface & to prevent
convulsions # If this dose moves the bowels too much, we
may add “[illegible] or 1/6” one sixth of a 1/8 drop of Laudanum to each
dose The absorbent powder or the white decoction may 
be given at the same time#
Astringents should be cautiously avoided
until the stomach and bowels been thoroughly 
evacuated # “& if there is much fever” Where this has been done we may make
use of Moseley’s tonic solution, or cornus [circinata] [illegible] alba, or sericea or saffron safely & with advantage


It is to be remarked that chemical action is prevented by the
vital principle acting upon the food or articles introduced
introduced into the stomach, and putrefactive or [acetous]
fermentation if the vital powers of the stomach are [vigorous]
This principle applies to vegetables Plants taken up in 
full blown in August and packed in live [sphagnum]
will be preserved by the life of the sphagnum
In thrush the powers of life are weakened & not only
substances taken in but the secretions themselves are
subject to fermentation hance the use of obviating the 
effects by alkalies limewater magnesia, chalk [illegible]
absorbent powders
white decoct. Rx.
“To prevent the increase of vesicles of effervescences, syringe
off the acrimonious fluid as well as you are able, by some diluent 
or detergent gargle and expedite the separation of the
sloughs by invigorating astringents” vide Dr Good vol [illegilble] p. 30
“A little borax & ergot may be put into the mouth. But if the mouth
is dry & parched, this and other astringent shd not be used. In such cases
we should give mucilaginous substances as gum ar. slip. elm. or sassaf
X 5 or 6 gr a drachm? of each in a gill of water
# or viola pedata (parsley violet) or comfrey
We must be very cautious about administering it to infants


17
To correct the acidity which often attends this disease
we may administer prepared chalk or lime water
& milk Or Rx magn. usta 10 or 12 fr. elix. pareg.
xx gtts water zi given in teaspoonful doses every hour
If the stools are watery and the child is robust give
coct. ppt # vi gr. cal. 1 gr or the compd powder
of chalk in doses of vi gr. or a small quantity
fo rhubarb instead of the cal.
For watery stools give dal. 1 gr & chalk 6 grs or compd powder of chalk
It is too much the practice to scratch or rub 
off the aphthae in a violent manner with a brush
or swab. As well might the cure of any other
eruptive disease be attempted by violently rubbing
or scraping off the pustules. Rubbing the mouth with
a brush or swab until the bleeds is a cruelty which  
ought to be deprecated
Still something must generally be done
to the mouth in order to satisfy the importunity of 
nurses & prevent their mischievous attempts
A little borax and sugar X is as safe as any thing
If the mouth is dry it may be lubricated with 
muc. gum arab. slippery elm or sassafras twigs
When the mouth is in a very high state of irritation 
probably a small quantity fo sugar of
lead would be serviceable. I have not myself
ventured to administer it to infants within the mouth 
For the proper local treatment of ulcers vide ulceration 
of the mouth


From the sympathy which exists between these parts
and the surface, tonics should be combined with diaphoretics
I have given [illegible] [has] or [illegible] it is [illegible]
observed by tonic and determines to the surface
# It is mucilaginous sub-emetic & diaphoretic. It
may be given freely as a wash or administered
freely internally laxative diaphoretic soothing
antirritant “The other [illegible] may be as good”
The disease of which we have been speaking is 
a local disease


18
Ipecacuanha in this disease is emetic, tonic, diaphoretic
etc. alterative & since I have used it I have not lost
a single infant with thrush
The viola pedata (parsley violet in some 
degree resembles ipecac is its qualities & may be internally 
administered in its stead # “give a teaspoonful of 
of the decoction”
The peculiar kind of thrush of which I have been 
treating is a local eruptive disease of infants
but as it appears in children more advanced it
a critical determination of diseased action. It
is not unfrequently a favorable symptom, particularly
when it succeeds strong morbid action & 
[illegible] early in the disease In the latter stages & 
when the system is exhausted it is unfavorable
For instance in hydrocephalus, when the whole 
mouth will sometimes become sore, and the disease
seen to be translated to the mouth “from the brain to the muc. memb”
In the latter stages of any disease not
so fatal as hydrocephalus it is a very dangerous
symptom of exhaustion “In cholera infantum
it is a dangerous symptom. [illegible] there is not
translation from [illegible] essential part”


18 ½
Eruptions in General
Children of all ages are subject to various eruptions
These are generally occasioned by the quantity or quality
of their food. They are frequently cured by change
of diet alone & the greatest attention should always
paid to the diet is managing them Oily food particularly
nuts, must be strictly prohibited, as they often
cause eruptions. I have known some adults invariably
affected with eruptions about the lips or other
parts of the face after eating freely of walnuts
Fish & poke week may likewise [illegible] the eruption 
We may use the tepid bath for the purpose of 
cleansing the skin. The frequent use of the [illegible]
bath is important especially in chronic eruptive
diseases of children & adults vide p. 21 & p. 20
For infantile [illegible] [illegible] p. 1831-2 of Good
Case of a peculiar eruptive disease
vide [illegible] [illegible] P. 1831 1 [illegible] art.
The eruption was periodical, appearing at a certain hour every day
At first a light coloured opaque elevation of the skin about half an inch
log & a quarter broad like the sting of a bee or wasp. Soon after their appearance blood began to ooze
from them & producing a drop which concreted into a scab, & at the end of 3 days
fall off 8 or ten eruptions came out daily. Treatment was ineffective 
until a change of air & diet, which effected a cure
“Child 8 or 10 yrs of age about 5 p.m. it would complain of a pain
in the face then would appear elevation of the skin to the number of 10 or 12 
the issue was treated as if [illegible]
bark was tried also nit. sil. sulph zinc. arsenic & other minerals
emetics cathartics new diet finally fruit was recom ate freely 
of oranges & was benefitted. Then change of air & travelling were tried
or the first day the eruptions diminished & on the third disappeared
In such cases try changes of mineral waters & dieting”



19
Red Gum
Allied to thrush is that eruption called red gum
The original word was red gown (from a sort of spotted
red calico) which has been corrupted into red gum
It is called by [Willa??] strophilus intertinctus
It is a populous eruption & said to be peculiar to children
but this last is doubtful
The eruption is sometimes confined & sometimes
diffused over the whole body. The papulae rise
above the skin are distinct from each other & of a
rarely contain lymph
bright red colour. The vesicles contain by [illegible] only & 
terminate in scurf. Afterwards subsequent eruptions
makes their appearance. The constitution is rarely 
affected. Physicians are not usually called 
unless the nurse is inexperienced Nurses give saffron
Some physicians suppose this disease 
to be the same with aphthae. Dr [Willan] thinks they 
alternate. Dr Russell remarks “I think that aphthae
of infants is of the same nature with those
eruptions called red gum & differs in this respect
that one disease affects the skin & the other the internal
surface of the alimentary canal. Dr [illegible] thinks 
that this affection, preceded by sickness, arises from 
causes similar to those of aphthae, such as confinement,
heat, irritable state of al. can. indigestion [illegible]
If the disease be suddenly repelled
from the surface, vomiting & spasmodic affections 
take place. Hence the European physicians 


Belonging to the primary [page]
Probably the patient was not dieted so strictly as was
intended & I recommended change of air Oranges
however were beneficial. The was too fond
of good living, fond of oily nuts
There was a slight reappearance after it
but of short continuance
It was called [illegible], but improperly
The eruption was preceded by a warming sensation
of pain in the part.
“Red gum is an eruption of fine pimples of a red
colour affecting infants [illegible] within the mouth. It 
is a disease that rarely requires the advice of a physician
The cure is much better effected by diet and [regimen]
by the exhibition of medicines Still the physician
is frequently called in and he must prescribe something
if for no other object than to satisfy the friends
In order any case give a decoction of saffron & 
snake root to keep the eruption from [striking] in 
& keep the bowels soluble with tinct. rhei compd tinct
sennae magnesia, or other mild cathartics”



20
caution is not to expose infants with this eruption upon
them to a current of cold air, or to plunge them
into a cold bath. It is said that fatal consequences
have resulted from such imprudence
The child should be kept clean & 
be subjected to daily ablution of tepid water.
Particular attention should be paid to the quantity 
& quality of its food. If the eruption should be repelled
from the skin the tepid bath will be the best remedy
This disease often occurs within the mouth
& rarely requires the attention of the physician. [illegible]
tone of the mildest of the eruptive diseases
“We may give a decoction of saffron crocus? & snake
root to prevent the eruption from striking inwards 
& keep the bowels soluble by mild cathartics such as 
magnesia & rhubarb. Still more will depend 
upon diet than upon medicine. Wine & water or
one part milk & three water may be given”
[belonging] to p. 18a
“In managing most eruptive diseases more
attention should be paid to diet than to medicine. In 
most cases it is requisite that the quantity of food should be diminished.
If the food is milk, let it be three parts water, or
substitute whey. Infants should take no animal food & 
no crude vegetables within the year. Oily food and the various
kinds of nuts should be prohibited even for 2 or 3 years. A strong
child in the country, with abundance of air and exercise
might be indulged in such excesses with impunity
when a feeble child in one of our cities would be destroyed by them”


The eruption is so small as not to be observed
It is not my object to treat of eruptions in general
with minuteness but to give the general principles of
treatment food etc.
There are many eruptions met with [illegible]
children which cannot be classed or be found described
There is an affection of children appearing
within the weak, which is not described at all. In three
or 4 days after birth elevations of the true skin not of the cuticle upon the 
hands and arms & various parts of the body containing pus and [illegible] or as large, some of them as ½ dollar 
high [illegible] [fever] I have seen but few
cases they were mortal.  The books in such affections
direct bark & tonics. The practice proved
injurious. The disease as I have seen it has been 
inflammatory and required antiphlogistic treatment
It may however be typhoid sometimes perhaps.
If so it should be treated accordingly. I have seen but 3 or 4 
cases. There were inflammatory. I prescribed in all these cases & from an analogy more fancied
than real, between this & [illegible]
Eruptions are generally caused by 
improper quantity or quality of diet. The remedies
frequently get the credit of curing the disease when 
the amended diet cured the patient
Oily & highly stimulating food should be 
avoided. All the nuts one of the worst is the pea nut


21
Strophilus candidus
In this species of strophilus the papulae are larger then 
in any other of the genus. They are not surrounded with 
an inflamed base. They are very distinct smooth and shining & appear
like little pearls under the skin of about 
the size of half a millet seed. They may continue 
for some time. A close examination is necessary for
their detection. They appear on the bosom & chest
They may accompany other diseases
I have seen them accompany cholera infantum in the 
last stages & considered a fatal symptom
[illegible] dyspeptic consumption a dangerous
symptom The chest appearing to be covered
with an oil surface, looking like particles 
of water I have seen persons attempt to wipe 
them off as if water had been sprinkled on the part
Belonging to p 18 ½
Apples pears and fruits etc.
Cleanliness also shd be strictly practised [enjoined]
robust children, much in the open air, may have eruptions
about the face mouth etc. with impunity
when with the same diet delicate children, much confined, would have
fatal eruptions, diarrhoea cholera infantum etc. 


The appearance of the [former] [have] [illegible]
and the parents are often much alarmed. The disease is not
dangerous however, & leaves no scar behind
A scab is formed & the margin continues to suppurate
and matter forms underneath
“There is a thin [illegible] discharge from the part & the scab
comes off leaving a thing pellucid [illegible]” The disease continues
& this film is thrown off & the process is repeated 2 or 3 times 
It is sometimes occasioned by dentition
sometimes it is an effort of the system caused by 
disturbance in the al. can. “A prejudice sometimes prevails
with respect to this disease that it is an effort of nature 
& ought not to be checked It is a loathsome disease extremely 
unpleasant to both to the patient and the nurse & if allowed to continue
some time it would not be safe to stop the evacuation, at 
least without keeping the bowels open” 
Some [Phys.] recommend partic [illegible]
as specifics. Cal. or blue pill occasionally 
may be advantageous
Buckthorn has been much celebrated in 
this and other eruptions It is drastic& hydragogue
It is perhaps milder in form of syrup. Many families
keep it. Half a dozen berries will operate
If there is much plethora, the
neutral salts may be given Magnesia also both
for the indication & as a corrector
I have known the muriatic ether
much prescribed, but have not used it much
myself, substituting for it mur. ac. as below 


22
Crusta Lactea
This is the [illegible] larvata of Bateman
It appears on the lips, forehead & scalp in small pustules
yielding pus, which eventually coalesce & form large loose
scabs & perhaps extend over the whole face, down the neck
and over the whole body. This eruption never leaves a scar
behind it however long it may have continued. The skin is left smooth It is
more unpleasant than dangerous, as the children affected 
with it are fleshy and otherwise health. When it has
continued a considerable period of time, we must be 
cautious of checking it, as it is like a habitual discharge
from an ulcer
Treatment It is very common to give
laxatives, such as syrup of buckthorn, neutral salts, magnesia etc.
The sweet spirits of sea salt (diluted muriatic 
ether) is a very popular remedy. IT is given in doses of
from 5 to 10 drops, diluted with water & repeated 2 or 3 
times a day. I have seen this medicine given in 
hundreds of cases & am inclined to think it sometimes 
of service. It, at least give satisfaction to the parents 
& does no injury. If there is great irritability give 2 or 3 gr.
of cal. with chalk. In cases where I have thought proper 
to remove the eruption. I have given the muriatic
acid instead of ether, prepared in the following manner
Rx mur. ac. zi alcohol zi Give [3] drops night & morning
diluted with water


make [oxyg.] oint. by adding the nit. ac. to
lard until decomposition ceases, and the resulting
ointment is tasteless. It has about the consistence
of wax. Some add sulphuric acid but this is 
not decomposed & is acrid
Sometimes the ointments seem to irritate & 
then we use [illegible] The best is the sulph. pot.
zi to a porter bottle of water. Sulph. of soda
does not materially differ, but it is unpleasant smelling 
like bilge water.
In different cases apparently similar I have tried ointment
& succeeded in one, but failed in another, & succeeded 
by waste
I was led to adopt the use of sulphuret of
potash from the analogy between its solution & the water [of]
sulphur springs
“We may with advantage make application
of dry powders arrow root roasted flower hair
powder taking care to give a cathartic when we check
the discharge. We should pay particular attention to the diet
both of the child and mother making the food weak & [simple]
Laxatives will commonly be removed; a little magnesia
& sulphur so as to move the bowels once or twice a day
“A discharge like this may be checked with 
safety at the commencement, but when it has become habitual
it should not be stopped unless a drain is made
& kept open in another part.”


23
For this eruption I have found the oxygenated 
ointment, very efficacious in removing the scabs & healing
the sores It is always safe if well prepared. ‘It is made
by decomposing nitric acid with
lard’ Perhaps the [citric] ointment (nitrate of mercury
with lard) may be equally efficacious, but it is less
safe. A good ointment may be made by mixing
calomel zii with simple cerate zi or mutton suet zi
The sulphuret of potash is one of the best remedies 
for this & other similar affections Dissolve zii in a
pint of water & give a table spoonful night and morning
also let the part affected be washed with a solution of 
twice the strength “It sometimes [illegible] two or three days and [illegible] [illegible]” Some prefer sulphuret of soda
sulphuret of lime would also be equally efficacious
Such solutions small like bilge water & are analogous to the water of sulphur 
springs I have sometimes used the sulphuret of pot.
as an unguent. Sometimes liquid applications & 
sometimes unguents will succeed best, & if one fails we
may try the other “Calomel ointment may be applied
about the edges”
If the eruption should suddenly dry up 
& fever ensue, a dose of calomel should be given & be followed
by a few drops of antimonial wine 3 or 4 times a day 
or a small quantity of ipecac. White hellebore may be
given
Sometimes the eruption degenerates to a phagedenic
ulcer. In such cases I have used charcoal 
eternally also a variety of poultices. I have seen much 



The const. irr. may expend itself upon the skin
or upon the gland. syst. or upon the al. can. etc.
We must be cautious about suspending
them suddenly
“It is important in all kinds of eruptions
to keep the skin clean and soft & to effect this
we should prescribe the warm or tepid bath, every day or 
2 or 3 times a week. It removes itching and irritation, is always 
safe and almost always beneficial”
May be caused by teething or by food etc.
Such things often withstand various remedies & 
hence are prescribed for very empirically


24
benefit derived from the application of roasted flour. It 
absorbs moisture & excludes the air
Eruptions attendant upon Teething
Children are very commonly affected with eruptions 
when teething. They generally put on the appearance of a
fine rash, but sometimes consist of distinct pustules containing
matter
As they are symptomatic merely, they require
no particular attention to be paid to them & will 
disappear when the teeth get through. The worst consequences
might result from their sudden suppression; as
if this mode of action by which the system relieves itself
from the irritation of the teeth, be interrupted, there is 
great danger that the system will relieve itself by 
morbid action of the brain, or other parts more essential to life
Eruption resembling the itch
Another kind of eruption appears on children of one or 
two years of age. It sonsists of distinct pustules like
those of chicken pock, which form a scab, continue to 
inflame about the edges & contain a watery fluid
It usually makes its appearance in summer & if not cured
disappears spontaneously at the commencement of 
cold weather
It has often been mistaken for the itch, and 
attempted to be cured by [?dock] root, but without success.
The sulphuret of potash used as above is a good remedy 


The tepid bath is apt to be neglected but shd not
Dock root often fails in this. It is
often very successful in children’s eruptions. It is
a very old remedy (centuries) Sometimes goes
into oblivion & is again revived
Prof. Smith thought most highly of R. patientie 
6 feet high in gardens. Woodville mentions
R [aquaticus] I know not that either is better than 
our [common] [illegible] I prefer the [Robtusifoli??] or [horserock]
It is acrid and acts well when ext. [applied]
and is good int. like rhub.
R. crispus also has about the same properties but is
milder. R. sanguinea is kept by many for it is
as a specific for cutaneous eruptions. called also 
jaundice root & used in jaundice I have
used them all and cultivated than all The leaves
of the R. sanguinea have all red veins.
You will often have such cuticles
exhibited to you in families and be [illegible] of about
them. Hence the importance of a knowledge of their prop.
I have never known them in any but
the children of [foreigners] I am inclined to 
think the taint may be dormant.
The eruption at first resembles what
is called “horn pock” “sometimes resemble a [illegible]” The nurse was changed 
& though the new one was
health yet the ulcer appeared on her nipple


25
I think this kind of eruption might be cured by diet
and the warm both. In all cutaneous affections the 
warm bath is very important to relieve the skin
from every thing that may obstruct perspiration
Eruptions & other irritations of
the skin translate action from the viscera. Where irritated
action exists in the viscera they are symptomatic
Gutta rosea of drunkards is an instance of translation of 
action from the liver “When a cutaneous eruption appears
we may generally apprehend that the al. canal is disordered”
I cannot too strongly enforce attention 
to diet. Nothing will avail without it
Venereal Eruptions
These appear infants born of parents tainted with 
syphilis, though they may have no symptoms of it at the
time of the birth of the child. Some physicians are of opinion 
that this child may inherit the disease from its ancestor 
the parents having been apparently free.
The eruption appears in smooth hard, circumscribed 
elevations of the skin of about half the size of a 
pea 7 resembling a wart before it has seeds. They continue
to increase slowly in size for two or three weeks, & become
soft, containing a watery fluid in [honey] like substance Subsequently the skin
gets rubbed off & leaves an ulcer with ragged edges & sometimes resembling a chancre which
is very difficult to cure. I have known one instance
in which the ulcer was communicated from the child to 
the breast of the nurse. Children affected with this 


Eruptions sometimes depend upon morbid state
of the liver analogous to gutta rosea of drunkards
Prescribe to the liver
“The disease often proves very obstinate”
Mercury does not seem to act as in the
primary disease
Corr. sub. given in this way is as
safe as any other article
The bowels should be kept free
“I think the sublimate acts more on the skin & is therefore
preferable to other mercurials”
The plantain was once celebrated for the cure
of cut. aff.
I have known the plaintain in this
way apparently cure after mercurials had failed
Still the mercury might have prepared the system
The plantain is an old English remedy for bites of spiders etc.
It is treated of by Woodville & [Willan] It has as little acrimony 
I have some confidence in its efficacy. There is an old story about a snake & [spider]
I have known nondiscript eruption
which had resisted the prescription of several phys.
cured finally by diet & change of air



26
complaint have a pale & bloated appearance & the powers of
life are feeble
Treatment. Change the nurse if derived from her
Give corr. sub. in doses of 1/30 or 1/40 of a gr. Give the blue
pill in moderate quantities but it subl. is better Give the tepid bath. Try
the preparations of iron, such as the mur. ferri, or 
tartr. ferr. or the alkaline solution of iron. This complaint
is not so easily cured as the primary [illegible]. Sometimes
it will resist the operation of mercurials & all 
the treatment for scrofula. In this case send the patient
into the country & try simple vegetable articles especially 
the expressed juice of the plantain (plantago major) externally
and internally. It is a popular remedy for poison & is apparently 
valuable. I have known patients cured by the use 
of this, and of the air of the country. Still I think its 
main virtue to consist in its bland & mucilaginous quality
[In these cases the whole lymphatic system is
disordered & deobstruents are indicated. Now the expressed
juice of most green vegetables id deobstruent. For instance 
the farmers make use of green rye in the spring
for this purpose] Perhaps the expressed juice of the green
plantain is deobstruent


Infantile Erysipelas is an improper name
vide Gray [illegible] of Erysipelas
Good’s is an entirely different disease and his account 
will completely [illegible] Corresponds perhaps to the 
rose of the W.F. Goods account of the rash may do pretty well
The infantile erysipelas of Europe described in 
the books is a different thing # 
Resembles shingles this is accompanied with fever 
The primary affection is of the al. can. therefore
the attention is not to be directed exclusively to the skin
I commences with [illegible] [illegible] you are to prescribe
to the fever [illegible]
This disease is distinguished by the eruption 
resembling a rose in the shading off of the colour from 
a dark rose to a light colour & in the concentric circles As I have seen the disease
the rash has appeared in patches about the [illegible] thighs 
principally & the local affection gave no [illegible] and was
trifling while the constitutional fever was severe and dangerous.
The fever if not broken up in the commencement will
resemble a severe case of [autumnal] remittent
I have found no satisfactory account
of the disease in the books, not even in the W. P. writers. I have
however been informed a conversation with W. Indians that the 
rose is one of their most severe and dangerous infantile diseases
fatal in a week
and is treated by a vigorous administration of calomel
# I have never seen the infantile erysipelas described as occurring
in the European lying in hospitals contagious & terminating 
in gangrene I have seen common erysipelas upon infants 
however


27
Infantile Erysipelas
The classification of this disease id doubtful. It answers tolerably 
well to the exanthesis roseola of Good “but [illegible] febrile” there is no species in 
Bateman & Willan which corresponds to it
Efflorescence in blushing patches, gradually deepening
to a “dark” rose colour, mostly circular or oval, alternately
fading & growing brighter chiefly on the legs with irregular
appearance somewhat like concentric circles if the patch is not circular the general circumference
This is a disease of rare occurrence with us
I have met with three or four cases.
It is a severe and dangerous disease, apparently 
the same with the dangerous rose of the W.F.
As it appears with us it is very different from 
the erys. that described by European writers & which is sometimes 
epidemic in their hospitals. In children in this country
it is generally a disease sympathetic with a morbid state
of the bowel
The elevation of the skin is less than in erys. of 
adults the discoloration less deep in colour & the skin though
a little tumefied is as smooth to the touch as if not
diseased In the cases to which I just alluded, the erysipelas
began upon the thighs & extended all over the legs. It was accompanied
with considerable fever & a hot dry skin The colour of the 
efflorescence was purplish rather than red ‘We rarely see
watery or bloody vesicles, as in other erysipelas’ I evacuated 
the bowels thoroughly with calomel (for the sake of the excitement
rather than the evacuation) & rubbed the part affected 


The fever will much resemble that of infantile
remittent
“The spots are in patches from the size of a
dollar to 5 or 6 times as large They are shaded in concentric
circles from purple in the center to a lighter colour”
“If the disease is not checked there will be 
increase of fever, constipation and tumefaction of the
bowels irritation of the stomach affection of the brain, [illegible]
death”
Administer a full dose of calomel in the first place
and repeat it once or twice. Work off the cal. with other 
cathartics. The secretion excited by the calomel is
what we want. The cathar. subsequently given bring away 
Antimony in small quant. & nitre may be given
until the liver is subdued
“When the febrile symptoms run high
pulse tense, tongue furred skin hot it is a very dangerous
practice to apply discutients applications to the eternal
affection Acetate of lead applied externally will probably 
translate the disease to the bowels”
“Treatment I first give colored in full
doses to alter the secretions to change
excitement and promote evacuation, but do not depend
upon it as a cathartic I then give [illegible] or [illegible] & [illegible]
etc. to move the bowels I afterwards use the absorbants
or alkalies, or ant. or iped. in small doses, as the case
may require


28
It is attended with constipation & tumefaction
& [illegible] of the bowels; with hiccup & severe fever, & may 
terminate fatally with severe coma
“Pulse small & frequent child dies usually 
on the 5th or 6th day”
“Dr Dewers says that in the cases he has
seen the disease was not local but would spread rapidly 
over the body disappearing in one spot without leaving a trace
behind it & breaking out in an other & perhaps a remote
part thus changing from one end of the body to the other”
Treatment. “Evacuate the stomach with an emetic, as
ipecac” Clear the bowels thoroughly with cathartics, for the
sake of the impression on the system. Give calomel in a 
dose of from 5 to 10 grs. If it do not operate within three
or four hours repeat the dose. If necessary , work off the
calomel with senna (or scammony?) adding aromatics
if the stomach is irritable or with castor oil if the senna
fails using also some laxative injection & the warm bath
to assist. Then keep the bowels open with blue pill & 
“use some mild diaphoretic as aqua amm.” or  give antimony
from from 1/20 to 1/16 of a grain
Pay little regard to the eruption and direct
your attention to the bowels I have letters from physicians
who have followed my directions & treated the disease not as a 
local one but with cathartics which testify the complete success
of this plan of treatment. In the W.F. also where the


“As palliatives after a strong impression has
been made on the bowels by calomel, we may give sweet 
spirits of nitre, aqua ammoniae etc.”
I have tried various either applic. without benefit
I have
“In those cases when the treatment wa local only 
the patients have uniformly died. I have not lost a single
case to which I was called with commencement. I have
conversed upon this subject with medical [illegible] out from
the W.F. and find that the practice there coincide with
mine”
“When called to cases of some standing I have endeavoured 
to arrest the progress of the disease by a blister
as [illegible] in gangrene & in the erysipelas of adults. The 
disease would extend beyond the blister just as if none
had been applied”
There is an erysip. affection which occurs about the
head of children which resembles that of adults which 
I have treated with lead water


29
disease is frequent it is treated by the physician with 
calomel & cathartics. They give calomel 10 gr. & repeat
it in 5 gr. doses until 20 gr. have been given
I once saw a child with a swelling on one
ankle supposed to have been produced by the sting of a bee or bite 
of a spider, which had resisted the operation of poultices & lead
water. I gave cathartics but they did not operate, & the child
finally died
External applications of any activity
should not be used, Still it may be necessary to apply something
in order to satisfy the parents. The best will be roasted
four “dried [illegible] [illegible]. Warm bathing will be very useful. If treated
with lead water & cathartics not used, probably every case 
would be fatal. I have blistered in imitation of Dr
Physick, but never with any advantage
‘If the disease be followed by diarrhoea
give absorbents & aromatics such as compd powd chalk or white
decoction. If followed by weak pulse etc. give tonics’
I have not lost a case when called early 
‘This disease is supposed by some to be hereditary 
I have seen it affect infants on the scalp when it appeared to 
be a local affection merely In cases of this kind I have used
lead water with [illegible] continualy advantage & without any evil consequences’
Cathartics however should be more or less employed
in conjunction “afterward aromatics or tonics as the case may require”
‘It sometimes affects the brain’


[illegible] a more [illegible] or [illegible] intertrigo an attenuation
& sometimes abrasion of the cuticle. The vessels forming
the cuticle are diseased and the skin is formed
in an imperfect manner It occurs also about the
nates, [illegible] etc. where the skin folds upon itself & the
air is excluded sometimes an acrid discharge Cullen
thought it a very thematic affection. The skin looks
like a new skin upon these parts. it arises from 
want of cleanliness & from confinement. The stomach
may in a state of indigestion secrete an acid and the
skin may secrete an acid. Exercise cleanliness
treatment in general of eruptive disease 
When [illegible] flax they would
burn a rag and put it in an axe & rub their finger
on to harden the skin when chafed. A scorched rag is
beneficial & use absorbent powders first nit. [illegible]
might be used keep dry the parts
Nurses apply “powder post” which is made by [worms]
Sometimes it is a vesicular eruption
which upon the head is called [farrigo] & in some situations
is called ring worm
To the [illegible] or intertrigo occurring in 
various parts the nurses sometimes apply the membrane
from suet which is smooth keep off the air, prevents farther
chafing and does well. The absorbent powders as starch
alabaster etc. do well


30
Sore Ears
This forms a very important subject in treating of the
diseases of children. Nature has chosen the part behind the
ear for eliminating irritation from the system. Under this
head I shall speak of purulent discharges from the cavities 
of the ears & nose
Slight blisters and ulcerations behind
the ears of infants are very common & are in most cases, so mild 
as merely to require washing with cold water weak soap
suds & with cold water, & being covered with a scorched rag
or with roasted flour, to prevent irritation from the cap
Frequently the discharge is acrid & excoriates
the adjacent skin. Often a miliary eruption at the part
commences the disease & is followed by excoriation 
Affections of the brain are sometimes relieved
by a discharge from this part. The discharge is very important 
to children in time of teething & when affected
with bowel complaints.
If suddenly stopped fever may follow
with full pulse, tense constipated bowels & fulness of the fontanelles &
“often nearly all the symptoms of hydrocephalus”
cold extremities Blisters behind the ears will generally 
restore the child to health
When an infant is suddenly attacked with 
symptoms of hydrocephalus [illegible] disease, enquire whether it has had sore ears which have 
suddenly dried up, & if so, apply blisters behind 
the ears, for without them nothing perhaps will cure
the new complaint. The same is true of old sore legs stopping of the [illegible] & other charges
The theory of this, in all such cases, is the necessity, not 



The quantity of evacuation will not amount perhaps 
to more than a teaspoonful & the fullness of the fontanelles
[rain] in the head & plethora is not owing to the quantity of
fluid. The same plethora, pain in the head etc. will 
result from cessation of catamena which discharges will 
not amount to more than a table spoonful
So you may bleed to the amount of pounds 
in cessation of a slight discharge for an old sore leg
with out relief. while if you start the ulcer again 
by [illegible] or [mustard] the symptoms will be relieved
Case of a man with ulcers on the legs of 10 to [20] years standing
discharge stopped [illegible] pleurisy & aff. of liver the
discharge restored by [illegible] blisters caustic etc. cure affected
Sulphate zinc 10 gr. to oz or 2 oz
may be applied Solution [illegible] sil. is one of the mildest application for irritated surfaces vide infra
Oxygenated [illegible] is mildest & 
less apt to become acrid Sometimes when the aff
is of an erysipelatous kind [illegible] relax the parts & 
are injurious
Change the nurse also if necessary
If the child is fed upon milk by hand, add perhaps
a little magnesia or lime water 
Similar affections may affect the 
cavity of the ear & the cavity of the nose. If the 
cavity of the ear is affected in this way & neglected ulceration 
is apt to take place & the small bones affected
causing deafness. First reject milk & water or
carb. soda etc. [illegible] Finally if these means fail use
stimulating injections myrrh finally [vit.] sil.
In the use of [illegible] sil. external began with 5 grs to the oz & increase if necessary 
to xv or xx to the oz


31
of the evacuation, as is generally said, but of the habitual
action of the system.
This affection sometimes degenerates into a very 
troublesome ulcer, extending down the neck, accompanied with 
much pain & yielding a discharge so acrid as to excoriate the 
skin wherever it touches it Deep sores will be formed
& the affection may terminate in gangrene & death
In such cases it may be proper to apply 
emollient poultices of bread & milk; to which may be added
poppy leaves, or pulverized stramonium seeds or ac. plum.
Powdered gypsum is one of the best applications Alabaster gypsum
is the finest kind Some apply red precipitate but gypsum is far better. Case in which this alone cured;
Another physician advised red precipitate The oxygenated ointment if well made is a smooth
dressing for them & is the best kind of ointment, where 
ointments do not disagree, as it sometimes the case. The 
bowels should be kept open with cal. or blue pill.
It will sometimes be necessary to correct
the milk of the nurse by administering magnesia & confining
her to a simple diet
Troublesome & sometimes fetid discharges 
on the internal surface
from the ear arising from a kind of eruption may follow this eruption & may cause deafness if neglected I have known also the 
cavity of the nostrils & the frontal sinuses affected in the 
same manner. A cure may 
be affected in either case by exciting the discharge behind
the ear though it may be necessary to keep it open for some time 
If this fails use (in addition?) milk & water Milk 2 part water 2 part lime water 1 part Tinct. of 
myrrh if the discharge is fetid & troublesome a teaspoonful to a gill, as an injection for the ear
Sol. nit. sil. 1 or 2 gr to oz. water? externally


Be very careful in watching the symptom Case of a 
young man who had had such a discharge for years 
checked by astringents [delirius] inflammatory fever
ertc. bled cathartics etc.
Porrigo galeata ([helvetea])
Cuticles below the scales dotted, shining
Said to be contagious. I have never happened to see it so
though I do not doubt the fact. I have never seen more
than one in a family have it
A very troublesome complaint The 
hair becomes pale, perhaps the roots are affected in which 
case mercury is indicated.
Salivation seems to do no good I have 
seen it practised without any benefit
Recent cases I have cured very speedily 
with oxyg. ointment. Any smooth substance applied
to the part & excluding the air, will often cure as for in stance
a bladder, or the membrane of suet what is useful
also for [fret] Poultices do well, whether upon this principle
or moisture changing secretion
When a student I recollect there appeared 
a strong recommendation of poultices A physician of my 
acquaintance prescribed a poultice & left his patient. It adhered
the hair grew into it and the hard
crust formed a helmet indeed. It [was] a long time a
period of week, before it was removed When it came off
however, the disease was removed!



32
Tinea Capitis. Scald Head porrigo
This is a local affection & yet much influenced by diet. Sometimes
however it affects the system, or is sympathetic of a general affection 
of the system.
The disease consists of scaly eruptions, eventually 
covering the head with a hard & generally brownish
coloured crust. The hair often comes off.
Cleanliness holds of course the first place
in the list of remedies; the head should be carefully shaved 
and washed repeatedly with soap and water. Perhaps as
successful a mode of treatment as any will be to shave the
head closely and apply a bladder or affect skin in close contact with the
skin. It excludes the air. Sulphuret of potash zfs or ai to a porter bottle used as a 
wash & given internally tablespoonful 3 times a day has cured the complaint in a 
few days mercurials or corrosive sublimate will be useful, but do not always cure.
Sulph. prt. internally zii to lb i [illegible] ext zii to lb is [illegible]
The ueast poultice is good, but care should
be taken that it do not become dry on the head, which should be 
first shaved. The oxygenated and the citrine ointments
have been found useful, as had also the tar ointment which 
is made as follows Rx tar ziv wax zfs sulphur zi or is
Mercurial cathartics should be given from 
the first and particular attention paid to the diet. # vide last par.
The practice in this complaint has been 
quite empirical & a great variety of remedies, have been 
popular. Veratrum viride & v. albus & [apocynum] [androsaem??] 
olium have used for external washes. Syrup of 
buckthorn is recommended as a cathartic. Muriatic acid


Lunar caustic about 6 grs. to zi of water (rain water)
well water may decompose it
Decoction of cocculus indica, is given
internally & externally.
Cal. zii al burnt zfs red lead zfs z6 zifs spermaceti cerate head shaved & washed with soap sude every
night and afterwards apply this ointment. It is given by 
[illegible] & Bates [illegible] & called
Diet must be attended to 
Terebinthinate ointment as tar ointment
Tar ointment is made of tar and lard or tar & 
simple cerate
There is no difficulty in the diagnosis of the
disease. You will be called to prescribe for scalled head
and you will find that the nurses have not mistaken the
disease. It begins with small pustules the matter
[illegible] which is acrid and soon forms a scab over the whole
head.
The treatment must be principally local. But
mercury may be given occasionally. I have not derived much 
benefit from the common mercurial ointment. Citrine ointment
is good however. Also cal zif lard zi


33
has been used 3 or 4 drops in a wine glass of water
Finally the sorts of the various species of dock (rumex patientia, crispa
obtusifolia, sanguinea, aquatica etc.) have been much used
All the species have about the same properties, being acrid
purgative etc. They are given internally as cathartics, & 
externally applied, made for instance into an ointment, by 
pounding up the fresh root with lard. The following
is a recipe Rx yellow resin zii
best ale lb i finest flour ziii mix the all & flour thoroughly 
together & add them gradually to the melted resin.
# The tepid bath may be used when this is used always
take care to have a supply both of hot and cold water
in order to keep up the proper temperature. Ipecac may be 
administered to equalize excitement in some cases, & as a 
valuable substitute for this article we can use the
root of asclepia, tuberosa, which is expectorant, diaphoretic 
and laxative.
“Vary the remedies according to their affect
soften use decoct. rumex particularly r. obtusifol. 
called horse dock. It at firs increase, the 
irritation & secretion. Use it externally & internally”


The excitement of the al. can. is affected also of
the nervous system
Various cutaneous aff. different kinds also of
local inflammation, or erysipelatous phlegmous gangrenous 
scrofulous the inflammation varying according to the 
constitution scrofulous gangrenous
I have frequently heard Pres. Dwight
speak of the pain he experienced in cutting his wisdom teeth
suffered extreme pain for a whole summer
She did not appear to me to look like a person in the consumption I was puzzled [illegible] [illegible] I looked into her throat and mouth
and found she was cutting r wisdom teeth
# The irritation may continue for mouths, from 
the pressure upon the gum
Those who commence cutting teeth at 10 mo.
to a year or even later do not necessarily suffer more
Delicate & scrofulous children suffer more


34
Dentition
Among the causes of infantile diseases no one more
claims the attention of the physician than dentition. The bowels
and the nervous system are always more or less affected by it
& to this cause we are frequently to refer affections of the lungs
of the brain, of the ear, of the skin, of the glands, & of the cellular
tissue in general. On this subject there is however a difference
of opinion, for it is said by many medical men that children which are
healthy # well teeth with as much ease as adults. Allowing
for the peculiar irritability of [illegible], no doubt they do,
but in granting this we concede nothing, for adults often
suffer extremely from dentition. I well recollect the case
of a Mrs Waters perhaps about 20 or 21 a married woman and the mother of 
said to have a [illegible]
several children, who was supposed to be in the last stage 
a good deal of cough etc. had raised a little blood
on consumption & upon examination & found was cutting
the four wisdom teeth. The gums were divided & 
antispasmodics administered, when she recovered perfectly.
# Case of Mrs Purcell’s child had been sick
with diarrhoea and fever for some time a flush of fever 
coming on every day. I had previously extracted defective teeth
from the [illegible] mouth. I now looked into the mouth lanced
the gum over a double tooth gave no remedies
The period of dentition commences at different
ages times in different children, varying from the fourth to the sixteenth
mouth, but most commonly in 
the sixth. The two central incisors of the lower jaw appear
about the sixth month and are followed in about a month
or six weeks by the corresponding teeth of the upper jaw.


very [illegible] [illegible]
[illegible] cases I have known a double tooth cut
first in others an eye tooth in others all the teeth at once
You must always examine to see what teeth are
cutting You will perceive the gum swollen and harder 
Some children are born with teeth but
such teeth re merely attached to the gum and are useless
and should be removed
Sometimes there is too much anxiety about
dentition generally however not enough Case of a 
child mother called me insisted upon
# irregular distributions of temperature are [illegible]
[illegible] hot 5 [illegible] cold


35
Next come the inferior lateral incisors & after these the corresponding
teeth above About the twelfth or fifteenth or 20th month
appear the anterior molares & are soon succeeded by the 
cuspidati those of each kind in the lower jaw cutting
through before those in the upper. Next we have the posterior
molares. The last molar teeth are not found in the child & hence
their name, dentis sapientiae. They appear from the 18th to the
25th year.
The above is the order in which the teeth 
commonly appear, but they often come irregularly, sometimes
the lateral incisores, sometimes the molares, & in
a few rare instances the cuspidati appearing [illegible]
Some persons never have more than two incisores in each jaw
Occasionally we meet with families who are said to 
be destitute of teeth. I have known a family from Charleston,
who had this peculiarity. The fact however is in such 
cases that the teeth exist but not rise above the level
of the gums, so that they are not ordinarily seen 
Such teeth have this advantage, that they are not subject
to decay & are also very serviceable.
Whenever between the fourth and the eighth
2nd year? month symptoms of irritation exist, the cause of which is
not obvious, the state of the teeth must be examined. The 
symptoms of difficult dentition are fretfulness 
inclination to bit hard substances, putting the fingers into
the mouth, slavering, starting in sleep eruptions about
the face & on the scalp, flushings in the cheeks. # hot head


pupils contracted sometimes dilated sometimes
losing their brilliancy
In delicate children the eff. will be more
chronic & in vigorous more acute
The system relieves itself often by evacuation 
and this is considered often a good symptom as [illegible]
there is a great flow of saliva. The system relieves itself
by diarrh. by salivation by sweating [illegible]
by every mode of equalizing excitement which 
is the great principles on fevers & indeed in most diseases


36
and cold feet, irregular paroxysms of fever, remitting
fever vomiting diarrhoea irregular & green stools wine
small in quantity & voided with pain or in large quantities 
and of a pale colour bloating of the hand feet and 
face contracted pupils. All the symptoms indeed of extreme irritation
may be met with & we likewise find in many 
cases a tendency to phlegmonous inflammation suppuration in various parts of the
body particularly in the ear. Case of a child who was
thought to have an affection of the brain. A tumour was
found under the arm.
Sometimes dentition is accompanied with 
phlegmonous local inflammations in different parts of the 
body & suppuration of the glands about the ar by which 
relief is afforded
Ricketty children cut their teeth more
slowly than others but not in general with greater difficulty.


The child must be held, and the fingers
keep in the mouth to keep it off the tongue
# The guard being made with a spring, so that when 
pressed upon the guard will yield and permit the
lancet to descend (in the slit of the guard)


37
Treatment. The first and most important indication is 
to divide the gums with a gum lancet or other convenient instrument.
The operation is not usually painful the child will 
even press against the edge of the lancet. The relief is often immediate and permanent
Some relief may indeed be afforded by rubbing the gums with 
a hard & polised substance & by giving the child something
of the same kind to bit, but the most effectual relief will be 
afforded by the lancet. The chief difficulty in the performance
of the operation consists in confining the child. It
may be done while the child is asleep & often without
waking it. We must also be cautious not to cut the tongue
To prevent this it would be better to make gum lancets with 
a guard # For the double teeth two incisors
should be made & it may be necessary to make a transverse 
one in order to divide a band of a sort of ligamentory
substance which confines the tooth.
It is sometimes objected to cutting the gums
in particular instances that, if it is done too early, the
cicatrix formed by the healing of the incision will subsequently 
render it more difficult for the teeth to push themselves through
This is not true for the cicatrix though apparently harder [illegible]
less vitality in it than a part which has not been wounded and will be more easily broken through
Solution of continuity is more easily made by disease in a cicatrix
than in a part which has not been wounded vide J. Hunger. It is a 
common maxim that an old scar is apt to break out in to a sore
The gums should be divided as often
as there are any symptoms of irritation, until the teeth 



Some other diseased action may exist in the
system, and the irritation of the teeth be superadded
the lancing will only relieve the latter
# For the gums having been exposed for a long
time to irritation because [illegible], and perhaps
ulcerated and are kept irritated by contact with 
the hard tooth


38
get through I have repeated the operation three or four 
times upon the same teeth. In some cases however cutting
the gums relieves the symptoms only in part. Indeed the irritation
sometimes continues after the teeth get through # “use astringents”
If any disease from the causes attacks the child
during the period of dentition it will be very important to 
remove all irritation from the latter source, for otherwise
all the symptoms may be aggravated & a disease be rendered
mortal which would otherwise have been mild.
In children of a vigorous constitution dentition
is often accompanied with inflammatory symptoms which require 
an antiphlogistic plan of treatment. Lancing the gums
will then be useful as local bleeding & it may even be advisable
to bleed from the arm though a few leeches behind the ear
are preferable.
It must not be forgotten that in 
infants, the bowels afford a great outlet to diseased action
and to irritation: hence the frequent occurrence of a spontaneous
diarrhoea. If the patient is costive or if it has a 
diarrhoea, a dose of calomel should be administered & if
the bowels are soluble a milder mercurial, as blue pill
may be given. During the whole period of dentition the
bowels should be kept open by such cathartics as the state of 
the system may indicate, such as magnesia, rhubarb etc. adding
aromatics if the system is relaxed and debilitated & chalk
if there is acidity
If a diarrhoea suddenly stops and
vomiting supervenes, externally irritant to the [illegible] [surface] generally, injections, calomel


The skin shd be kept moist for diaphoresis
is one of the most powerful means of equalising excitement etc.
If there is much perspiration you may 
depend upon op. alone but whenever there is much 
[unequal] excitement opium alone will not do well and
ipecac shd be combined with it in small doses
# Also by drafts to the [illegible], by local irritants 
to the skin generally also keep the bowels from 
remembering that there is no outlet to the brain 



39
and the warm bath are to be used, as has already
been mentioned under the head of diarrhoea
Another & a powerful mode of equalizing excitement & relieving 
irritation is by diaphoresis. For this use the warm bath & 
small doses of ipecac & opium or of antimony and opium.
Opium will always be useful to allay irritation & particularly 
if combined with ipecac or antimony, & always safe when 
there is no determination to the head
Small blisters behind the ears relieve the 
symptoms of dentition & prevent the disease from terminating 
in hydrocephalus. # If these cannot be kept behind the ears
mercurial ointment or cantharides may be applied to the 
same part. Nervines may be employed either with our 
without ipecac
During dentition exposure to dampness & 
to currents of air should be carefully avoided & the patient
should be kept warm


X summer & autumnal epidemic
Indeed the effects of it sometimes continue through 
the winter
The desire often resembles spasmodic
cholera in the premonitory diarrhoea & the sudden
collapse 


40
Cholera Infantum
This disease appears in New Haven in the month of July 
August September & October. It rarely commences until 
the latter part of July & in October there are few cases except
those which have commenced in one [illegible] other mouths & continued
until this. Indeed cases are sometimes prolonged till 
the middle of November
Symptoms. It begins in various ways; most commonly 
with diarrhoea, which may continue for days & 
even weeks without any very alarming symptoms; At other 
times times with violent vomiting & purging accompanied with high
fever.
The discharges from the bowels very much in their
usually [illegible] from natural colour [illegible] [irritated] [secretion]
appearance. Sometimes they are yellow, brown or green, sometimes 
in small quantities & slimy and bloody & at others in 
large quantities & watery, smelling like water in which 
putrid meat has been washed. Worms likewise may be
found in all these various sorts of discharges “dead in the advanced stages”
The disease is usually accompanied with great
restlessness & often with severe pain, which increases
by paroxysms at intervals of from 
fifteen minutes to two hours
The pulse is usually quick and weak, the
head hot and the extremities cold. The fever is ordinarily remittent
but the exacerbations are frequently quite irregular
The disease is attended with thirst often [illegible]
and after drinking the child vomits.
The eyes often appear languid and hollow  


During the whole progress of the disease [volvulus] may 
occur Be on the look out for it
“The termination of this disease in hydrocephalus 
I have reason to think is more rare than is commonly 
supposed. Many cases of this kind occurring in my 
practice, I have reason to believe were cases of volvulus
Or varying from cholera morbus of [illegible] [remittent]
bilious fever sometimes putting in the form of cholera of [illegible]
at others that of remittent bilious fever


41
while in other cases they may have an unnatural
brightness as in pulmonary consumption indication a high
degree of mental [illegible] excitement “of bad symptoms” Sometimes the eyes are half
open during sleep, as is indeed the case in various bowel complaints 
of children when severe we often find the diseased action 
translated from the bowels to the head and terminating in 
hydrocephalus. Volvulus also may be another termination.
Sometimes the vomiting ceases
for several days and then returns, while the diarrhoea
continues the whole time
Duration As to the duration of the disease, it may 
be very rapid in its progress & terminate fatally in forty eight hours, or continue for
months, & the symptoms may vary very much during the 
progress of the complaint. A damp hot atmosphere will aggravate 
all the symptoms, while cool weather with the wind 
from the northwest will mitigate them. In different
seasons also cholera infantum will have symptoms peculiar
to the year, varying in this respect like other epidemics
Finally when it proves mortal, the child is
carried off in convulsions, or is worm out with emaciation 
& dies with aphthae while in some cases death is ushered in by hydrocephalus,
volvulus & other diseases
Causes. We may consider the cholera infantum 
as an epidemic sometimes an endemic confined to a particular season of the year
analogous (in its grade of action) to the cholera morbus o f
adult “This disease is perhaps most analogous to a remittent
bilious fever varied by the peculiarities of the 


[illegible] [illegible] will see in [Jackson] all that can be said in 
[favour] of the opinion. The very fact that it is often [illlegible]
disproves the opinion besides the fact that the disease does
not occur at all seasons during the period of dentition 
The disease is affected by the state of the atmosphere
being much aggravated by a damp state of the air 
always minded by a cool bracing northeast wind
The kind and gentle excitement produced by 
nursing is important in chronic disease
“Children should not be weaned till dentition is complete or till
1 ½ years & in the fall”


42
infantile constitution”
Dentition has been considered by some as the 
cause of cholera infantum but to this opinion I cannot assent thought it is held by Dr Jackson & many of our most respectable physicians
Dentition may indeed be an exciting cause; it often aggravates
all the symptoms & accelerates the fatal termination 
yet in the winter spring & months it does not produce the disease of
not unfrequently children are affected with cholera infantum
without any appearance of dentition
Worms sometimes make their appearance during 
the progress of the disease but they cannot be considered as
a [illegible] or cause of it. When they exist during the complaint
the irritation which they produce must be obviated by 
such anthelmintics as are not contraindicated by the state
of the system. “I think I have seen the [illegible] productive 
of unfavorable effects.”
The cholera infantum probably arises
from the same remote causes as the (cholera morbus) & the
bilious remitting fever of adults such as damp hot confined
air (which can be counteracted only by exercise in 
the open air) want of cleanliness & bad diet. Improper 
food may be both a remote & an exciting cause & the same
is true of a bad state of the atmosphere muggy or [illegible] of inequality of temperature & exposure to cold. The predisposing
cause produced by these remote ones is debility
Children weaned in the spring are mor apt
to have this complaint, & do not bear the disease 
so well as those at the breast. I would therefore advise
that in places where cholera infantum prevalent.
children should be weaned in the fall




43
Some consider malaria the cause
Like dysentery this is a disease translated from 
the surface to the first passages. The fever is of that kind which 
Sydenham calls febris introversa the action being of an 
irritated kind in general & rarely of an inflammatory 
Commencing at the skin & breaking up the balance of the
system by obstructing the perspiration the morbid action is
transferred to the mucous membrane of the intestines & involves
the liver, pancreas & all the glands immediately sympathizing 
with them.
Indications. The indications are
1st To evacuate the first passages; if this has not been already 
done by the disease itself
2ndly To translate action to the surface & in general to equalize 
excitement
3dly To excite healthy secretory action and regular peristaltic
motion of the bowels
4thly To avoid the causes of irritation and to remove irritation 
when it exists
5thly To restore the tone of the system & particularly of the
stomach and bowels
1st When the disease comes on like the
cholera morbus of adults, the stomach and bowels are sufficiently 
evaluated by the disease generally when the phys. is called and no evacuation s
are to be used. It is to be treated like cholera morbus
with aromatics as essence of peppermint, with Laudanum 


We must be careful not to prescribe for the [name]
of the disease nor necessarily pursue the plan of treatment
generally proper. Often you will find the patient so
much debilitated at first as to require stimulants & acrids
When we have the collapse stage and
a collapse may recur in any disease then the practice
of the nurses is correct in acting on the skin
Some recommend large doses of cal. [illegible] much 
smaller the [common] Dr Jackson recommends large doses
common in the commencement. Dr [illegible], 1 gr. doses
and salt & water I recommend cal. from 
1 to 10 gr Though sometimes small doses repeated may change
the secretion better than large, yet often a large dose 
will operate more kindly, then a small one [which] merely
irritates
“Dr Dewers recommends injections of salt & 
water 2 or 3 teaspoonfuls to a gill, instead of cathartics. Repeat
the injections till full catharsis is produced the morbid
action is changed, by translation of excitement from the stomach & 
small intestines [illegible] [illegible] with cal. ¼ gr. every [illegible] to alter secretion


44
with counterirritants, as mustard, horseradish & brandy on 
the epigastrium & abdomen with the tepid bath & with injections 
of starch and laudanum. But when it attacks
with a diarrhoea, accompanied with occasional vomiting
unless the constitution is very feeble constitution [illegible] extremely delicate the stomach should be evacuated
by ipecac and the bowels by calomel or blue pill
To vigorous patients & often give in the commencement 
six grains & would not hesitate to give 10 grs of calomel & an hour after give from one 
to ten grains of ipecac according to the age and vigour
of the patient for in this way the stomach and bowels are
more thoroughly evacuated than by giving the calomel
after the ipecac has ceased to operate In some cases
a single dose of calomel will thoroughly evacuate the
bowels, but in others it will only remove the contents 
of the stomach and small intestines into the colon & 
a dose of castor oil must be given or one of senna with 
aromatic seeds
The southern physicians, make less use 
of cathartics and depend much upon stimulating injection,
as of salt & water 3 teaspoonfuls to a gill. This 
practice does not succeed well with us. They also give
smaller doses of calomel. This also I cannot approve for
a large dose of calomel, ten grains for instance, will 
evacuate the bowels copiously and kindly, when small
ones produce scanty stools, with irritation of the stomach
and tenesmus. I may mention also that the French expectant 
plan of treatment adopted in Philadelphia will 
frequently be utterly inefficient.


Where excited has not been equalized, calomel
or any other cathartic may act upon the duodenum only 
and not produce
Such facts as there have been given rise to the
opinion that the disease arises from stricture but then 
the al. can. may be subject to unequal action as much 
as the skin
# a castor oil with elix. sal. aa zi every 2 hours
# Yet this practice shd not be adopted indiscriminately
where there is weak morbid action accompanied 
with coldness of [surface] etc. the exhaustion of cathartics
will be injurious 
This is the most important principle in the cure 
of diseases
Sometimes cath. cure the diarrhoea, where
the action is unequal. For instance the lower intestines
may be torpid and the feces accumulate, the bowels above
may be irritated and a diarrhoea of [small] liquid 
stools may pass by the feces



45
If calomel or any other cathartic produces watery stools
in which are small pieces of feces of an ordinary appearance,
and there have not previously been copious evacuations,
we may conclude that a thorough evacuation of the
bowels has been prevented by a spasmodic action of the
intestines which has constricted them in places, & confined, perhaps
a large quantity of fecal matter. Indeed this may be
proved by the success of the treatment, which should be 
the administration of a dose of opium with a little calomel to change action followed at an interval
of one or two hours by a dose of z ¼ and z ½ castor oil or elixir
salutis teaspoonful #. It is of the first importance in all typhoid 
diseases, particularly in those affecting the bowels, that 
thorough evacuations should be made #
2ndly so translate action to the surface and equalize 
excitement This indication will be answered by an emetic
at the commencement, as already directed & by small 
doses of ipecac, repeated throughout the disease, & also
by small doses of mercurial medicines opium being conjoined
in many cases, as will hereafter be mentioned. In 
some calls where there is much arterial action antimony is 
preferable to ipecac & the lancet or leeches may be indicated
but such cases are rare This indication is also answered
by applications to the abdomen of fomentations,
with decoctions of aromatic herbs sinapisms, blisters, burdock 
leaves, horse radish leaves, ginger in spirits aq; amm or the 


Ulceration of the bowels is generally preceded
by aphthae both are effects not causes of the disease
“An [epispastic] should not be applied after 
aphthae have made their appearance. If the pat. is languid
& sleepy we may suspect aphthae.”
Diluents may be used
Obviating irritation by opium is often necessary to have
the proper effect of cal. for instance Give opium first & follow
with cal. & often you will succeed in obtaining the effect of
the cal. when you had failed before
“Ipecac when it acts as a cathartic
is more apt to produce fecal stools than any other article


46
terebinthinate oils An epispastic upon the epigastrium 
is very useful to relieve irritation of the stomach & to prevent
ulceration of the bowels and aphthae. The warm bath 
will tend powerfully to equalize excitement will relieve
vomiting, quiet restlessness, produce a uniform perspiration 
& if used at evening, procure a quiet nights’
rest. It may always be used and at any time, unless 
the patient is in a state of exhaustion.
As a substitute for ipecac, the root of the 
asclepias tuberosa may be used. It is much used in 
infantile diseases as diluent, to determine to the surface
& to promote expectoration.
3dly For changing the secretion of the stomach and 
bowels and keeping up a gentle peristaltic motion I have found
small doses of mercurial cathartics with ipecac of opium
superior to all other remedies. If any article deserves the
name of a specific in any disease, it is ipecac judiciously 
administered in cholera infantum. It relieves this disease
with more certainty as certainly as than cinchona does intermittents. It
may be observed however that a man successful with one
remedy only m ay be compared to a mechanic, very skillful
with a pen knife! My method of administering the articles
is the following. For a child four months old, mix 4 gr.
of ipecac & 5 drops of laudanum in twelve teaspoonfuls 
of water & give a teaspoonful every fourth or fifth hour
& at the same time give so much of the blue pill as to 


You will know when the blue pill begins to have
its appropriate effect by the change in the color of the stools
Pills of blue pill may be given without much difficulty to children there is little
taste except of the saccharine matter. They may be given in food
[illegible] dried huckleberries which I have often called for in the
country where there was difficulty in administering remedies. There
is often great difficulty with respect to this. A child will
often scream at the sight of the doctor
Opium to allay the irritation of the stomach
and prevent the ipecac from being thrown of Ipecac
to equalize excitement & determine to the surface Ipecac
also, to qualify the opium
# Or if this cannot be done, introduce a paste of opium just within
the sphincter
# Case of a child in a family where 3 or 4 children 
had previously died of chil. inf. [Lax] & [illegible] habit
etc. I commenced the treatment
with the pill and ipecac 
I treated it mildly giving blue 
pill instead of calomel N.B. For such cases [illegible]



47
procure an evacuation from the bowels two or three
times in [never twice] in the twenty four hours. For a child a year old
take twice as much ipecac & laudanum with the same
quantity of water and give it in the same way. Sometimes
three times the quantity of laud. will be necessary; for instance
if the child has been in the habit of taking it or if the diarrhoea is very urgent
If the diarrhoea is urgent, it may be necessary 
to administer injections of starch and laudanum & 
to apply to the abdomen ginger & grandy volatile liniment poultices or other irritants
The enema may be made with three table spoonfuls of flour
& about 3 or 4 times as much laudanum as you give by the
mouth say 10, 15, or 20 drops. # I prefer flour to starch 
because the foreign starch often contains acid. The chalk 
mixture or white decoction may also be used.
# “Children of a bucophlegmatic temperament 
and lax habit are very apt to have this disease & with 
them I have sometimes commenced the treatment by administering
blue pill & ipecac.”
The success of this plan of treatment will be strikingly shown
by the following case. A child 10 months old was taken sick in this town
last summer, with cholera infantum, grew worse and was
directed by the physicians to be carried into the country
Unfortunately the child was carried to a situation not more
elevated than N. Haven & while there its strength decayed
and all its symptoms were aggravated. The parents despairing 
of it recovery returned with it to N. Haven & sent for me with 
a request that I would do something to alleviate its sufferings 


On recovery from the disease they usually crave [salt]
food and salt is a grateful stimulus


48
I found it in a state of emaciation, with hippocratic countenance
frequent vomiting, urgent diarrhoea, with stools fetid, watery 
and containing some slime and mucus, & leaving streaks of
blood upon the cloths. The countenance and gestures, expression 
of great anxiety, and there were frequent paroxysms of extreme
distress. I directed ipecac 5 gr. & laud. 10 drops to be put 
in 10 teaspoonfuls of water and a teaspoonful to be given once in 
four hours flannel wet with ginger and brandy to be applied
to the bowels & gave 5 oz. blue pill, & ordered the diet to be of
arrow root flavored with a little brandy. After the second dose the vomiting stopped, the
stools became less frequent & within 24 hours the complexion of
the stools was much improved. The next day the same medicines
were continued and four drops of the tonic solution with 
a little brandy and water. On the fourth day from my 
first visit, the child began to relish salt fish, which was allowed 
Capt. Dennison’s children
To correct fetor in the stools we should give
charcoal. Carbonic acid, by injection, is given for the same
purpose. The mode of injecting carbonic acid, is to place chalk
& vinegar in a bladder, and 
force the gas into the rectum, as it evolved. “This is 
recommended. I have tried it but not very thoroughly”




But if vegetable food undergoes the acetous fermentation
it shd not be used. The putrefactive fermentation 
however is more injurious than the acetous


49
4thly The most common cause of irritation is dentition 
The gums should be often examined, & be divided if they appear
at all swollen. All kinds of food that is hard of digestion 
should be carefully avoided though for children
somewhat advanced perhaps a small quantity of ripe fruit
may not be injurious If the child has not been weaned
the milk of the mother will be the best food; for those children’
who nurse are more apt to recover than those that 
have been just weaned. The act of sucking is highly soothing
and gratifying & operates like a nervine medicine.
The best food for children that have been weaned, will be arrow 
root, with a little brandy or wine as a condiment & as a substitute
for this & similar articles from the shots, we can
direct a porridge made of roasted flour. If in the latter 
stages of the disease the child craves any particular of food, as
salt fish, or salt meat, or wine or brandy, it should be given, & 
all kinds of medicine laid aside if the stomach leathe3s them; for 
strong disgust will debilitate by exciting nausea. Frequently 
however we can succeed in preventing this effect, by a different
mode of administering the medecine the sight of the spoon for 
instance may may give rise to the loathing & nausea.
With respect to food we may lay it down as a general
rule in such cases that when the powers of the stomach are
so weak that food must undergo fermentation in it, vegetable
diet should be preferred to animal.
For local irritations, various applications should be made
& various articles administered, especially in the latter stages 



“Tea juice? boiled beef a teaspoonful with pepper & salt
is grateful frequently & checks vomiting but at
first vegetable preparations are better”
vide supra
The chalk mixture made with a little opium 
in some cases or with astringents etc. a valuable [illegible]


50
of the disease or when we are compelled to try a variety
of remedies. When there is unequal excitement & unequal temperature
blisters may be used. Blisters sometimes produce perspiration.
To relieve irritation of the stomach effervescing mixtures
may be drunk, they are often more grateful. [illegible] we may 
fill the stomach where there is vomiting and dilute its contents with a tumbler of wine whey 
I have often succeeded with it
with a teaspoonful of aqua ammoniae in it as being thrown up will be no objection. If the disease commences
with much irritation in the stomach, it may be useful
to overcome it by counterirritation in the rectum produced by an
injection of soap suds or of salt and water 3 teaspoonfuls of 
salt to a gill of water, for a child a year old. Dr Dewers
relies must upon this latter article in the commencement of cholera 
infantum and repeats the injections until the bowels are
fully evacuated. He likewise recommends small doses 
of calomel, a quarter of a grain for instance repeated once in 
an hour until the bowels are evacuated. In cases of irritation 
of the stomach & torpor of the liver & portal system, this 
practice of salt & water & small dose of calomel does well. In chronic cases he gives magnesia
rhubarb & opium. With respect to small doses of calomel
it may be further observed that they will not answer when 
the intestines are much coated with mucus & that in some
localities they do not answer so well as in other places. On 
the shores of lake Erie for instance the physicians are obliged
to give large doses of calomel than we give
There are cases in which small doses seem
to irritate & large doses operate kindly 


“In the latter stages Rx magnesia grs 4 SS gtts
Rhei gr i.”
C. Florida not so pleasant but loses its mawkish & 
herbaceous taste by keeping (like peruvian bark)
The spiraea is though less inclined to act unequally 
in this state than most other astringents
If one astringent wears out try another
Oak barks
Rose [illegible] (salix [illegible} “A valuable popular remedy” 
has mucilage combined
seeming to resemble ([illegible]) [illegible] was formerly 
much used but is now superseded by native articles
It is well known that because These astringents are often prompt up is specific
[illegible] virginica was specified good [illegible] & [illegible] it
e.g. viburn. lentigo, raspberry, blackberry, [illegible] [illegible] root decoction
recommended by Dr Rush thought to deter to [illegible] used by many) [illegible]
bark has [mucilage]
There is apt to be a paucity of [urine] in this disease
as well as in Diarrhoea & dysentery and then diuretics
are indicated and are highly valuable


51
5th When in the latter stages of the disease the principal 
indication is to restore the tone of the system & particularly of the stomach
and bowels we must make free use of tonic and astringents.
Moseley’s tonic solution will be one of the safest and best articles
in this stage. If the bowels, by a habitual action keep up the 
diarrhoea, astringent will be more specially indicated such
as the compound tincture of vitriol. I prefer however, the 
cornus circinata to all other articles
C. servicea (red [illegible]) C. [illegible] C. alba nearly allied
Of astringent vegetables we can make choice
from a great variety which are indigenous & common. All
the various species of viburnum all the [potentillas] & the 
roots of the strawberry to say nothing of the bark of the oak & 
indeed most of our forest trees, are astringent & may be used
The spiraea tomentosa is much used in decoction or extract 
All the species of [illegible] are astringent & the C. [rivale] is a most
valuable article; as is also the geranium maculatum, which 
may be be given in wine & then we shall have red wine.
The sttici limonium (marsh rosemary) is not so agreeable but
is frequently more efficacious specially if the mouth is sore. Its taste resembles that of salt
mud. When given internally, it is boiled sweetened & has a 
little wine or brandy added. It is also used as a wash in 
case of the supervention of aphthae.
The erigeron canadense, called colt’s tail
& strangury weed has been found a valuable article in the 
latter stage of this complaint and of dysentery given in decoction.
It is acrid pungent like [illegible] bitter & stimulating & acts also
upon the kidneys as a diuretic. It seems likely to prove a 


Give it in decoction or in milk which will cover 
the taste of it
Balsam of copaiba or turpentine cannot be combined
with mucilage so thoroughly as in the white pine 
bark in milk & water diuretic & [sheathing] to the bowels
I have often used the expressed juice of spearmint
as in diarrhoea q.v. It is important in long continued bowel
complaints of children that the medicine shd be grateful
The diuretics are useful both in children and adults
(dysentery diarrhoea & cholera infant) because there is a
paucity of urine and acrid irritating secretions
In some cases of exhaustion we give opium constantly
in small quantities to keep up the [illegible]
Mucilages marshmallows or substitutes for
which hibiscus palustris hib. syrica hib. [illegible] hib.
(rose of [shora])
Mucilages by stopping irritation are
diuretic


52
a valuable article in the latter stages of bowel complaints 
provided there is not too much vascular action. It has been 
long used, vide Barton, the N.Y. Medicophys. Transactions etc.
In 1790 an itinerant came through N. Haven offering to 
cure the dysentery; and attracted a good deal of notice.
It was found that his [illegible] consisted of this article. The 
other species of erigeron have similar properties.
In the latter stages of the diarrhoea mucilages
should be given. They made of any of the various in articles in 
use, but perhaps the most valuable mucilage, will be that made
from the inner bark of the white pine, which will furnish a terebinthinate 
principle in addition to its mucilage
Often in the latter stages of the disease, great
benefit will result from supporting the abdomen by a bandage
and a plaister of white [diachylon] and opium or
a soap plaister (of [illegible] & soap) 2 parts sp. 4 pts plaister
In extreme exhaustion & debility from the 
long continuance of the complaint with cold extremities, aromatics
and stimulants may be required & we may give spiced tea
spiced wine or brandy in small quantities, or the white decoction 
and apply cloths dipped in brandy to the abdomen & to the extremities


Nothing has more affect upon complaints of the 
stomach liver & bowels than the state of the mind as
we see in dyspeptics
The
We are apt to suppose children not subject to 
notice of [illegible] children [illegible]
mental impressions. When the matter has been dissolved
in grief & abandoned to despair
I told them to tray as a last resort carrying
the child in a hack out of town the excitability was entirely 
gone the child might as well die in the back
as any where strange advice On the top of the [illegible]
about two miles out lifted up the child [sound] trees
grass birds, etc. opened its eyes before this had lain
with eyes half closed noticing nothing 


53
Finally when every form of medication seems to fail, our
only remaining resource will be change of air. This is a
most powerful remedy. The physicians of N. York and Philadelphia
are continually recommending it. We are apt to suppose 
that in children it can be only the purer air 
& the exercise of travelling that produces a good effect, when they 
are carried from home for their health, but on the contrary 
the change of scene seems often to have a more powerful effect
upon them than it would upon adults. Children that
have lain sick for weeks, instead of pursuing their accustomed 
amusement even though mere infants seem of ten to settle into
a state of utter despondency from long confinement & the
constant sight of the same unvarying objects around them, & 
appear to loath every thing offered to be done for them. This morbid
condition  of mind seems to be one directly opposite to that of
nostalgia or homesickness & is to be relieved in a corresponding
manner. I well recollect a child apparently 
in articulo mortis cold & vomiting nothing wd [illegible] the vomiting
entirely beyond the influence of medicine
or food. It was carried in a hack to the top of a hill
without the town N.Y. [illegible] where it had a view of the sound, & the
scenery of the country around. While there is brightened up
vomiting ceased and took food staid an hour or more & then was carried back to town, where it
finally recoverd.




54
The symptoms attending cholera infantum very very 
much and give rise to considerable variety of practice
It is probably owing principally to this circumstance more
than to any other that physicians differ from each other
in their mode of treating it.
Post mortem examination show that this disease
affects principally the mucous membrane of the stomach & the
small intestines; rarely the large ones. Sometimes coagulable
lymph is found in the intestines but less frequently than in 
other diseases. Sometimes the mucous membrane of the intestines
is thickening & according to Dr Jackson ulcers are occasionally 
found both in the small & also in the large intestines. The 
liver is usually enlarged without derangement of structure
Ordinarily the brain exhibits no morbid appearances, unless
the disease has made a determination to that part constituting
hydrocephalus 
N.B. The remarks upon asclepias tuberosa
introduced under the Head of [illegible] capitis probably 
belonged here


Fever of the bowels Acute [illegible] of [illegible]
Different writers give different names and do not always give
the same symptoms. The European disease differs somewhat
from ours. It is our infantile winter epidemic.
Typhus infantum of Prof. [Tully] “Disease of the bowels
bowel complaint, plague of the bowels, winter epidemic 
& [illegible] epidemic. Remittent bilious fever
(at south) Musgrave’s spurious [illegible] fever Duncan III or IV”
There is some [illegible] action but more of the
character of irritation like other infantile fevers
Rarely vomiting never diarrhoea in commencement
The morbid excitement often extends to the lungs
putting on the for [illegible] what is called in adults bilious pleurisy
The disease is not common at this time
though it was very much so formerly Probably it will 
return It is almost the only winter infantile disease
& so common has it been also that the nurses call almost
every disease in winter, of childr, by this name 
of choler.
The dis. is to be broken up in its [illegible]
by means various in various patients by a strong impression 
upon the stomach in a strong constitution but by 
an impression upon the whole system in the delicate
constitution Comparison to a weight upon a [illegible] If applied upon one part only it will break it not if applied to [illegible]
It is desirable that vomiting or at least
nausea should talk place from the cal. In enteric 


55
Constipation with Fever
or
Remittent bilious fever of children Musgrave’s spurious worm fever
marasmus acutis
This complaint has been known in N. Haven for more than 50
years by the name of choler. It is called in some places at the 
“It is unfortunate that we have no better [illegible]”
eastward, the plague in the bowels. It is a common bilious 
“It affects however the duodenum & small intestines rather than the liver”
fever produced by causes which operate upon the bowels a 
part of the system which in children more particularly invites
Children are attacked by it from the age of 3 mo. to 2 or 3 yrs.
febrile action. It is often inflammatory in its commencement
Sometimes it [illegible] in the form of typhus
Symptoms The pulse in the commencement of the disease is 
full, frequent & sometimes tense, the skin is hot and dry 
face flushed, respiration, short and laborious, tongue covered
with a white fur, the abdomen fuller and harder, than in health, & the bowels costive; the urine small in quantity
and high coloured & sometimes the fever is attended 
with cough & expectoration. This disease is a fever
which often affects the lungs and always the alimentary 
canal & liver, the secretions being suspended and the 
bowels constipated.
Treatment. This will be antiphlogistic in the commencement
of the fever & the first indication will be to evacuate thoroughly 
the stomach and bowels. This will best be answered by a  
single dose of calomel of from 5 to 10 or 15 or even 20 grains for a child 
from four to twelve months old We shall thus produce a strong
impression upon the whole alimentary canal & upon the
system at large. In entonic cases and vigorous habits a
little tartar emetic may be added to the calomel
Usually the calomel excites both vomiting and purging, but 
sometimes it is retained on the stomach and has no immediate 



cases it may be beat to conjoin tartar emetic for this
purpose.
Sometimes the cal acts upon the stomach & 
duodenum & excites the action of the liver, and spends
itself there, without producing catharsis
Sometimes it is necessary to repeat 10 gr
doses of calomel once in 2 hours until 40 or 50 gr have
been given and cause them to follow with liquid cath.
a [illegible] or jalap or scammony
N.B. If there is great difficulty in giving medicine
repeatedly, we may give powder of jalap in 
coffee or fermented liquor or we may give a teaspoonful
of the tincture of (not briony root but pure jalap
in milk & water which will not be tasted
Feeble constitution must have the warm’
bath. # Rx senna zjs man zi senega zii anise seed zis
liquorice zfs [illegible] ½ [illegible] This I have held the child with. remember large doses are needed
Rx scamm. grs 2 or 3 chalk & diaphoretic antim. this
was called Earl of Warwick’s powder & was kept in the shop
here. Tart. emet. would be a more certain prop. of art. It 
produced violent vomiting. Scammony is better united
with cal. however. # 
# Cautiokn about covering the [illegible] with a blanket
vide
# Cal. was finally substituted for the [diaph.]
ant. This Warwick’s powder used to be a shot preparation
in this town and parent would send for it. From the uncertainty 
of the strength of the diaph. ant. however, [dangerous]
vomiting sometimes occurred from the use of it 


56
effect. In the latter case a second dose may be
given two or three hours after adding from an eighth to a quarter of a grain of
tartar emetic for a vigorous patient Fifteen or twenty 
grains of calomel will often empty the stomach and
bowels freely & remove all the symptoms. The calomel
may however evacuate the bowels but partially & in some 
instances not at all merely moving the contents of the 
small intestines into the large ones. In such cases another
cathartic is needed for completing the purgative operation 
If the calomel appears to have no effect, it should be repeated
in 5 gr. doses every three or four hours, the patient
put immediately into the warm bath & we should
commence feeding the child as freely as the stomach
will bear with the following R fol. sennae zfs, mannae zi
steep in ½ pint of boiling water & if there is a cough, add
senedae zii & rad glycyrrizhe zfs. If the stomach
will not retain the mixture of senna the powder
of jalap or scammony mixed with tea coffee or milk must be substituted, giving 4 
or 5 grains in the intervals between the doses of calomel
Injections vide p. should be given to assist the operations of the
cathartics and repeated every 2 or 3 hours until the 
bowels have been thoroughly evacuated taking care
however not to commence with injection until the cathartics
have had time to operate
When we have succeeded in procuring stools
we shall find them to consist of viscid green mucus mixed
with half digested food. Sometimes in the progress of the disease they exhibit the 
appearance of small pieces of membrane, of 


There is a membrane [illegible] inflammation of the duodenum
similar to that of croup. This indicated by pieces of 
membrane preceded however by pain in the part
obstinate constipation etc. This is a strong indication for
calomel which however will not operate as a cathartic
until the violence of the disease is broken Warm bath
& injections will also be more particularly
In some violent cases of the fever where
calomel seemed to have no effect. I have known acid
as lemon juice advantageously combined with calomel
Among the cathartics and laxatives used in 
the second stage we have the wild liquorice or [illegible] [circa???]
which was formerly a popular article and kept in families. It is 
diaphoretic and laxative and possesses and also deobstruent properties
It is said that with this the Indians formerly [died] their porcupine quills
# The acids are sometimes used in combination with 
mercurials I should not use them unless when
mercury fails
Sometimes it affects the ear & produces suppuration 
& discharge. It may terminate in effusion into the ventricle
of brain. It may terminate by exhaustion Or may 
terminate in thrush “in which case there is a double translation 
1st from the bowels to the head & thence to the mouth oesophagus & bowels



57
& of about the size of petals of peach blossoms, 
floating in a liquid of the same colour. Such stools
as these latter are a sure indication that a farther evacuation 
from the bowels is needed vide p. 207 They are frequently 
evacuated by adults in bilious (or common cholic.
If such continue it is well to vary the cathartic and give
magnesia, or soluble tartar (peerlash & cremer tart.)
or phosphate of soda, or any other neutral salt.
generally the violence of [illegible] [illegible] & The blue pill may be substituted for the calomel & given
three or four times a day, until the stools change their
appearance or the mouth is affected, though this rarely 
happens to children under four years of age. These
stools rarely have any smell & as they indicate a want 
of secretion I the liver & glands of the abdomen, mercurials
are peculiarly appropriate. In some states of 
fever attended with stools of this kind I have known
the free use of acids with mercury very useful # 
After 48 hours the fever generally 
remits, and sometimes it continues in the form of a remittent
for six or eight weeks or more. Very frequently 
however it changes its seat in the course of 15 or 20 days
& terminate in a phlegmous swelling of some of the glands or in phlegmon
or is determined to the head
& puts on symptoms of hydrocephalus, which are best 
relieved by blisters behind the ear, a place which is the natural 
outlet of diseased action in children. They may terminate
naturally by a discharge of purulent matter from the 
cavity of the ear or fatally by effusion into the ventricles of 


I recollect two cases early in my practice, which 
continued 6 or 8 months. They were very violently attacked
They continued 6 or 8 months coma 
Hence we should never despair
In the latter stages it may be proper to 
give tonics or those articles which are called tonic
very unlike the vegetable tonics however. They produce a
[illegible] excitement
Giving arsenic is no new practice 
It is a safe and efficatious remedy, when the dis. continues 
as a remittent It comes after cal. & tart emet. producing 
liquid secretions. If long continued it must be followed 
by bark to restore tone and obviate the debility caused 
by the arsenic Arsenic can only be called a tonic
as it removes disease. It would never be given as a 
[illegible] is pure debility #
# I have used digitalis, in the latter stages to allay irritation
# In many cases the fever continues from habit
& medicines have little affect. There will be an accession 
of fever every afternoon. Here give sol arsen 2 drops
twice a day which is a full dose for a child ½ years old
If this has no effect give it [illegible] times a day”



58
the brain; in two cases I have known them relieved
by a thrush.
If the disease continue a regular remittent
without symptoms of hydrocephalus, it will be proper to give
tonics, such Moseley’s tonic solution or if the fever intermits or remits Fowlers solution of arsenic
the latter in doses of two or three drops the former
from 4 to 20 drops, 3 or 4 times a day. I have known a child
18 months of age cured in this stage of the fever, in the course o f
two or three days by taking 2 drops of Fowler’s solution 3 times
a day. This article however is liable to produce edema or dropsical
effusion & if it does we must substitute the tonic solut.
(beginning with about four drops) or some preparation of
bark. The dose of the tonic solution will depend upon the
irritability of the stomach If irritable from 3 to 6 drops will 
be as much as can be borne
After the inflammatory action has subsided
narcotics anodynes are necessary to remove irritation and
to procure rest We may use opium, either alone or 
better combined with ipecac or antimony # Indeed as the
skin is usually dry antimony is indicated in almost every 
stage. The warm bath also is indicated in every stage except
in the low typhus state of the fever when it would be too debilitating.
Epispastics & irritants are useful in the progress of the
disease, to translate action from parts essential to life & in 
the last stage also perhaps to keep up the action of the system. They 
may be applied to the abdomen if it is much swollen to the
head behind the ears where there is danger of hydrocephalus & 



Avoid too much heat to prevent tumefaction of the
bowels.
Terebinthinates a [illegible] oil may be needed proper 
If pneumonic symptoms blister etc.
“If the lungs are much affected, apply a blister to the
chest, give expectorants, and pursue the treatment required
in pneumonia. Senega & squills are good, but
are too stimulating for the earlier stages liquorice anise”
By this disease it is sometimes proper to do nothing 
and omit all medicines in mania etc. In those cases
as I have had difficulty to persuade parent to do nothing.
I have applied aloetic plasters 
to the bowels I think they have produced evacuations
injections also can sometimes be given
Case of a very [illegible] child
[furious] parents passed in review before him with 
roasted apples pears etc. after 26 hours he snatched
an apple relapsed in 26 hours they probably had over 
loaded his stomach however the same management 
finally succeeded afterwards of the patient recovered. vide p. [20?]
The same season I had 3 or 4 more such 
cases of mania which required to be cured by fasting


59
a large one to the chest if the lungs are affected.
“This disease is sometimes followed by thrush
when an emetic of ipecac will have a good effect. If the stools
are fetid charcoal should be given. If in the latter stages
there should be tumefaction and pain in the bowels, the
abdomen should be supported by a bandage. In the latter
stages also a decoction of the inner bark of the white
pine be useful. It possesses some tonic properties”
Sometimes in diseases of children the mind is 
affected, the patient will take neither solids nor liquids & struggle
till it is exhausted whenever an attempt is made to administer
any thing. If that is the case in this disease we must use
the tepid bath & we may a apply for purpose of moving
the bowels, a large plaister of aloes and ginger to the 
abdomen Frequently this derangement & morbid revengeful
disposition (according to Dr Rush an affection of the moral
faculty is so great that we must wait even for 24 
hours or more without administering any thing. It may 
require great prudence and judgment in such cases, to 
satisfy the parents.
Before leaving the subject I may observe,
with respect to the propriety of the course I have directed
in the commencement of the disease, that if the cathartic which 
we administer first produces emesis we may be sure that
the alimentary will be operated on, & also that we often 
require a remedy more powerful than the disease, just
as in croup.
“As to diet meat must be forbidden but sometimes salt food is craved. The weak chicken broth is good.



The dis. is something very rapid & violent
Fever as violent as the constitution could bear
Collapse from the violence of action
Parents considered the patient & dead
After the mustard was applied as soon as the
skin was reddened a blister was applied, which 
produced a sore 2 or 3 months in healing
“In one hour pat. revived”
Nervous system affected
Irregular action such as after collapse of
cholera Strong clonic spasms once in 15 min.
“Pat. kept under a constant [narcosis]”
Antispasmodics & tonics finally In two or three weeks [illegible] recovered some strength
It was called the child that died & returned to life again
The above is account of the disease as it
most commonly appears. It is different however in 
different years sometimes effecting one part of the system
sometimes another A practitioner keeps this [illegible] [illegible]


60
Case of a female child 2 yrs of age. The disease ran
the most rapid course I ever witnessed. 
The whole system became
affected; the pulse was full & frequent, the skin hot & the
tongue furred. In 24 hours the disease came to a crisis
and exhausted the excitability of the system; the pulse
grew faint, the skin cold and the respiration languid
the patient became insensible & was apparently dying
sinapisms were applied to the abdomen, ankles & wrists & 
heated bodies put into the bed, to restore warmth. After
the sinapisms had been on an hour and excited some
redness, epispastics were applied in their stead.
Ammonia & ether were put into the mouth & caustic ammonia
was applied to the nostrils to excite 
Inflammation so as to blister. Ether was also put into the mouth
In about two hours the system was resuscitated. Immediately a train of most violent nervous
symptoms followed the chill became convulsed
almost instantly. After trying antispasmodics in vain 
the convulsions were checked by laudanum, 6 drops,
every two hours. The laudanum lost its effect in 
two hours & needed to be repeated. The blister on the 
chest produced a deep ulcer which was difficult to cure
Finally tonic solution was administered. The child recovered
Child of Mrs “Moulth???]
Child of N. Beers’s vide p. 208
diseases and consequently meets with no new disease
For they do not make sudden transition as in botany plants
he is guided by symptoms & by the operation of remedies



Appendix to Mes. fever acute marasmus
This disease sometimes appears in an acute form
with great irritation Sometimes terminates in hectic Patient will run down
very rapidly [illegible] appearances enlargement
& [illegible] of mesenteric glands “Called” consumption 
of the bowels” or Marasmus”
Mesenteric fever is thought to terminate
in hectic Probably it does especially in scrofulous
patient and in those bad cases where the tubercles with a mesentery ulcerate
“The pain in the bowels is no usually very severe 
but of a continued aching kind generally better
removed by [camomile] injections than by anodynes”



61
Mesenteric Fever
Marasmus tabes [illegible] [illegible]
This disease arises from obstructed glands in the mesentery 
& is accompanied with morbid secretions of the stomach & 
liver bowels. It is sometimes the consequence of some other
fever. It is often connected with scrofula, & it is apt 
to be attributed to worms. The disease attacks children
of from two to ten years of age.
Symptoms. The fever is of the intermitting remitting kind, with 
irregular paroxysms attended with tumefaction of the abdomen, 
costiveness, indigestion, loss of appetite & very irregular
appetite & with paroxysms of pain in the bowels. The patient
complains much of its bowels, but the affection seems to be rather 
distress then sharp pain & is neither constant nor regular. The 
countenance is very pale except when the cheeks are flushed with 
fever & the limbs are emaciated
This is generally a chronic disease, but 
sometimes it is acute, & exhibits strong marks of irritation in 
the system. It may terminate in hectic. Dissections exhibit
an enlargement of the mesenteric glands.
Causes. It is sometimes as has been said above, the effect of
another fever. Among the poor, with whom it is most frequent,
it is caused by coarse and unwholesome diet. Children 
born of scrofulous or gouty parents are more subject to it
& hard labor by the mother during the period of gestation 
may have some influence in predisposing to causing this disease in the 
child.



Patients in this disease are subject to paroxysms
of pain


62
The indications are 1st to empty the bowels and to keep 
up a gentle peristaltic motion in them 2nd to change the
secretion of the chylopoeitic viscera.
3d to remove paroxysms of pain
4th to remove the obstruction in the lymphatics.
5th to impose the digestion & to invigorate the system generally 
1at To move the bowels and keep up a gentle
peristaltic motion mild mercurials as blue pill or calomel & chalk should be given & at
the [illegible] time friction as in almost all chronic [illegible] complaint should be employed, upon the
abdomen, and persevered in by the attendants. A very good
mercurial preparation, will be a pill of four parts gr. blue
mass and one 1 or ½ gr of ipecac adding a little opium ½ or 1/8 gr of the bowels
are very irritable. If this preparation 
is not sufficient calomel may be substituted in 
a dose of 4 to 6 grains. The tincture of rhubarb has 
in some cases answered well as a laxative & corrector
combined with neutral salts and aromatics
2nd For changing the secretions, we must rely 
upon the articles just mentioned, and also upon those
to be mentioned under the 4th head
3d For alleviating sudden paroxysms of pain injections
of a gill or a half pint of camomile tea have been found serviceable.
If these fail give a camphor injection
The pain is relieved by opium plaister



There is but a small quantity of iodine and [illegible]
effect appears to be produced than shd result from 
the small quantity of iodine
Neutral salts in connexion with tonics have
undoubtedly [illegible] deobstruent powers


63
4th For removing obstructions of the mesenteric fluids
burnt sponge has been thought very efficacious. I formerly 
questioned whether it had any superiority over soda.
Now it is supposed that all the virtues of the article are
owing to the iodine continued in it. It would probably be [illegible] better
better to give tincture of iodine in doses of 2 or 3 drops.
Still the burnt sponge containing carbon & alkaline matters
may have peculiar properties The neutral salts given
with tonics have some influence in removing these obstruction 
It has been proposed to use mercury by injection for this purpose.
I know not that it has ever been tried
For the indication I have been in the habit of
employing the muriate of lime & here given it in connexion 
with the mercurial pills mentioned under the first head 
It may be made by adding muriatic acid to chalk 
or marble & the dose for a child of 3 or 4 years, should 
be from 5 to 50 drops, given in tea coffee or milk.
It is best to begin with a small quantity, say 3 drops & increase 
by one drop at every dose until the stomach
is offended remembering that the stomach bears the article
best if much diluted. The muriate of barytes might be 
used; also the carbonate of barytes is used in dose of but
2 or 3 grains, it being a powerful article. But iodine is
probably the best article that we know of
Other articles containing iodine, have been 
used besides burnt sponge, as [fucus] [nodasus] & vesiculosus
[reckoned] vide scrofula



mur. [illegible] dose 4 or 5 drops in milk & water for a child of
3 or 4 years increasing to 50 even 100 perhaps
This [illegible] is not to [illegible] [illegible] it iodine as to be substituted
by the latter We are apt to neglect an old remedy as 
a new one comes on
The tepid bath shd not be used when the system
is too much debilitated
It excites the action of the mucous membrane
and of the skin not affecting particularly the blood vessel 
add a little spirit to make the opium 
[illegible] if necessary 


64
Muriate of lime has the important advantage of exciting
the action of the skin which is generally torpid.
Hence also the tepid bath has been used with 
success in this disease The flesh brush too if thoroughly 
applied several times a day will have a powerful effect.
5. To improve the digestion and invigorate the general system
Carbonic acid is a most grateful stimulant to the stomachs 
of patients in this disease. Hence soda water and other effervescing
mixtures, may be recommended spruce bar also & 
similar articles, if they agree well with the stomach. Aromatics 
as ginger & spice may often be added to them with advantage 
Among the tonics which are used to invigorate
the system. Iron is very often employed & frequently with good
success. The mildest preparations least irritating are the best, such as 
the tincture of the muriate, the martial flowers & the
alkaline solution. Still iron is apt to cause irritation
Cold bathing is a good remedy for invigorating
the system but if the patient is much debilitated, a cordial
should be administered previous to using it
When the patient is much debilitated I have found
anodyne plaisters upon the abdomen
give great relief (where opium did not agree) I have 
used Noel’s plaister (similar to dyachylon) with soap mix
opium zii with zfs of this plaister & spread it sufficiently
large to dover the whole abdomen


Children are very fond of potatoes but they should 
not be allowed, unless cooked so as to be dry and [illegible]
and then thoroughly mashed
Some vegetables as spinach, [illegible] & asparagus
may be allowed but only in moderate qualities
Preparations of meal of [illegible], especially fried, are bad
Rx dough roll it in flour and then cut
into thin slips, twist & bake them for [some] hours An excellent preparation
for dyspeptic batter than crackers called twisted bread
In making broth avoid adding rice, flour, etc. which 
will make the compound approach the nature of pastry 
and be more indigestible. Make broths as simple as possible
& season with pepper & salt


65
Under this head may be ranked the use of the terebinthinates
which have a valuable effect upon the mucous membrane of the alimentary canal
The best article is a decoction of white pine bark, which is
milder than any preparation of the turpentine of the shops
Regimen. Flannel should be constantly worn next the skin
to keep up an action in it. The patient should take exercise in 
the open air whenever the weather is good & damp
easterly winds should be carefully voided as they have great
influence in all chronic affections particularly glandular of the bowels. Friction & 
cold bathing have been already mentioned.
Diet. This should be carefully attended to Raw fruits, 
potatoes and other garden vegetables, corned beef & in short all 
articles which are not of the easiest digestion or which have any 
tendency to ferment & become acescent in the stomach should be 
forbidden & caution should be enjoined that the stomach
be not distended with liquids, so as to interrupt digestion.
The diet should be dry consisting of toasted bread & farinaceous
vegetable substance, as arrow root etc. well boiled & seasoned
with a little wine & spice. If meat be given it should 
be broiled & eaten, with condiments. In some cases a piece of 
lean beef that has been partly broiled & then boiled, makes
a broth that is grateful & sits well on the stomach. But if
there is much dyspepsia, broth of any kind a not good
If this fever terminates in hectic the mineral acid shd be used 



Undoubtedly however the affection may be produced 
by excessive purging vide next page
low states of fever in adults also for the 
state of the bowels occurs much oftener than some phys. are
aware of
“The gases may arise from the ingestion, from a 
fermentation of the natural secretions, or, as I think from a
direct secretion of gas by the intestines. this alone would see
to account for the rapidity of its production”
sometimes small watery stools


66
Tympanitis
In diarrhoea dysentery & constipation with fever & typhus fever
after these diseases have passed the first stage, the bowels of 
children affected with them, are liable to be affected with 
tympanitis. a troublesome symptom This state of the bowels may occur of itself about
the time the febrile action begins to subside, or it may be brought
on at an early period by the use of astringents, or by heat
produced, either by too many bed clothes or by hot articles
applied to the body for the purpose of exciting perspiration
it is important to examine daily the state of the abdomen in 
children affected with bowel complaints, that a tympanitic
state may be obviated, as soon as it begins to appear
The abdomen is [swollen] and elastic to the touch
feeling tense like a drum head under the fingers
We can tell as soon as the hand is applied whether the
swelling proceeds from inflammation, or from imprisoned
air, for in the former case the pressure will cause pain
The proximate cause of this state of the bowels 
I believe always to be a relaxation of the villous coat of the
intestines & a deficiency of peristaltic motion in consequence
of both which the villous coat falls down & forms a 
valve which confines the gas, while at the same time there
is a morbid secretion of all the chylopoeitic viscera 
which [illegible] the evolution of the gas
In the first stages of tympanitis, the alvine
discharge usually cease even if there had been diarrhea
& dysentery before & the little patients exhibit signs
constant [illegible] not acute pain
of great uneasiness from the unusual distention of the 



“It is thought by some that tympanitis is always 
occasioned by bad treatment in not giving cathartics enough at
the common [illegible] Such persons probably do not examine
the abdomen of their patients with sequels of severe bowel
complaints. Tympanitis comes on whether cathartics have
been used or not and nothing is more likely to bring it on 
than an excessive of cathartics at the commencement of the
disease”
The temperature had been raised above it
secreting [illegible] & the child might have died
“I am very partial to diaphoretic measures in general
but must confess it is often abused If carried to excess 
it rapidly exhausts the patient also if excessive heat as aplied
and the pat. does not sweat.” 


67
bowels. In the progress of the disease tympanitis the child frequently 
comatose. The tympany is not always to be regarded as 
a dangerous symptom it sometimes indicates a favorable
crisis, yet if it is accompanied with coma, there is danger
that the brain may become seriously affected. If symptoms 
of congestion in the thorax exist, the disease of the thorax
should claim our first attention, and the tympanitic
state of the bowels be treated as a [illegible] complaint
Treatment. The indications are to evacuate the flatus 
and excite healthy action of the viscera of the abdomen
If the disease has been produced or aggravated by heating
applications too many bed clothes or too 
confined an atmosphere, the heated substances should 
be removed, the bed clothes thrown off & air admitted
freely to the patient. In the summer of 1814 I was
called to a child sick with dysentery whose bowels became
extremely inflated in consequence of filling with 
the steam of boiled potatoes in [illegible] the bed in which he lay
The child because if much [illegible] & [illegible] was so difficult that it 
was thought to be dying; but upon removing
the potatoes throwing off the bed clothes & opening the
doors, the symptoms were at once amended & in the
end the disease was completely removed by the use of a little [cajeput] 
oil in water and laxatives
For removing the flatus of the bowels 
we may use enemata of the decoctions of aromatic plants or 
suds, such as catnip, camomile; the seed of fennel caraway 
or masterwort seeds or the essential oil of such suds may 


I prefer camphor to any other articles 3 or 4 [illegible]
IN colicky complaints etc. I have known more benefit [illegible]
injections of camphor in milk & water than from any [illegible]
articles and that too after the most violent purgatives
had vailed. I know of no article which operates
so well in relieving irritation of the pelvic viscera
[Anodyne] balsam Rx vol. [lin] zi [illegible] camph
“Sometimes blister the abdomen”


68
be injected in milk and water. But I think I have experienced 
the greatest benefit in the case of children from the 
injection of a teaspoonful 2 or 3 of the tincture of asafoetida in a 
gill of warm water. It unites more readily with the water
of a little milk is added
A pipe of ivory or the pipe of a common 
injecting syringe may be introduced into the rectum as is
recommended in hysteria, for the purpose of evacuating the
flatus. I have sometimes used an elastic catheter with success
The peristaltic motion of the intestines is
to be excited and healthy secretions induced For this purpose
we are to apply friction with dry flannel to the abdomen
and mild cathartics are to be given. The latter may be jalap
aloes rhubarb etc. with castor oil to work them off
If frictions do not succeed, we may apply volatile liniment
camphor, oil of origanum & finally epispastics
We may likewise give internally cajeput oil in 3 or 4 in sugar oil 
of mint, oil of caraway, asafetida zfs to si etc. which is [illegible]
to offer [illegible] its stomach & is not offensive to the taste
and magnesia with [illegible] & cubebs [illegible] [illegible]
or guaiacum 


Dr Good classifies [worms] according to their locality
yet he makes mistakes as to their locality
Much has been under the subject, and the
remedies are almost innumerable. It is rather difficult to select 
the most important parts of the subject


69
Worms
This subject naturally follows that of bowel complaints
From testimony which cannot be invalidated it appears that worms
of various sizes and forms have been found in almost every 
part of the human body. It is only in the alimentary canal
however, that they occur with any frequency and give rise
to symptoms, from which we are led to infer their presence
Those worms which are of anomalous kinds, or
are found in anomalous situations (oftenest perhaps in the lungs
& frontal sinuses) as they are of rare occurrence & as the indications
of their presence were either very obscure or altogether unknown wanting 
are interesting only as curiosities and will be passed over,
without any notice, except an occasional reference to 
the fact known with regard to them
“Worms in the alimentary canal are so 
common, as to have given rise to a class of diseases called
verminous & a class of therapeutic agents called anthelmintics.
The kinds of likewise of worms which occur in 
this part of the body have been thoroughly investigated & we
are in possession of a large mass of information upon the 
subject
I shall consider this subject under the following
heads 1st The kinds of worms found in the al. canal
2nd their origin & that of worms in general, found in the body
3d the general effect they produce on the system & the general symp
5th the morbid effects produced by each species, with their treatment
4th the general treatment of verminous diseases




70
II. The genera of the common intestinal worms are three; toenia ascaris & tricephalus
Of the tania there are two species. Tania solum or cucurbitana
& t. lata or vulgaris. Of the ascaris there are also 
two specis of a. vermicularis & a. lumbricoides.
1st Tania This a long flat worm varying much in breadth
and thickness which is formed by a chain of flat articulations,
united by a border or edge. The accounts of the length 
of this worm are almost incredible from thirty to a hundred
feet. Taenia solum (called also cucurbitina
or gourd seed worm & the armed taenia) is distinguished
by having the head forked and surrounded
with papillae or long fangs (holders) by which it fastens
itself to the mucous membrane. The broken off joints have
when discharged the appearance of gourd seeds. hence 
its name of gourd seed worm.
Taenia bata (or vulgaris the unarmed taenia) has an 
external form like a ribbon joints scarcely perceptible
& is white and seen transparent. The head is
narrower & smaller & the papillae not elongated
2nd Ascaris vermicularis & a lumbricoides
The first, a. vermicularis (thread worm, pin worm & when
existing in number called ascarides) is filiform, slender at
both ends & from half an inch to an inch in length & of the diameter of a small thread found
generally in the rectum & though not confined to that part of
the intestines. It feeds on the mucus of the intestines & produce
its young in immense quantities. It is found in the stomach 
& called maw worm





71
Ascaris lumbricoides (or [illegible] long round worm) is perfectly 
round & from four to ten inches in length bearing a striking 
resemblance to the common earth worm It is said sometimes to perforate 
the intestine with its mouth 
3 The trichocephalus now called [tric???] is a small capillary worm from 
an inch to an inch & a half or two inches in length. The body 
is about half an inch in length & Is terminated a tail which 
is twice as long & end in a fine hair-like point
In addition to these worms have been reckoned
two others the vesicularis & the gordius. The former is a 
small vesicle found in the brain (sometimes in great numbers)
& containing many small worms. It is now considered a 
hydatid & is excluded from the subject of worms & verminous diseases The gordius (horse hair worm) is found in soft
stagnant waters from four to six inches long & twisted into 
various knots & contortions” Good. They are sometimes found
in the earth in great numbers they turn black on exposure
to the air & resemble horsehair, hence their name
of horsehair worm They are very common in our vicinity They are rarely found in the human
stomach. I have known them coughed up in abundance from the 
lungs; when they had probably come from an abscess in the
liver. It gives rise to a severe disease among the [lapladens]. Vide Good. 
The maggots of the common house fly & the’
larvae of many other insects, have occasionally been met
with in the alimentary canal of the human body vide Good
What were formerly called vesicular worms
are now considered as hydatids. [Brera] or worms recommended 



An attempt has lately been made to revive the doctrine
of [equivocan] generation. The learned advocate has
attempted to fortify his opinion by the analogy of 
vegetables. But where the experiment has been made the 
seeds of the forest trees that come up as [illegible] may 
be found at the roots of the young trees
Hyoscyamus formerly was common here
but is not now However when the gourd is broken in the 
college yard Hyoscyamus springs up. It has also in the
soil brought from a cellar in Chapel St.
Leeches & a variety of insect are undoubtedly taken in in water etc.
In Duncans [illegible] we shall find an account of
a number of caterpillars [illegible] by a child produced by eating cabbage leaves
I think I have never known an instance of worms
in children while nursing


72
II II. The origin of worms in the human body
Worms arise from eggs. Some multiply by depositing
their eggs to be afterwards fecundated by the 
male. Others are propagated by copulation between the 
two sexes While a third kind of the taenia fecundate themselves.
I have spent much time in investigating
the origin of worms in the human body but must confess
that I cannot satisfy myself upon the subject.
It has been supposed that worms found in the human 
body are produced from eggs deposited by flies about 
the rectum, at the time of going to stool. Were this the
fact, they ought to be more abundant in summer 
than in winter, while the reverse is the fact. I am 
inclined to think that the rudiments of worms are 
contained in certain kinds of food as apples pears, cider
water & unboiled fruits and vegetables. In infer this
from the fact that worms make their appearance, oftenest
when such articles have been taken & disappear
when they are avoided. If confirmation of this view 
of their origin we find that children are rarely if ever affected
by then when under three months of age & seldom
while they are nourished from the breast. For though
some have asserted that they have seen worms in the
bowels of children within the mouth & even before birth 
yet the fact is not well ascertained.


Breras opinions, also adopted by Good speaking of the
fluke worm
There is no doubt of the fact of worms within [fetus in uteri]


73
Brera thinks that the minute eggs of worms are absorbed 
into the circulation He says “when we consider that the
eggs of worms are so small that they are not perceptible by 
the microscope of Hoffman and these eggs themselves are masses
of small eggs, nothing is more probable than that the eggs of worms
are absorbed by the lymphatic vessels, pass in to the circulation
pervade the system with the blood & are deposited in the various
parts of the body, where they enlarge and unfold themselves when 
circumstances favour their development.”
If worms are found in the foetus, the fact
will favour this idea that the eggs of worms are carried 
into the circulation. It may be remarked also that
the parts of the body which favour the development of their eggs
are those abounding with mucous
The hypothesis of equivocal generation 
is neither specious nor probable. It derives no support
from analogy aid from reason, nor countenance from fact
In its operation it is worse than useless as it tends to obscure
truth by substituting conjecture while it disregards with 
the most vague and licentious imagination the boundaries
between the animal and numeral kingdom & ascribes 
to chemistry what pertains only to animal life
When the creator first gave being to 
the natural world, every part of the vegetable and animal
system was brought into existence by 
an extraordinary exertion of productive power. They  were
not moulded by the slow operation of time & the cooperation 





74
of mechanical and physical forces, but he spake and it 
was done. But since that first act of creative power, we
find are that these creatures are propagated and perfected by processes
more gradual successive and [operose], many of
which may be traced by human wisdom and admit
of being regulated and controlled by human culture & ability
Rosenstein says “from the eggs of a fly proceeds 
a fly, from the egg of a hen a pullet and not a 
serpent, from the egg of a goose, a goose and not a fish
So from one worm is produced a worm and nothing else”
II II II. The effects of the presence of worms in the body
When the seed of worms are once developed in the human 
body, the health is more or less affected, and the morbid
symptoms which then appear are in proportion to 
the number of size of the worms the sensibility of the part
they occupy and the general morbid diathese which
takes place at the time, whether the cause or the effect of
the worms
Worms in the alimentary canal are less
frequently the original cause of diseases than is generally 
supposed, inasmuch as in many cases of disease where 
they exist, the disease was merely aggravated & not originated
by the worms & all the symptoms of worms from which it is 
common to infer their presence, may be occasioned by 





75
undigestible substances for a diseased state of the bowels
Worms are often also found to have existed & that too in 
great numbers, where the general health has been apparently 
good. I well recollect the case of a child in 
North Milford who fell from a height & was taken up in 
a state of coma from the concussion. A dose of calomel was
given him which brought away twenty or thirty large
worms. The child had been healthy to all appearance previous
to the accident.
Some physicians go so far as to say that worms
are necessary for the health of vigorous children that they 
are nature’s scavengers a natural provision to destroy the
superabundance of food taken into the stomach. Dr Rush
was of this opinion. The opinion supported by Dr [Parr] It is a fact beyond controversy that
very healthy children have worms with out manifesting
any symptoms of their presence until the supervention
of some other disease causes them to make disturbance 
in the system. It is but seldom that they are the excit. cause of dis.
The following are some of the ways in which 
worms are injurious to the system. They may be injurious
from their number obstructing the bowels and consuming
too much food. They are particularly hurtful by 
the irritation which they produce when the irritability
of the bowels is excited by fever. They sometimes threaten
suffocation by rising in the oesophagus & in one instance 
a single worm I have known to lie in the fold of a volvulus 
of the intestines so as completely to obstruct the passage 





76
Linneus attributed the dysentery to a worm or insect [illegible] dysenterical
[languis] the measles to a similar origin. Various
authors the itch, sigler, petechiae lusitanus the syphilis
martin the elephantiasis nyander, eruptive
& contagious diseases in general lancissi, plague, remitting & 
intermitting fever considering miasm [it] being a collection of insects # some authors, toothache Dr [Adam]
observes cancer itself is nothing more than an animalcule 
a worm or an insect. It would seem from 
such speculations, that a great part of the diseases
which flesh is [illegible] to result from a superabundance
of vitality and that as Good remarks in his [illegible] corruption is no longer the triumph 
of death over life, but of life in one form 
over life in another. Such fancies lead into the 
wildest speculations of equivocal generation & relinquish 
all principles & all limits in natural 
history.
# Vide N.Y. Rep. about the year 1815




77
Symptoms of worms. Those children are most frequently 
troubled with worms whose powers of digestion are weak.
The symptoms of the presence of worms in the alimentary canal
are very equivocal, for they may all proceed from other
causes. They are countenance pale or flushed sad and dejected 
livid around the eyes, eyes sunken
eyelids swelled pupils dilated itchings in the nostrils, head
ache after taking food, mouth water [illegible] filled with saliva, breath
fetid, great thirst, grinding of the teeth in sleep, starting
in sleep fainting vertigo, palpitation of the heart, irregular
pulse & cold abdomen bowels flatulent
costive or loose colic throbbing in the bowels severe from [illegible] the small [intestines & umbilicus] appetite irregular
& craving loss of appetite pain in the stomach when empty, which is relieved
by food urine increased or diminished turbid and milky, stools irregular,
containing much mucus nausea & vomiting Sleepiness particularly
after eating, bloated countenance swelled nose & upper
lip, paleness of the lips, irritation about the mouth, rubbing
the nose, itching at the anus irritation about the neck of the bladder dry & convulsive cough
difficult respiration sense of suffocation paroxysms 
of suffocation body emaciated frequent flushings of fever with irregular pulse convulsions, epilepsy
and partial palsy. Of course these are not all present
at any one time
Chorea catalepsy & epilepsy are produced
sometimes, by worms
Dry convulsive cough Diff respiration
In addition to the other symptoms there may be these of irritation
of the lungs producing cough also irritation of the brain




[772]



It will be impossible to class all the articles inasmuch
as we do not certainly know the modus operandi of many 
articles which yet have sustained their reputation for [illegible]
Much stress has been laid upon the operation of cathartics
in evacuating the [illegible] which the worms generate by their irritation, 
just as irritation in the lungs produces [illegible]. But then
the [mucus] although it forms [illegible] for them, an effect more 
than a cause, and the worms will make [mucus] enough for themselves
Probably many caths act by their acrimony upon the worms
themselves. Others by the violence of their operation dislodges 
them. “Aloes are beneficial in mild cases as a tonic
when there is no excessive irritation. If there is excessive sensibility
& irritability they are improper as they irritate the
rectum they may be given by injection When there are
symptoms of worms though no worms exist aloes are serviceable
in the form of elxiir prop.”


77:a.
IV.
[general
treatment]
In the treatment of patients afflicted with worms two 
general objects seem to have been pursued both in popular
practice & in that of physicians 1st to destroy & 
expel the worms themselves & 2d to obviate their effects
upon the system & at the same time by the improvement
of the general health of the patient, prevent their recurrence
and increase This second indication will often coincide 
with the first, inasmuch as a diseased state of 
the body is the most favorable for the multiplation of
worms
Of those remedies which destroy or expel 
the worms themselves we have three kinds
1st those that expel them by strong cathartic operation
2nd those that act mechanically upon them
3d those that are prisoners to them.
1st Although strong & even violent
purges may be used to drive out an accumulation of 
worms in the bowels yet they should not be often repeated
as they would increase the weakness & irritability of the 
stomach & bowels to such a degree as to favour this increase.
In general calomel will be the best cathartic 
inasmuch as it will tend to promote a flow of healthy bile 
& to restore healthy secretions. In Europe the gall of 
animals has been administered. One of the best forms 
for the administration of cathartics is that of alkoholic
tincture, for the sake of the joint effect of the alcohol
hence elixir proprietalis in teaspoonful doses & the tinct.


“The bark of the button wood taken from the north
side of the tree has been recommended. It is a nauseous bitter
& a cathartic good” #
“It is a question whether cowhage acts mechanically 
or whether it contains an acrid principle like that which 
exists in the nettle”
# One of the remedies that I have most 
reliance on for ascaride in tinct [illegible]. Fill a
bottle with the young inner bark fill the interstices
with [prosp] spirit & give I to zfs night & morning
It is an old remedy and better than tinct aloes
It is tonic & deobstruent”
Some of the acids to be narcotic, are more probably active
merely by their pungency, odour etc.



77:b.
of hickory bark or buds have been found very serviceable
Podophyllum peltatum is much used but is probably not better
than other cathartics. The best form would be that of a tincture
2 Mechanical remedies are not now used. Cut hair
has been given cowhage though some doubt whether the operation 
of this is wholly mechanical. I have thought that the root of
osmunda given in pieces acted mechanically The filings of
tin, formerly were much employed as was also an amalgam
of tin & mercury. There is a curious account in one of our
journals of a man in Kentucky who took a pound of the 
amalgam & was unable to expel it from the bowels The 
mass lodged in a part of the intestines & could be felt externally
It was very troublesome to him when riding.
Oil has been given with the intent that it should fill the 
respiratory pores of the tape worms & thereby destroy its
life. In Madame Nouffeurs recipe The supper of
panada is intended to act mechanically by its bulk.
3d The remedies which destroy the worms seem generally 
to be narcotics All articles of this class however do not
have this effect opium for instance. Particular animals
are sensible only to particular narcotics as for instance
swine are poisoned by stromonium while sheep eat it with
impunity. The most valuable article of this class
are the two species of spigelia s. [ma??ndica] & s. anthelmia



A strange notion has existed about a little innocent [illegible]
was considered as the narcotic agent
Similar reasoning has been used with respect
to denarcotising the opium Opium denarcotised would
be not better than bread
Spigelia zii in ¼ pt water to a child may be given in divided
doses. It is better to give a cath. e.g. cal. or ruhb
Spegelia from zfs to zf for an adult
Sometimes but rarely it operates itself as a cathartic
Sometimes convulsions are produced
Our pink is bad because it is gathered by [illegible]
packed in hogsheads & the rotten saved & the rest [illegible]
The emigrants from St. [Illegible] brought what they 
called worm syrup which they said shd be given in the
night because it affected the eyes
S. [anth.] is [illegible] S. [illegible]
about zi if S. anth.
“Pink is given more especially for the [round worm] & sometimes
for the tape worm”
[illegible] [illegible] & [areca] [oleacea] zii to zfs
“The French use the syrup of peach flowers & seeds 
They first give sulph either zi in [illegible] decoction male
form & an injection of the same. They probably act by 
their prussic acid”


77:c.
The former is the one commonly used in this country
and in England It is called Carolina Pink. This is a most
valuable article and is useful not only for its operation 
upon the worms but for its effects upon the system, in allaying
the irritation which they occasion. I have prescribed it for 
a cough & other symptoms of irritation where I had no reason 
to suspect the existence of worms Then given for its effect
upon the worm from half an ounce to two ounces should be 
given in decoction in the course of the night, accompanied with rhubarb
or some other cathartic to drive the worm off while in a state
of intoxication. It may be given in powder in a dose of from 
10 to 20 grs The French W. Indies s. anthelmia is used
& called wormgrass. It is a stronger article than ours
The French use the article in form of a syrup & give a 
teaspoonful at a dose.
Veratrum subadilla & helleborus [fetidis]
belong to this class and have been given in doses of 2 to 6 grs for
children In Europe the most famous article
of this description has been the Felix mas
Other articles of this class are camphor, prussic acid & tobacco
The bark of the cabbage tree (of which there are two species
vide Good) is found highly valuable in this way by the
West India physicians
Other articles which have been said
to be successful in cases of worms owe their success apparently 
to their acrimony in whole or in part, such as
the terebinthinate oils Oil of turpentine is the one commonly 


Various aromatics have been used, as chenopodium 
[illegible], rue tansy
“The leaves of cedar juniper & [illegible] powdered
20 grs They are acrid stimulating and tonic & may have
a mechanical action. It might be used to add to the
powdered leaves some aromatic as rue ol. tansy [worm]
wood etc.”
“Melia [azidurach] bark of root or plant
zfi to zi act as emetic cathartic & narcotic. Acts
more effectually at the south where the recent article is
used”



77:d.
employed should be given in large doses, when it will
prove cathartic. A concentrated solution of salt has been
strongly recommended given by the mouth or by injection 
Ether is much used by the French & perhaps has an effect
upon the worms. Some of the other antispasmodics 
which have been popular may also have some effect upon 
them such as asafoetida, petroleum the essential oil of
the chenopodium etc. Perhaps arsenic poison intestinal
worms I have known it cure. Ammonia may perhaps act on them
2 Of the remedies which are designed to have an effect
upon the system. In severe affections from worms our first
attention must often be directed toward quieting the excessive
irritation of the system, by antispasmodics. Various popular
remedies for worms seem to have little other virtue
The chenopodium anthelminticus & c. ambrosioides called 
worm seed & the c. botrys. or [juris]
oak ar probably valuable, mainly if not entirely a
nervine. They may be given in decoction or the essential
oil may be used. The garlics are used in syrup or decoction they are nervine
7 have considerable effect as condiments upon the intestinal canal. The 
ictodes fetidus is of this class & so are the empyreumatic
oils, petroleum given in a dose of 10 to 40 drops barbadoes tar etc.
For giving tone to the digestive organs
and exciting their sluggish action the tonics
the bitters & the aromatics are indicated while mercurial


[Artemesia] ][santonica] is no better probably than the
other bitter tonics Some confusion results from the appellation 
worm seed being applied both to this and to [illegible] botrys
c. anthel. & “Indeed anything which tends to [procure]
healthy secretions of the viscera. Of this kind are the
mercurial which produce healthy bile which is especially [illegible] 
to [illegible]”
# “Indian corn or maize has been supposed to 
favour the generation of worms in the body. The aborigines
of this country have been peculiarly subject to them perhaps
from this cause”
Worms are far less common now as are also colic dysentery et. than formerly when cold
water & cider were drunk instead of tea and coffee AT the
south likewise the negroes who feed more upon crude and raw
articles are more subject [illegible] of the plantations it is a 
rule to give a decoction of melia to the black children once
in 3 months #
Though you can cure worms generally by calomel
yet sometimes they will resist all treatment
Eupatrium perfoliatum is used for worms
Flowers of [zinc] are antispasmodic so also sulph zinc 
Dr Rush thought well of [sugar] especially when given in the
morning
Petroleum seems to be a valuable article a substitute
for turpentine It may be supposed dangerous, but I have
used it for many years without inconvenience I began with 
small quantities from fear of danger, but now I give 10 30 or 60 grs
It very often to produce no violent effects. Yet we must not conclude
hence that it is useless. Asafoetidae for instance produces 
nothing but a little [illegible] in healthy persons


77:e.
preparations & other deobstruents will be valuable 
adjuvants. The metallic tonics as the preparations of iron
& of zinc, the mineral acids, myrrh, bark, the various bitters 
& the astringents have been found useful I have used alum whey with advantage. Among us the geraniums
& all the indigenous aromatics & bitters have been given
in popular practice. Alcohol from its stimulating effect
upon the digestive organs will be a useful vehicle, for the
exhibition of medicines. Condiments used freely with the
food, will answer to the same indication
The diet of patient troubled with worms
should be dry & stimulating, rather than liquid & cold
raw fruit, acids cold water & all indigestible articles
should be avoided & in extreme cases I would advise that
neither food nor drink be taken but which has not been
subjected to heat. I have apparently cured patients by this
means. “[illegible] toasted bread [illegible] [illegible] vegetable
[illegible] though they occasion [illegible] dyspepsia”
A multitude of heterogeneous articles have been 
used as anthelmentics, besides those already mentioned; some of 
them are sugar; worm-wood; rue; peach flowers; bark’
of prunus virg; valeriana selequa used by the French; muriate of
barytes; injections of mur. of tin (Alibert); oxide of tin grs iii with
etr. of juniper (Alibert) mur. of amm. of linseed; mur. of amm.
[illegible]I with jal. or rhub 10 gr.; all the forms of ammonia; crude
mercury; merc. boiled in water; aethiops mineral; artemisia
[illegible] [illegible] ([illegible] [illegible]) & a. [illegible] [illegible]
[s?tonica] worm seed bitter & of some value; melia azedarach much
used at the south; butternut bark intensely bitter dose a tablesp. full of decoct cathartic & said to be narcotic;
allows asclepiadis I think I have seen the a. [illegible] then beneficial; etc. etc. 


Garlics seem to do well how it is difficult to 
say perhaps operate upon the worms. Garlic also 
will relieve the eruptions of worms. It is though also
that garlic prevents worms
I have a very good opinion of sulph ether
introduced into the rectum used by the Germans, Italians
nervine & antirritant. It is valuable both in cases for worms 
& in those of irritation & affections of liver severe pain in bowels etc.”
½ oz or 1 oz. iron filings taste by [illegible]
remedy worse than disease
Wherever leaves of [illegible] are recommended
you may give our common juniper For the imported [illegible]
loses its strength by keeping & drying
Rosenstein recommends cold water during the
operation of a cathartic He recommends effervescing mixtures
to destroy the worms by carb. acid
An old remedy of the tonic kind is alum whey
Rx milk & water equal quantities & put in [illegible] [alum] to [illegible]
give the whey [illegible] children takes it pretty freely; It is a 
given in cases of relaxation of bowels and for ascarides & round worm
It is of consequence often to have a remedy [illegible] and not require
to be forced down


77:f.
Various external applications have been prescribed
Oxgall & venice soap aa zi made into a liniment with 
oil of tansy or wormwood;
Aloetic plaisters; ether oz vi, bruised garlic zi, camphor 
zi (used by the German Brera) for a liniment; petroleum mixed with gall;
Most of the patent medicines for worms [illegible] or both contain calomel,
Storr’s lozenges are calomel with sugar & gum. These
are his white lozenges. His brown are resin of jalap,
gum tragacanth & calomel.
Good on the authority of the Germans recommends 
[illegible] milk
Electricity 
A popular article (cath.?) is decoction of [plantanus]
occidentalis strong bitter
For ascarides I rely as much as any thing upon a saturated
tincture of the juglans [illegible] & [illegible]
All the indigenous bitters as cherry bark [illegible]
melia [azedarach] zii of recent root is divided
doses ½ pt water. When dried & long kept it is apt to 
disappoint here.
It is acrid [as the] narcotic & cathartic
a powerful article The berries are also narcotic causing
lard to fall down not from [choking] as has been thought
The [planters] think it too powerful for [white] children!


Tape worms frequently produce headache 
[illegible] about the umbilicus
yet generally produce a sense of weight. Yet I have known 
persons evacuate them when they had not been suspected
Case of a man who had kept taking remedies for a catarrh
Finally a medicine ? brought away to his own surprise 
and that of his physician a tapeworm
Perhaps vomiting occurs oftener from tape worm
than from any other species
# “When the worms are very numerous, there is a sensation 
of something falling from side to side on a change 
of posture”


78
V. Symptoms of each of the kinds of worms with the treatment.
1st taenia solum. This worm generally inhabits the upper
part of the intestines & adheres so firmly as to be removed
with difficulty It is sometimes solitary but commonly in 
considerable numbers. When brought away from the bowels
many of the joints are separate & have the appearance of gourd
seeds hence the name. 2 T. lata or vulgaris This likewise
inhabits the upper part of the intestines and is usually in families
of three or four
Both are called by the common name of tapeworm
They may exist without any apparent symptoms of worms
or they may give rise to the severest affections In general 
they are attended by severer pain in the bowels & more violent
symptoms in general than the other worms. The diagnostic 
marks of their presence in great quantities, are
sense of weight in the abdomen, # irritation of the stomach
nausea & vomiting loss of appetite, irregular appetite
weakness of the chylopoietic viscera, bloated countenance
emaciation of the body etc. All these symptoms however 
may arise from mere irritation of the stomach of a child
Adults are more generally affected with
tape worms but children sometimes have them.
For the taeina solum t. lata or vulgaris or cucurbitina the
gourd seed worm the spirits of turpentine has been 
very successful. Though not prescribed by the physicians
it has been used as a popular remedy here for more than
T. lata
fifty years. I have known a man of intemperate habits 


No cautions are given about the use of the article (so far as I know)
But if it does not act as a cathartic immediately, it will produce
great irritation especially of the urinary organs
I recollect the case of a lady who had been treated
with aph turp. in N.Y. taking 2 or 3 ounces Violent vomiting
& catharsis had been produced and the tone of the 
stomach and bowels seemed to have been permanently destroyed
Worry had indeed been brough away, but then they would 
come away themselves & the relieve was fallacious
In delicate cases it had better be combined
with castor or sweet oil
In the case of the lady cath seemed to do no 
good, they would indeed bring away large quantities but
they would return in a few days. I put her upon arsenic 
but she left town and I have not heard from her
It is difficult to tell how arsenic operates whether 
upon the worms or producing healthy bile
For the t. lata the spts turp. seems to do 
better


79
take a wine glass full of spirits of turpentine to expell a
tape worm Though an habitual inebriate, he said he never
had been so drunk in his life & large tape worm of this kind? came
away # It is said sometimes to intoxicate & sometimes to produce irritation
T. solum
2d The t. lata is the most difficult of all 
worms to manage. Spts of turpentine do no good at
least in those cases in which I have tried the article In
T. solum
one case I gave zfs. In another I gave it in teaspoonful
doses. In the latter it operates freely as a cathartic
a single teaspoonful procuring as many as ten stools 
Worms were evacuated but they would make their appearance
again in as large quantities as before. Indeed
any medicine may bring them away for the bowels
are sometimes so filled with them that they come away 
T. solum
when the patient is walking, or is asleep. I have known
two quarts to be brought away in a day, & then a fresh
supply in a few days after!
T. solum
# Arsenic has succeeded better for this kind? with me than any other
remedy, which I have used. In the case of a child
5 or 6 years of age who had both the round & the gourd
seed worm the common cathartics were given with some
advantage, as some worms were brought away; but the
symptoms still continued and the worms passed occasionally
with the stools. Fowler’s solution of arsenic was 
administered in doses of four drops three times a day. In a 
few days worms ceased to be evacuated the symptoms 
disappeared & the child has once had no recurrence of the worms



[Osmunda] cinnamonea is bitter, subastringent
and perhaps deobstruent. So is polypodium vulgare
and perhaps more decidedly so
The polypodium vulgare & felix mas They 
are used in chronic affections of the stomach & bowels & thought 
they have not obtained much reputation for worry in 
this country yet they have sustained their reputation for
2000 years. It was used by Galen
“The [form] is tonic”


80
I recollect case of one patient, a woman, who kept 
passing tapeworms, in great quantities, for months. After failing
with medicines I threw them all aside & tried diet
All the food taken was roasted or boiled even the water
used for drink was boiled. She was cured. It must be 
remembered the healthy bile & gastric fluid will destroy 
those worms & from this fact results an important indication,
which I shall presently dwell upon.
Felix mas the male form has been considered
in Europe, as a specific for this worm. With us the
osmunda cinnamonea [illegible] ([hog brake]) has been used as a substitute for 
it. It is bitter, astringent & sweet. The polypodium vulgare,
which is tonic & deobstruent, & other forms may 
probably be used also
The famous fern remedy bought by the king of France of Madame [Nouffleur]
is as follows. Take a super of the following panada
Rx water lbi [illegible] fresh butter z 2 or 3 bread cut into small pieces
zii add salt zi & boil thoroughly. If the patient is costive
give an injection of water lb is in the evening olive oil zii salt gr. s.
The next morning eight or nine hours after the supper the
specific is to be given viz. Felix mas ziii in powder, mixed 
with 4 to 6 z of the distilled water of the fern or the
flowers of the linden tree the whole to be swallowed at a
dose. In children the dose is reduced to zi of the fern
Two hours after the fern is taken the patient is to swallow 
the following bolus R. cal. & scamm. aa grs xii
Gamboge grs V powdered fine & made into a bolus to be 
given at one dose to a person of vigorous constitutiokn


Ether acts especially upon the nervous system
on which account it has been used as an anthelmintic 
Alibert for taenia gives about zi in a glass of the
decoction of the male form in the [illegible] an hour
after his doze zi of the ol. ricini are to be given
in syrup or in composition the dose to be 
repeated twice & sometime three times a day
The worm is usually evacuated after the first doses 
Mr [Bonadier] directs an injection of the decoction 
of the male form to which zii of ether are 
to be added Mat. Med. art. ether


81
Mathieu adds to Mad. Nouffleur’s remedy the filings
of tine & the sulphate of potash
The French & German add ether to the same
remedy
Rothier’s method is Rx powdered savin grs xx
seeds of rue 15 cab. grs x oil of tansy gtts xii syrup 
of peach gr. s. make a bolus Take half in the morning 
& half after dinner, drinking with each dose a glass of 
vin. tincture of peach kernels
Dr Baurdier gives the following 
Rx sulph. ether zi decoct felix mas 1 gill taken fasting
4 or 5 an injection of the same decoction with 
zfs of ether an hour after zii ol ricini or zi of
the syrup of peach blossom the worm is discharged 
half organiz
Oil is used in order to kill the tape worms
by filling their respiratory foramina. Ol ricini has
been given for taenia & other worms in doses of 3 or 4 z
Liquid carb. amm. might be given for taenia
The German physicians are fond of giving 3 or 4 
ounces of castor oil They are fond likewise of peach flowers
Within 5 or 6 years the bark of pomegranate has
been recommended. Paris says bark of the root [illegible] probable
however the office preparation is meant viz rind of 
the fruit which is the most astringent substance to 
the [illegible] which we have [illegible] also cathartic! I have
not [illegible]
N.B. The male form is astringent, and is given
to enable the bowels by the tone it gives, to bear the [strong]
cathartic afterwards. Hence the union of these give in [illegible] [illegible] may be useful



I have seen the worm occasionally in rain water
I recollection one man of 60 who informed me he had been
troubled with then nearly all his life until he removed his [illegible] Change of place
may effect a cure by change of water
Probably [illegible] of our cholera are
troubled with this worm delicate children only suffering much
children troubled with them will be faint, have
turns of colic etc. you will be called [illegible] Give an injection, and no worms will 
come [illegible] yet give afterwards a strong cath. & or repeat
the injection and worms will come away proof that they 
were not in the rectum They probably breed in the duodenum
I have known but one case in which they were vomited
up. The subsequent cath. will bring away 
smaller worms 
More is done by diet int his worm than by 
any thing else
Alcohol in this morning especially its bitter
tinctures. Condiments are useful. Worms are less common 
now because condiments are more used. It is said that
the aborigines when they cannot get salt used potash ashes
by a condiment The aborigines are said to be very subject 
to worms
# Ascarides sometimes produce severe pain at the 
umbilicus and colic
# “Ascarides though often found in the rectum
are generated in the stomach & small intestines. Hence they 
are sometimes no discharged till the second or third operation
Hence they are sometimes thrown up by vomiting. I have examined this point carefully 


82
3d Ascaris vermicularis. This worm is always troublesome
when it exists in considerable numbers though it is but seldom
that they exist in healthy persons in such numbers as to 
give rise to morbid symptoms. They are very common in 
children, and not rare in adults & are called by the
generic name ascarides
These worms are commonly found in 
the rectum & hence are often said to inhabit that part 
This is a mistake they multiply abundantly & lodge in 
the rectum as they daily pass void by sphincter. Sometimes
they exist in the stomach in vast numbers (hence called
maw worms) so as ever to threaten suffocation by rising
in a ball into the esophagus & sometimes they 
cause severe griping pains by their presence in the 
small intestines #
They pass in the stools & sometimes come
away spontaneously at night, they are said even to 
make their way to the vagina & urethra of females producing
troublesome symptoms X Ascarides are most troublesome
in the latter part of the day & the first of the 
night, when they excite an intolerable itching 
at night [illegible] probably than feeding They give rise to symptoms of general irritation
& sometimes to a cough # Ascarides are particularly 
injurious to dyspeptic patients & they themselves may give 
rise to the symptoms of severe dyspepsia such as craving
appetite, indigestion, faintings. Flatulence, cold
extremities pale & sallow countenance, cough etc. The irri


“They are attended with violent itching
about the rectum general irritation convulsions
irregular appetite pale urine flatulence want
of vigorous action of chylopoietic viscera increase of mucous
secretion darting pains in the abdomen stomach 
& chest faintness cold extremities the symptoms of
dyspepsia sporadic cough”
Tobacco injections & tobacco smoke injected are
very useful and will often cure. It is not safe for children
I have seen great prostration produced in children & I have
known an adult killed by a tobacco injection #
A physician who had been much troubled
with ascarides told me he had tried merc. oint. externally 
with advantage. “I have used it but was rather disappointed
# When the ascarides are in the small intestines, tobacco
smoke will do not good & by its debilitating effect will
favour their existence
“Injections of camphor and milk 
have done more to remove ascarides
than all other remedies I have used. The injection 
immediately removes the irritation produced 
by the ascarides & the ascarides themselves. It
may be made of milk ziv to spts camph. zi
This is the form in which I have used it, probably 
an emulsion is as good, perhaps a
better form” M. M. 


83
which they cause sometimes, in children brings on convulsions
Whenever, finally, they exist, in the alimentary canal
they are accompanied with great quantities of mucus in 
this part. They feed on the mucus of the intestines, the flow
of which they excite by punctuating the mucus membrane
Treatment It is very difficult to cure a patient
troubled with ascarides. The most immediate relief is
given by injection. If the worms are in great quantities & too much 
“Tobacco smoke is one of the most powerful means we possess for the
involved in mucus, they may be completely removed by 
cure of these troublesome worms”
injecting tobacco smoke. Injections of warm water or milk & water will
relieve for the time being by washing out the rectum & if
a quantity of aloes zis to ½ pt is added a still better effect may 
be expected though camphor being a nervine & a poison to the 
worms would be a still better addition. Injections of milk 	
and water, with camphor zii tinct camph to ½ pint, 
will if preserved [illegible] destroy them 15 grs of [illegible] [saladilla] have been injected. Still the frequent injection,
required in bad cases may debilitate the bowels
& consequently invite the return of the worms.
For internal administration. I have found
a tincture of the buds or bark of the hickory given in doses
from a tea to a tablespoonful one of the best articles both
for removing the worms & for preventing their return
Drastic cathartics should not be depended upon 
for they weaken the bowels & increase their irritability & 
hence favour the production of the worms. On the contrary 
calomel & tonics should be given to restore healthy secretion
Aloes if given should not be in large doses, for that will
irritate the rectum still further, but in smaller ones as a tonic


Oily articles shd be avoided as butter, because
they relax the [illegible] of the intestines Potatoes, vegetables 
All kinds of pastry avoided
All the metallic tonics are useful as tonics
They are thought also to be unfriendly to the worms
It is said that forth ascarides a pint or a quart
of sea water has been drunk with advantage, producing
vomiting & purging. Salt is a good remedy. Dr Rush proscribed
a teaspoonful of salt in the morning to a gentler one
much troubled with ascarides. He told him after trial than 
the remedy would not do. Dr Rush gave him, then, for worm
powders # 
For the worm the [illegible] the pink shd be the remedy vide [illegible]
“Rhub & cal. are the best cath. but all are useful For children Rx
tinct. [illegible] Fowlers solut. cold water” 
“Common salt ground up with cochineal to colour & disguise
the article. The gentleman reported that the last prescription 
had answered well. Dr Rush also believed
in sugar. This more doubtful
The asclepiasis have been much used especially 
for this worm especially A. incarnata called wild hemp It is 
dried pounded to a fine powder mixed with molasses & given in doses of a teaspoonful
Or [illegible] down and make a strong decoction [illegible] the [illegible] with it
molasses and give freely until it moves the bowels
This much used by the practitioners of the state more than any 
other article after calomel. it is an article which may always
be obtained growing in clayey situation and is safe
The other asclepians are similar & may be used S syriaca
is the most laxative


84
To prevent the return of ascarides, condiments should be freely used
such as pepper, ginger etc. in short all warming and bitter things
In extreme cases let the diet be so regulated that nothing shall be 
received into the stomach which as not been subjected
to heat. Mercurial ointment has fasted in my 
hands.
4. Ascaris lumbricoides the long round worm is perhaps
more commonly found in the alimentary canal than any other
This worm more than any other is found to have existed in 
the stomach or intestines while the general health has been good
is the presence of worms not suspected.
Strong purges may be used to remove
them & alcoholic tonic tinctures given to prevent their increasing.
For this latter object the carbonic acid has been recommended 
in the London Med. & Phys. Journ. & in confirmation 
of the idea I have used soda water with advantage
Melia azedorach or pride of India a decoction of the bark
is much depended on at the south for their young negroes
who are much subject to worms. It loses much of its virtue when dried. The spigelia is also
sued but of this I shall speak under the head of general 
treatment.
I recollect with an aff. of the liver
wh often vomited up dark [gravous] blood, which had evidently been 
long in collecting. Finally he was said to have thrown at 
a snake. Many eyewitness testified to the snake & to its eyes 
& teeth. I saw it. It was a very large round worm of the kind


To be distinguished only by the violence of the
symptoms. The same itching at the arms will exist as of the
ascarides, but non violent etc.
“Treatment similar to that for ascarides. It
is more common than is generally supposed. Many 
of disease & death by irritation from an unknown cause, are probably 
owing to this worm. In examination the contents of 
the bowels should be placed upon linen cloth and then
this worm can be seen.”
For the gordius Linnaeus recommended the angelica
Archangelica (not our viz the [atropur????])



85
5. The tricocephalus is but seldom met with 
The irritation produced it may be so great as even to bring
on delirium & will be manifested by screaming
throwing of the hands & [fat] etc. I have found this worm in a 
fold of the volvulus of the intestines vide Volvulus.
I should try narcotics for this worm, but 
cannot speak from my own experience. I should recommend
also an injection of a table spoonful of ether in a gill of
water or mucilage. Ether given in this way will undoubtedly 
pass the valves of the intestines in a state of vapour 
Vesicular worms, according to the old division of verminous
diseases, are met with commonly in the brains of adults & 
are attended with the symptoms of vertigo, convulsions
apoplexy & hydrocephalus.
Cases of worms & of colic are much less frequent with 
us than formerly; owing to the change in our mode o f
living. They are said to be very common among the 
aborigines of this country



One volvulus may be received within another
a second, a third and fourth time & [illegible]. The whole may 
then become inflamed, the vessels may run
from one to another, and the whole become one complete mass 
of organised matter or sometimes [illegible]
“It may occur in any part of the intestines except the rectum
though the colon is often received into the rectum”
The symptoms of the two kinds [illegible] [illegible]
owing to the different susceptibility of these two portions of the 
al. canal, and the diff. ages of the subjects of each
Nor located in books vide Ed. med. & surg. J
where the best account of it is given. Good merely mentions it
as an accident that is found sometimes to have occurred in ileac
passion
“Predisposing of exciting causes”
The cavity of the natural stricture may not be large than a goose quill, & such 
children will be very liable to an occurrence of volvulus
This is not a primary disease. It occurs more
in some families of [illegible] fibre & [illegible] phlegmatic
temperament
It may occur from debility of constitutional
or that of the bowels [illegible] by bowel complaints etc.
Local violence One instance, in here the child 
was apparently thrown into it by being carried over the shoulders


86
Volvulus or Introsusception
This is a disease with which I was at first very much perplexed
especially as I derived little satisfaction from the books
Volvulus or introsusception is the reception of one portion of
intestine within another. It doubtless exists often in a 
slight degree, when there is a strong action of the bowels
& are inverted peristaltic motion & the bowels disengage
themselves. Sometimes there is a double involution, or one
involution within another. In some cases likewise the 
cavity of that portion of the intestine is entirely obliterated by 
the tumefaction of the coats. I have always found in post 
mortem examinations, that the upper portion of intestine was
received into the lower & not vice versa the involution having been caused apparently 
by inverted peristaltic action
This affection of the intestines occurs oftenest
in children though adults are liable to it. It would seem also 
that some families of a leucophlegmatic temperament & 
delicate constitution are particularly liable.
It may be caused by a natural stricture
of a portion of the intestinal tube when it will be incurable
It may arise from extreme irritability; local violence
& injury may occasion it, & the irritation of worms may 
bring it on. Drastic cathartics may bring on volvulus
& hence should be cautiously avoided where there is a liability
to it. Bowel complaints, as colic, cholera, dysentery
etc. sometimes terminate in one or more volvuli of the
small intestines. The disease is more frequent in the 
summer, when debility is greater & bowel complaints prevail 


“Symptoms incessant irritation one or two copious evacuations
but usually these have ceased entirely before the physician 
arrives constant efforts to vomit, resembling hicup constant
efforts to pass stools & nothing passes but mucus streaked with blood
Generally mistaken for hydrocephalus
In bowels complaint of delicate children look out
for volvulus It is much more common in some seasons than 
in others. About 10 years ago they were quite common. I had
many letters from our students, who met with the disease
& disagreed with the phys & gained [reputation]. They 
frequently sent me such accounts.
Sometimes there will be a partial involution of the
large intestines [illegible] to relaxation of inner membrane what descends
like a funnel & may be felt by the finger #
In the large intestines there is not very much irritation
than is torpor of al. can. not much vomiting except upon 
the administration. There is no purging
You may sometimes determine that of the
large intestine by heaving the peristaltic action discard
& stop at the [illegible]
This is most common in adults. The symptoms
are more mile
# It occurs in females who have had long continued effetion
of uterus, occurring in females about cessation of [catamen]
and from long continued bowel complaints. The [inner] membrane
will descend like a funnel An injection will perhaps 



87
Symptoms These will be different according as the 
affection is of the small or of the large intestines
1st Where the small intestines have one
or more volvuli the symptoms [illegible] vomiting or
Symptoms like those of violent injury to abdomen vide case 1st 6.89
a constant endeavour to vomit as often as once in ten 
or fifteen minutes the matter thrown up being a greenish 
fluid or simply mucus. In severe cases the vomiting is 
attended with a discharge from the rectum at the same 
time. The stools are fecal at first & copious but afterward 
they are small in quantity & consist principally of white mucus streaked with blood
the blood not being diffused throughout the mucus as
“no fecal smell generally”
in dysentery, but in streaks or specks. These symptoms 
are attended by others which indicate great inquietude or irritation
such as throwing the h ands & feet, rolling the 
head paleness of coutenance This set of symptoms resemble those of hydrocephalus
& hence volvulus is often mistaken 
for this disease. The pulse is small and frequent
“[illegible] usually occurs in 24 or 36 hours”
2 A volvulus of the colon or rectum 
is not usually attended with much vomiting unless this
is excited by cathartics. It is attended with the ordinary 
symptom of constipation. There is no evacuation 
from the bowels unless at times a little blood and
mucus. If the passage be not completely closed, an 
enema thrown-up will remain & not come away if
completely closed. it either cannot be thrown up 
or it returns immediately. Blood often follows the introduction 
of the pipe. Indeed the inflamed part is often 
so low as to be reached by the pipe & admit of being felt
by the finger.



come away immediately. [Schyl?la] of feces may come away 
And large quantities of mucus may come away sometimes 
½ a pint. This is not apt to be fatal. Treat by a strong
inject prescribe for the [illegible] with conium [illegible] etc. mechanical 
means
The more cath. you give the more the unsolution is
increased therefore give more
Give mucilaginous injection, in involution of the 
small intestines, sufficient to fill the intestines. If it is
said that the injection will not pass the valves. I answer 
that whether by sympathy or in whatever manner, I am satisfied
of its utility # 
Give [illegible] enough to allay irritation 
I have treated # patients for 8 or 10 days without 
evacuation & cured them 
Not long since I had a case in what
I suppose there was such a volvulus, for the attendants
could not make the child receive injection. “thought
the bowels were swelled” The child was suffered to 
get 8 or 10 days without evacuation & eventually died
of another disease with which this was connected
# In the incipient stages, filling the intestines
with warm water [illegible] recovered. I was led to it from 
its [illegible] strang. hernia I am satisfied it acts well as a 
local nervine etc.
I would recommend the injection of ether 
in cold water table sp. to a gill warm wat. will make it fly off. The inject of it
is practised by the French & Germans. Other antispas. might be [injec??]
is asaf. petroleum etc.


88
We may often hear a rumbling noise proceed as far as 
the stricture & then stop.
Treatment The indications of cure are principally,
to relieve the excessive irritation both constitutional & 
local & to attempt the restoration of the involved intestine
chiefly by mechanical means
When the small intestines are affected we
must give opium and aromatics & depend mainly upon
these as internal remedies, until the intestine restores 
itself. As an adjuvant the warm-bath will be valuable
& fomentations or irritants, as mustard & horse radish
leaves may be applied to the abdomen. Soothing injections 
also may be copiously given. The quantity of opium 
which will be safe at a dose may vary from half a drop to 30 
None but the mildest cathartics are safe, as blue pill
and aromatic tincture of rhubarb I have succeeded in giving 
only a decoction of senna & the blue pill [Savage]
When volvulus is in the large intestines
all our remedies must be given by injection. The 
warm bath etc. may be used & we may also attempt
the restoration mechanically, by means of copious 
injection repeatedly given & thrown up with force
Two cases are related of young men cured by inserting
into the rectum & keeping these for a considerable time 
as spermacete candle with a quantity of opium at 
its extremity.




The first case which I had I treated for constipation 
with repeated cathartics, which are thrown up etc. The
attendants complained that they could not give the injections when
I ordered I was ignorant of this case Tried warm bath & 
every remedy for colic constipation etc.
Upon examination at first the colon was
apparently wasting at the sigmoid flexure where there
was a large tumour which we thought to be a malformation
It proved to be a repeated & insolution of the intestines Inflammation 
had taken place & the whole was adherent, some
[illegible]
Afterwards I was called too late, to a similar
case which upon an examination showed circular appearance
Afterwards called in consultation to a child
said to have hydrocephalus all the children of which family 
had died in a strange way. I pronounced the disease
not hydroc. but some could not say what was the matter.
No treatment was serviceable. Examin showed volv.
of small intest. Symptom is above. vide p. 204
The children of the family were subject to 
diarrhoea & were leucophlegmatic. I afterwards 
[illegible] the family and was very cautious about cath.
giving nothing stronger than blue pill or tinct. rhub. The
family raised 5 or 6 children afterwards
Case of a student [unaccountable]
Dr Munson & Dr Smith at a loss. [Cath.] retained & yet
not thrown off by vomiting Sitting by him I observed
a rumbling noise Which he said upon my enquiry, he
felt & which stopped. I felt the stricture. Spermacite 
candle, sharpened, opium at [end]. kept up about a [illegible]
[renewed] afterwards injection passed up 
Case of a gentleman on the wharf similar cured


89
Cases. A man over whom a cart had passed without
leaving any external injury, died with all the symptoms 
of volvulus of the small intestines. On dissection the duodenum 
was found cut entirely in two. One remarkable
physiological fact occurred in this case; a cathartic
was given by the mouth & produced a regular 
evacuation from the anus, although the intestine
was completely severed.
An interesting case occurred to me
in which the worm ascaris tricocephalus was found
to be the cause The worm lay in this fold of the intestine. Grace Linsey, a delict schoolgirl
on was taken with slight in disposition for 3 or 
4 days the rejected her food by vomiting then came
on constipation with vomiting attended with great
restlessness & throwing off the bed clothes, cold extremities,
low & small pulse the tongue not much furred,
little or no thirst, no tumefaction of the abdomen
no determination to the head. She was visited on 
Tuesday and died on Saturday. A blue pill was
given & followed by 15 or 20 grs. of calomel in divided
doses No effect was produced though they were 
not rejected. Opium and stimulant were tried but
were not retained. There is no pain but faintness & 
an uneasiness about the alvine & urinary passages.
Both copious and small injection pass up well but
produce no evacuation. On Wednesday injections produce
stools which are clay coloured. Black vomit came
on two days before death. P.m ex. liver very pale
little bile in the gall bladder no marks of inflammation cavity 
containing the intestines very dry as in cholera. Two volvuli were found one in the
ileum which was disengaged with difficulty, & one in the jejunum 


In other cases with similar symptoms I have had supposed 
there was volv. caused by worms, but have had no opportunity 
to examine Vide p. 204
[illegible] Lindsay’s case continued. After the examination 
we accidentally observed some of these worms minute 
& coiled up among the mucus on the cloths. The worms seem
more calculated to irritate the bowel than any other “If it
could have been known that the worm was there, perhaps tobacco should aught have
succeeded
# It is called leg ache in slight affections 
alluded to by DR Rush
Affects the legs, calves of the legs
[illegible] continues extends up to the [illegible]
coats” It is a disease manageable in its commencement
Being a severe disease it calls for 
decisive remedies
The indications are to allay pain 
equalize excitement & promote peristaltic action
by opium by diaphoretics by cath.
Cal. in full doses some would call 5 grs a
full dose some 10 But if 5 gr. should be given
every hour it would amount to a full dose. You 
may give 10 gr. 2 or 3 times repeated. AT the
same time apply warm bath & fomentations
not regarding your giving cath. Put drafts
at the feet. Follow the cal. with senna, salts etc.
But do not be too anxious about the calomel’s operating
immediately It is better that it shd lie sometimes in 
[illegible] vessels
With the cal give opium also guiacum 
& guaicum with dovers powder the latter
to act on the skin and the whole to produce a 
decided [nerve] action affect on the al. can. and on the whole system


89:a.
Nervous Rheumatism
Infantile neuralgia
This is a disease which has never to my knowledge
been described in the books, though it may have existed unnoticed
I first met with it some years ago, but it is [not] some years
since I have seen of a case. It may occur again
It occurs in the winter and spring mouths & 
occurs after exposure to cold especially after the feet have
been in snow water.
Children are the only persons that I have
known attacked # 
This disease is in its symptoms allied to neuralgia
acuta. The affection leg ache is probably allied
The attack is sudden after exposure to cold 
with excruciating pain in the inferior extremities sometimes
rigidity of the whole muscular system more or less disorder
of the digestive passages (apparently the muscular coat of the
intestines is affected) abdomen frequently tense
and full stomach sometimes irritable. If the disease advances
there is nausea, vomiting, tumefaction of abdomen
(appearance of tetanus?_ (coma?) etc. and the patient dies
in 4 or 5 days
The indications of treatment are to equalize
excitement by acting upon the whole surface of the alimentary
canal and skin at the same time introduce new action in the system
commence with a full dose of calomel 5 to 10 grs or 20 & follow
it by senna and manna, or castor oil and enemata
“I do not expect that cal. [illegible] I as above will operate at 8 years therefore follow it.


Immediately after administering the calomel I put the patient
into the warm bath or the feet in to the tepid bath,
wrapping them afterwards in flannel or boil cedar boughs
in water, roll them in cloths and apply them to the body & 
feet. Irritants also may be applied to the extremities and
to the abdomen
Sometimes it will be best to repeat the cal
in the course of 2 hours. The stools will be fetid and
dark but this must not be considered as an indication 
for further evacuations as the appearance may be caused by 
the calomel, and is a sign that secretion is beginning to take
place. After producing free evacuations by your cathartic
you must keep up a regular course of exciting the secretion 
by cal. & guaicum with Dover’s powders, especially if 
pain continues & keep up a diaphoretic action by Dover’s
powders calomel and camphor alternately increasing 
doses if necessary. Calomel and gum arabic, as an emulcent, 
& calomel and decoction of cedar twigs, as a diaphoretic
may be given
Give the calomel first in divided doses
If cold applications are made to the extremities, to 
discuss the inflammation the disease is translated to the
stomach and death is the consequence
I called in the first stages, & am always successful in effecting
a speedy cure



The irritation of the system is so great that secretion 
is prevented hence the production of
secretion
I have been called to patients with [illegible]
where little had been done the abdomen was
swollen the patient went into a comatose state
& died and that too where the disease
was not of the most violent form
After the bowels are thoroughly evacuated
depend upon diaphoretics camphor guaiacum and 
[illegible] etc. giving so as not to offend the stomach 
and beginning gradually 
It is a violent and excessively 
painful disease and it is a great satisfaction to the 
phys. to cure it
Dark stools [illegible], satisfied
“The pain usually begins in the calf of the
leg and extends to the contiguous parts. Sometimes it is attended
with tetanic spasms & a constant rigidity of the abdominal
muscles. The stomach becomes in these cases irritable,
and nausea & vomiting prevail. In the progress
of the disease the abdomen becomes full and tense, with 
constipation.”
“It should be our leading object to make the
muc. men. of al. can. & the cutaneous system active [concert]
After the operation of cathartics, if the pain is severe give diaphoretics 
with opium, as Dover’s powders. Camphor & cal.
in small doses as an alterative. If the stools are watery & fetid
give opium ¼ gr. guaiacum 1 or 2 grs. camph. 1 gr. Ipecac ½ gr.
with cal. repeated till some effect is produced not to salivate, but
to this children are not so liable as adults”


Young physicians are often called in a case of convulsions
as their first case The neighbors & friends (women) have assembled
in great numbers and their sympathies are excited. Hence
an impression is made with respect to a young physician’s talents which 
will be of great service or detriment
Morbid condition to brain so that ordinary stimuli
produce convulsive action
Convulsion fits may continue 5 m or from 1 to 2 hrs


90
Convulsions vide costiveness 12:a
This is a very common disease of infants. The mortality from 
it is truly appalling nearly one seventh part of the whole
number or deaths of patients under the age of puberty
by the bills of mort. in Phil in 20 years
Medical writers commonly make two 
kinds of convulsions idiopathic and symptomatic, the
former arising from some morbid condition of the brain 
and nerves and the latter from some other disease, or from 
irritation. Children are subject to both kinds & most
of the diseases of children may be expected when they prove mortal
to terminate in convulsions
The causes of symptomatic convulsions
are as various as the agent capable of producing irritation
though the causes of convulsions in one child will not 
necessarily produce them in another. The susceptibility to 
them varies with the age of the child and the peculiarity 
and degree of delicacy of the constitution.
Convulsions may arise from the sudden suppression 
of evacuations to which the system has become
habituated. Irritation from teething is a very common 
cause. Worms in the alimentary canal may excite convulsions.
But perhaps the most frequent cause is the 
presence of indigestible substances in the primae viae.
irritating the nerves of the stomach & through them those of
the whole system. Over distention of the stomach, even with 
food of a healthy quality interrupt the progress of digestion
& the food undergoing action [illegible] fermentation 


“Or the excessive quantity of food may produce
convulsions from the mere stimulus of distention”
“Dyspepsia is a cause”
This is an important maxim in the first children of 
young mothers Their anxiety of mind will often affect their
milk


91
in the stomach, becomes noxious matter & excites convulsions
In the season of fruit we may always suspect this as a 
cause in children old enough to eat it. Calomel has been
known to be so irritating to the system as to bring on convulsions
Costiveness also is a cause of convulsions in children
A change in the quality of the milk of the
mother or nurse, produced by improper food or
by strong affections of the mind, in some instances
is the cause of convulsions in young children. Hence 
not only the diet of nurses should be regulated, but their
minds kept tranquil. It may be observed also that the 
countenance of the mother or nurse as also those of the bystanders
has more influence upon children than is commonly 
supposed. Even a child but 3 weeks old, will be strongly affected.
In some families there is said to be an hereditary 
predisposition to convulsion among the children.
For the treatment we have two indications
1st to remove the exciting cause where this is local & 
2nd to relieve the irritation of the system
1st We must enquire into the causes with 
with care. If evacuations are found to have
suddenly ceased they must be restored. The guns should
be lanced. Anthelmintics should be given if there are worms
If improper food is suspected we must be particular 
in our enquiries, or we may be misled by a [vague] & 
general answer. When the convulsions have been brought
on by improper food or by food in large quantities
recently taken the stomach should be evacuated by an
emetic of 5 or 6 grs 4 to 8 of sulph of zinc or of ipecac.


# How long should we wait after giving one cathartic
before we try another? the child being in convulsions 
all the while?
The equilization of temperature will do a great deal
to remove convulsive action Besides the soothing of the [nerves] etrc.
Some rely on one and [illegible] or another
Oil of a amber is not in my opinion better than many others
The oil of amber apparently is the [illegible] the oil of [capal] brought from its E. [illegible]
It is recommended to dissolve the oxyg oil in [illegible]
[but] it is slow of solution It dissolves readily in either


92
If the offending substances have probably passed the stomach
& the irritation is in the bowels, these must be evacuated as
speedily as possible giving and injection to begin with [illegible] it to [illegible] cathartic. Sometime
it will perhaps be best to give a dose of calomel
large enough as to operate both as an emetic & cathartic.
Frequently large & repeated doses of cathartics
will be needed in order to overcome the torpor produced
by an excessive quantity of food. The food also diminishes
the cathartic operation is the case with the French
[dinner] pill. We may give calomel, 5 to 10 grs. or scammony 
3 to 4 gr. jalap 2 to 3 gr. senna & manna, castor
oil, neutral salts etc. If dry cathartics fail to produce
the desired effect, the liquid should be tried. Sometimes
will be acted on by one kind when they will not by the 
other # If one fails after 3 doses try another & assist with injections
Begin with cal. & follow with the others
2. If the convulsions continue after the removal of the cause we must
rely upon antispasmodics or even at the commencement. Of these the warm bath must
be considered the most powerful remedy in convulsions
of children always [illegible] & often efficacious. Its influence is immediate and extensive.
Antispasmodics, as pearl ashes or aromatic herbs, may be
put in to the water of the bath
Of antispasmodic articles a great variety are 
used. Oil of amber Dr Rush called his sheet anchor in 
spasmodic diseases. It is useful internally, and applied
as an external irritant along the spine. The artificial
musk a preparation of amber is in my opinion a better
article than amber itself, for all cases where amber is 


“# Seneca oil is more limpid & pure & approaches nearer to naphtha”
Soot is a [illegible]
Soot is efficient as a nervine tonic & deobstruent
It is sometimes very efficacious in jaundice & dyspepsia It was
very popular in Philadelphia with ashes for stomach complaints
“The British oil is manufactured in this country from 
Barbadoes ter & spts turpentine”
The nostrils may be rubbed & it may be given
internally “also rubbed on the skin”
Though so offensive to the small yet children taking 
the tinct readily
potash [illegible] & [illegible]
All the alkalies & alkaline earths are antispasmodic.
They are not nervine properly. There yet
seems to be abundant testimony to their antispasmodic
properties. They are to a certain degree tonics. i.e. they 
have a specific action on the mucus membranes. I have maintained [illegible]
they operated by generating excitability a view supported by Jobe
vide Hufeland’s Journal in Lond. Med. & Phys.


93
indicated. The mineral oils from whatever source obtained,
such as petroleum, seneca oil, British oil, are
little inferior to the oil of amber I prefer the seneca oil 5 to 30 drops #. The eympreumatic oils
are useful antispasmodic and soot is often given by nurses in 
decoction
Ammoniae in any form is a good antispasmodic 
A solution of ammonia in spirits often contains an empyreumatic
oil of this solution we may give to a child from 2 to 
6 drops in an ounce of water. Either the spirt, the carbonate
or the aqua ammoniae will be useful in alleviating spasms 
in children either applied to the nostrils, rubbed
upon the skin or given internally. Dippel’s animal oil, a
very fetid substance distilled from bones in a state of putrefaction owes to antispasmodic
virtue to the presence of ammonia. It is too disgusting
Castor and valerian are good articles
of this class, but in cases of children they are too bulky & a sufficient quantity
cannot be introduced into the stomach. A more
powerful article than these is the asafoetida fetid gum 10 or 20 40 
drops of the tincture. This is a very valuable remedy to 
give by injection using for this purpose either the tincture zii
or a decoction
all the alkalies are antispasmodic & 
are proper for children. The most powerful is 
pearlash given by injection, zi to zii in lbis of water 
I have seen more sudden and permanent effects in cases
of spasm produced by injection of this kind, than by any 
other remedy. It has been successful in cases both of 



In for [illegible] who have [resumed] in convulsion 2 or 3 days
when a variety of narcotics had been given. I have seen
surprising effects produced by the injection
These applications sometimes fail & we 
cannot tell to what sort of cases they are Yet we must have
a variety of resources if we would be able practitioners
Opium is powerful, but though it
frequently relieves, yet it sometimes aggravates the symptoms
I have given it with great success in paroxysmal convulsions
anticipating the paroxysms yet in these it will sometimes
fail



94
infants and of adults. Sometimes however this remedy 
fails & I am not able to point out in what particular
“We are compelled sometime to practice [illegible]”
instances it is indicated. All the narcotics
are antispasmodic. Opium is a powerful antispasmodic
and may be given to patients of any age when the condition
of the system does not contraindicate it vid. lect on m. m
I have given opium
where the convulsions were violent & returned
at stated periods with fever preceding. When the
convulsions appear at regular intervals, as once in an
hour, or day, opium in repeated doses may be considered
a specific.
Counter irritation may be valuable adjuvant
in the treatment of convulsions. Oil of [origanum]
& similar articles may be rubbed along the spine
 drafts may be applied to the feet and wrists & mustard
horse radish leaves etc. to the abdomen.
When the convulsions are frequently repeated
in children and become in any degree periodical, a
cathartic of calomel given once or twice a week, rarely 
fails to prevent their recurrence. If this fails I give
stramonium or other narcotics
If convulsions arise from organic affections
we can expect to effect more than to palliate
instead of curing the disease.
“Counterirritation by mustard, horseradish etc. may be
useful”


An injection can do no harm can always be administered
and if one cannot administer articles by the mouth
Irritants may be applied immediately e.g. mustard
horseradish garlic N.B. we do not need powerful vesication
for the tender skin of infants. Even garlic sometimes vesicates
Ammoniae to nostrils & in mouth
Be sure that you have [water] enough to [illegible]
the child completely for the nerves are apt to think that it 
is sufficient to half [illegible] child & then sprinkle
or scatter water over producing an equal excitement
Friction may be applied while in the bath & after
coming out [illegible] with dry flannel
If the irritants have been applied before
the bath taken then off when [illegible] about to immerse in the
bath & put them on again if necessary after coming out
If the child seems to be in a state of asphyxia 
the emetic may not take effect; then irritate the fauces
the child being lard on its abdomen supported by the
hand of the nurse



95
When you are called to a child in convulsions, without 
previous sickness, direct an injection to be immediately
administered and the warm bath to be prepared. if the
injection does not relieve, put the child in the warm bath 
previously adding pearl ash in proportion of zfs to a gall.
of water. Let the child remain from 5 to 15 minutes taking
it out when it begins to grow exhausted. When taken out
of the bath let it be wrapped in flannel & put into a 
warm bed. Then apply irritants as mustard, horseradish
garlic, or aqua ammonia to the abdomen feet and wrists
Apply aqua ammonia to the nostrils and temples
As soon as the child can swallow give a dose of calomel;
If the countenance is pale or livid the
cause may be suspected to be some offending matter in the 
stomach & an emetic ipecac not [illegible] generally should be given. We may often
succeed in exciting vomiting by irritating the throat with 
the finger or a feather & this method should be tried
when the patient cannot swallow & is known to have taken
improper food or when it is desirable to hasten the 
operation of an emetic. The child will vomit with much
more ease if it is held lying with its belly upon 
the nurses’ hand, which this supports the abdominal 
muscles
If the child is much agitated at the 
sight of the water which it is to be immersed, let
the tub be covered with a blanket & the patient gradually 
lowered into the water there will then be 
no difficulty




96
Epileptic fits are very frequent among children
Epilepsy is defined by Good A “spasmodic agitation & 
distortion, chiefly of the muscles of the face; without sensation
or consciousness; recurring at periods more or less
regular.” One side is generally more affected than the opposite
The limbs may be fixed and rigid with twitching 
of particular parts. The pupils may be contracted or dilated
& the attack may be followed by coma. The attack may 
be abrupt and without warming or may be preceded by 
hilarity, or a giddiness or other unpleasant sensation.
Sometimes there is what is called the Aura epileptica, a
sort of formication, creeping up the body for which the 
ligature may be applied
The fits may be kept up by the constant 
presence of the cause such as malformation of the brain etc.
or, by habit & while in the former case the disease
will be incurable, in the latter habit will be very 
difficult to break up.
The causes of epilepsy may be, malformation 
of the brain tumours of the brain derangement of the system 
produced before birth by syphilis & rickets or the same
causes as those which produce the rickets & in children oftener than after preventing the disease
may also arise though more rarely from mere excessive irritability of the system, even’
without any exciting cause of irritation such as indigestible substances
in the alimentary canal or suppressed evacuations
Among children however epileptic fits are
most commonly excited by teething, suppressed evacuations
& the irritation of a morbid condition of the bowels or of 


In scrophulous children remedies for scrofula
may be given. [illegible] rickets I have often
found advantage from blisters behind the [ears]
I have found the cath mode of treat successful 
for children within the year especially calomel
In some cases the most powerful cathartics are
required
If there is acidity of the passages so that cal. seems
to gripe much [illegible] chalk any quantity from 5 to 10 
It is immaterial whether the action is chem. or certainly 
the effect is good
The system being very irritable ordinary stimuli
or rather a little more than ordinary brings on [illegible]
Hence improper articles improper exertions of mind & body
etc. Careful management & [illegible]


97
indigestible substances in them.
The treatment of epilepsy must vary
with the causes which produce it but does not differ materially 
in the case of children from that of convulsion fits
In epilepsy from rickets I have used the
cold bath with advantage. In children our attention 
in the treatment of epilepsy must more especially be directed 
to the alimentary canal. Cathartics are far more valuable
with them than for adults. I have almost always succeeded
by means of a course of mild cathartics & 
joined with one of tonics, such as the tonic solution 
& the different preparation of iron
When called to an attack brought on 
by offending matter in the stomach and bowels, we should
commence the treatment with a strong cathartic in 
order to thoroughly clear the alimentary canal
calomel is the best article but if the bowels are loaded with 
mucus so that calomel fails to operate we may conjoin 
1 or 2 gr. of gamboge & of scammony & 5 of jalap & this
though powerful, will yet operate kindly. In 
the subsequent treatment calomel should be given 3 or 4 
times a week; though if there is a deficiency of mucus
in the bowels an abrasion as it were the blue pill will
be preferable or chalk may be conjoined.
Among infants most cases are curable
by careful management, both of the physician of nurse
The diet should be regulated with great care Generally 
however there is a morbid appetite, & a sub-[insanity]


There is often a difficult, particular waywardness
[illegible] like into [illegible] etc.
In children more than a year old I have given stramonium
so far as to dilate the pupils keeping the child under
the operation of it I have not prescribed it to children
under 2 yrs or 18 m. I recollect one case in which 
the convulsion begun to subside as soon as the pupils began to 
dilate
I would not prescribe to [illegible] but to [all]
symptoms e.g. tonics all the nat. ton. tinc irr. cap.
lead
I would give the lead where cathartics, from 
the excessive irritability of the al. can. aggravate all the 
symptoms Lead will produce a torpor or sub paresis
contrary to this Narcotics also will meet this condition
Opium will occasionally, but not generally 
Why it is we know not but the fact is that phys. do 
not depend on [illegible] ep. seems to cause a determination
to the head


98
with regard to food. This subderangement of the mind
manifests itself also in other ways by oddity of appearance
gesture & action. A strange propensity for climbing for
instance is met with & epileptic children will often be so 
active & so artful as to be very difficult to manage
For more particular treatment see my 
lecture on m. medical articles stramonium & nit. silver
[illegible] turpentine from 10 gtts to zi diluted
stramonium, camphor, opium atropa belladonna
& most of the more powerful narcotics Arsenic
zinc is one of the best of the metallic tonics
Actual cautery, [moxa] etc. have been highly extolled
“In epilepsy caused by rickets or by the same
causes as those which produce ricketts. I have used the 
cold bath with advantage”
“Mercurials followed by mild cathartics
[Seontod??] etc.”


The child will be still breathing languidly
The parents think it dead If you look at it carefully 
you will perceive as languid treating & looking at
the eyes you will often perceive a little convulsive motions of 
the balls pulse not much disturbed
The child continues a few [illegible]
with paroxysm & comes out with a scream like
an adult from nightmare
Not dangerous
In a few instances [somerset]
Case adult patient [illegible] a chair stands fixed eyes fixed
come out with a stare irritable & sub derangement
for a few days Afterwards [somersets] “asleep
once a sleep twice”
Case a girl last year gather up [illegible]
[somerset], even 50 times than cataleptic then exhausted
This case changed from chorea to catalepsy Repeated
bleedings did not change the emaciation etc.


99
Catalepsy
This affection when it affects children, is called in 
poular language still convulsions. It is a very rare disease 
among adults, but among children I have met with several
cases of it
In catalepsy the muscles are universally 
or partially affected with a tonic spasm. The patient remains
fixed in the position in which it happened to be
when seized appears asleep, is insensible and scarcely 
breathes. The eyes are commonly fixed, but sometimes have
a little motion. The paroxysm may terminate with common 
convulsions. The length of the paroxysms I have known
vary from a few minutes to three hours & in some cases
they are frequently repeated
The disease arises from the same causes
in general & requires the same treatment
as epilepsy & convulsions. Cataleptic convulsions 
sometimes follow other convulsions & in some instances
have been brought on by drastic cathartics
In adults catalepsy is often followed by irritability 
& a degree of mental derangement.
“Catalepsy arises from the same causes and
requires the same treatment as epilepsy chiefly 
by cath. & antispasm. Sometimes children are
affected with catalepsy without it being observed
When I commenced practice I thought the notion of
still convulsions a mere whim”


Dancing before the [illegible] of St. Vitus
Dance [illegible] 3 or 4 well persons
Comes on gradually parents complain that
their children are getting into bad habits Awkward
motions
The dis. is not benefit. by [illegible]
I recollect a gentlem. 40 or 50 yrs told
me he had chorea when a child & recollects perfectly 
the indignation, horror & disgust when so long as to be 
unable to speak [illegible]
Hand carried not to the mouth
Sometimes the motions finally become regular
“The dancing master” feet blind [illegible] then 
hands then body then stop like a statue then begin 
one foot like a [falling] [illegible]


100
Chorea Sancti Viti
This is a disease not to be mistaken in its ordinary appearance
the voluntary muscles are but partially subject to the well
and their motion is convulsive. It occurs oftenest in 
females of relaxed habit & about the age of puberty
especially if they have grown rapidly or been much 
confined to the needle or to study.
In children this disease is often caused
by irritation in the primae viae Chorea also arises in 
some cases from a peculiar irritability of the system in 
which ordinary stimuli produce convulsive action
This irritability may be accompanied with 
relaxation, or with increased action together with a
determination to the head. Indeed it is said sometimes
to be connected with inflammation of the brain 
 & hydrocephalus. With those who are predisposed
to this disease, particularly if they are females
about the age of puberty affections of the mind may bring it or
epilepsy sometimes runs into chorea, or alternates with 
it. Finally, the disease may come on in a very gradual
manner, so as not to be suspected, causing a strangeness
in the gestures walk etc. which at first is attributed 
by the friends to the formation of bad habits.
This disease is rarely fatal and is not
difficult to cure in patients under the age of puberty after
that period it is seldom cured. When the disease is
of long continuance a great variety of remedies are generally 


“When I give cathartics in chorea it is not for the 
evacuation but to produce a new action. All cath.
will not act favorably. Hamilton’s views in prescribing 
cath. are not generally correct.”
There sometimes irritation of al. can. from accumulation
of feces about the coecum. Hence Hamilton’s
plan of purgatives Purgatives will cure but [general]
by impression on system
It is said to arise from a tonic infl. of 
brain I have read periodicals have not so
I have seen all kinds of treatment tonics, cath
narcot. electric. galvan. cold bath etc. etc.
Perhaps no disease prescribed for more [illegible] periodically
We find one and another article fails and are obliged 
to go the whole [illegible] off [illegible] narcotic etc.
# “In one case of chorea I tried the arnica until the
head became affected. The patient began with a decoction of zii
the flowers & increased to zfs without any abatement of the disease”
Prof T’s [illegible] [illegible]
Nux vomica has been used with success in many 
cases but there are other narcotics which act more powerfully 
& more certainly I have not used it deterred by [Ba??]
[Surrey] who found it injurious for some convulsive cases 
“Stramonium succeeded in a case following
epilepsy”



101
tried and the one last given is apt to be considered
as having effected the cure; but I am inclined to think that 
in many of these cases the disease instead of being cut
short by the treatment and run its course and then ceased 
of itself
The most common indications are [for] narcotics
and tonics with antispasmodics as palliatives & 
permanent counterirritation along the spine in some cases.
In children however cathartics are commonly indicated; though
in general the plan of treating chorea by cathartics, has not
succeeded very well in my practice. Dr Hamilton however
depended upon cathartics and had better success, though it may be remarked that those who act on that treatment are also the metallic [illegible]
When there are symptoms are symptoms of worms, of hydrocephalus, or of
inflammation, of the brain or when the disease follows epilepsy
we must treat as for those diseases; & if it the chorea
is the result exclusively of the peculiar irritability above
alluded to, narcotics must be our chief dependance. 
The principal articles which I have employed
in my practice are conium, conium & iron
sulphate of zinc, sulphate of iron & other metallic
tonics. Various narcotics are used, as the nux
vomica in doses of 1 or 2 grs of the seed in pill or 15 or
20 drops of the alcoholic tincture; and antispasmodics
as valerian musk etc. may be used as palliatives
Cullen’s favorite tonic was the ammoniuret of copper 1 to 4 gr.
I have lately used it with advantage in pill 2-3 hours in creasing
other tonics are mineral acids, nitrate of silver, bark
& the arnica montana #, which is a narcotic & tonic & 
was successfully used by Dr [Monsen] in chorea” Dr. T’s copy [M. ?]




“Sulph zinc 1 gr. may be given 3 or 4 times a day
nit. sil. 1/6 to ¼ gr. succeeds best in relaxation of the blood-vessels”
“Evacuate the first passages and restore the healthy
secretions & irritability of the system by tonics & antispasmodic
“I have rarely effected a cure by cathartics though I generally 
begin with them The cure with antisp. & tonic is slow 2-3 [illegible]
with narcotics more speedy but uncertain”
A good deal may depend upon the careful management
of the patient keeping him quiet & amusing him especially 
avoiding the irritation of the [pressure] and the impertinent
curiosity of strangers
The young man in a debilitated 
“So camphor has sometimes been given in mania to 
such an extend as to produce epilepsy & sub-apoplexy & this 
sometimes cures the mania”


103
double the quantity, when the head began to be affected still
there was no considerable relief The patient was finally cured
by taking the bark in substance zi a day.
One case which came on in the gradual
manner above described & was brought to a high degree
by a dysentery proceeded so far at least as to present
the peculiar symptoms of hydrophobia such as horror of
water etc. convulsives perfectly [like] that frothing of the mouth etc. died in coma exhausted
narcotics tonics etc. no effect excitability exhausted by [illegible]
This disease may affect the mind causing
it to run upon particular subjects especially upon that
of numbers & calculation. I once travelled a short
time with a book pedlar who had the odd gestures of 
chorea & had also this facility in calculation, being
in this respect fully equal to the famous [Serah] [Colbourn]
[Serah] [Colbourn] though furnished in Europe with 
the best advantages for education never improved
and this result I ventured to predict, when I first
heard that he was to be educated. I have seen several
such cases. # They have a peculiar articulation & expression
of countenance; and are deficient in memory and
judgment. Vide [illegible] 12 [illegible] for [Serah] [Colbourn]
Case girl at stool good talents studied
hard [stand] out of schools [illegible] Cal. narc. cath. tonics
operated but
[Elateri.] 1/16 gr. once 4 hr in about 24 
hours deadly sick nausea prostration vom. purg.
disease broken up. It may be diff. to class this
A year after similar causes brought on a second attack #


Connected with acidity gives great pain not
dangerous
“This is a troublesome and not unfrequent 
complaint, arising often from improper food 
and that stab of the stomach which causes acidity. In 
a torpid state of the stomach when the healthy action 
ceases or is feeble, chemical action commences, and
the acetous or putrefactive fermentation, prevails according
to the contents of the stomach”
“If our remedy fails try another for there are no two
exactly alike & the judicious physician will discriminate as
they are indicated”
Among the astringents should be mentioned the rose
willow It is one of the pleasantest astringents & is a popular 
remedy in canker It seems to combine a mucilage
Almost any of our wild willows may be used
Nitrate of silver may be used It is often however
difficult to touch the ulcers and we may then use astringent
washes.
Rhus glabra and R [typhina] are good astringents
vide hosp. [illegible] sub. [illegible]
The poison of R [vernex] I have more than once known
communicated in more than one instances by using the wood as
fuel. I recollect a man’s [illegible] to me on account of an eruption 
on his legs. I told him he was poisoned. He replied that
there could be no cause for it but a pair of the pantaloons
lately dyed black. Upon investigation I found that
the poison species of sumack had been used by the dyer
by mistake for the common one. Young persons are more 



102
Cold bathing is sometimes advantageous tepid is seldom proper
Electricity has been used. I have seen little benefit from it
Setons, issues, tartartar emetic ointment along the spine & 
other modes of counterirritation, are employed & may be advantageous
but where the irritability is great they do injury
If the disease is not translatable it is made worse by counterirritation
In the treatment of patients affected with 
this disease, we should bear in mind, that they are the
subjects of great mental sensitiveness & irritability
The presence of strangers in injurious & the remarks of bystanders
upon the patient may cause an amount of mental
irritation little suspected.
I have succeeded in curing chorea by 
elaterium though this is an article not mentioned by writers
as applicable to this disease. A young man debilitated
by confinement as a clerk in N. York was thrown into
convulsions and derangement of mind, by a sight of distress
while on board the packet for this place Elaterium was
given to prostrate the system & break up the habit. It was
successful & this led to its employment in chorea. I have
completely broken up the latter disease by an eighth of a grain
of elaterium & this is the only case which I have broken up
vide end of this article
Case a female delicate 14 yrs of age had not menstruated had been
treated with cathartics, epispasmodics and narcotics, which 
palliated the symptom. The patient then took arnica for
10 or 12 days beginning with moderate doses (zii to a pint
of boiling water being given in 24 hours) & increasing to 


I have found [illegible] which however was Dr [Rush’s]
favorite remedy in females about the cessation of the [illegible]
useful
Friction antispas. electricity etc. had merely palliated
The case then [illegible] to indicate tonics
[illegible] the other remedies had [illegible] effect or not recovery
rapidly upon bark
Sometimes connected with pneumonic affected
or with [organic] eff. of the heart In some of these cases 
[illegible] of copper 1 to 3 gr. rarely more than 2 gr. nauseating article [illegible] in such cases more
especially
As the [disease] advances sometimes [illegilble]
difficult [illegible] swallowing dark [tongue]
# [illegible] of them the book pedlar and [Minot]
[Sheri] [illegible] [illegible] Both these had this facility in [calculating]
# At this time there was not excitability enough left to enable
the elat. treat. El. shd not be cont. more than 


103:a
Ulceration of the mouth in children
This is sometimes a troublesome complaint and one that
does not readily yield to remedies. It is commonly called
canker. The complaint consists of one or more ulcers, which 
commence with an inflamed point or with a white slough
situated commonly near the frenum but sometimes extending
over the whole inside of the mouth. The edges of the ulcers are
inflamed & elevated & their surfaces excavated, as if they had
been eaten out with caustic. The child drools much
and nursing is evidently very painful to it. A febricula
attends the first stage. The bowels are slow and digestion
not vigorous indeed the complaint often arises from improper
food and is connected with that state of the stomach
which causes acidity
Treatment. First excite action of the bowels by magnesia, 
if there is acidity, blue pill, if there is torpor, or calomel grii & chalk grvi. After this give
tonics & astringents as Moseley’s tonic solution 3 to 12 2 to 10 gtts 4 to 6 brak compound
tinct. vitriol 4 to 5 gtts & the vegetable astringents as geranium in a [ter] spoonful of water
statici spriaea cornus etc. a little laudanum may be added
For topical applications we may use the
vegetable astringents just mentioned, catechu, kino etc. or
the following which has been recommended as very efficacious RX sulph. cupri grs x, cort. peruv. zii acad. gum zi
mellis et aquae aa zii make a soft paste to be applied to the ulcers with a 
pencil. A weak wash of corrosive sublimate may be used
Sometimes a mild caustic is serviceable, as nitrate of silver
A wash of opium or of opium & corr. sub. is sometimes the best
viola pedata makes a valuable wash. Asclepias tuberosa is
escharotic. [Post] [illegible] case


affected by this poison than old. When young I have often
been poisoned myself by boing near the plant
merely. Now I can brush past it with impunity provided
it does not touch my hands or face. Some
persons are not affected at all. The uncertainty of its
operation is the only reason why it is not used in 
medicine. Corrosive sublimate is a good application
for the affection of the skin. Yet the disease is
a specific one and must generate run through its
regular course. A similar disease is produced by 
the oil of the shell? of the cashew nut
Ulceration of the mouth continued “The disease
sometimes attended with severe pains, as severe as in tooth ach
in which case opium is serviceable. Case of an adult use
veg. astring. copper, zinc, opium, nit. silv. & at last corros.
sublimate. This last would not be safe in the case of children.
Intense pain was produced, which was remedied by holding
it in the mouth There was a profuse salivation but it soon 
ceased and the disease was entirely removed. The surface of the
ulcer was destroyed by the sub. & the dis. being local this effected a cure
# I have turned my attention particularly to the question whether
cal. produces it. I have known the dis. to allow dysentery
It was an old notion that cal. broke down the crasus of the
blood and it produced a tendency to gangrene. But 
in the venereal wards of hospitals you will see patients 
with sloughs all over the mouths and yet no gangrene 



104
Gangrene of the mouth
This is not a primary disease but a termination of other
diseases making its appearance soon after their abatement
I have known it follow dysentery and other affections of the
bowels, but not any disease in which the blood vessels
have exhibited an inflammatory action. It seems to follow
diseases of the nerves rather than of the vascular system
Children are generally subject of it.
This disease is sometimes accompanied 
with much pain & at others with none ordinarily with little or more. One of the first
symptoms is a constant inclination in the child to pick
some part of the mouth with the fingers where the gangrene
first commences either the teeth gums, less or cheek 
That part becomes spongy & has a fungous appearance in 
the course of a few days discharges a [illegible] matter, has
 a livid appearance & finally becomes black and dry 
the adjoining parts of the face become tumefied and indurated
and the disease continues until a considerable part
of the face becomes completely [sphacelated] when the 
patient dies It may continue sphacelatal in [illegible] etc.
the sphacelus being hard dry & black like a piece of leather
This disease has been attributed to the 
use of calomel, but it is entirely unlike that produced 
by this article, and occurs also in cases where no 
calomel has been given. # In those cases where calomel has been freely 
given the disease is not so apt to occur vide case 4th
I have known a similar affection occur
in the leg of a child, & an irritative fever preceded by rheumatism.
Commencing with a spongy and orange coloured spot
which afterwards become hard & black, the gangrene 


livid purpled as though the blood had settled
pulse small not much disturbance of the circ. syst. except that it was large
# & Prof. Smith & myself could not get down much medicine 
and were obliged to [illegible] [illegible] with external applications
We [illegible] injections and a great variety of external application 
blisters
“When the disease appears with tumefaction I think
leeches might be of service. This was called by Dr Smith congestive
inflammation. In other cases of gangrene, leeches would not be of service
It is not easy to [class] the operation of charcoal It
has been called a tonic, but it does not much resemble peruv.
bark and we do not gain much by classing it with it
It seems to act by generating an excitability
Charcoal shd be made of soft wood or of lamp black 
burned over again in crucible, as is sometimes done by the
apothecaries


105
extended up the leg and the child above the knees on both sides died [illegible] No applications 
seemed to have any effect. The child was irritable &
The disease under consideration is nearly allied to 
that called swelled tongue, but the latter oftener attacks
quadrupeds 
The treatment should be stimulant & antiseptic.
Acrids as capsicum may be used & the arum 
triphyllum accidentally has been known to cure.
In one case which I shall relate charcoal appears to have
effected the cure.
Case 1st The first patient that I saw affected
with gangrene of the mouth was an adult female who had the typhus 
fever. The gangrene commenced on the inside of the 
cheek & when I first visited the patient a portion of the
cheek as large as a dollar had sloughed off out? Great
part of the food taken into the mouth passed out at the
hole in the cheek. The patient continued in this state
for eight or ten days & then died The attending physicians
informed me that she has received the ordinary
treatment for typhus fever.
Case 2nd The next patient affected in a similar
manner was a girl seven years of age. Previous to the
gangrenous affection she had had a most excruciating
disease, which affected the knees legs and bowels I have
called it nervous rheumatism & shall notice it in another 
place. For this she had taken large doses of purgatives




106
calomel & opium, with diaphoretics & tonics. In three
or four days the pain ceased and the fever almost
entirely disappeared. The guns presented no symptoms
of salivation & there was no increase of saliva.
In five or six days after the fever subsided 
the patient complained of severe pain situated in the right temple
& extending down to the shoulder like that which had been in the extremities. This was removed by opium
to complain of the teeth
Soon after she began to work at the molar teeth of the upper
jaw, on the right side, at the same time she had a cough
which was accompanied with an expectoration of white
viscid mucus, and the breath became very offensive, resembling
the effluvia of an anatomical room where 
subjects have been kept a long time. The appetite
was tolerable, however the patient took animal food, with 
relish, and the bowels were easily moved with a little
rhubarb
the patient world at the teeth until she had removed two 
of the molar teeth with her fingers, she still continued
to pick at the gums. The cheek of the side affected
became hard, swollen & red. In forty eight hours a 
black spot appeared in the centre of the swelling. This 
spot the patient immediately began to rub with her fingers & 
soon made a hole through her cheek. The gangrene 
continued to extend, for a week & at the end of that period
had proceeded as far back as the angle of the jaw
affected the throat & perhaps the aesophagus The patient then died, having taken
food and medicine will until within forty eight hours
of her death.




107
Peruvian and oak bark, opium & camphor were
very freely given the affected side of the mouth between the 
teeth & the cheek was filled with superfine bark & poultices
of bark were applied to the face In the last stage affected
perhaps the lungs
Case 3rd Another case occurred in [illegible] subject a child etc.
A female child, about 5 years of age was attacked,
in the winter of 1813 with “constipation with fever”
the complaint being principally confined to the bowels The 
attending physician gave a dose of calomel and worked
it off with senna and manna. A considerable quantity 
of matter was discharged from the bowels, but from its appearance
further evacuations were deemed necessary, and several
doses of castor oil were given. On the fourth day I was
invited to see the patient. I found her with considerable fever 
of the typhoid grade, attended with pain in the bowels and
head. There was also some swelling of one cheek & the child
complained of one or two of the double teeth of the upper jaw
on that side. These she frequently attempted to pull out
with her fingers & finally succeeded in extracting one of them
The cheek afterwards became swollen, inflamed, and hard to the touch
& in a short time an orange coloured spot, appeared, upon
the outside near the centre, which soon became livid,
and the gangrene spreading rapidly, the child died, in 
eight days from my first visit. She became delirious previously 
to the cheek becoming livid & afterwards, was comatose.
In this case the disease seemed to affect the brain 
as it does in some cases
Bark, opium and camphor were truly given & antiseptic





108
poultice applied to the face as bark [illegible] [fermenting] [poultice]
Prof. Smith saw this patient
soon after my first visit & agreed with me in the opinion 
that the case would terminate fatally. He informed
me that he had seen but one case of the kind before & 
that he had attributed that case to an injudicious
use of calomel After seeing this patient however, he considered 
his former opinion as incorrect since in this case
there were no marks of the effects of calomel & there was no 
probability that the single dose of calomel, given in the
commencement of the illness, could have produced such 
an effect, especially when repeated doses of other
cathartics, had subsequently been given & 
had operated freely 
4th Case. The next case which I met with was that
of a female 12 or 13 years of age, who had the dysentery,
in the summer of 1815, accompanied with much typhoid
fever & rather a larger discharge of blood by stool than 
is common in dysentery.
The child had been sick for some days
before a physician was called. I did not succeed in 
my attempts to determine the diseased action from the
bowels to the surface by diaphoretics & the warm bath, & 
the disease ran its course and nearly exhausted the patient
When it began to decline, the stools to present a fecal appearance
& the appetite to return, the friends were 


There had been some aphthae and I was on a 
careful watch


109
much encouraged I, however, began to expect a fatal
result for I observed, between the anterior incisors of the
lower jaw, a fungous enlargement of the gum, the apex of merely a slight discoloration [illegible] & swollen between two teeth 
which had a purplish appearance somewhat as appears in salivation sometimes. I apprehended gangrene
in the case (perhaps from the countenance) and on the first
symptoms of it informed the parents, who however, could see 
nothing alarming in the small swelling between two of
the front teeth. I began early with oak & peruvian 
bark, and at the same time gave freely of brandy and
porter. As this course had no effect I applied 
bark and diluted sulphuric acid to the part affected
& also covered with the lunar caustic. Still the treatment
had no good effect the gangrene extended under lip and chin became
black and the child died
Case 5th A child about 3 yrs of age cousin of the previous one [illegible] had a dysentery,
in the summer of 1815 [illegible] as there was another
member of the family sick in oil uncommon & interesting
manner viz the case of chorea resembling hydrophobia was much neglected Her fever was typhoid
& the stools sometimes bloody and sometimes of a 
green mucus. After a course of 15 days and amendment
in the symptoms took place the stools
became less bloody, the green stools more rare & though
the patient was extremely weak but no reduced low as the previous one, the appetite returne
After convalescing gradually for six or eight days, there
came on a samous discharge from the nose, small in quantity
but very fetid which reminded me of gangrene


# In this case I examined the gums to see if there
was any appearance of salivation and found the gums etc.
Two teeth and a piece of the alveolar process came out
The disease did not spread so rapidly as the other ones
In addition to bark, tonic solution etc.
I gave charcoal


110
of the mouth which I had not been on the look out for AT this period the patient inclined to 
keep her fingers I her mouth. # The gums were very clear
and bright & adhered firmly to the teeth, except on the 
left side of the upper jaw, where the gums of the biscupides
appeared discolored and discharged a samous
matter. I declared the parents that in my opinion 
the case would terminate fatally. The child complained
of pain in the face and teeth. The cheek opposite the teeth 
became swelled and hard and of an orange colour. I declared to the friends
that mortification had taken place 7 pointed to a black
spot on that cheek which happened however to be accidental. I was mistaken for the next day
it was found that the black spot was produced by a piece
of burnt apple skin, which was washed off This encouraged
the friends; yet within 24 hours sphacelus took place 
the apple skin was
in the very spot where I had supposed that I had seen
it. This gangrene ceased to spread after 
the spot became as large as the end of the little finger
 A circular piece sloughed out and left a hole in through
the cheek of about a quarter of an inch diameter
The disease abated, the affected teeth and a piece of the alveolar
process came away the lips of the wound produced by the sphacelus
healed up & the child recovered
I recommended the same treatment in this case as in 
the preceding, but having no confidence in it, & abandoned
it and gave charcoal to the amount of perhaps a pound
or a pound & a half a day I h ad pudding made of 
half charcoal & half flour, sweetened with molasses & sugar
& fed to the child for the appetite was good. Tonic solution 



When the disease commences of itself
# At the time when the disease called the scalled
tongue was very prevalent affecting cattle principally with 
swelling of the tongue & salivation but to some extent human 
beings with swelling of tongue cheeks etc. It was found that
acrids as [arum] were the best remedies
pulse 120 tongue then [brown] fur, considerable pain



111
and compd tinct. vitr. were also given & I commenced
the treatment with white oak & peruvian barks & yeast
poultice. I attribute the cure, however, to charcoal.
Case 6th This was an idiopathic affection. Martha Denison
a delicate constitution about 12 yrs of age was attacked in 1819 with symptoms of gangrene
of the mouth. There was severe pain in the teeth and jaws
oppression at the stomach and symptoms of fever. I discovered
the purplish spot in the cheek & “the gums soon put
on a spongy appearance” In this case I commenced
the treatment with an emetic, which operated favorably 
I gave it to [illegible] the excitability of the system
& gave relief. I then gave stimulants, bark, brandy & 
opium & kept in the mouth between the gums and cheek a paste made of powdered
bark wet with brandy and laudanum. The patient
recovered, but the two front teeth of the lower jaw became
very loose and there was occasional pain & 
suppuration for nearly a year. It was about a year before
the teeth became firm. [Superfine] bark was occasionally 
used.
Case 7th In 1820 I visited a black child in the last
stages of this complaint. At the time when I saw it, it
could not swallow. It lived however in this situation for several days
I have seen several children in the latter stages 
Even if there is no chance for a cure it si desirable to be able
to give a correct prognosis Trouble has sometimes arisen
from the opinion that such cases were produced by calomel
A student of this school in [Litch.] cty from notes of 
my lectures



It is known by an [illegible] swelling in the throat
some fever etc. etc. 
In some seasons it prevails extensively & 
affects persons of all ages. In some seasons these diseases
which are called contagious affects one description 
of persons in another another owing to mode
of life etc. “It rarely affects a person the second time. It is said
that if it affects the parotid of one side only it may occur again”
I have treated cases of this disease with 
great anxiety. I have never known cases of greater 
irritation than from this disease
“It is milder in children than in adults & is
seldom translated to the mammae or testicles till after puberty”
“Sometimes the swelling of the testicle is simultaneous
with that of the parotid gland or [previous] I have seen
several such cases”
“The first symptom observed is sometimes
a soreness of the testicles. They at length become 4 or 6 times
their natural size a suspensory bandage will be 
necessary”
“In some cases there arises suddenly, [illegible]
pain in the head pulse full and tense eyes red & all 
symptoms of phrenitis”


112
Cynanche parotidea Mumps
This disease is an inflammation of the parotid glands & is generally 
moderate in its symptoms Sometimes however it is translated
to other parts & is then a severe disease endangering life. It is milder
in youth than in adults & in general it is only after the age of puberty 
that it is translated. The parts to which it is translated 
occasionally, are the testicles & the prostate gland in males
the mammae of females more rarely & sometimes the brain or stomach
I have never myself seen a case in which the inflammation was
transferred to the mammae but do not doubt the fact
Sometimes it appears first in the testicle or at least simultaneously in that
& the gland This disease has been considered contagious
In my opinion it is not, but on the contrary is liable to be
epidemic. When its prevailed in college, the students who 
left in order to avoid the contagion were attacked as early 
and is certainly as those who remained. I have noticed 
that it made its appearance pretty regularly once 
in seven or fourteen years
The fever which accompanies the severer
forms is either of the inflammatory or the typhus grade or may be merely irritative & 
should be treated accordingly When the testicles are affected
they are painful swollen sometimes to an excessive degree & 
sometimes so highly inflamed as to indicate venesection 
When the stomach is affected “it puts on crythomatic inflammation”
and there is hiccough, subsultus tendinum, irritability
of stomach and frequent vomiting. # When the brain is affected
there is pain of the head & eyes, with hard and tense pulse
When the parotid glands only are affected the
# These symptoms may come on after the affect of test. [illegible] continued, some
[illegible] begin to subside.


Dr Rush observes that applying a blister
directly on the infl. prevents the system from being
affected. I do think blisters keep the aff.
in one part “In some seasons an emetic at the commencement
or a blister will prevent a translation”
Having [learned] the importance of attempting 
the breaking up of diseases I cast about
one year for means to interrupt it & found emetics
quite efficacious
Stramonium
After the testicles have been affected some time 
and the affection begins to subside the symptoms sometimes change 
There is subsultus tendinum the stomach become affected 
vomiting is frequent with hiccough etc. In this case apply 
mustard to the stomach & feet etc.


113
a generally mild and more inconvenient than painful
A translation makes it worse; more so when the translation is
to the stomach than to the testicles & most of all when to the
brain. Sometimes the complaint is very severe, the fever lasts
three or four weeks and the patients are many years in recovering
from the disease
Treatment. The disease is often broken up by an emetic
in the commencement It is best to stop it in the first stages
if possible. Mild applications to the inflamed parotids
we generally sufficient, such as ammonia or volatile
liniment. Dr Rush however recommends blisters to the parts
affected, in order to prevent a translation.
When the disease effects the testicles & give emetics
and apply discutients to the local affection. I also 
apply blisters to the inside of the thighs. They relieve the 
testicles when they are swollen & prevent translation to the 
stomach For a discutient was we may take the following
Rx mur. amm. ziii; camph zi; brandy or vinegar 1 gill;
water 3 gills. When the inflammatory action is high, bleeding
may be practised. It will be well also to use a suspensory 
bandage.
If the stomach is affected in the manner above
described
we have a difficult case to manage. Epispastics must be
applied to the scrotum, counterirritants to the epigastrium
to ally vomiting, with effervescing mixtures internally for the 


Ether is best given in effervescing mixture (carb amm. & 
lemon juice) Carbon ac. makes stimulants more diffusible
& hence causes them to be [used] gratefully and often to be well borne when 
otherwise the would not be
Case 18 grs plethoric parot. gland & testicles swollen
head affected Relieved by bleeding decidedly entonic
the only entonic case which occurred In the 
progress of his case stom. became very irritable abdomen
sore & tender excessive irritability Did not 
recover his health completely for years was left dyspeptic
& with nervous irritability.
To correct irritability of stom. lem. juice
[illegible] is most grateful add [doses] of aromatics
lime water also external blistering etc.
Tonics or metallic tonics myrrh 
asafoetida (nervine also) hops lettuce
These cases are so obstinate and will 
give you an opportunity to try a great variety of
remedies cajeput oil on sugar ol. valerian
Though the cases may be apparently alike
yet you may find one article best for one & another for [another]
A very distressing hiccup, accompanied
with spasms might have been mentioned in connection 
with the vomiting give ether lavender cajeput
oil also & valerian which are called terebinthinates 


114
same purpose diffusible stimuli as ether given
to rouse the system opium ipecac, as tonic stimulant, diaphoretic
& nervine 7 finally to allay irritation of the system 
in general antispasmodics as castor & counterirritants to the
extremities effervescing mixtures absorbents, also, as chalk & magnesia, cathartics
cantheride & occasionally emetics may be indicated.
When the brain becomes affected, the lancet
should be freely used, cupping, leeches & blisters, applied
to the head of the neutral salt given as cathartics
Antimonials nit. [illegible] cal. & neutral salts # 
Some cases will require a vigorous antiphlogistic 
course of treatment, others with typhoid fever
will require in the [illegible] a stimulating & supporting one, while others
again will have symptoms of irritation chiefly & require 
a corresponding treatment
In the progress of the disease uniform
perspiration will be valuable
Angostura serpentaria, qualified
with cardamom or cubebs The old writers
recommend also [contrayerva] I have much used it
atonics of a peculiar character resembles much 
agrimonia eupatoria which I have used for it
in the country where it is easily obtained the latter is non 
astringent
# “Cold to the head and warmth to the feet avoid mental
irritation recovery is usually speedy adults most
liable to this translation”



I consider [quinsy] an affection of the mucus membranes
and [tonsils] nearly allied to catarrhal aff. There
is a catarrh aff. nearly allied in which there is a
thickening of the membrane. This diathesis may also 
run into croup
Good classes angina maligna with 
quinsy Here is the evil of nosology For scarlet
fever gradually runs into quinsy. We must have
science and nosology but still we ought to 
know the errors which nosology is apt to lend [illegible] & 
the imperfection of science
I have the advantage of not [illegible]
having seen the disease but of having had it myself
often
[illegible] with an unpleasant sensation
a relaxation a disposition to hawk and throw off
[illegible] In this stage it may certainly be cured
After the symptoms comes on swelling, or moderately 
succeeding to this a chill then swelling with 
pain perhaps extending to the [illegible] The tonsils enlarge
The fever is considered enteric or a common but
unless among the labouring men in the country it is 
more usually subacute
One tonsil is perhaps more enlarged
than the other perhaps one goes on to suppurate & 
the other becomes of the natural size and appearance 
The uvula and fauces swell and respiration and deglutition 
are prevented. Sometimes ulcers from at first
upon the tonsils. Examine each case and do not be
too positive in calling it quinsy for this & scarlet
fever do blend
These symptoms continue 2 to 36 or 48 hours
I do not know that I have ever seen a fatal case of 


115
Cynanche Tonsillaris Quinsy
This diseases has been called
“I include also under the term quinsy all effections of the upper
part of the aesophagus and pharynx which resemble quinsy in 
their grade of action”
Quinsy is an inflammation seated in the larynx glottis & fauces
The characteristic symptoms is swelling of the tonsils
Sometimes it is seated lower down in the pharynx than the tonsils, but this 
does not alter the nature of the disease
In some cases it is complicated with catarrh. Those who have once had this disease are very liable to a return of it
“The disease common at the age of puberty that before or after”
Quinsy may be divided into two stages
1st Predisposing debility indicated by relaxation of the uvula
and tonsil, irritation about the fauces, weak deglutition,
general languor, with cold chills and uncommon sensibility
to cold. This usually continues from 3 or 4 to 12 hours
the progress of the disease being sometime rapid and sometimes
slow
2nd As the disease advances we find, soreness, pain, redness
and swelling of one or both of the tonsils & an inflammation 
of the mucous membrane of the pharynx; deglutition
in exceedingly difficult; there is a severe cough & especially 
a spasmodic one upon taking food or drink, there is
much heat about the throat and about the head & sometimes
pain in the head, with a pulse so full and tense as to 
indicate bleeding. Sometimes there is an excruciating
pain in the ear. “rarely cough unless complicated with catarrh”
This stage may continue three or four
3 to 7 days days. It terminates either in resolution, or suppuration.


of quinsy though I have seen many that I thought 
would prove fatal. I have known a patient
continue unable to swallow for 3 days and yet recover
When however it is in the form of swelled tongue it may 
prove fatal. “An entonic fever may attend, with fullness
of pulse much headache excruciating pain extending to the 
ear; but for more commonly at least in my practice, the pulse
is little affected, and the disease is almost not entirely local”
# riding on horseback and having the snow melt on 
his throat & [conduct] off the [caloric] rapidly
# and shd carry a piece of alum in the pocket
“It is important to distinguish this disease from 
roseola (scarlet fever) There is an erythema of the fauces
distinct from both which yet may terminate in either
[illegible] The diagnosis is generally easy but there are cases
where it is extremely difficult & indeed there is no definite
line believed the two especially in the first stages
We must bear in mind that quinsy is commonly 
more inflammatory that it is not apt to ulcerate
& we must be guided somewhat by the prescribing epidemic


116
The suppuration is generally in the tonsils, but in some cases
where the disease is seated lower down, a part of the aesophagus
suppurates. “The tonsils often remain permanently enlarged”
Causes. Quinsy occurs must often in the latter part of autumn
& in winter. It is caused like catarrh by alternations of heat
and cold by exposure to cold & especially by exposure
to cold storms of rain or snow. # Sometimes it is connected
with dyspepsia & it may be brought on by irritating 
substances, as acids, acting upon the mucous membrane
of the stomach. I recollect a case of a young man who 
was attacked with a severe quinsy in consequence of drinking
freely of cider made cold with ice
Persons who are subject to quinsy should be very cautious 
about exposing themselves to the alternative of heat and cold # 
Diagnosis. This disease has sometimes been mistaken for 
scarlet fever. It is not difficult however to discriminate
between them by attending to their prominent symptoms the
quinsy being as inflammation of the mucous membrane etc.
The first stages however of scarlet fever, resemble those of
quinsy, and the difficulty of discriminating between them 
is at that period much greater. In deciding upon any 
particular case we must be governed by somewhat by the nature
of the prevailing epidemics


Chewing camphor will also but not so well break up quinsy
in the forming stage but chewing this article
is apt to produce pleasant symptoms in the stomach 
and head Other stimulating applications 
would probably answer as [guaiacum] & any 
alcoholic tincture “The prophylactic plan of carrying
alum in the pocket etc. has succeeded in hundreds of cases. Indeed
when called in the latter stages I often tall them I can do 
little except to prevent it in future”
When the dis is fully formed and when 
there is much pain in 
the neck running up into the [illegible] fomentations
and the vapour of warm water, the steam bath 
by throwing over the patients head a blanket and
having a teapot of warm water
A blister also in the above circumstances
will relieve the pain and give great relief 
An emetic also will be often very 
beneficial in the commencement of the second stage
There is often an excessive quantity of acid in the stomach 
Case A young man in very hot weather [illegible]
a large quantity of cider made very cold with ice was taken at night
with great pain and difficulty of swallowing
The patient was very anxious to be cured that night
A large quantity of tartar emetic was given in excessive
doses until a severe orgasm was produced then seeing
to [illegible] stricture of the upper orifice of the stomach the 
[illegible] & secreted from every pore from the violence of
the action of the system finally he [illegible] away, and
continue in syncope for 10 or 15 mins came out of his 
fainting fit, the tart. ant. acted as a cath. and the patient
was entirely relieved of the difficulty of swallowing [illegible]
was merely feeble and exhausted from the prostration of the [tart]




117
Treatment In the first or forming stage. Quinsy may 
be easily broken up by keeping a small piece of alum say 
of the size of half a pea in the mouth, and swallowing the 
saliva until the symptoms have left. Various other astringents
may be useful in the first stage. I have given the astringent
barks and bitter roots, catechu etc. & have also combined
with them the mineral acids chlorine etc. “But all these things will be injurious in the 2nd stage”
When the disease if farther advanced a more
energetic treatment is necessary. If the tonsils are largely swelled astringents will merely aggravate. IN this stage it may often
be broken up by a strong impression made by nausea
and vomiting. A strong emetic 3 grs tartar emetic with 8 grs of ipecac # may be given & when the 
disease arises from a chronic affection of the mucous membrane
& acidity of the stomach, an emetic will remove it. In one
case I gave half a grain of tartar emetic once in 15 min. 
until the system was affected, I succeeded in conquering
the disease. The patient was in extreme pain & exhausted 
he fainted previous to fainting he was unable
to swallow after coming to, he could swallow & the
disease was removed. “But if the case has advanced a 
little farther, emetic will do no good”s
Gargles will in general do harm 
rather than good, where there is much inflammation.
If the irritability is extreme mucilages may be given, and 
when there is great difficulty in swallowing a cloth wet with 
spirit and water ay be applied over the mouth and 
nostrils. Cold water applied externally & internally has
been recommended but is dangerous. It may be used however
as a preventive.
# Eupatorium etc.


I have known some phys. generally successful [illegible] breaking
up quinsy with cold water but as I predicted
there was danger of the translation to the brain he lost
one patient in this way “It may be used as a preventive”
When the trails are much enlarged it is
customary to bleed I would bleed it there was
much fullness and strength of the pulse I have often bled
and seen it done without the beast benefit still however 
without any injury as I could perceive “V. S. is important
when there is danger of affection of the brain”
Scarifying is generally practised. It is
sometimes beneficial but often it increases the disease
as is the case when a boil is scarifyed I do no t
know that I can point out the circumstances
which it is beneficial but if there is much irritation 
I think I would not scarify I have often
had my own throat scarifyed without benefit
Perhaps it is as often as once in 20 cases
that the disease proceeds to suppuration. But if 
you puncture the swelling be careful 
to see where you introduce your lancet Case of [young]
an opening was made which subsequently caused a troublesome sore the
swelling burst of itself
In various cases astringents was useful 
Lister’s [scoriae] (devils bit button snake root) it acts 
a little like seneka stimulating the fauces it operates considerably 
in a decoction It has been much used not of
much consequence
I have not much confidence in gargles
The patient cannot gargle
But you will give great relief
by washing out the mouth with warm water or with 
mucilages or with a little old spirits and water which 
is very grateful to the patient Wash off the [illegible]
which [illegible] Great advantage is derived from 
injecting with considerable force with a syringe & washing on 
the parts Spirits & water will be grateful & reviving


118
When there is redness and swelling but not extreme
irritability, scarification is beneficial. If there is irritating
soreness or inflammation scarifying will aggravate it
After the inflammatory stage is past, blisters
may be used I have not been successful in scarifying
Bleeding may be necessary, if so it will 
be indicated by pain in the head and a full & tense
pulse.
When suppuration is about to take place
poultice may be applied externally & vapor inhaled The 
latter remedy may be administered, very well in 
the following manner. Put a vessel of hot water in the
bed, by the side of the patient & cover him with a sheet. # 
Touching the tonsils with nitrate of silver, is 
highly useful
If the ear is affected, wet a piece of cotton 
with strong ammonia and apply it to the dear. it produces
a pungent sensation and often gives relief
The [liatris] scariosa is used in quinsy
in the form of a decoction of the root. It is expectorant, diaphoretic
& diuretic. It is called “devils bit”
“After the inflammatory stage is established
apply blisters”
“If the irritability is extreme apply mucilages”
“[illegible] & diaphoretics have been used 
in the early stages and are undoubtedly serviceable”
# If you cannot well distinguish where suppuration has
taken place, you had better not attempt to open the tonsils 


When the swelling is great poultices are very beneficial
Dove’s [Dury] poultice Devils dung asafoetica
Album graicum blown through a quill!! much used
by my predecessors in this place
Cathartics are proper early in the disease
neutral salts if the fever if phlogistic
Diet & regimen
Give while the patient can drink, nitrous
ether & water or a acidulated drink etc. Feed
with arrow root etc. for the diet
When the inability to swallow has 
continued sometimes the action is not enteric & the
patient shd not be bled nor exhausted by cath.
The disease is at this time principally local & 
from want of food etc. the pulse becomes feeble spirit
and water injected into the throat will bring grateful and 
reviving [illegible] exhausted patient “Apply poultices keep the bowels
open with enemata” “Inhale vapour of ether”
Various gargles are recommended
such as chlorine muriatic acid & water etc.
but when there is much action they are apt to irritate
Camphorated gargle vapour of camphor
etc. There are a variety of these things which are
mere palliatives
The difficulty of swallowing is not caused 
so much by the swelling as by the soreness and pain 
for I have seen patients declare themselves much relieved
and able to swallow when upon looking into the throat
I could perceive no change in its appearance



119
“Scarification is recommended but I could never succeed
with it. If the disease were pure inf. scarif. would be of service 
but it is an irritation infl. & scarific. increases the pain & 
infl.” In [illegible] case a free scarific. made the case worse in 
every respect” There is a stage when scarifying is beneficial
when there is redness & swelling but not extreme irritability”
“Leeches have been applied in the inflammatory
stage externally and to the tonsils. It is difficult to make
them take hold on the mucous membrane, but they would
be more effectual there”
“Suppuration does not take place in one 
tenth part of the cases. There is free secretion but no solution 
of continuity upon extermination” “When suppuration
is likely to take place use poultices and inhalations of vapour 
poultices of bread and milk with stramonium are serviceable
Gargle or syringe the mouth with spirits & water or
camphor”
“When the disease is seated farther down 
in the larynx it is essentially the same”
“White dry pigeon’s dung in a poultice with 
bread and milk was used by Dr [Monson] He thought the
phosphate of lime of service” I prescribed it in one
case and they mistook for it devils dung (asafoetida) 
& it did wonders. I did not tell them of their mistake”



[illegible] state of fever is a better
classification than Good’s. Good separates the disease
under different classes making one part are [illegible]
disease another an aff. of the blood vessels
“Scarlatina & angina are sometimes considered 
as separate diseases, but they seem to be only different forms
of the same disease”


120
Scarlet Fever
This disease has been called by various names, among
medical writers, though the popular English appellation
has been scarlet fever with little or no change. Canker
rash however has been its common popular appellation in 
New England, until of late. Under the name scarlet fever 
I include both scarlatina mitis & S. maligna & likewise the
paristhmitis maligna or ulcerated sore throat called also malignant
sore throat & malignant quins. Other names that
have been given are Scarlatina mitis & maligna 
cynanche maligna paristhmitis maligna 
scarlatina anginosa 
Enanthesis rosalia is defined by Good
Rush a scarlet flush appearing about the second day 
on the face neck or fauces; spreading progressively over
the body; and terminating about the seventh day; fever
a typhus. This author divides rosalia into two varieties
simples or mild scarlet fever which he considers as
being slightly contagious & paristhmitica with an ulcerated
throat & a rash not so regular
as that of the other variety. This he calls highly contagious
Under the name scarlet fever I included
both the common mild scarlet fever with a rash & nothing more and the most malignant forms
of ulcerated sore throat with the intermediate varieties
considering them all as being but different degrees of the same
disease
This disease with its varieties a naturally associated 
with pneumonia quinsy influenza etc.



Quinsy is an exception persons who have had
it are more liable to another attack
So too in tropical climates even have what
is called a seasoning
As a matter of fact this disease is theoretically 
considered contagious practically not so no precautions being
taken the patient not being separated nor the friends and
neighbors refraining from coming “The notion of contagion
may sometimes be useful in keeping away idle visitors
case in Guilford”


121
Scarlet fever often appears as a sporadic and
sometimes as an epidemic disease. In general it affects children
and women more than men. Dr. Rush’s opinion Some say that the disease never 
persons over 40 years of age. When epidemic however it attacks 
persons of all ages, though even then the majority of cases
are among children and persons of delicate constitution.
In general persons who have once had the 
scarlet fever are not attacked with it again, still this
rule is liable to many exceptions for I have known repeated 
instances of a second appearance of the disease in the
same person. This partial security from a second attack
is met with in various epidemics & we may say in general 
that a person who has had any one of several different
diseases the same general diathesis is less liable to have another
Scarlet fever is said to be contagious especially 
in its severer forms The fact is disputed but this is 
the general opinion. Some fevers are perhaps contagion & among
them some forms of this may be so. It certainly, however
appears to follow the laws of epidemics and I am inclined
to think that the facts which have led to the opinion 
that it is contagion are better explained by reference
to those laws. It is said sometimes to go through the country 
like the influenza.
Like other epidemics, those of scarlet
fever exhibit appearances
in different seasons, being sometimes milk and
harmless & at others highly malignant & dangerous
It has occasionally been as 



# And because blisters applied produced
mortification
It swept off whole families
The fever considered a typhus It is not always
so It is sometimes [sub-entonic] always however
of a typhous grade



122
as the plague. About a century ago this disease prevailed
in this state in its most malignant form, sweeping off whole
families. It was called the black canker because the sloughs
in the throat turned black & this name, though the influence
of tradition, inspires terror in this town even to the present day
Since that period the disease has probably been growing 
milder up to the present time. In 1794 however it
was very severe in this town in Litchfield county & over the state more malignant than it has
been since. Subsequently to that period adult males have
been less affected. The last severe epidemic in this town was in 1803.
Though sometimes attended with inflammatory 
symptom. Scarlet fever as a general rule, is of the typhoid
or typhus grade & when malignant puts on the form of typhus 
gravior or gangrenous state of fever
Symptoms. This disorder, when not malignant, nor
irregular, commences with ordinary febrile symptoms general
disturbance of the functions of the system, chills alternated
with flashes of heat & pulse in most cases frequent and soft
In severe attacks there is much nausea, sometimes
vomiting, pain in the head back and limbs & great prostration 
The tongue
of strength. In 1803 the disease frequently commenced
with pain in the teeth or in the ear is the first symptoms
In the progress of the disease there is more
or less tendency in proportion to the violence of the
disorder. In severe cases there is often great heat and dryness
of the skin & perhaps the color mordax. In such cases also 
we frequently with an acrid discharge from the eyes & 


“When delirium is present it arises rather from inanition 
than repletion IT is accompanied with subsultus”
Swelling of the tonsils is rather a favorable
symptom Swelling and suppuration of the
glands in the neck
haemorrhage for the [illegible] & petechiae
may occur


123
nose which excoriates the skin wherever it touches.
Irritability of the stomach & vomiting are common & sometimes there
is a troublesome diarrhoea. Petechiae may make their appearance.
Case at [Hotchk??] town Haemorrhages sometimes take place; & in case of 
heat on the surface and what Armstrong calls congestive state
of the system, a slight haemorrhage from the nose will be
beneficial. Finally in the ordinary malignant forms of the disease 
the breath is very fetid.
The epidemic of 1803 was characterised by 
great irritability of the stomach vomiting & diarrhoea pulse
very low and feeble. In this epidemic after obviating the
inverted action (of the stomach) stimulants were indicated.
The throat is more or less affected from a 
slight redness to a deep slough. Sometimes there is a high degree 
of inflammation of the uvula & tonsils at others a relaxation 
indicating astringents both conditions accompanied
with a high degree of tumefaction.
A common appearance, in the commencement of the severe form
of the disease is that of a white coat upon a part of the tonsils
In the progress of scarlet fever, the affection of the throat 
may be more or less troublesome. It often terminates in ulceration
& sometimes in gangrene
In three or four days from the first appearance
of febrile symptoms or rather on the second day of 
the fever the eruption appears in the form of a fine rash
as described in the definition. In about as many days from 
its appearance about the seventh day of the disease it disappears 


Peculiar dulness of the eyes hollow sound
of the voice patient appearing much like a night walker
The first case of the kind which I saw I had no doubt 
about The friends had doubted whether he was sick enough
to send for a phys. I declared at once that he probably 
would die. This was a case of pneumonia notha
Most resembles measles Ordinarily distinguished 
readily sometimes with difficulty
If scarlet fever is accompanied with 
a running of the discharges from nose with catarrhal symptoms, and is somewhat 
distinct in its eruption (hard under the touch under
the skin) and such cases occur it cannot be distinguished 
from measles except by the general character of the epidemic
I used to notice in the first commencement of my practice
that on the first breaking out of the epidemic the older phys. used to 
wait and observe several cases before they decided upon the name 


124
with branny scales & in ordinary cases the patient is then
out of danger. The eruptions, however may vary much & even
be altogether wanting the local morbid action being determined 
wholly to the throat. Ataxic cases will have no eruption.
The worst cases of scarlet fever are those
which transcend ordinary febrile action. In these the patient 
is scarcely sensible of being ill, appears dull and languid, his
countenance indicates torpor of mind, he has little irritability of 
mind and is indifferent to surrounding object, his extremities
are cold & his pulse small frequent and feeble & 
perhaps intermitting. Upon examining the throat ash coloured
sloughs are found upon the tonsils and uvula. In these
cases life is extinguished without any reaction 
of the system in the course of 24 or 48 hours, unless the tendency 
to death is obviated by the most powerful treatment.
These ataxic cases resemble the ataxic cases of yellow fever
pneumonia typhodes etc. which have sometimes been called 
walking cases
The scarlet fever is liable to be confounded with 
measles, the disease which it most resembles. The marks of 
discrimination are these. In measles the eruption is less diffused
is in pimples or circular dots more pointed & partly distinct & partly in clusters & the pimples produce a palpable
roughness of the skin. In scarlet fever the eruption is diffused
like erysipelas & consists of innumerable points or specks under 
the cuticle, intermixed with minute pupulae In some
cases the eruption is in irregular patches & in others are uniform flush 


“Symptoms of pneumonia rarely attend scarlatina”
This is one of a series of epidemics. It is usually followed
or succeeded by measles & is followed by hooping cough
For only it probably existed only as an epidemic now
we meet with sporadic cases continually 


125
while no roughness is felt, except in a slight degree upon 
the arm. The two diseases differ also in the time at which 
the eruption appears. In scarlet fever it shows itself
upon the face and arms on the second day, but in measles
it is not seen upon the arms till the fourth day.
The scarlet fever is distinguished also by the absence of the
catarrh, cough & determination to the lungs, suffusion
of the eyes & the red and swollen state of the eyelids, which generally 
attend upon the measles. The latter disease also
is generally accompanied by an inflammatory fever instead
of the typhus which characterises the former.
Still these two diseases of ten blend together
so as to make the discrimination very difficult. It is barely 
 possible that they are the same disease, though it may 
be objected to this view, that scarlet fever likewise is occasionally 
seen to blend with influenza # 
Epidemics of influenza are followed by [measles & scarlet]
The prognosis in this disease will be obvious
upon attending to the malignancy or the severity of the 
symptoms. In its severer forms it is always a dangerous
disease & in its highest malignancy one of the most fatal
while in its milder forms there is but little danger.
# It is sometimes difficult to determine whether a particular 
case should be considered as one of scarlet fever, or of quinsy
A case of scarlet fever in which there is no eruption & the
tonsils are inflamed &swollen can be distinguished from one
of quinsy only by attending to the state of the pulse, the prevailing epidemic etc.


I have known it appear as an epidemic
when it required nothing more than nursing
One idea which I wish to impress particularly 
upon your mind, is that you must investigate the particular
epidemic which you have to treat for no previous one
will probably have been similar


126
The treatment of this disease must vary according
to the diathesis. Epidemics of scarlet fever will differ
widely in different seasons & different places & require very different treatment
In a country where intermittent prevail the treatment will 
be different
This has been some dispute about using the
lancet in this disease. This will depend the degree of inflammatory 
diathesis. As a general rule emetics are indicated, 
but not always. Cathartics are generally improper 
but sometimes are required. In short indiscriminate treatment
is as improper in this diseases as in any other.
In this milder forms of scarlet fever, we
may employ the usual treatment for typhoid fever, & administer 
those remedies which translate & keep up action 
and equalise excitement, as diaphoretics, the warm
bath etc. For the mildest form it will be sufficient to 
give mild diaphoretics such as wine whey & elder flower
tea, with perhaps a little antimony, acidulated drinks
& gentle laxatives
As the fever is generally of a typhoid or
typhus grade, emetics are of especial importance in its 
treatment. They affect particularly the mucous membranes
and may be repeated in the course of the disease, for the
purpose of throwing off the accumulated mucus. The violence
of the disease may often be completely broken by an emetic 


“In some epidemics when there is considerable action cath. of cal. are
important especially in intermittent districts Rx cal. & 
jal. as for remittent bilious fever”
“When there is tremor paleness, cold sweats, vomiting
diarrhoea, cathartics might destroy the patient We must
rouse the patient by counterirritants etc. and then we may go on 
with the treatment by emetics of ipecac etc.
“Dr Rush bled but f.s. is very rarely indicated 
and in such cases as approach to A.  tonsillaris” “Still it
[illegible] all forms entonic atonic etc.
“If malignant give bark & the min. 
acids. If the system does not respond give cantharides 
& capsicum oil of cinnamon cloves or cajeput”



127
at the commencement. All writers agree in recommending
them. [Witherin] advises ipecac grs vi & tart. ant. gri for
an adult followed by a strong decoction of senna
Dr Rush recommends the turpenth mineral 2 to 6 grs with the view
of strangling the disease in its birth. Sulphate of zinc is a
good emetic & is preferable in the latter stage. It is local
in its action & tonic in its effect. It operates speedily and
produces less exhaustion. Vomiting by snake root has
been practised
In the irregular forms of scarlet fever, this
practice is more questionable & if emetics are given they must
be preceded by stimulants to rouse the powers of the system
Cathartics are sometimes needed & calomel
is to be preferred The judgment of the physician however 
must be exercised & the character of the epidemic studied, 
for great caution must be exercised that the system be not weakened 
by them & in extreme debility they should be preceded
by stimulants. In some epidemics they will destroy the pat.”
In some epidemics bleeding may be 
proper, but the apparent indications for it will generally 
be better answered by leeches about the throats and [temples]
In malignant cases where the powers of life
are very feeble no evacuations are to be used. External 
irritants are to be applied to rouse the system such as ginger
mustard brandy a paste of mustard spts. turpentine & 
aqua ammoniae etc. Internal stimulants must be given 


Ammonia with bark opium etc.”
“Tinct. canth 20 drops once in 2 hours till
there is some effect.”
“Serpentaria with ammonia acts as a tonic
and diaphoretic”
Where there is a prejudice against cold affusion
with water alone spirits or [illegible] or camphor
may be added


128
[illegible] to 4 [illegible] 3 or 4
such as capsicum Capsicum especially when the stomach is debilitated 4 to 5 grs [illegible] Cantharides in 20 drop doses. Ammonia
camphor quinine, mineral acids etc. Carb. amm. & cantharides 
may be given to excite the system & be followed by 
bark and brandy to keep up the excitement.
Diffusible stimulants also may be required, such as chloric
or sulphuric ether 20 gtts to a teaspoonful of water
for a child. In small children if there is difficulty in getting down
medicines the bark may be given by injection, or the body covered 
with it, by means of a bark jacket.
In severe cases, not of the most malignant
form, the heat and dryness of the skin are often very 
great & calor mordax may exist. Cold applications to the 
skin, especially those of stimulating kind will then be beneficial. The cold bath
cold affusion, or sponging with vinegar & water or spirits
& water may be used according to circumstances. The cold 
bath or affusion of cold water may be superseded in case of 
prejudices on the part of the [illegible] or objections from other
causes, may be superseded by sponging the body with vinegar
& water If the case is attended with extreme debility 
and relaxation of the system or if
any chills are present sponging must be used
& [illegible] with caution. If the cold applications produce a chill or
if the eruption comes out irregularly. I should advise 
the tepid bath to determine to the surface. In the advanced
stages of the disease when debility & relaxation are
great the vinegar & water should be made tepid & spirits
may be added. The rules with respect to these applications 
are the same as in typhus. In the atonic form of 


“In children with disturbance of the stomach
and pain in the bowels at the same time the eruption not
coming out well use the tepid bath It obviates the tendency
to convulsions and makes the disease regular In the most
malignant forms it is inadmissible”
“If there is irritability of the stomach give chloride [illegible]
4 grs 2-3 hours absorbents counterirritants”
“In the latter stage of protracted cases emetics of 
sulphur zinc or copper are very useful”
“Withering advises in the typhoid state, after evacuating
the stomach & bowels to give senega freely This 
would be injurious in a malignant case”


129
scarlet fever, the cold bath or cold affusion must not be used
IN 1803 I used sponging with vinegar and gave internal
stimulants at the same time as min. ac. alc. brandy
For children the tepid bath is invaluable in scarlitina 
particularly in the early stages of the disease and 
when the eruption is not fully out, or where the eruption is 
irregular. It is questionable however, how it would succeed
in the most malignant form of the disease
If there is great irritability of the stomach
with vomiting, absorbents and counterirritants are to be used
& in malignant cases capsicum, tinct. canth. & care to be given
In cases of vomiting saffron & snakeroot
If there is much diarrhoea we may 
give # white decoction with opium, injections of laudanum
etc. astringents etc.
In ordinary cases, when the eruption has been 
regular & ends with branny scales, about the seventh day
the case is out of danger But when the disease is protracted
sulphate of zinc or Moseleys tonic solution is
to be given as a tonic. The latter article in a dose from 
a teaspoonful to a tablespoonful is an emetic in cases 
of great morbid action. Emetics of sulph. zinc & sulph.
of copper have been recommended also of acetate of copper 
The latter article is also escharotic tonic & caustic. The chlorides chlorates are adapted 
to this stage of the disease
[illegible] [chlorate of potassa]
grii to vii


“In those cases that require stimulants blisters
may occasion gangrenes”
“When there is tumefaction of the tonsils use
blisters paediluvium & gargle with the mur. ac.
especially the [oxymorestic] diluted with 6 parts water”


130
The treatment of the local affection of the throat is of two
kinds, external & internal When there is much inflammation 
about the throat, with the uvula elongated, the
tonsils enlarged an inflamed & the pulse full I apply 
epispastics externally. Blisters, mustard, oil of origanum 
ol. monard punct. etc. may be applied to the throat
Gargles are injurious in bad cases & perhaps
of little use in most. Still in ordinary forms of the disease
from four to six ounces of any mild astringent acidulated
perhaps with muriatic acid may be thrown in by 
a syringe. The marsh rosemary is considered better than 
any other astringent. The alum root (henchera amer.) is
useful both as a gargle & given internally. For the latter
purpose sweeten it & add a little brandy
When there is not much tumefaction & 
considerable relaxation of the parts stimulating garbles
are good, as capsicum & brandy astringents may be 
added. In gangrenous cases quinine is good if it can
be got down. In the latter stages of the disease it may 
be useful to touch the ulcers in the throat with nit. silv.
“Vinegar & lemon juice may be 
used as a gargle”
“If the ulcers are thick and leathery
apply nit. sil.”



“I have seen the brain affected and much spasmodic
action subderangement pain in the head 
and all the symptoms of hydrocephalus with a bloating
of the whole cellular membrane pulse frequent & extremely 
quick and all the marks of irritative actions
For 3 or 4 years I have used tinct. dose in 4-5 & sat. tinct.
canth. in 10 3 or 4 times a day giving also the tonic
solution and keeping the bowels open”
“It produces eruptions on the skin, heat dryness & 
soreness of the fauces febrile action & if continued 8 or 10 
days I think it would be useful. I would try it were the
disease severe and epidemic, whether I thought it contagious 
or not”


131
The sequel of scarlet fever is dropsy. In children
especially an anasarca and sometimes an universal
dropsy comes on after the disease has subsided. The 
first two cases which I met with were in the severe epidemic
of 1803. I treated them according to the direction 
of the books, with bark & brandy opium & lost my patients 
Considering this as an affection of the absorbent and nervous
system I treated the subsequent cases which fell
upon my hands with tinct. cantharides & tinct. digitalis
The digitalis allayed the morbid action of the exhalents 
& absorbents & the cantharides acted as a diuretic.
“Give of each 
2 or 6 drops every 3 or 4 hours It [opens] [illegible] in these cases the
effect of irritative action hence the propriety of digitalis
Hanneman proposes to prevent the recurrence
of scarlet fever by the administration of moderate
quantities of atropia belladonna an article which produces an
eruption upon the skin, similar to the rash of scarlet
fever. The influence of belladonna, upon this hypothesis
is similar to that of vaccination in preventing small 
pox.



The termination of the chain of actions in health
in some diseases & if we say nature cures the disease
then we may say when the tendency is [inevitably] to death
that nature commits suicide. The latter is true
of this disease Yet if this chain of morbid actions is 
broken up by a powerful impression the constitution
will take on its ordinary action
Scarce any disease is more curable
when taken in season yet it would not be proper
for a physician to say he could cure all cases
then pretending infallibility
I shd doubt whether Good had ever
seen the progress of a single case. He says nothing 
about the first stage.
The tendency of the disease is to destroy 
the patient not by infl. or irritation but by 
suffocation from a foreign body in the trachea
The stages run into one another, and 
yet a phys. watching the progress would naturally 
divide it into three stages
Always curable in the first stage unless complicated with some other disease
rarely in the second almost never in the last yet
I have known cases cured in the last stage
The peculiar sound of the cough is 
alarming (in the first stage) even to those who have never
before heard it
Dr [Hesark] I have been told divides the
disease as I have done into 3 stages and directs to give
2 grs. tart. ant. combined with ipecac. I shd give
for the effect not according to the quantity. I put out 3 or 4 gr
and give till the effect is produced
rarely over 10 grs


132
Croup
This disease has been called in America by the popular name
of hives which is probably a corruption of heaves called rattles
The name given it by Good is empresmia bronchitis. The 
most common scientific appellation has been cynanche
trachealis or angina trachealis
The persons attacked by croup are
I have never [illegible] 3 and [illegible]
almost exclusively children from 3 months to 12 years 
old # in one instance I have known it attack
a person 60 years of age When it occurs in adults it
succeeds other diseases I have known 2 or 3 cups of [illegible]
“Croup sometimes though less frequently than most diseases, blends with
other diseases as catarrh” Some have considered the disease as
contagious, but though a few facts appear to favour the
supposition, they are not numerous enough to establish a 
general law.
Croup usually occurs in the winter
and spring, when it is brough on by exposure to a cold
and damp atmosphere. Children upon the sea coast are
more subject than in the interior of the country, because
exposed to more variable weather and more frequent [thaws]
& notwithstanding the greater warmth of the climate on 
the seacoast For when the air is filled with 
vapour, the caloric of the body is conducted off with 
more rapidity than in a dry atmosphere, even if the
temperature of the latter is colder.
# It is principally confined to persons under 5 years of age
though it sometimes attacks persons of all ages, and 


It is not precisely entonic or atonic & hence
might be called specific in peculiar
It is said that in croup the exhalent
arteries are affected & in catarrh this [illegible]
vessels Whether the different vessels are affected or not there 
is certainly a different action
“I have thought croup might destroy life by 
coating the entire surface of the lungs with a mucous
or membranous coat thus preventing the decarbonization 
of the blood”
“I have never seen croup without more
or less spasm; & probably in fatal cases it is always a 
spasmodic contraction that closes the passage to the lungs 
which is only diminished by the membrane. I never
saw a case on the other hand of what is called
spasmodic croup which did not if neglected put on the
membranous & inflammatory form”
A similar [membranific] inflammation
exists in the duodenum


133
Croup is a specific disease of a peculiar kind and
is never malignant. It comes on with all the symptoms
of pyrexia and consist in an inflammatory affection of
the mucous membrane of the larynx and trachea, which
causes a remarkable shrill sound in breathing & a ringing
cough by which those who have seen the complaint
cannot fail to recognise it. The proximate cause is a 
peculiar inflammatory action of the system, 
determined to the exhalent vessels arteries of the trachea
and bronchial vessels, where there is produced an exudation 
of coagulable lymph similar to that which forms
on the membranes of closed cavities from inflammation & 
entirely different from secretion of the mucous glands
whether healthy or unhealthy. This coagulable lymph 
which is thus exuded, always forms a membrane which 
lines the larynx and trachea, if the disease proceeds
to a fatal termination, and causes death by suffocation. 
This appearance is always found in the
tracheae of those who have died of the disease.
The membranific inflammation distinguishes 
croup in its nature, from catarrh which is in all its
varieties, an affection of the mucous glands



Most diseases attack in the night
“Diseases are cowards, they mostly attack in the
night” Rush.
“The peculiar ringing sound of croup is made in 
[expiration] that of hooping cough is inspiration”
# As is the case when respiration is impeded
by any foreign body there is a great deal of
irritation
# when the nose discharges [illegible] [illegible] it
bronchial vessels secrete mucus and a new
action takes place the patient will be apt
to recover
# The patient was subject to asthma
and the croup was neglected until the latter 
stages finally died
+ “I have known this to happen only once
In this case the friends were not alarmed because the
child had been subject to catarrhal affections & the symptoms 
received no attention till the last stage”
# Frequently appears to be [illegible] in the
very commencement of the disease


134
This disease sometimes come on like a
catarrh and continues two or three days without any 
alarming symptoms, until suddenly, & often in the night
the peculiar symptoms of croup appear. At other times 
the first symptom of the disease is a severe paroxysm of 
suffocation attended with the hoarse & shrill ringing noise made
during expiration like air through a broken tube & the peculiar ringing cough. The cough
in its progress is attended with more or less of spasmodic
action. # It is always dry; and when it becomes loose
or when mucus is expectorated the disease is broken up 
and there is no further danger # It rarely continues so long as five
days and is sometimes fatal in twenty four hours. Sometimes,
though rarely the membrane of coagulated lymph is
coughed up. I have met with but one case + In this the 
membrane was thrown up three times, at each subsequent
time forming lower down than before # 
No disease resembles croup so much as
suffocating catarrh yet there are obvious marks of discrimination
The latter disease as I have seen it is not attended
with much cough and the difficulty of respiration is
not in paroxysms but constant & commence with the disease. The pulse is often quickened
and when the system is prostrated may be low. #  In suffocating 
catarrh the powers of life are to be raised by external
irritants & excitement equalized by the inhalation of the vapor
of [illegible] of warm water etc. “Mustard” “If pulse tense
bleed”



From the earliest of my practice I 
have been in the habit of dividing it into 3 stages
[illegible] that they are perfectly distinct, but [illegible]
person would naturally take this view
Quiet between the [per.] apparently 
not much affected during the paroxysms Between the paroxysms pulse natural & eyes bright. You will 
know this disease in this stage only during the par.
Parents in this place know the disease in this stage
and send forth phys. 
In this first stage, the disease 
must be broken up by a powerful impression 
upon the system This may be done many ways
Some are partial to a [illegible] & some to another 
“That which is best administered is best” A local
effect upon the stomach will not answer
I have relied more upon tart. ant.
than any other & found it answer all reasonable
expectations. I have preferred it to any other
I have occasionally used other [illegible]
I have found seneka better as an auxiliary
than as a commanding [remedy]



135
Croup may be divided into three stages each 
of them requiring different treatment. 1st The forming stage
2nd The inflammatory stage & 3d The last or suffocating
stage
1st In the forming stage, the cough
is severe & hoarse & occurs in paroxysms of from five minutes 
to have an hour in interval. “There is little or no fever” The
pulse is regular and small, & sometimes trembling. The patient
is often chilly. In this stage the disease may with
certainty be cured
“I have not lost a patient & have not saved one
in [illegible] when not called till the second paroxysm 
had commenced”
In the treatment of this stage we must depend
upon emetics. Large doses must be given moderate
ones do no good. A dose should be administered sufficiently 
powerful to affect the whole system and call into action 
every muscle. We must be regulated not by the quantity 
but the effect for we must calculate to overcome the diseased
action completely by the operator of our remedy.
I have given three grains of tartar emetic to a child three
months old, & kept up the action by the large doses of seneka
repeated every half hour for six or eight hours
Tartrate of antimony is the best emetic to 
commence with and may be given in a dose of from 3 to
six grains of strong tart em. After its operation a constant nausea must
be kept up by seneka or some similar article, for some
time in order to prevent a return of the disease. The seneka
excites a new action in the system. It may be given
in decoction. Take zfs or zi of bruised seneka to half a pint of
water, & boil away a quarter. Give a table spoonful for a 



It has so happened that with us the [serpentaria]
has not answered so well as tart ant. It acts 
on the fauces perhaps more [illegible] than tart. ant. 
but does not affect the system act upon the skin 
& determines to the surface so well as tart. ant. We have 
not used it however except in the latter stages & perhaps have
not given it a thorough trial
Sanguinaria vide p. 212 has been used 50 perhaps
a hundred years. Three generations of physicians
in one locality have used it and relied on it
in croup with as much success as upon other articles
These mode of using it was in strong decoction 
without weight & give a table spoonful until 
the desired effect is produced till vomiting is excited
or the disease is broken up There are however
forms of the disease where it fails even in [illegible]
“Much has been said of the good effects of calomel
Give in large doses 20 – 30 [illegible] acting as an emetic it is
serviceable but when catharsis is produced, the emetics 
would fall in with the catharsis. I never could in such a 
case make the strong impression on the system what I 
[illegible]”


136
does once in half an hour or as much as the stomach
will bear. Seneka has been relied upon by some as
a specific in croup, but it is inefficacious when inflammation 
is present, being a stimulant, and it is too slow in its operation
for the first remedy. After giving it as the first
article, other emetics seem to lose their influence; acting
as cathartics; but after the violence of the disease has
been broken up by other emetics, you may avail yourself
of the nauseating & deobstruent effects of the seneka & effect
a cure. Dr Rush preferred the turpeth mineral 2 to 6 grs
as the first emetic. The physicians in Wallingford for 5 years
make a strong decoction of sanguinaria, and give it
until emesis or a cure is effected. This article may be
used instead of seneka in the way above directed
In connexion with these means the warm
bath and fomentations may be used as adjuvants. Much 
has been said of the good effects of calomel in this disease
You cannot rely upon calomel for the cure of the disease
It is too slow in its operation. Never give calomel until 
you have broken the violence of the disease 
After emetics have operated and you have availed your 
self of the operation of seneca & sanguinaria and the disease
still exists, give from 5 to 10 grs of calomel
By this producing an orgasm in the 
system more powerful than the disease & continuing it until 
the latter be overcome, croup may be cured with more certainty
than most other diseases. All diseases should be attended



I know that there are some very respectable physicians who rely
upon calomel For this purpose they 
give very large doses and produce [illegible] & [illegible]
I should prefer it as an auxiliar. I have often 
used it but after the emetic or with the
emetic or before the emetic
A variety of other men [illegible]
India tobacco which though not allied in 
botany are so in their operations The common 
tobacco is generally applied eternally to the pit of the 
stomach. Lobelia acrid & emetic loses some of its virtues by drying
In its recent state 1 gr will often excite full vom.
Indeed I have known vom. prod. by merely 
chewing the capsules & [illegible] without swallowing
by the impression upon the mouth	
Dose of tinct. 20 drops to a t. sp. according to age
Other acrid narcotics as veratrum & colchicum
may be used
In this forming stage bleeding is not
indicative by the pulse, nor by state of the
system and you will obstruct your efforts to excite
a powerful effort of the system if you bleed
2nd stage
In this acrid emetics are injurious
seneka is too stimulating Sanguinaria had I have
seen all the symptoms aggravated by bloodroot in [illegible]
the high entonic stage
# “If the disease is complicated with a similar
affection of the stomach & duodenum give calomel & other
cathartics”



137
to in the beginning & it is owing to the imperfection of 
or our art that every disease is not broken up in 
its first stages. When however croup supervenes upon other
diseases, it is more dangerous. “Those who practice in the
country rarely see the disease in the forming stage. I had one
winter 20 cases of croup all in town recovered most of the in the country died”
2nd Country practitioners however seldom see
this first stage which I have just been treating of when the 
tongue is not discoloured, the fauces have a natural appearance
the pulse is unaffected respiration natural & ordinarily 
no inflammation about the tonsils. On the contrary 
they too generally arrive when the disease is in the
second or inflammatory stage the disease has effected in which the bloodvessels the skin is hot and 
dry, the face flushed, the pulse tense & sometimes full the
tongue furred, respiration between the paroxysms difficult
tongue furred, respiration between the paroxysms difficult
and the cough so severe as to threaten immediate death vide p. 213. In this stage 
we should immediately bleed from freely from a large orifice the arm or jugular vein
freely, even until syncope is produced put the patient
in the warm bath & let him also inhale the steam of warm
water, and give calomel and other cathartics. # Never
give emetics in this stage until after depletion by V.S. 
when we may give 4 grs. of tart. ant. in a table spoonful
of warm water & apply epispastics to the throat” in the commencement 
apply a blister” I dread to be called in this stage of 
the disease, for it is the almost always fatal venesection 
sometimes succeeds but very seldom. I would not apply 
leeches cupping would be better & perhaps friction might be serviceable.
Digitalis has been recommended, but 



In this stage inhale the vapour cover
the child & nurse in a chair with a blanket
In this stage cal. & cath. may be given
In the first stages I have conserved it very unfortunate
to find my patient under the operation of a
cathartic It feels as if my hands were tied
The excitement is of a different kind from what is wanted
And emetics are apt to produce hyper cathartics
Where the dis tends to the [illegible] the
[illegible] a specific. This is known by the
cough being less hoarse, by fever, by constipation 
fever more intestinal membrane
will pass off from the duodenum I was formerly 
disposed to cure this form of the disease [illegible]
& described it as such
In the second stage epispastics
over the whole chest also diaphoretics
and tepid bath When the cough is milder
and beginning to be loos after being principally 
broken up in the first stage give cal. in 2 or 3 gr
doses once in 2 or 3 hours
In the 2nd stage remedies have been
given to obviate the fever & digitalis has been used
with good effect It was used as a depressing agent
It operates by its narcotic power however. here refrigerants
are of little efficacy
In what may be seen to be the last


138
I have not used it. It is at best but a doubtful remedy
in inflammatory effections though calculate to remove more irritations. Sanguinaria diminished arterial
action like digitalis and operates powerfully as an
emetic. I have not succeeded with it in the last stages of
croup & have not used it in the first. [?ronchotomy] has
been proposed, but does not promise much benefit, as the
disease is seated below the place for operating. “Dr Smith did not recommend it”
After depletion and especially after the disease assumes
a bilious form you may give powerful cathartics
The pt. begins to thrown his head back death may happen any moment
3d IN the last or suffocating stage* you may give emetics
of turpeth mineral sulphate of zinc or even
corrosive sublimate to throw off the membrane. Something may depend upon changing
the emetics & sulphate of zinc may be tried. The cold bath
is said to have been successful in this stage, but the fact is
not well authenticated. I have used calomel and the
warm bath with advantage.
Child of Mr Culver
[last] in chronic stage
“I regret that I have not tried 
affusion of cold water in the last stage. It is 
said to cause the membrane to be thrown off & to procure
relief even in the very article of death”
vide p. 182
*”In the last stage respiration is constantly laborious
head thrown back pulse often irregular
& intermittent sometimes strong”
Chronic form “Sometimes though rarely the disease is only partially 
subdued I [illegible] on in a chronic form. Calomel
vapour best tepid bath are the appropriate remedies”




139
Angina Laryngea
Empresma Laryngitis of Good, q.v. for a definition & 
an account of the disease
In this disease the symptoms differ somewhat
from those of croup, though the cough is similar
The disease is seated in the larynx glottis and fauces & the
characteristic symptoms is swelling of the tonsils. The cough
is spasmodic and is excited by taking food with drink in this respect also indistinguished from croup. The
disease is more violent and rapid than croup, as the inflammation 
being seated in the narrow part about the glottis
produce suffocation sooner. The respiration is more difficult
than it croup particularly between the paroxysms
This disease more commonly affect adults
The first case that I saw was that of an old man in whom
the disease was brought on by exposure to cold after a pneumonia
From a relation of his symptoms I prescribed
seneca which only exasperated the disease, so that when 
I saw the patient he was unable to speak or swallow. A 
small red spot appeared on the tonsils. venesection, epispastics,
pediluvium, inhalation of vapor etc. were resorted to with 
no abatement of the symptoms. Venesection was performed a second
time & as soon as the patient was able to swallow, 4 grs. of 
tartar emetic were administered. Some nausea and vomiting
with considerable catharsis followed. The vesication 


“Angina laryngea is mor apt than croup
to recur several nights in succession”
“The slough were thick and leathery. Sloughing
even under blisters. In one instance blisters did not
heal in 4 mo. Lunar caustic applied to the tonsils & 
uvula & inflamed parts proved serviceable
# “In one case of A. laryngea I gave sanguinaria 
It was too acrid and increased the cough etc. It might 
do good if we could avoid the local effect of its
acrimony”



140
was extensively returned & the patient recovered.
Much the same treatment is required
as in croup but it should be more prompt and with earlier
venesection. For the inflammatory stage comes on earlier
and the disease runs a more rapid course
Last year this diseases differed in its appearance
from the former years
It has often followed certain affections
of the tonsils called black canker. The tonsils are inflamed
in black canker and sometime covered with a leathery
crust. This comes off and leaves an ulcer. If the inflammation 
extends to the larynx, symptoms of croup 
supervene
Case of black canker. Two called in the
last stage gave blood root with disadvantage # Still at 
this late period calomel and other cathartics in large
doses produced free evacuations and the child recovered 
Cathartics appear to do better than emetics. In one case after 
giving cathartics I used the vapour bath and applied 
a large epispastic over the whole sternum. Though at
so late a period the disease abated. A large slough however
was produced by the blister which required three 
months to heal. The morbid action on the skin being
similar to that of the tonsils
Vie p. 187


Sometimes comes on with a sudden paroxysm of
suffocation sometimes gradually 
“Distinguished in its commencement
from croup by the quantity of mucus in the bronchial
vessels”
“in the case which I have attended, 
not much febrile action attended the disease”
Proximate cause a morbid action of the lining
membrane of the lungs accompanied with a viscid secretion 
of [mucus]
By vomiting the disease may be relieved & apparently 
cured but may appear again in the course of 
an hour
The quantity of mucus is greater than in 
any other catarrhal affection”


141
Catarrhal epidemic resembling croup
Peculiar catarrhal affection resembling croup suffocating
catarrh
This disease is characterised by a severe hoarse 
cough, much resembling that of croup. The disease is distinguished 
in its commencement from croup by the excessive quantity of
mucus in the bronchial vessels which causes the suffocation 
The disease resembles croup likewise in the mode of its attack
which is sometimes sudden with symptoms of suffocation, and at
other times gradual with paroxysms of coughing and intervals
of perfect ease The turns of coughing are so violent in this
disease as to produce a livid colour of the face. The extremities
evident determination to the head
are cold and the head is hot from the quantity of blood
thrown into the vessel of the head by coughing. The evacuation 
from the bowels are healthy and among children with no disease which I am acquainted
affect the bowels so little ass this.
The proximate cause of the disease is a morbid
secretion of mucus on the lining membrane of the lungs & 
trachaea with obstructed perspiration. The quantity of
mucus thrown out by this membrane in this disease is astonishing After
the disease is fully formed, great quantities of viscid mucus
may be brought away by vomiting, to the great relief of the
patient for a short time, and yet within an hour the patient
will appear to be suffocating from the the quantity again 
collected in the bronchial vessels
In the commencement of this disease, the indication
is to break it up at once by a powerful emetic, of
tart. ant. unless the system 


The principal indication is to break up the disease
by a powerful action on the skin on the stomach
the duodenum and the fauces It is best affected by 
tart. ant. which is more difficult in its action than
[ipecac] though is very delicate constitutions ipecac 
may be practicable
# prevent accumulation of [mucus]
The bowels shd be evacuated not for the purpose
of curing the disease but for the prevention of an
accumulation of feces which would be irritating
In all diseases of the lungs examine
the state of the skin and particularly that of the lower
extremities for perspiration upon the upper extremities 
[only] may be a part of the disease
I have known the lives of several patients saved
by the use of the vapour bath
I formerly [illegible] and used [illegible]
for transmitting vapour by transmitting air through
boiling water
It was old practice to apply cat-skins
fowls split open (to the feet) etc. with the intention of
communicating vitality


142
is too much weakened to bear this treatment. This is a 
general principle viz, if possible to break a disease in its
commencement by means of a strong orgasm. Often the
emetic is to be repeated, and it may ever be necessary to give
four or five emetics 1 gr [illegible] tart. emet. each in the course of a day. After the disease 
is somewhat broken up, and epispastic applied upon the 
breast will assist much in allaying its violence #
If the disease still continues or if when first
called we find it fully formed and powerful emetics inadmissible
the primary indication will be to open the pores of the skin and
keep up a gentle perspiration, by small doses of antimonial wine
to which may be added in all quantities of camphor by elix. [illegible] & in 
some cases tinct opii by fomentations and especially by 
the warm bath and the inhalation of vapour. To affect the 
latter object the child may be placed in the warm bath & 
a blanket thrown both over it and the nurse, so as to keep
the child in an atmosphere of vapour. Long continued 
perspiration invariably relieves the symptoms. I have known
an instance in which the skin of a sheep warm from the animals
body was wrapped round the naked body
of the child with beneficial effect.
In small children when the stomach ceases
to be excited by emetics the throat should be irritated 
by a feather or the finger, when we wish to produce vomiting 
For we must never rest satisfied with merely endeavoring
to palliate the symptoms. In small children also the
mucus should be wiped out of the mouth by the finger or a cloth 
This disease prevails most in the winter and spring months & does not
occur every year. The first patient that I treated for the disease suffered
from it a year. I gave mercurials & finally the silver pill (nit sil)





143
I was puzzled with the first cases of this disease
which I met with. Some of them continued for weeks
and months I was obliged to use perspiration,
by warm bath to vapour bath emetics etc. I determined
to break up the next cases in the commencement
with tartar emetic repeated until full vomiting
was produced walking my patients. This 
plan was more successful
A s a general rule break up 
all diseases if you can
“The complaint is epidemic or rather
endemic. It has been mistaken for croup, but it
differs As croup formerly occurred no mucus was raised
in the earlier stages, and when there was an excretion
of mucus we considered the disease cured
But of late years the two complaints are somewhat blended.
Mucus is thrown off sometimes without permanent
relief”
“There is often in this disease a disturbance of 
the brain and nervous system resembling epilepsy or chorea
produced by the cough”


A distinction was formerly made by some
writers and some practitioners, between hooping cough
and [chin] cough the latter being a spasmodic cough
without the hoop. Such a distinction will not hold
good there is no difference
“Linneas and Rosenstein attributed it to an insect
others to malaria”
There had been a very severe winter & no one
had left the island for months


144
Hooping Cough Pertussis
Called also chincough
This is a disease which generally attacks children
yet occasionally, adults are the subjects. I have known persons
of 60 years of age affected with it. As a general rule also it
does not affect persons a second time. I have known about 
20 or 30 exceptions & among them was the late president Dwight at 60 years
Hooping cough generally appears as an epidemic.
With respect to its origin there is considerable difficulty 
in making up an opinion. It is said to be contagious 
to arise from a specific
contagion which affects a person but once. Dr [Dewers], however,
says “We confess that we are inclined to believe that it depends upon 
causes of a more general and pervading influence that 
contagion.” Dr Cullen asserts that he has said a disease which 
though evidently arising from chincough contagion never put on 
any other form than that of common catarrh. In the tenth
volume of the medical commentaries DR Willey gives an account of
the breaking out of the disease on Block Island under such 
circumstances that it would seem that it could not have originated
from contagion. When the disease prevails many become effected
where every precaution is taken” When the disease has been extensively 
prevalent I have not been particular about keeping patients
apart, perhaps however it is best for prudence’ sake to consider the disease
as contagious and to treat it as such. One fact I have noticed
that in particular seasons may have the disease who have had it
before.” Some suppose that it is contagious only in the first stage 
others in the second “Some think it caused by malaria or
animalcular”


“The stricture may be overcome by not
attempting to inspire, but to expire till the lungs are
emptied the pat. can then inspire without difficulty
I have known persons subject to this kind of hooping
without cough Adults are sometimes attacked in the night
with paroxysms of suffocation they start from bed when 
the recover their breath there is hooping but no cough, at
least at first The more they struggle to catch breath 
the greater the difficulty there seems to be a spasm of the
glottis Let them make no effort to inspire but expire 
the little air remaining in the lungs & they will bye relieved at
once. The disease is liable to recur bathe the feet at night 
give paregoric wine whey diluents The disease is not described


145
Some suppose this disease a peculiar inflammation of the
mucous membrane of the trachea and lungs, others that it arises
in the bowels
This disease often commences with the 
symptoms of ordinary catarrh & continues without alteration for
some days.  Sometimes the peculiar mark which gives this
cough the appellation of hooping & distinguishes this disease
from every other does not appear until the 3d or 4th week
It is impossible however to distinguish the disease until this
peculiar hooping makes its appearance. When the disease
is prevalent it will be safe to treat every severe case of catarrh
among children as one of this disease
The phenomena peculiar to this disease may 
be the described. Several frequent expirations are made in 
succession by spasmodic coughing, and a full inspiration is
then necessary to restore air to the lungs. The air as it passes
rapidly into the lungs produces a loud sound called whooping
The sound however is made more by the structure of the passage 
than by the rapidity with which the air is drawn into the lungs
I have known persons subject to this kind of whooping, without
having a cough caused by a spasm of the muscles of the trachea 
larynx? to which adults are sometimes subject. (Goods laryngismus?) 
A similar sound is also made in croup, when 
the air is expired after the passage becomes constricted
The patient is aware of the coming on of a 
paroxysm of coughing by an unpleasant sensation in the throat, & 



The cough is violent in proportion to the shortness of 
the paroxysm


146
it is common for children support themselves during its continuance
by changing to a chair or other support near them. During the
paroxysm the blood is returned with such violence to the head as to 
produce a livid colour of the face & often in 
bleeding at the nose. Very violent paroxysm sometimes
in young children terminate in convulsions or death The paroxysms continue
until a quantity of mucus is thrown up from the
lungs or the contents of the stomach are evacuated by vomiting
They are short in proportion to the facility with which the mucus
is brought up or rather in proportion to the rapidity with which it is secreted
It is the secretion of mucus, not its removal
which gives relief to the irritation of the lungs 
Many suppose that this mucus which is generally in considerable
quantity is the cause of the paroxysm of coughing instead 
of the effect of it. The peculiar irritation of membrane in 
a paroxysm of coughing produces a secretion of [illegible], and 
when a sufficient quantity has been secreted it is coughed up 
like the secretion of tears from an irritated eye
and the paroxysm is relieved “The mucus sheaths the part & the ceases”
The disease continues from one to six
months It is often kept up by habit. The cough is usually more violent by night than
by day. Violent cases are often attended with considerable fever
and in the worst cases respiration is laborious between the fits of
coughing. The disease may terminate by apoplexy or suffocation
or by ulceration of the lungs and hectic & sometimes by 
permanent visceral obstruction “or apoplexy or suffocation”
Whooping cough is not dangerous to adults
and I have never known a child over two years of age die
with it. It is most dangerous to infants and the younger the 


It is usually dangerous to children within the mouth
It is apt to wear out very young children especially 
if they are of a scrofulous tendency
It is frequently accompanied with a morbid sensibility
and irritability of mind and hence in the latter
stages a change of air and of place is salutary as in 
cholera infantum The same despondency of mind takes place
as in chol. inf. q.v.
The disease is a fever spending itself upon the
lungs and trachea, and affecting also the glandular
system
Some phys. think this dis. like common
catarrh, is always inflammatory in its commencement, and 
requires antiphlogistic treatment. But we know that
pneumonia may be highly typhoid & require treatment
opposite to [enteric] pneumonia. If infl. of the lungs exists
the antiphlogistic treatment shd be adopted in its fullest
extent I have seen antimony as efficacious in this dis
as in pneumonia. In general perhaps mild
antiphlogistic diet & treatment will be proper.
In some cases I have thought the
veins lost their power, and in such cases the
blood [illegible] has been prescribed & with advantage
It is a catarrhal fever at first and to be
treated as such


147
child the greater danger in children under the age two years
The anger, to be apprehended from the disease will also depend
upon the debility of the child when attacked. The cough may be
violent and attended with frequent vomiting yet of the patient’s
appetite be good there will not be much danger
to be apprehended. A moderate hemorrhage from the nose
is often salutary
Treatment. If the disease is mild and the constitution
good little need be done with the way of treatment. But if inflammatory 
symptoms supervene with a tendency to pneumonia
the antiphlogistic treatment must be adopted. Bleeding
will often be advisable. A small quantity of blood
taken from the arm proves serviceable. In general greater 
effects may be expected from the application of a few 
leeches to the breast or neck than from bleeding at the arm
but when decided symptoms of pneumonia appear, & the blood 
seems to be transmitted with difficulty through the lungs.
I would recommend venesection. In this case also the 
bloodroot will be the best article for internal administration
In most cases the disease comes on like
a catarrh, and should be treated as such, with mild 
antiphlogistic regiment [illegible] important part of the
antiphlogistic treatment of this disease is the keeping 
the bowels open. Costiveness frequently attends the disease & should
be carefully avoided. In general it is better to obviate 
this symptom by diet as far as it can be done 



Begin with antimony in small doses 1l or 2 drops ant wine & 
in [illegible]
For very delicate children however it may be better
to give ipecac
Almost all the writers recommend vomiting [Best]


148
rather than by medicine. The best cathartics for the
indication are those which excite the secretions of the stomach
and liver. Sometimes the disease has a tendency to produce
congestion of the liver and obstruction of the mesenteric glands
and in that case also mild mercurials should be given 
and their use continued as long as any symptoms of congestion 
exist.
All the medical writers on this disease recommended
vomiting in the first stage
Tart. ant. is in ordinary cases the best emetic. Sometimes
for a child from two to six months old two drops of antimonial
wine will be an emetic dose while for another
of the same age 20 or 3o drops may be required. In 
affections of the lungs children will bear antimony better
than in those of the stomach and duodenum. In some
constitutions antimonial emetics produce (in this disease)
a sort of spasmodic stricture other emetics also may produce
this effect a symptom which must be relieved by diluents 
and opium
In general antimony in small doses
may be given to children of any age, either by itself or combined
with a small quantity of paregoric or any other mild preparations
of opium. Given in this way it removes febrile action and 
congestion of the lungs, and determines to the surface
When the disease has proceeded with 


You may see the fontanelles swell in such 
cases. I recollect a child in the whooping cough going
into the country I told the parents not to suffer the child
to be vomited. A physician in the country said the child 
must be vomited of course all the books directed it
in whooping cough He vomited the child. It went into
convulsions and died
# Here insert the recipe for hire syrup or 
compd sys. of squills p. 150
I have known the lives of some patients saved 
by 
this antimony internally had lost its power produced no effect


149
violence for some time and there is much determination of
blood to the head, threatening convulsions or apoplexy from 
distention of the blood vessels, or when the patient has become
debilitated vomiting by emetics should not be practises
or but cautiously.
When the system and particularly the
stomach has become debilitated. Ipecac is preferable to 
antimony, given in emetic doses, or in small quantities 
as an alterative diaphoretic and antispasmodic. And in the
latter stages likewise on account of the debility, sulph. tinc. is a good
emetic using 5 or 6 grs. with as much of ipecac
If there is not much febrile heat, and there is much 
viscid mucus in the stomach and lungs, and emetic of
squills is often serviceable # particularly I [illegible] phlegmatic temperaments syrup of squills vinegar of [illegible]
In this disease if there is danger of convulsions 
from vomiting, blood root and similar articles should
be given. The hive syrup or compd tinct. of squills may be used
In children under three 6 months, whooping
cough may be much relieved (respiration being promoted)
by vesication on the breast. A blistering plaster may be applied but
I have more generally used the following. Rx common or mild
tinct. canth zi targ. ant zi Dissolve the ant. in the 
tinct. & apply a linen cloth with the mixture till [illegible] or partial vesication 
is produce & then dress with simple cerate In this way we have the vesicating & irritating
qualities combined. This external use of tart. em. was
recommended 20 years ago, in the Lon. med. & ph. Journ.


This disease may be cured in its first stage but it
ordinarily runs a regular course & the treatment is generally palliative 
brown mixture
You will perceive that this is a strong decoction
of seneka and squills, with a large proportion 
of tart ant. shd be given cautiously 4 to 30 drops 
Narcotics have been strongly recommended
e.g. atropa belladonna & hydrogen of the former
for 2 gr of the leaves in powder Alibert recommends
the fresh bruised root


150
A popular remedy in whooping cough in Godfrey’s cordial, made
of molasses and water with a little laudanum and oil of [illegible]
“Hive syrup” (or compd syr [illegible]) is made as follows Rx bruised seneka root & 
squills zz z8 water lb 8 boil and evaporate one half
strain and add honey 4 pts boil to lb 6 Add tart.
ant. gr.i to every ounce Give for an emetic 8 or 10 20 drops
to a child 4 mo. old & repeat the dose every 15 or 20 minutes
until vomiting is produced
The “brown mixture” is as follows elix. pareg. zi; ant. wine zfs;
ext. glyc ziii pul. gum ar. zii wat. zvi trit. & boil 
dose from ½ teaspoonful to tablespoonful
This has been very extensively used
This disease has been prescribed for more 
empirically than most others; a fact which proves the
difficulty of curing it It is a popular notion that it must
“run its course” & under the influence of this many parents
object to its being prescribed for. Undoubtedly this
like every other disease must “run its course,” if it is not
cured; but this is no reason why the cure should not be 
attempted.
Ammoniae asafoetida (especially if
the cough is kept up from habit)


1st antispasmodics 2nd tonics
# An emetic is occasionally administered with advantage 
“I have prepared this from seneca oil also
from gun copal”



151
2nd In the second or chronic stage tonics & 
antispasmodics are indicated. Sulph. of copper or of zinc
tinct canth. cinchona, arsenical solution etc. may be required 
to rouse and support the system & as antispasmodic
tinct. asafoet. petroleum Artificial musk etc. and also
the narcotics, as hyoscyamus, conium, stramonium, belladona arnica, opium etc.
When the cough is kept up by habit, # asafoet.
is often administered to children with advantage. It may 
be given in tinct. or decoct. & if it cannot be given by 
the mouth it may be thrown up in an enema, using 10, 20, or 
30 drops of the tinct. It is a valuable [illegible] the taste is less
unpleasant than the [illegible]
Artificial musk or oxygenated oil of 
amber was first introduced by Prof Hufeland of Jena
as a specific for whooping cough and has since been found 
very useful in other spasmodic diseases vid. Lon. M of ph. J.
vol. 1: p.181 van Swieten’s comm. etc. Rx nit. ac ziiifs
cl. succini zi. And the acid gradually, ina temperature 
of 100 [degrees] or in the sun. Prof. Hufeland triturated
x or xii grs. in a mortar with a few almonds & diluted with 
z 5 or 6 of water & gave a teaspoonful every 2 hours to 
a child a year old. This preparation was very celebrated 
and very effectual, for a time, but afterwards fail 
was thought to be ill prepared. The truth was the diathesis had 
changed. Probably it will be as affectual at [illegible] time
I have given the above article in tinct. Rx zii 
of the oxyg. [illegible] [illegible] lbfs alcohol dose 10 to 12 20 gtts
It is much more soluble in ether. I frequently dissolve zi 
of oxygenated amb. in zi of ether dose 1 to 2 drops on sugar 





152
It may be prepared indeed of any strength, to suit the
convenience of the physician. Probably gum copal oxygenated would
answer the same purpose as amber as there is every reason 
to suppose that the two are essentially the same
amber being gum copal mineralised Case of a vein of 
olibanum or Frankincense found in S. America.
Opium is not indicated in this disease
except when it is qualified and its action determined to the
skin by antimony ipecac or camphor. Hyoscyamus
is better than opium for in the cough it produces no constipation
and the tincture is very pleasant. I have not
however used it in this disease. Conium has been recommended
by writers of the first respectability, but later authors do not 
speak of it with much confidence. It deserves a trial
when other things fail. Alibert recommends atropa belladonna 
1/6 gr. of the root or leaves powdered & given in milk
I have used I have more confidence however stramonium in the [illegible] & think it preferable
most of the narcotics
to any other narcotic It is peculiarly calculated
to remove spasmodic action depending upon irritability 
of the system or kept up by habit From the relief obtained
by its use in asthma I was led to employ it in this disease
and from those cases in which I have tried it I am of opinion 
that it is a very valuable remedy in it 
The ripe seeds of the stramonium are best the full dose of 
these for adults is gr. ii for a child  1/10 gr. or more according 
to the age



Mercurials occasionally blue pill rhub & 
ipecac enough to keep up a gentle excitement in the 
bowels
Not unpleasant to the taste
An old [illegible] Chalmers ([illegible] of silver) recommends sulph. cop. & 
tinct canth in wh. cough
# [ago] more used than any other Lately the ox. bis.
has taken its place dose the same used  for irritating
cough & irrit. of stomach


153
Carb. potash is a good antispasmodic used externally 
and internally. It is not only antacid & antispasmodic but it appears to 
me to produce a peculiar excitement upon the stomach
and aesophagus, which makes the more susceptible to 
the impression of other articles. Pearlash zfs & water z8 with 
cochineal enough to colour the solution has been considered
relied on by some physicians
a specific. The cochineal merely colours the solution.
is an article from which I never could perceive
any medicinal effects when used alone. I have tried the
experiment & could perceive no medicinal effect from it
Tonics. I have given the sulphate of zinc
more than any other tonic in this disease, and have experienced 
the greatest benefit. Sulph. tinc given by itself,
sometimes produces spasmodic action, the effect I attribute
to its being used in substance & hence I always
give it in the form of Moseley’s tonic solution. This 
preparation is both conic and antispasmodic is easily 
taken and retained on the stomach of very small children
Sulph. copper possesses properties similar 
to those of sulphate of zinc. It is administered in the 
low stage of whooping cough. In this place the preparation
of it called compd tinct vitr has been used
according to the recipe in the 10th vol. Duncan’s Commentaries
in doses of 3 to 30 drops according to the age of the patient
The oxide (or flowers) of zinc & also bismuth 
formerly much used in spasmodic cough 30 grs
have been occasionally used 1 to 3 grs 1 to 10 to an adult
The Peruvian bark is a good remedy in 
the last stages. The only objection to it lies on the difficulty 


It sometimes happens that the physician is 
not called in until the latter stages. As one resort we
may have recourse to irritate along the spine
It is an opinion very extensively prevalent to that
it is of no consequence what kind of food a child takes
when he has the whooping cough But great attention 
shd be given
Removal from sea side to country 
and [illegible] country to sea side either is beneficial


154
of administering to small children, a quantity sufficient
to produce any considerable effect. This difficulty may 
now more be overcome by using sulph. quinine ¼ gr to 1 gr Dr Chalmers of 
South Carolina recommends a combustion of bark, sulphate
of copper and cantharides
Tinct. cantharides has been long since
recommended for whooping cough. It is useful when the system
requires an inflammatory diathesis to be produced. Its action on the stomach 
is probably similar to that which it has in cases 
of gleet and leucorrhoea the stomach being in a relaxed
state & requiring to be excited to a healthy inflammatory 
action
Irritants, as oil of capsicum canth. [illegible] or ol. orig.
or vol. lin. rubbed along the spine have been used in 
the latter stages. They should be tried when you have reason 
to suspect that the spinal marrow or the nerves proceeding 
from it are affected.
Attention should be paid to the diet of children
in the whooping cough avoiding potatoes, oily foods etc.
Change of scene & change of air especially by 
riding should be resorted to in bad cases, to tranquillise 
the patient & furnish mental excitement. Sometimes the little
sufferers will be excessively irritable constantly worrying and teasing until 
this is done requesting first one thing & the other to be done. It is the worst of such cases, medicine does
little good, even the irritation produced by administering 
it may counteract its beneficial effects.


violent palpitation throbbing of the heart
a soft flowing pulse and a jarring feel of the pulse under
the finger ([illegible]) (The French call an enlarged heart
hypertrophy I object to the [name])
For this I have given nit. sil. 1 or 2? gr.
(in the chronic stage of [illegible]) Digitalis & also
[languinaria] (tinct. 2 or 3 gtts.) This article is dangerous for
children because it accumulates in the system
Lead has been recommended 
I have been doubtful with respect to its propriety in affection 
of the lungs etc.
# Pneumonia typhoides 1815 the system seeming to lose the
power of [illegible] the blood and the bloodroot was
given to promote venous absorption The digitalis
might probably be given in such cases but is not as
well adapted. I used the blood root and found
as much benefit as could or [expected] from any article


155
If the patient having the whooping cough happen to be teething
the treatment recommended for dentition should be employed
The patients are very liable to have an 
inflammation of the lungs from taking cold in any stage
of the disease & in such cases the remedies for pneumonia
should be administered, such as antimony bleeding
epispastics, bath etc.
The disease I think sometimes determines to the
head & produce a relaxation of the sinuses & 
[illegible] likewise produces a relaxation of the ventricles of the 
heart the immediate cause being the violence of the cough
In such cases I have used lead, but not in sufficient
quantities to enable me to recommend it Iodine has been
recommended 2 or 3 doses 3 times a day Nit. sil. languinaria & digitalis
When in the progress of the disease
the circulation becomes much affected the pulse frequent,
soft, flowing with occasional intermission
respiration high frequent and laborious, with a bloated
and sometimes analogous to # a livid countenance, the blood root has
done more than any other remedy not failing in any 
instance to give relief & palliate sympt & in some cases the relief has been
permanent. I gave the bloodroot repeatedly, the last
spring, 1815 to my patients in the whooping cough. To a
child a year old 5 to 10 or 20 grs of the dried root, according
to the urgency of the case, infused in 6 or 8 teaspoonful of
boiling water. Give a teaspoonful every hour, until 
vomiting is produced or the patient relieved. Children 


Sometimes the dis. will be very mild and yet leave 
the system in such a state that a slight subsequent disease
will carry off the patient e.g. in 1815 the dysentery
attacking children would often be very slight and yet
would carry off every one who had had the whoop. c.
in the spring. The attack would be mild and insignificant
of dysentery and yet the pat. would go into 
a [illegible] very speedily like cholera
Elaterium has been recommended I shd
be cautious in trying it except in very vigorous children
I can speak with confidence of arsenic. Excepting
occasionally prussic ac. I know of no remedy which 
so completely cures the wh. cough except prussic acid in 
some cases.
Case child 2 gtts night & a [illegible] in a
weak countenance pale, eyes dull face bloated muscular
strength weak muscles soft & flabby Parents
much [illegible] cough gone recovered colour & 
strength upon bark I have known several such 
cases and have known no ultimate injury result from this practice
Yet parents are afraid


156
who had the whooping cough that spring were very liable
to be carried off by the dysentery of the following summer
none died in 1815 of the disease but many in consequence
of it, with hydrocephalus and dysentery
Prussic acid dose 1/3 of a drop to begin with and arsenic
occasionally cut this disease entirely short; and these are 
the only articles which I have known do so, without leaving
a vestige of the disease behind. The former is a dangerous
article to use, from its want of uniformity and strength
Fowler’s solution of arsenic gtt more [illegible] is safe but does not answer
so well in the first stages. If it makes the patient feeble
livid bloated & with swollen lips etc. it must be stopped & perhaps
bark administered. It has cured the cough in the 
second stage. Dose 1 drop 1 or 2 drops twice a day. Sometimes is only palliates
Case. June 1815. A child of Capt. Totten’s a boy 
of 5 yrs of age rather full habit had been affected
with the cough for a fortnight before I saw him 
I found his pulse very frequent soft convulsive & with intermissions
face swollen and livid, circulation much increased on 
slight palpitative [illegible] motion of the body in the symptoms aggravated to an
alarming degree by a paroxysm of coughing. Previous t the
disease a remarkably even tempered and pleasant child he
was not on the contrary very irritable. Trifles irritated his
mind, and when irritated, all the symptoms of his disease
were aggravated. He took an emetic of ipecac, with 


The sequels of this disease are numerous
Sometimes the heart is affected as above and continues
so for years. Sometimes the glandular system
is affection. Sometimes the lungs. There is a lady in 
Philadelphia who had (under my care) suppuration of
the lungs whoop. cough now healthy hence never despair
The stomach and abd. visc. are
sometimes affected in a chronic way requiring 
dandelion mercurials hop [illegible] etc.
It is very tedious to attend children in the 
chronic stage an account of the excessive irritability
When bath recommended
Cold bath doubtful. I have known patients killed
by being brought from the country and plunged in the
sea bath
“Good speaks highly of rhus [illegible]. It is
given to produce a distinct action on the system which shall
overcome the diseased action. It determines powerfully to 
the surface and has a powerful exciting effect on the
blood vessels while it does not produce a determination
to the brain. I should not recommend this article and 
it is so uncertain in its effect. On one person it will
have no effect at all, when in another it will cause
swelling of the eyes, blindness, fever, & great irritation


157
but inconsiderable & temporary relief. He was directed
to take the bloodroot every hour, as much as the stomach
In relieved the violent symptoms
would bear. It was continued for two or three days, and the
palpitation of the heart was much abated, the circulation
was less irritated, & the livid colour of the face was gone still did not cure
When costive he was benefitted by full doses of cathartics.
because the system was [illegible] deranged heart lungs etc.
I considered the case a fatal one and expressed that opinion 
to the parents. The cough and other symptoms continued
though in a less violent degree disease chronic an epispastic was applied
to the chest very irritating (changed clothes often in the day [child] run upon various subjects)
Patients strength began to fail and tonics were given
white vitriol bark cantharides Finally the patient refused
to take any medicine and was left to his own appetite
called obstinately for it took cake for food for several days then baked pears then [illegible]
Afterwards recovered but was unable to run “for some years”
without a palpitation
If this disease should again prevail
I think I should atropa belladonna as a prophylactic.
As the disease continues the stomach
may become very much debilitation and require 
compd powd of [contragerva] cat carilla etc. etc.
“Ledus palustra are narcotic”


It is not certain that the dis. did not exist before
It may have existed before but no general account
given of it. It may have been known in diff. places by 
diff. varies and it [illegible] have been known than the 
diff names meant the same disease Diseases are not
apt to appear suddenly. Still at this period, there
[illegible] cause operating for the increase of the dis.
Belly usually large and limbs small
Joints unusually large
Often morbid cravings of appetite
Yet the same causes operating in a higher degree
produce cretinism
There is no difficulty in recognizing the disease
You will be struck at first sight with the large size of the
head the blue [veins] of the forehead paleness of countenance as you cast your eyes
down you will notice the large joints


158
Ricketts
This disease according to Underwood was first noticed
in England in the year 1628. It is said to have immediately 
succeeded the increase of manufactures, when people left the villages
to settle in large towns, where they wanted exercise and a
pure atmosphere
Children are rarely attacked with this disease
earlier than the sixth month and not usually until after
that period. The symptoms are soft flesh muscles & cell. sub. relaxed general relaxation 
of the system paleness of the countenance unless the face
is flushed with fever, which when it exists is of the hectic kind a fever of irritation
pulse, usually quick and feeble,
tumefaction of the abdomen appetite and digestion bad tendency to acidity
veins of the head [illegible] and blue the sutures of the head not firmly closed head large fontanells unusually 
open joints large in bad cases all the bones of the system enlarged & softened
One effect of the disease is that the teeth are cut later than 
usual. Ricketty children are usually precocious in 
intellect. Their mental faculties are developped more early 
but are not capable however of so much improvement, as
those of others. Evolution of the mental faculties does not
proceed with the tardy progress of the assimilating function 
The child learns to [illegible] very early and exhibits an acuteness
of intellect beyond his years with the exception however of those
cases so severe as to have a tendency to cretinism It is a common 
saying that very forward children are not likely to live long
and the precocity of scrofulous & rickety children may have contributed
much to the production of this impression.


Too much heat may produce an indirect
debility
Undoubtedly aff. the brain & nervous system
Give mercurials occasionally Do not produce salivation
and do debilitate by mercury
Frictions are very efficacious exciting the skin
The reasons why friction are not more successful is that they are not perservered 
[illegible] the al. can. etc.
The cold bath is the only strengthening remedy which 
acts suddenly
No effect can be produced by any medicine
equal to the astonishing effect of exercise & amusement in many 
cases of chronic aff. of stomach & bowel.


159
The causes of this disease as in some instances a predisposition
transmitted from debilitated parents sometimes
a syphilitic taint of the parents In others bad nursing
the children being kept wet and dirty and confined in 
close & damp apartments or if the child has been carefully 
fed and kept clean debility produced by confined air
too great warmth, too great variety of food and as some think
too much saccharine matter in its diet. Inanition may be
a cause. The disease prevails among the Alps
and is perhaps there caused by the combined influence of 
cold and moisture
This is a disease of debility nearly allied to 
scrofula & cretinism affecting the viscera of the abdomen generally, the
lymphatics and the [isseous] system. The chylopoietic viscera
are probably first and afterwards the mesenteric & lymphatic glands generally 
the indications are to give tone to the system 
and excite healthy secretions
The diet should be dry and nutritious
and such as is not only easy of digestion but rather stimulating
and the bowels kept open by cathartics which act on the
secretions. A dose of calomel with a little ipecac will 
be useful. The cold bath should be used every day Take the child out of bed in themorning bathe & return. If the
Cold bath of salt water is [illegible] tonic
patient be very feeble it should be begun with at of a temperature 
of about 80 [degrees] and gradually used colder
The child bath is equal to all other remedies It is more tonic if made of salt water 
As a substitute for exercise, frictions will be very useful
But exercise in the open air should be like whenever the
weather is good in a carriage or on horseback and exercise
should be so managed as to afford amusement and mental 



The [guephalin] [polyapt] & also the gr. marg.
(which is less odorous) are also used Their agreeable odor
if there is no other advantage will prove grateful
stimulus & promote healthy secretions
Take the child out of bed and plunge him
in water (about 70 at first) and replace him in bed
Yet in exhaustion of fever the cold bath
gives a shock from which the system will not react but
yet in the debility the cold bath is highly beneficial whether
we can explain it or not.
It may be necessary to vary the tonic And 
it is desirable to have a variety of tonics to [chorea] from 
also carb iron & tinct. carb. iron ac. fer. alkaline solut
The sulph. zinc is not inferior to iron and is not subject
to the inconveniences of iron not producing inconveniences Mosely’s sol.
The compd tinct vitr. although apparently [illegible] is yet
certain in operation and has been long used in this vicinity
A tinct. of potash is thought very useful to 
rub the body with. It is a popular remedy & has sustained
its reputation in this neighborhood for many years
Lime water made of caustic lime is more tonic
than the carbonate That made of shells is thought better being
pleasanter than that made for stores probably not as pure
but containing muriate of lime. Be careful to see that the
shells are thoroughly burnt so as to fall in powder when 


160
stimulus by the sight of scenery vegetations, flowers etrc. The patient
may even be benefitted by being carried in the arms into the garden
and amused in this manner. It must not be forgotten
that this cheerful excitement has a powerful effect on the secretions.
Feather beds should be prohibited. They are too 
enervating, and hard ones should be used in their stead.
Beds made of the sweet fern (comptonia [asph??folia]) are
popular & do very well. They not only from their hardness
check the profuse perspiration of the hectic diathesis, but correct
the acid smell of the sweat which is very common. IN general 
heat should be avoided as too relaxing
I have rarely failed of curing the disease by 
the cold bath as the principal remedy, using tonics however as
occasion may require. The tonics which we may use are sulphates 
Phosp. & mur [illegible] 3-10 grs
of zinc & of iron muriate of iron martial flowers of iron
etc. and the plan has been tried of applying finely powdered bark eternally in a 
quilted jacket of flannel. It is difficult to give bark in substance to small children. Astringents may be indicated & 
there is often a degree of acidity so great as to indicate a free use
of absorbents
The alkalies as pearlash may be beneficial internally
& frictions with pearlash & water zfs to a pint may be recommended.
Of late iodine has been given in doses of from 
2 to 4 drops of the alcoholic tincture 3 or 4 times a day, given
mucilage or other convenient vehicle. This article when persevered
in has cured a great many cases. It should be [given] at first
in small doses & the quantity be gradually increased or 
a disgust towards it may be created


Phosphate of [illegible] was popular
Forgetting that the deficiency of [osseous]
matter may be defect in the action of the secretions
Though the theory was wrong yet the practice
was found beneficial absorbents
Give a solution of the acid of about the strength
of lemonade The phosporus is preferred to the phosphoric
quenches in the water you will then have, not as is
too commonly the case merely smoky water but lime 
water of full strength These preparations are called
tonics by Good called stimulants (too loose as use of the
word) Long before I had any explanation in [illegible]
I thought I observed that these articles created a susceptibility
to the operation of tonics apparently as generating excitability


161
It has been supposed that the proximate cause of this disease
is a deficiency of phosphate of lime with bones but 
this is an effect, caused by want of action as those vessels which 
secrete this substance. The proximate cause, as it is called, is in 
this case the disease itself. In consequence of this notion 
burnt bones have been much prescribed. They are probably 
useful not as supplying the matter of bone but as an 
absorbent & perhaps as a tonic
Acids especially the phosphoric have
been given. Phosphate of lime has been used with benefit
muriate of [illegible] and barytes were
formerly much prescribed.
The worst cases are those of children
born of syphilitic parents for these tonics mercurials and 
the cold bath will also be the treatment.
I give them corr. subl. 1/30 gr with
no injurious effect


Nearly allied to ricketts and often as sequel
of it ricketts often running into it Sometimes appears
with ricketts sometimes afterward Ricketts occur with 
the year. Scrofula occurs later. Ricketts children
are more generally of a scrofulous temperament
The tendency may exist in the parents and yet
be developed only in the children from the causes of 
bad food [illegible] pain etc.
These swellings may continue
in children of 5 or 6 [illegible] or within the year with little or
no change but increasing of size in spite of poultices filling the whole neck
I have found poultices apparently injurious promoting the
relaxation but blisters would stimulate and bring on 
a suppuration. The pus will not be healthy but curdy 
and whey like The edges will be ragged, not unite
readily, and will leave a bad scar. Scrofula,
ulcers are said to be distinguished by a smooth overlapping
margin. the disease may continue for months
and years with little or no change of it does not attack
a part essential to life as the lungs, producing tubercular
consumption attacking the liver producing a peculiar
atonic infl.
I have seen cases of scrofula that were [entonic]
They were injured by tonics and benefitted by cal. and ant. They 
would have borne bleeding



162
Scrofula
This is a disease of the lymphatics and affects persons of a peculiar
temperament this temperament is characterized by a fair, thin, translucent
skin, light hair, blue eyes, sometimes black hair and eyes delicate 
fullness of lips & nostrils usually texture of skin and cellular substance general laxity of
muscular fibre usually delicate organization mental faculties 
developed early on in ricketts. Person who have been affected with ricketts
in infancy are after affected with scrofula in after life.
This peculiarity of constitution, when a morbid action 
is superadded, gives rise to the following symptoms
First small swellings appear about the neck, slow in their 
progress & with an imperfect suppuration. Small holes
form in the swelling and discharge a subpurulent,
watery and flocculent fluid. These scrofulus 
ulcers when fully formed are distinguished by smooth spongy 
and overlapping margins & by very lax granulations. The disease forms tubercles upon the lungs, liver
kidnies & ovaria & causes a great enlargement of the mesenteric
glands
This morbid condition and action may 
be transmitted from parents to children. It prevails especially in cold and variable climates exists most in 
large manufacturing towns where it is caused by bad food
and air, want of cleanliness all of them debilitating causes
It is sometimes also in persons predisposed, a sequel of other
diseases particularly of small pox, hooping cough & measles
Treatment. more may be accomplished in 
the treatment of scrofula by diet, exercise, sea air etc. than
by remedies. Scrofulous swellings should be treated by 



Avoid cold vegetables & watery diet give animal 
food articles containing nitrogen as infants are said to 
abound more in albumen and adults to be [illegible]
“Iron zinc copper silver tonics & antispas. are useful”
“Conium 2, 3, 4 grs with carb. fer. 10-20 grs”
# “I have used with advantage mur. lime 3-4 drops increased 
to a tablespoonful & also mur. [illegible] 3-30 drops given
in milk & water or in coffee. They are tonic & act on the lymph. & gland. syst.”
Articles containing [illegible]
In [anthelmint???] vesicular [illegible]
F. idealis ([illegible]) (sea cabbage) has been given for worms and
some families learn their children to cut it
A mucilage may be made F [vesiculosis]
[illegible] which with bran has constituted a popular poultice
for scrofulous tumours
When there is loss of tone & an ill conditioned discharge 
cantharides with opium is a valuable excitant
Never continue any remedy after it debilitates
by exciting disgust and nausea
Mercurial plaister of the shops (gum ammoniac 
& blue ointment equal parts) has been much used 
especially for scrof. [swell.] of the joints In these [illegible]
become extensively effective and become spongy
A man at the westward was very celebrated for 
curing scrofula. He used wild violets but was not particular
as to which species he used



163
blistering van Heuvel’s child a round of remedies had been tried [illegible]
Occasional purging with calomel and rhubarb
and ipecac in a pill will be useful
Preparation of iron, carbonate of iron with conium etc.
muriate of [illegible] 3 drops or 6 and barytes in [illegible] you give a teaspoonful iodine
scrophularia mar. [Cistus] Canadensis uva ursi
Mr Daggett Havanna Dublin Eliza Collis
Vide p. 209
Iron no prep. perhaps are better than myrrh
mixture or Jenkins’ pills (carb. per. [illegible] camph.)
“Bark & quinine”
Different preparations of [illegible] & barytes # Now
superseded by iodine. I have seen more powerful
affects produced by 4 dr. tinct. iod. persevered 
in a long “5 to 20 gtts within the year 2-3 gtts ter in die”
Various vegetable articles I think very highly 
Rock rose or Cistus Can. (Helia [illegible] [pity] it is changed)
Some years since a person went to Long Island to be cured
of scrofula to a family famous for curing scrofula returned much benefitted should his remedies
they [illegible] [illegible] & [illegible] always used than 
afterwards, when [illegible]
[illegible] from Havan. neck filled up 
cured by [illegible] had been salivated W. I. without benefit
Eliza Collis scrofulous cough much [illegible]
cured by [cistis] vide p. 209.
Scroph. maril. has been popular has been
much used by empirics I have seen it sold at a great price 
brought from the west a very common plant It has been 
celebrated for accelerating parturition probably with out foundation
The article has probably little or no power. Yet it is advantageous
to know such articles in order to [illegible] [illegible]



Two entirely different diseases but are classed
together and may be treated together
“H. externus is correctly named hydrocephalus”
“No fever ordinarily attends. The disease
consists in loss of town in the absorbents”
Of late iodine has been recommended 
[illegible] two years since I was called to a patient with 
had enormously distended [illegible] [upon] gr. cal. & 
2 drops tinct. iod. [illegible] recovered
Tinct. canth. Face pale and bloated child sleepy and [illegible]
I know one child who recovered, but at at the ages of 5 or 6 years died of H. 
internus. If the patient recovers he is more liable to the acute disease
afterwards. Puncturing the membrane has been tried with success,
and the application of bandages then supporting the 
child. It is said that puncturing of the pressure
has [illegible]



164
Hydrocephalus
Divided into two species externus and internus
In H. externus the water is formed between the membranes
of the brain (between the brain and its membranes?) In H.
internus it is in the ventricles of the brain
H. externus make its appearance at birth
and is usually born with the child. # In its ordinary form
it is fatal (It is almost always fatal when it makes its appearance
immediately after birth and always so if born 
with the child)
Stimulating and discutient applications
to the head have been recommended. Epispastics are 
said to be serviceable. (Blisters have been found serviceable
they should be kept up for a length of time) Mild mercurials
cal. or blue pill & the muriate of lime or sometimes [illegible] pressure by bandaging . If
the disease is accompanied by rickets the cold bath 
is indicated and has been found serviceable
I have known one child recover from 
this disease and other who has been mending under
medical treatment for 2 years past. I do not know whether it recovered
# H. externus appears to be nearly allied
to those watery tumours which affect the spine.
In consequence of a partial opening of the sutures of the
cranium, or the absence of a portion of one of the
bones the dura mater and scalp are protruded by the
pressure of the contained water & form a swelling on the
outside of the head. Puncturing this tumour is suddenly 
fatal (is as fatal as the same operation performed on the tumor
of the spine.


Arachnoid inflammation, arachnitis, apoplexia hydrocephalica 
(Cullen) encephalitis phrenicula of Rush
cephalitis profundu of Good We might multiply 
[illegible] but perhaps this is sufficient
The disease different in different cases
A great deal has been written and great deal
of confusion exists
“In this species of hydrocephalus the effusion 
of serum is into the ventricles of the brain. This
serous effusion is the effect of the disease and not the
disease itself & hence it may follow diseases of
various kinds. I consider the name very improper”
# “The vomiting if it cannot be ascribed to improper 
food in the stomach is an important symptom in 
the diagnosis”



165
Hydrocephalus Internus acutus
Under this unfortunate name I propose to treat of all
those cephalic diseases which are less violent in their action
than phrenitis (or are less inflammatory). I shall 
principally confine myself to the disease as it appears 
in children
“Symptoms different in different cases”
The disease commences with the following
symptoms (one form of the disease is well described by Dr
Quin) vide [illegible] vol 2 p. 315 The patient is languid inactive and drowsy 
more or less feverish at times apparently free from any 
complaint (drowsy & peevish at intervals easy and
apparently free from any complaint) The appetite is
poor and irregular (week) & (Nausea &) in many 
cases vomiting # occurs once or twice a day. The skin
“Exacerbation towards [illegible]” 
is generally hot and dry (towards evening) and if a perspiration 
occurs it is partial. Soon after these symptoms. The 
patient is troubled with a headach. The seat of the pain 
varies in different cases, sometimes it is confined to one
side of the head (Soon after these symptoms commence
the patient is affected with a sharp headach either 
in the fore part or crown) It is a common observation 
that the headache alternates with the affection of the 
stomach, the vomiting being less troublesome when the pain 
in the head is most violent. The pain occasionally 
attacks other parts of the body (& sometimes principally confined
to the back of the neck and the space between the scapulae)
At this period the patient is averse to the light, cries
much & sleeps little While asleep the patient shows 



# “The tongue is commonly clean & in this respect this
aff. differs from remittent bilious fever, in which the vomiting
& febricula are attended with a yellow fur upon the 
tongue”
One side of the face body one arm or one leg more affected or moved often is perhaps
a severe a pathogen sump. as any other. This is an
indication of paralysis I have known [illegible]
patient recover from paralysis 


166
signs of uneasiness grating grinding the teeth. starting
and screaming in sleep as if terrified. The bowels are usually 
constipated though sometimes relaxed. The pulse in this early 
stage does not indicate much danger (These symptoms 
however are subject to great variations). These symptoms
are succeeded by affections of the eyes. One eye is turned
in ward to the nose its pupil is dilated The pupil contracted in this early & dilated in the latter stages. Sometimes both
eyes at the same time are affected in this way both turned
inwards & both pupils dilated. In this stage the 
vomiting becomes more constant and the headache
more excruciating, the pulse is frequent and the breathing
quick. # If these symptoms supervene to typhus fever,
the pulse becomes more slow Exacerbations of fever
take place towards evening. There is often a flush upon 
one cheek (flushing is usually confined to one cheek)
Perspiration if it appears is usually confined to the
head and chest. A discharge of blood from the nose
at this time relieves the symptoms of fever (& removes the
flush from the cheek) for a time & any favorable symptoms. Delirium often takes
place at this time and is violent in proportion to the age 
of the patient All this time the disease is undergoing a change. As the disease advances the pulse becomes
more slow and unequal & the patient becomes 
less sensible to (the pain in the head) his sufferings 
Lethargy succeeds the disturbed sleep and restlessness
of the early part of the disease. The strabismus and
dilatation of the pupils increase & the eye loses its sensibility
Loss of vision (The patient after sleeps with one or both eyes half
closed) The patient in this stage often takes medicine & 


# “Even in this stage patients have been cured
by the strong impression on the system made by tartar em.
pushed so far as to produce colic” vide infra
Sometimes when hemiplegia takes place the 
disease puts on a chronic form
In the


167
sometimes food will sometimes however
he obstinately refuses to take any thing. The bowels for
the most part continue costive. #
To these symptoms succeed a quick small
pulse (almost imperceptible) bad symptoms in 
the last stage sure forerunners of a speedy dissolution 
(a difficulty of breathing in many cases the flushing of the
face is succeeded by extreme paleness sometimes in this 
stage petechial eruptions appear on various parts of the
body & the patient dies in convulsions or sometimes a hemiplegia
takes place two or three days before death
The disease sometimes runs through its stage in 4 or 5 days
at other times it requires as many weeks. The dilatation 
of the pupils in some cases does not take place until 
the last stages & perhaps sometimes not at all. In 
all cases the proper treatment should have been 
pursued before strabismus, blindness or coma
takes place, because very little is to be done afterwards.
A constant rolling of the head & moving one
arm and one leg are among the most important 
early symptoms which indicate a dangerous affection
of the brain)
The disease sometimes puts on the form
of an intermittent. When the disease has terminated
in effusion the case is probably always fatal.


much dissatisfaction after
existed When an ordinary fever terminated in hydrocephalus 
thinking that the phys. was mistaken at first
“I think this disease is rarely an idiopathic
affection. It supervenes upon other diseases & generally 
depends on disease of the stomach & bowels”
The disease when from ext. violence may 
exist without any [pathognomic] symptom


168
Causes external violence teething worms
Other fevers forming a crisis by effusion into the ventricles 
of the brain. Typh. fev. & dysent. in children terminate in [illegible]
I have known more than one instance in which it followed [illegible] of hip joiont
This is very rarely an idiopathic affection 
unless it may be considered so when it arises from external
violence Vide L. J Pringle on dis. of [illegible] When it does arise from external violence
it rarely puts on the same symptoms or the same appearances 
after death
All the diseases of children from infancy are
liable to terminate by hydrocephalus & hence it is important
to examine all the symptoms which may indicate
a determination to the brain & check the tendency
if possible
Case A girl 14 years of age, had symptoms
of affection of the brain from a fall upon the occiput she complained
of pain in her head for two or three months before she died 
& occasionally had regular epileptic fits [illegible] [mouth] The pain 
the head was relieved by cupping and epispastics to 
the head, but she finally died in an epileptic fit
On dissection the dura mater under the cranium, where 
the injury had been received was thickened and the vessels
were injected with blood. The ventricles contained half a
pint of water. Dropsy in the brain Yet the
pat. had no dilatation of pupils etc. The dis. put
on the appearance of epilepsy occurring once a month.


More common in some families than 
in others 


169
Causes. Hydrocephalus is a disease nearly allied to with scrofula
& like that seems to run in families. Delicate children
in whom the mental faculties are more early developed
are more subject to it. Hence the common observation 
that the child is [illegible] forward that it will not live
long I think persons of a scrofulous habit 
are more subject to this disease & that of the hip joint
When there has been no local injury to the brain, the
disease commences with affection of the bowels, or it is a 
sympathetic affection from disease of the bowels
In the progress of bowel complaints in children, the
[illegible] and the small veins become turgid. This enlargement
of the vessels seems to invite the blood to that 
part. In consequence of this child may die
with symptoms of hydrocephalus, from the turgescence
of the vessels, without any effusion into the ventricles
In typhus fever, in dysentery and in
other bowel complaints of children it is not uncommon 
for children to die with symptoms of hydrocephalus


It is a good symptom in hydro. to have a 
discharge from the [sch??der???] membrane


170
Diagnosis “In its early stage, this disease is scarcely 
to be distinguished from remitting fever When 
from the anxiety of relatives & of the physician, a
diagnosis is eagerly desired, the following circumstances
may perhaps assist in forming a judgment
If there is occasional vomiting, with febricula
the tongue at the same time remaining [illegible], there is
reason to apprehend that the primary irritation has
its seat in the brain and that it will prove a fatal
case of hydrocephalus. But if along with the fever 
and vomiting the tongue is covered with a thick
yellow fur, we may hope that the complaint is confined
to the digestive organs and that the disease is
nothing more than coler or remittent fever.”
Ed.reviewer
Diagnostic symptoms between idiopathic
arachnitis or cerebral fever, and infantile remittent
or fever from intestinal irritation choler
In cerebral fever the abdomen is
flattened, not tumefied but in intestinal fever it 
is tumefied. In idiopathic cerebral fever 
the secretions of saliva and that form the schneideran membrane are diminished. Unless complicated with aff. of muc. m. which is rare. In cerebral
fever the tip and edges of the tongue are red 
In intestinal covered with a thick fur. In cerebral
fever the pain in the head is severe and excruciating; 
in fever from intestinal irritation it is obtuse.


# the sides of the head, back of the head on 
the forehead
Perhaps a constant rolling of the head & 
movement of an arm & leg are among the most important
symptoms
Different opinion ben entertained
about the nature of the disease Some 
have been so anxious about determining the exact
nosological nature of it disease as to refrain
from prescribing until the first stage has gone
by. Prescribe for the symptoms at all events
and make up your mind about the nature of the
affection as fast as you can. Too much discrimination 
cannot be exercised & cultivated yet where 
we cannot determine the exact nature of the disease
we had better treat the existing symptoms & the obvious 
indications
# It varies in scrofulous constit. there is 
no such state It may approximate in some cases
And I might cite the opinion of 20 others
The [illegible] it is sometimes entonic & sometimes 
tonic. It more frequently [illegible] determined 
Why shd not fevers terminate in the brain as well as [illegible]


171
In intestinal fever the patient more frequently directs 
his hand to the nose & about the face in cerebral puts his hand to his head # 
In cerebral affections the head is hotter than the abdomen;
but if the disease originates from the bowels
the abdomen is the hottest. “There in a very few cases seen
picking at the nose in cerebral fever but in general the rule
holds good” “The state of the bowels is not pathognomic”
Dr Beddoes thinks the disease belongs to 
inflammations & that at an early period he should be
inclined to bleed as largely as in pneumonia #
Dr Withering observes “in a great many 
cases if not in all, congestion or slight inflammation are
the precursors of aqueous accumulation
Dr Rush thinks that instead of being 
considered an idiopathic dropsy, it should be regarded 
only as an affect of primary inflammation or congestion
of the brain
“Dr Rush says” It appears that the disease in its first
stage is the effect of causes which produce a less degree of 
that inflammation which constitutes phrenitis & that its
second stage is a less degree of that effusion which produces
serous apoplexy of the brain
Dr Darwin supposes torpor or inactivity
of the absorbent vessels of the brain to be the cause of 
H. internus
Dr Whytt in his treatise on the disease
observes that this and every kind of dropsy depends
upon the fact that more fluids are thrown out by the exhalants
than [illegible] the absorbents take up



I chiefly depend upon calomel for a cure if it cause
too much evacuation check it with opium
There is no evacuation from the brain therefore
the disease must be overcome by altering the secretions
counterirritation etc.
Bleeding with leeches from the temples
seems to translate to the surface and give relief vide
John Hunter.
Case young man apparently as
desperate a cure as ever I saw not scrofulous we
concluded to try tart. emet. gave it without
much weight in about 8 or 16 hours he complained
of violent pain ion the bowels and all the
symptoms of the head were relieved
[illegible] “Irritant to the schneiderian
membrane in the last stages are recommended
by Dr Malachi Foote of N. Y. in the Med. Rep. 
for about 1810. Turpenth min. 1 gr. with liquorice 20 grs 
[apreynum] [myrici] ipecac etc. are the best [stermentatories]” 



172
Treatment Evacuants Bleeding general & local
cathartics calomel and jalap gamboge
Counterirritation local bleeding cupping epispastics
behind the ears and to the whole surface of the head
Salivation should be induced but cal. often
relieves without altering the secretions
There has been a difference of opinion as to 
the application of epispastics to the head. If venesection 
be indicated they should not be applied until after 
bleeding. I prefer cupping and blisters to the back
of the neck and behind the ears
I think some advantage may be derived from applying
to the spine ol. orig. ol. capsc. etc.
Where considerable entonic action has existed 
I have cured this disease by giving tartar emetic until 
colic was produced. give perhaps a grain 
& continue its exhibition until the symptoms abate #
“gr doses every 2 or 3 hours”
Sneiderian membrane dry snuff
malachi root Irritants applied to the schneiderian
membrane have cured the disease in its last stages
Rx 1 part turpenth mineral & 10 parts powdered liquorice 
for a [ster??tatory]
Green tea is sometimes given



In the progress of the bowel complaints of
children the sinuses may become enlarged & a determination 
of blood [illegible] to the brain and 
produce symptoms of hydr. I have known
pat. apparently die of hyd. & yet upon dissection
no water be found in the [ventricles] in this
case some say that the water was absorbed in death 
this is entirely improbably. Certainly many of
the symptoms of hydr may be prod. by other
causes e.g. excessive doses of narcotics is stramonium
belladonna
It shd be remarked that many 
cases supposed to terminate in hydr. in cases
of [termination] in volvulus
“All the diseases of children are peculiarly 
liable to terminate in hydrocephalus. Hence
the importance of caution on the part of the 
physician. He should examine all the symptoms to check
the first beginning of determination of diseases
action to the head V.S. keep the bowels open 
blisters behind the ears cupping leeches”


173
Hydrocephalus from bowel complaints
If in the progress of any of the bowel complaints of children
morbid action should be determined to the brain, Epispastics
should be applied behind the ears and irritants to the feet
Cathartics are useful to obviate this determination. #
In some cases perhaps the determination 
[marise] from nervous irritation. In such cases the 
tepid bath gives relief “Strong green tea” Some
physicians of respectability have in formed one that they have used digitalis
in hydrocephalus with very good success. I have not used
it myself but should consider more adapted for that
form of the disease which arises from irritation, than 
any other
Hydrocephalus from disease of hip joint.
Child of Ezra Hotchkiss child of Horace Edwards.
“I have known hyd. alternate with disease of hip 
joint Case Narcotics etc. till suppuration”
Afterwards died of hydrocephalus
# I have cured a patient by giving him calomel and lemon 
juice in sufficient quantity to move the bowels. It increases the
secretions and improves the tone of the bowels


“I have seen a case in which the child
fell 8 or 10 feet upon a pavement & broke his skull
like a squash shell yet he recovered in 2 weeks and
did well. When the fracture is so extensive there is 
less danger of compression of the brain” The same case?
Hyd. from injury by a fall is not common 
in young children the sutures are not firmly 
closed (the bones are softer & more yielding)(
# He had other severe wounds as a compd
fract. of the radius yet he never suffered 
his head


174
When the disease is produced by violence
Depressions of the cranium in children
from blows or falls are not of course fatal though dangerous. A child
four months old fell head foremost upon the hearth striking
upon the vertex. The head was much flattened & the
parietal bones bulged out on each side. The child did 
not suffer much from the injury. The bowels were kept open 
by mild mercurial purgatives. In these the head assumed
very nearly its natural shape. A boy of eight years fell 
six or eight feet and struck his head against a stone
A depression of the cranium was made larger than the bowl
of a spoon. He suffered very little inconvenience from 
the injury #
There is less danger when the skull is so 
much fractured as not to cause pressure upon the brain 
If a child has received a fall we may apprehend
danger from the following circumstances. If the
fall has been upon the occiput the brain is more commonly 
injured than if the face is upon the os frontis. If the child
vomits after the fall and is very sleepy there is danger that
the brain will suffer.
Treatment If the child vomits or is
comatose after the fall upon the head and there is no
wound that bleeds the patient should lose blood and
take a dose of calomel, one or both according to the urgency
of the symptoms & the death of the patient. All the exciting causes of fever should
be avoided and the patient kept as quiet as maybe.
The symptoms should be carefully watched and if at
anytime there should appear to be a tendency to an affectation 


# for local bleeding is as important a general
bleeding
“[illegible] all causes of irritation, as light noise
heat, food. Keep the pat. perfectly quiet”
“Apply an epispastic behind the ear, or
better upon the injured part.” “Blisters are very 
useful” “Use counterirritation & the tepid bath”
# In torpor of the br. [illegible] al. can excite the latter
may excite the former and excessive action in 
the former may be translated by it act on the 
latter “Give strong cath. cal. gamboge jalap etc.”
“Afterwards give cal. in small doses as an
alterative If it causes too much evacuation check
it with opium”
“In N. Haven we have followed 
Abernethy’s plan of treating infl. of brain for 
40 years”



175
of the brain the patient ought to be bled & leeches or cupped. #
The bowels should be opened with calomel and small doses
of the same remedy frequently given as an alterative
After depletion epispastics may be applied behind the
ears and upon the part of the head where the injury 
was received. 
There is no outlet to the brain & 
consequently more evacuants are needed than in most diseases 
Frequent cathartics are useful as evacuants and 
also to translate action from the brain # 
When effusion has taken place the 
case is probably always fatal Yet I have had 
a pat. with dil. of pupils, who cont. so & paralytic
for months & finally recover
Vide p. 200


The treatment consists of local applications
A variety are used One of the best is [illegible] zii alc. zi
An equally good or a better application is seneka oil but the
smell is disagreeable. Cold water is applied but
though it relieves the pain and the insupportable itching
it is doubtful whether it is of any permanent benefit
Basilicon [illegible] [illegible]
absorbents to ulcers


176
Chilblains Pernio
This is a local affection to which children and old people
are most subject. Some are much more liable than
others. [illegible] [illegible] more liable. The parts affected are the toes heels fingers, hands
face, ears and with ladies who wear short sleeves
in winter. It is caused by exposure to extreme cold & to cold & damp air
& on the feet, more especially by walking through 
melting snow. It is most common in the early part of winter
This affection should be prevented by avoiding
an exposure of the parts to the air, by keeping the hands
warm with soft leather gloves & by keeping the feet warm 
with stockings and shoes
The skin of the part affected becomes tumefied
and hard & of a deep purple colour, there is a 
pungent pain in the part accompanied with an insupportable
itching; & these are often so great as to prevent the patient from 
sleeping. If the disease advances, the cuticle breaks and
discharges a thin fluid. Sometimes a deep ulcer is formed
The treatment for the first stage should consist
of stimulating application as if for a burn. I prefer oil of origanum
alcohol & seneca oil are good applications. Spirits of 
turpentine will ordinarily do well, though in some idiosyncrasies
it acts as a poison. Cologne water may be 
applied or alcohol two parts with one of ol. orig. #
For the ulcers you may use the oxygenated
ointment ointment of red precip. citrine oint.
# or apply a plaister Dyachylon or Noel’s 


Not being able to have any fire on board
for some days
[illegible] to pain of a neuralgic kind as [illegible] were a toothache
One of the best applications is a cataplasm of stramonium
seeds give internally opium narcotics & 
stimulants
Apply [illegible] & narcotics
Followed by no infl. to supp. etc.



177
Painful affection from cold
We sometimes meet with a painful affection of the feet 
without discoloration, or any other visible mark, which 
has been brought on by long exposure to cold without
freezing. Sailors coming upon our coast from the I. in winter, from 
a warmer climate are liable to it.  The affection may 
be a very painful one and give great uneasiness both
night and day
It is relieved by the external application 
of stramonium & epispastics or rubefacients, and fomentations
Cathartics and opium may also be given internally.
Singular effect of cold in Wm Daggett 


Burns are dangerous in proportion to their extent
[illegible] young physicians are called to prescribe for
burns it is important for them to treat them in the best manner
About 30 years ago a great controversy existed in England
between those who advocated [stimulating]
In recent cases stimulating or exciting applications are 
the best provided the burn is not very deep. About 30 years since 
spts turp. were much used. It in some case and these are 
not very rare
Case myself [water] boiled over into my shoe
I immediately poured spts tupr upon the stocking then 
took off the stocking applied a cloth dipped in spts turp. put
on a dry stock. & boot rode out of town and suffered My father
was a man of florid complex. & thin skin He was burned in n
a similar manner
Ol. orig.
Linseed oil is smooth mixed with limewater
alcohol or proof spts good when the skin is [illegible] off
Others use camphor Others stramonium in ointment contain
what [illegible] when the article s off
Carrot poultices etc. exclude the air
Cotton does well except when the cuticle is off if it is
used then you had better smear it with oil


178
Burns
This subject belongs more particularly to surgery, yet as
burns occur most frequently among children, and you may 
be suddenly called in on such an occasion, when it is important
that a remedy be speedily applied. I have thought
proper to make some remarks on the subject.
For the treatment of burns very different 
modes have been recommended. A long controversy was
carried on in one of the English journals with respect to the
phlogistic or antiphlogistic treatment, one party being in 
favour of cold applications in cold water and the other of
stimulating ones as spirits of turpentine The truth seems
to be that in adults where the injury is not extensive and
the powers of life are strong cold applications do well, but 
they are dangerous for children especially if the injury is extensive.
Burns upon the abdomen will not admit
of cold application even in adults
It is necessary that reaction take place
If there be no reaction of the system, no pain, no inflammation
the child dies. The cause of its death is the irritation of 
the nervous system, extended to the stomach, & hence
the death is preceded by cold extremities and vomiting
Where cold application are proper such
applications may be made as scraped potatoes, cloths
wrung out in cold water etc. But if it is necessary 
to produce reaction and inflammatory action stimulating
remedies must be used. And we know from 
experience that these remedies do effect a speedier cure 




Cold applications may do well if immediately
e.g. dip a burnt arm immediately into cold
water. But stim. app. are better. I have tried
both. Cold applic. very dang. in extensive burns
of children Case scarped potatoes no infl. livid
appearance of the burn extrem. cold [illegible] death
In such cases apply stim. app. & give ether, elix.
[illegible] etc. etc. In these cases the child dies of irritation
not infl. It seems to be necessary for a regular [course]
of continuity of action in infl. & suppuration
The best and mildest application as has
been proved by experience is petroleum or seneca oil
In one case I tried the experiment of applying seneca
oil upon one hand & ol. orig. upon another (both being known
alike) one hand was easy the whole night the other painful 
(the burn was a very extensive from the clothes taking fire)
In the suppurating stage use 1 part seneca oil
& 3 parts cerate
These cases are very troublesome to treat
In the above case the system was exhausted by the extensive
suppuration the bowels had to be kept open & 
large quantities of opium to be given. I gave columbo
bark and various tonics and aromatics
Turner’s cerate is a good application
chalk may be sprinkled over it
In the progress of the suppuration a pale
flabby fungus almost like a blister and is difficult to 
manage I have applied a sol. nit. sil. also nit.
sil. & laudanum [illegible] cop. sometimes after these
I have succeeded with ac. op. in ointment green basilicon
i.e. verdigris ground fine & mixed with basilicon
But if you apply only applications after these caustics 


179
The reason is that we apply to the part a stimulus
less powerful than that which produced the injury
and thus render the diminution of the excessive excitement
gradual. On this principle holding the injured part near the
fire is beneficial
Another important indication in the treatment
of burns is to exclude the irritation of the external
air Hence the popularity of some applications as cotton.
sweet oil etc.
1st Of stimulating applications. Spirits of turpentine
will answer for a robust and healthy person but not
for a slender & feeble one; and it must be remembered
that from a peculiar idiosyncracy it is a poison to some 
persons. In general spirits of turpentine is liable
to cause irritation and may be suspended by better 
articles. Being burnt myself a complete cure was effected
without the least appearance of inflammation, by this article
but in the case of my father such violent irritation was
produced as to oblige him to desist from applying it
A common remedy in this town is the oil
of the origanum majorarum called burn oil
mix ol. orig. zii with ol. oliv. zi or mix it with
alcohol or cerate. Cloths may be dipped in the diluted oil
and kept constantly applied
Of late years I have used seneca oil
and prefer it to either of the two already mentioned. In 
several cases I have tried both this and the ol orig. & 
found that the seneca oil relieved more speedily & 
with less irritation. I usually apply the seneca oil & 



the fungus [illegible] Apply rather chalk or fine alabaster
or scorched flour
The sooner you apply stim. appl. the
better ol. turp. produces [illegible] etc. seneca oil
does not
Case a woman thief etc. etc.
we rolled immediately in the snow was thrown by it into a state
of syncope life almost extinguished was burnt universally 
except on the legs covered by the stockings was wrapped
in sheets dipped in a mixture of ol. orig. & 
spirits


180
then cover the part with cotton to exclude the air. I let them
remain till suppuration takes place, particularly if the skin
is broken. When suppuration takes place, apply a poultice
to the loose dressings and then apply simple cerate
or a cerate made by melting together beeswax and lard
and stirring in seneca oil while the mixture is cooling 
This last is an admirable application for burns Dr
[Mons??] said he knew none so wild. It protects the raw 
surface from the cold air and keeps in the animal heat
In the latter stages of the cure, the oxygenated ointment will 
be a soothing application
A popular remedy is stramonium, used
in the form of a plaister of the seeds or leaves. It answers 
well and I have known no ill consequences to happen from 
its use though it is said that in extensive burns it is dangerous
Cotton is a popular application, used by itself
For slight burns it will answer but if they are so
extensive that suppuration is to take place, it should
not be applied in this way
Other remedies that are useful upon the
principle of excluding the air, are the oils as sweet oil & 
lamp oil. Linseed oil mixed with one third part lime
water, is especially recommended
When suppuration takes place and 
the cicatrices do not form well, oily application should 
be laid aside and if there is considerable discharge
apply absorbents, as plaister of paris, chalk & chalk & cerate
i.e. apply chalk first & cover with cerate.


Note from Dr Woodward of Wethersfield extracted
from Dr A. Talcotts notes “Apply immediately spts turpentine
to the inflamed parts and cerate of limewater & 
linseed oil equal parts on cotton to the vesications
2nd If pain & irritation ointment of stramonium
3d To prevent fungus Rx white lead a teaspoonful
lard 2 tablespnfl. ft. ung. Orgrate or
chalk and apply simple cerate over it.
I have seen a metastasis at the end of a week to the bowels
with diarrhoea & tumefaction or the bronchia with 
croup Treat with opium & bark Dr S. B. Woodward”
N. B. I extracted this principally on account
of the definite direction about the difficult treatment
required according on the burned part is vesicated or
not a point on which the above notes of DR Ives
do not seem to be sufficiently precise


181
Should there be a fetid discharge from the burn, it may be
remedied by pulverised charcoal. Sometimes the ulcers are 
very difficult to heal and repeatedly break out afresh
A fungus may arise upon the part if so it should be touched
with caustic. The eager of the ulcers may be touched
with sulph. copper or nit. sil. chalk then applied
and the whole covered with cerate.
If the burn is on parts liable to unite in 
healing, as between the fingers and toes, care should be
taken to prevent the union. A bad cicatrix is often
formed which it is difficult to prevent or cure.
Internal Treat When the constitution has received a severe 
shock and the extremities become cold and the powers
of life being to fail, the system must be supported by 
stimulants & cordials & the excessive irritation relieved 
by opiates. Laudanum ammonia, spirits, alcohol
ether are all good. To a child from 5 to 10 years 
old 15 drops of laudanum may be given; warm-applications
may be made & warm aromatics drinks as ginger tea & 
mint water administered. Elixir paregoric is one
of the best preparations of opium in such cases
In a case in which a large quantity of
sulphuric acid had been drunk by a boy who immediately
afterward, ran to a brook
and drank of the water. I merely give mild mucilaginous 
drinks & the patient being of a strong constitution
recovered





182
Croup from p. 138
In what may seem to be the second type of patient
may go off suddenly. If he throw his head back
in order to enlarge the chest it is a bad sign
I have found the treat. by tart. ant. so 
infallible in the first stage & in general so useful that I have not been tempted
to desert it. If I am called rather late and
find ext. ant. acting locally upon the stomach, I seldom
succeed in curing the patient.
Other emetics may be used when the excitability is worm out for [illegible]
Calomel is proper in the latter stages, [illegible]
the disease is partly broke up by antimony
If the first stage is not interrupted
[illegible] the child may be playful between the paroxysms 
and though the pulse is not affected, yet the second will 
surely come on
In the second stage bleeding is to be first 
resorted to in order to prepare for emetics bleed even to fainting
conjoining the warm bath for the same etc.
Exciting and irritability [illegible] in this 
second stage do mischief. I have seen sanguinaria do much
mischief. Even after bleeding purges is not advisable
for as has been remarked there is a constant tendency 
in the system to the return of this inflammatory symptom
Cal. may be given though if it act by 
the bowels it will be useless. I have seen bleeding and the 
vapour bath palliate the symptoms. Scarcely ever
will the patient recover



183
Croup
In the latter part of the last stage the child
throws its head back. This is a dangerous symptom.
Now the patient goes into the last or suffocating
stage. The patient lies on its back struggles
violently for breath countenance livid appears apoplectic and often goes into convulsions
and in these convulsions sometimes dies
Sometimes in this stage you may hear a
flapping of the false membrane. This is sometimes
thrown up and great relief is afforded and 
the friends think that all is over. Soon however 
in most even of those cases a membrane is formed
lower down & the patient ultimately dies
In this stage the metallic emetics
have in a few cases succeeded The sulph. 
cupri & the sulph. zinc have each
cured Cal. is recommended & may be used 
The cold both has been recommended It may be tried
as a dernier resort.
In the second stage after bleeding blisters
shd be applied over the whole neck & chest
Dr Hosack recommends bleeding from 
the back of the hand immersed in warm water
After bleeding has succeeded in 
subduing the symptoms cal. & the warm bath shd be
used


184
Croup
This disease has been divided into acute & 
chronic but without much propriety
Sometimes it continues for some time. I have
known one case which continued 3 or 4 weeks
In some seasons a different mode o f
practice is better. I have known seasons in which 
cath. & diaph. were the best treatment Although
for the first 15 years of my practice I considered nothing
more unfortunate than to find the child under the 
operation of a cathartic. In these cases, it was the
form in which the duodenum is also affected in a similar manner
Case Wallingford [emet.]
failed & cal. & diaph [illegible] Others that season 
occurred which required the same treatment
Bronchotomy has been recommended
I have seen it performed but never with success
It has sometimes succeeded But in the cases 
which I saw the membrane form lower down, and 
the patient die


186
You will see by looking into the throat
the tonsils perhaps red & the epiglottis certainly inflamed



187
Angina Laryngia
Another form of the croup has been called
angina laryngia [illegible] the croup you can see nothing
by looking into the throat In this the epiglottis & 
the [illegible] glottidis are affected From the larynx 
being affected, the actions & more spasmodic
Frequently comes on while eating
Case of my child While apparently well was taken while
eating with the peculiar croup & respiration of croup 
& became alarmed & treated
This is the form which attacks old people 
probably Geo. Wash. died of it
Case The first time I saw this disease the pat. had had pneumonia & may nearly recover when he went into the cold open air
without stockings. I was informed that he was taken
with difficult respir. & without seeing him prescribed seneka injurious ultimately refused
to swallow anything as the act brought on a spasm
I tried bleeding, blisters, vapour
& after awhile persuaded him to swallow when I gave him 4 gr. tart. ant.
in a cable spoonful of water


188
Angina Laryngea
The dis. is brought on by eating
And if you examine the throat you will see a redness
perhaps upon the tonsils, and will certainly see the
epiglottis inflamed
Bronchotomy promises more in this
form of croup
Readily distinguished for the other by 
difficult deglutition paroxysms being brought
on by an attempt to swallow
This firm 
It is not of much consequence to 
distinguish the forms except that laryngea is 
more rapid And you must avoid acrids
in this form as they irritate the fauces & produce
spasmodic action
For the spasmodic symptoms give
in the latter stages of it asafoetida which also acts upon 
the secretion tinct. ant. & opium
It must be remembered that this disease
cannot be cured by bleeding alone. It is too far out
of the circulation. But by reducing the system very 


189
Croup concluded
When croup follows other diseases it is more
rapid and dangerous they are very apt to die
particularly when following ulcerated sore throat
You may treat by emetics blisters metallic
emetics etc. but you have not so much 
strength left in the system to act upon 
In the latter stage where we wish to 
throw up the membrane the stomach may lose
its excitability to a particular emetic then you are 
to change the em. I have succeeded in throwing 
up
Upon dissection a membrane is 
found formed But sometimes it is wanting and in 
A laryngea then probably is not [time] for a 
membrane to form 
Vide p. 211
low and suspending the functions you may change the secretions 
perhaps 


190


191
Scarlet Fever
Withering in his first edition separated ulcerated sore throat
from scarlet fever. In the second he changed his opinion
Where there is much heat and fullness of the
pulse I would much prefer a strong dose of cal.
followed by antimonials [to] commencing with emetics
Or is Dr Rush & the elder DR Barton thought best turpeth
mineral
Epispastics are to be used with caution
& adopted this rule viz to apply them where there
is much tumefaction [illegible] & enlargement approaching the
quinsy. Scarlet fever after resembling quinsy and
is with difficulty distinguished except from the previous
affections of the family and neighborhood
Mineral acids have been considered
specifics Chlorine was much used in this town
in [1801] etc. as a fumigator. You may give it internally 
with advantage
A great variety of gargles are
used generally stimulating ones are better as those
of capsicum (with salt say in cider water)
In some cases capsicum does not do well
If the patient is too weak to gargle use a syringe


192
Scarlet Fever
Chlorate of potash was used with advantage
to quiet the stomach. It allayed irritation etc.
Ammonia and amm. with camphor
& gum arabic
In the progress of the disease mineral emetics, 
as sulphate zinc will be useful to excite the system 
acting speedily they do not exhaust sul. zinc 5 to 20 grs 
mosely’s solution was the form most used
Sulph. copper 2 to 5 gr. also as an emetic
Acetate of copper was formerly kept as a nostrum in 
some families ½ to 1 t. sp. of sat. sol. of common verdigris
2 to 3 gr.
In some cases and seasons cath. are
required. I have treated children without a
single cath & yet in the same family I have given ant.
followed by cal. & worked off by salts and senna
If a diarrhoea occurs early it must
be attended to white decoction



193
Scarlet Fever
Dr With. lays great [illegible] upon diuretics
particularly senega giving it throughout the 
disease. In moderate fevers diuretics eliminate morbid action will
Serpentaria may be given freely throughout 
the disease adding bark alcohol ether 
or wine Diuretics & diaphoretics
Irritable state of the stomach is to be
counteracted by irritants by aromatics white decoction
etc. etc. a little alcohol upon the fauces voiding a great
bulk of liquid
Case of a boy in delirium his father 
was forcing down articles which he was puking up 
I put into his mouth spoon dipped in brandy 20 or 30 drops his eyes opened immediately 
said it was good continued it in tspfl doses through the night
saved his life
Scarlet fever occasionally passed by insensible
gradations into quinsy and is of an inflammatory 
character. No one character will distinguish them
No one mode of practice will answer in all 
cases though if any indiscriminate mode of practice is
to be followed that by emetics and stimulants will be best
In many cases no evacuations at all are to be
used if this you must judge by the symptoms
In the same family I have lately treated one or two patients
with antimonial and nitre and another who had been
worn down by fatigue and watching with feeble pulses vomiting
coldness etc. was treated by external heat, brandy in moderate


194
Scarlet Fever
quantities, counterirritants spiced tea etc. to stop the vomiting #
(One of the best articles in fevers of a low grade
is spiced tea or hot spiced wine or brandy. The strength is apt
to give out first, and an excitement kept up in the mucous
membrane of the stomach will have a beneficial effect)
# The first patients in this family I had evacuated freely
both by vom.  & purging etc. while this patient had no evacuation 
goodness & was supported throughout the whole progress 
of the disease
After I had seen the disease in 3 or 4 epidemics
I thought I had seen the disease in all its forms but I
found oftenwards that I met with different forms still 
Not only different epidemics differ, but different cases during
the same epidemic may require widely different treatment 
In the malignant epidemic of ’94 I was informed by some
physicians that they met with cases in which there was increased 
action though the many cases of the epidemic ran rapidly in the [illegible] gangrenous
state
In 1803 we generally gave emetics
It is said that in the malignant form the eruption 
is a bad symptom. I do not think so. I think it better
for a general eruption to come out the action is less unequal than 
if a scanty or no eruption appears
I hesitated in 1803 much about the application 
of blisters & I finally found that the rule was a safe and
beneficial one to apply them where there was swelling
of the tonsils
In this epidemic I gave bark, the mineral
acids, alcohol, wine, and (for the first time) tinct. canth
Tinct. cant. [illegible] zi to pt. give 20 gtts once in 2 hours ½ as much to a child


195
In many cases [illegible] requires to be qualified & corrected
by serpentaria or carb. amm. If wine injures
the stomach and [illegible] too locally continue carb. amm.
which will render it diffusible with white vinegar
will have somewhat of an effervescing mixture Use also
effervescing mixtures, as soda water, with brandy
or ether, or aromatics tincture. It is no objection that
you thus combine stimulants and refrigerants, for you 
thus get diffusible action and obviate unequal excitement.
The min. acids may be given in form of 
punch The sugar will be grateful & useful
A diarrhoea is apt to take place in the 
commencement of the disease. Use white decoction 
laudanum & injections of starch & laudanum RX
starch 3 bal. sp. SS. 30 gtts to 2 t.sp.
Pay great attention to cleanliness of the 
patient
Where there is fainting apply ammonia and ether 
& spirits at the nostrils keep them applied to the nostrils
to prevent fainting, I have never known any injury 
done by over excitement by these articles thus applied
Capsicum is used in tropical [illegible]
in very strong decoction. Salts and vinegar has been 
much used as an antiseptic gargle?
For the diarrhoea use tonics, bark,
contrayerva has been though valuable. Avoid injuring
the stomach by distention


196
A variety of garbles (or injections by a small syringe) are
used. [illegible] rosemary has been thought a specific & carried
hundreds of miles into the country Use others when pat. is disgusted
with one # 
Sulph. cop. ac. cop. nit. sil. ([touched])
apply these with a swab
What is called the leathery inflammation 
is sometimes met with. in which the skin dies at first and
afterwards comes off & then a discharge follows. This affection
sometimes extends down the throat. In such cases
apply blisters to the sternum Touch the part with
nit. sil. in such cases. IN one of these the blister on the
sternum produced an ulcer which was 3 mo. in healing
and in another though the affection with throat was relieved
the ulcer for the blister destroyed the little patient
# [illegible] oak bark etc. pomegranate combine brandy 
aromatics etc.
It might to be remembered that in the
latter stages of ulcerated sore throat where there is an
accumulation of [many] a phagedenic ulcer, 
emetics of sulph. zinc give tone
and excite action also when
Acetate copper in the latter stages
used in an emetic as a tonic or locally
applied as a caustic
When the stomach fails in the latter
stages we give capsicum in pill or strong 
infusion (2 tab. sp. to the pt makes a strong infusion give 
to an adult a tablespoonful also acrid oils
There seems to be an erythematic infl. of the mucous


197
membrane of the stomach hence acrids are indicated to excite action
Bark jacket also it seems to 
have some effect
In the latter stages also a cath. will
frequently be beneficial an accumulation
of feces may exist given mild cath. as castor
oil or perhaps a dose of cal. an
emetic also may be needed
One thing to be guarded against
in young children is the supervention of dropsy
In 1803 I had 3 cases all the writers
considered the disease as one of weak [illegible]
action and requiring tonics bark etc. Not
successful Bark does not generally do well when there
is unequal action
I have known in such cases the brain
& nervous system apparently much affected I have
given in such cases digitalis and cantharides to
produce as new excitement and ally this irritation in 
the nervous system
Case related patient very low from a disease digitalis
was given and elaterium being advised was given
when the patient died upon the second evacuation
In general treat these cases with diuretics 
a moderate use of cath. narcotics & remedies
etc. Digitalis is the best narcotic but be cautious 
giving it to children
In ordinary cases of such dropsy 
a cath. will remove it and frictions & exercise 
in the open air. Various articles are popular as ol. [mor]


[199]
[illegible] ol. gaultheria various irritants etc. and to 
encourage the attendants to persevere in rubbing
you may suffer friction to be made with these mere
dry friction though probably just as good does
not seem to them like giving medicine
Various astringents may be 


200
Hydrocephalus
The management of the pat. is equally important with
the medication avoiding in proper diet alternatives
of temperature, and all debilitating irritating and exciting
agents all the exciting causes of disaster. Sometimes
a patient may (after a fall perhaps) continue one
two or 3 years not entirely [illegible] and yet not quite sick
and finally die of eff. of the brain
Sometimes in strumous habits canth. internally 
may be advantageous
Blisters translate action 
The applications of remedies to the 
Schneiderian has been thoroughly treated by Dr Malachi
[Foot] in the N.Y. Rep. about 20 years ago.
The subject has not bee sufficiently attended to Give in 
the way turpenth wine (mixed with liquorice) verat.
vir. apreyn. [illegible] myrica cerifera etc.
If a discharge can be excited relief is afforded
Salivation can rarely be produced in children
In some cases where there is paralysis
the acrids and some of the narcotics as strychnos
Blisters are applied by some to extreme
parts of the body I sometimes change the place of
the blister to the back of the neck etc. But the back of 



201
ears is more efficacious. It seems to have a grater
affect upon the constitution to excite a discharge from 
this part
If the symptoms indicate bleeding
bleed leech also. If there is much infl. about the
mouth scarify the gums as a depleting measure
“In grade of action the fever of hydroceph
may vary from high entonic inflammation or phrenitis
to low strumous fever. If the action is too high or too
low counterirritation will fall in with the morbid
action We must first bring it to the “blistering point” 
(Rush)
“Blisters to the head are thought by some to be 
dangerous and the ears or neck preferred”
“In irritable cases and scrofulous habits, strong
cathartics are hurtful. Give blue pill especially when 
the bowels are primarily affected. But in entonic
phrenetic fever, use the drastic cath. & tart. ant.
ut supra after depletion”
“Scrophulous predisposed mesenteria
glands generally affected the fever analogous to hectic
never entonic pulse soft, frequent, quick I have
tinct. cantharides with advantage in this variety”




[204]
Volvulus continued from p. 89:a:1/2
“Cases I was called to a child 2 years old which 
had symptoms of irritation and was obstinately constipated
It had been carried on the belly upon the shoulders
of another person Gave a cathartic Ordered an
injection but the attendant said it would not [illegible]
The cathartic was thrown up patient died
Upon examination after death no color could be
found. In the upper [illegible] rectum there was a tumor
which seemed of solid flesh as large as the doubled fist
inflamed. The color had been completely removed from 
its place”
“I was called to another family 
where the children had died when 5 or 6 months old as was supposed
of an affection of the brain. This child appeared well when born
but was very costive etc. Upon p.m. [illegible] 2 inches of the
small intestine were found contracted
to the size of a goose quill the coats were thickened & 
the course the cavity must have been extremely small This
contraction undoubtedly existed at birth. This contracted
part was received into the part below it, and no
[illegible] could have availed”
from p. 99 ½ “In another family they 
had lost all their children at about such an age. They 
supposed the disease to be hydrocephalus. The older physicians
called it so. I told them I could not tell what 
the disease was but it was not hydrocephalus I had
then seen no case of volvulus. There were strong 


205
marks of irritation the face was pale and much distress
was depicted with countenance the head was rolled
back and hands tossed violently. There was vomiting and
tenesmus and a discharge of mucus streaked with blood
Cathartics had been given under the impression that the disease 
was an affection of the head The cathartics aggravated the
disease which ran a rapid course and the child
died. The small intestine was found received into itself
and its cavity obliterated. This obliteration of the cavity
would not of itself cause death; for a patient may 
continue several days with perfect torpor of the bowel.
It is the irritation as in cholera morbus which is the
immediate cause of death which [illegible] death usually 
occurs within 24 or 36 hours”
“Called to a child one year old
constant vomiting stool, mucus streaked with blood
Directed mucilaginous injections & fomentations combined with opium
Gave opium freely internally 10-15 minims to allay 
vomiting. The symptoms subsided gradually & in 
3 or 4 days the feces passed off without any cathartic”
“Was called to an Academical student
had given cathartics and they did no good. Called
in older physicians. They were in doubt respecting the
case and advised not to do any thing as we might do
hurt. As I was sitting by his side I heard a motion 
in his bowels. I noticed that it passed down to a certain 
point and then stopped. Upon examination I could 
distinctly feel the involution. I tried injections and 
some [illegible] of them would stay. Ordered a spermacetic
candle with opium upon its extremity to be passed up 
the rectum and allowed to remain. It was s


206
passed in to the length of 10 inches. The opium allayed irritation
and the application by repetition replaced the part & the 
patient recovered another case cured
by a bougie”
“Opium by taking off the spasm and
restoring the natural function of the bowels may be
said to act as a cathartic just as in spasmodic
colic”
From p. 56 “I have given when I 
could obtain it, the [resin] of Mandrake podophyllum peltatum It operates
kindly, and more certainly than any other article. If
the western gentlemen who have so much mandrake
and whiskey, would furnish a supply. I think it [will]
supersede every other article”
“If there is torpor & a stuffing or infarction 
of the bowels we must use injections to assist
cathartics repeating them every 2 or 3 hours. If other
cathartics do not operate give castor oil which will 
promote their operation”
“The particular kind of injection 
is not important and may be left to parents
Thoroughwort, camomile, mayweed 
catnip, dandelion, weak soap suds salt
& water a tablespoonful to ½ pint water


207
Continued from p. 57 “The stools resemble
meconium. In the progress of the disease they exhibit
small pieces of a membrane of a dark green colours,
about the size of the petals of peach blossoms 
floating in a dark green fluid. The membrane of 
coagulable lymph, resembles that formed in angina
trachealis and sometimes as in that disease
it is formed in such quantities as to cause obstructions 
Still in this case it may not destroy life
the action of this part not being so immediately
essential to life. Stools of this kind sometimes
attend the bilious colic of adults. They are an
indication that farther evacuation is needed
Continue the 
calomel or combine it with magnesia or soluble
tartar, or phosphate of soda or other neutral salts


208
Infantile remittent continued from p. 60
“Cases A child had violent fever gave calomel & cathartics
warm bath symptoms abated. In 2 or 3 weeks the
regular symptoms of hydrocephalus appeared; & the patient
seised in the greatest danger. In a short time these
symptoms were relieved by a violent and dangerous
attack of thrush The patient was very much exhausted
lay several days very low gradually emerged and 
after a long course recovered.
“Case of a small little boy
5 or 6 years of age After 5 or 6 days head affected
& became maniacal very irritable and cross swore
profanely would bite and strike all who came 
near him. If any thing was attempted to be administered
he would shut his mouth. If his mouth was pried
open he would close his throat with his tongue Advised 
his parents not to trouble him nor notice him to pass by 
him with drink roasted apples etc. but not to offer
him any thing. The first day to he took nothing second
day took roasted apples etc. readily but ate too 
much mania returned, but soon went off & 
patient recovered” 
“In one case the pat. took 
nothing for a length of time. Recovered by use of 
[even ato] & external applications as aloetic plaisters
to the bowels etc.”



Scrofula continued from p. 163.
“Scrofulous swellings are very difficult to excite
to suppuration I have however then poulticed without
effect for 2 or 4 months Of late I have disused poultices
& have applied blisters as soon as may be to excite invigorate the
absorbents and act as discutients. They do not disturb the
system. If there is suppuration the relaxed state
requires stimulating applications lunar caustic vegetable
astringents etc.”
“Case of a young act 18 with bad cough
swelled neck scrofulous temperament Gave laxatives
blue pill afterwards rub & spec. Then gave decoction 
of [cistus] [canadensis] for several weeks and pat. recovered
“ A physician (Smith) on Long Island (from an
old recipe) has acquired reputation by the use of cistus
canadensis combined with uva ursi at the same time
enjoining a strict & spare diet as in dyspepsia”
“I have given with cist. canat. 1/8 gr. corr.
sub. & also decoct. scroph. maril. which is thought 
by the vulgar to be a specific It has been sold as a nostrum
to facilitate parturition called nerve root.) I
think it useful in scrofula”
“I have known the comptonia [illegible] folia
given internally. It is tonic & has balsamic rpoperties”



“The remedies particularly indicated are tonics & 
deobstruents such as will not produce congestion 
such as uva ursi cistus scrophuloria contrayerva 
agrimonia (entire plant or root angostura etc.”
Sea bathing is recommended, but if the
lungs are affected, it will not be advantageous. A 
sea voyage to the eastward has been of service the constant
motion of the vessel stimulating all the vital organs
to healthy action The change of air is beneficial & at a
distance from the shore there is no danger of taking cold
In chronic complaints attended with a want of vital
energy I direct a voyage to the east rather than to the
south



Croup continued from p. 189
“Vapour bath Inhalation of warm water in 
a [pour] blow a current of air through hot water upon the pate & 
by means of a coffee pot with two spouts”
“Tobacco or snuff applied to the patient”
“Croup is an epidemic disease & of course it will vary 
at the different periods of its appearance We must take
into account the prevailing diathesis I have described the
disease as it has usually occurred in my practice”
“The proxim. cause of the dis. is a
peculiar morbid action translated to the traches for
the disease arises from general causes acting on the system. 
In catarrh diseased action is seated primarily 
with mucous membrane.
The exciting causes of croup act on 
the surface and with different diathesis the same
crises might produce pneumonia, dysentery enteritis
or cephalitis “Disease determines to the weaker part
as the rod attracts lightning” Rush Water & snow
cold damp air a [illegible] & low situation sudden 
changes as when the wind blows from Canada or the
gulf stream are the exciting causes



“In the treatment sanguinaria, if given early in strong
decoction very freely, so that enough of it shall be
given & still it vomits or relieves the symptoms, in very 
efficient practice adopted by Drs Jared Potter & 
Kirtland
“But if inflammation has taken place
& the second stage has arrived seneca and sanguinaria
are both too stimulating and I have seen them do hurt
sanguinaria is less stimulating than seneka
For p. 137 “Some authors state that the 
disease is entirely inflammatory not regarding
the forming stage. If the forming stage is wanting
we must rely solely on the antiphlogistic treatment”
“This disease has a direct tender eye to death 
The physician must take it out of the hands of nature”
“When croup supervenes upon catarrh as it
frequently does of late year the mucous secretion and expectoration
usually cease suddenly
“When croup follows diseases that prostrate
the system powerfully as angina maligna, there 
is little chance for recovery. The sympathies of the
system are broken down and Archimedes can find
no fulcrum for his lever”



“I used tart. ant. at the commencement of 
my practice and succeeded with it as well as I
could wish I therefore contained it, but only in
the early stages & to produce a powerful orgasm. If it
acts upon the stomach only it aggravates the disease
Other practitioners rely upon different
articles & probably with equal success bearing in 
mind however that a powerful impression must be
made Decoct. sang. to prostration & vomiting
seneca or lobelia inflam with the same view”
“Sulph. copper & zinc & acetate
copper useful to assist in the latter stages or when 
other emetics are worn our. So also hives syrup 
which is much used at the south.”
“For six or 8 years past croup has been 
occasionally different from the pure inflammatory.
It affects the lungs and duodenum& calomel and cathartics
are the remedies to overcome this form. The cough is more
frequent and loose the paroxysms less distinct there
is pain in the epigastrium vomiting & a membrane
is formed in the duodenum which passes off.
I have called it angina duodenitis.
The same year ulcerated sore throat came on with it
the slough leathery & like a burn it seems to 
be intermediate between A. tonsillaris & A. maligna


The application of lunar caustic by a pencil or brush would
prevent croup Blisters to the throat & chin were
useful yet a blister would produce the same action as
existed in the throat, forming an ulcer very difficult 
to heal Slough ¼ in. deep 3 mo. in healing. In 
one case the blister cured the croup and the ulcer
killed the patient It is desirable to translate
action to parts less essential to life. Cal. & carth.
would translate it to the duodenum Emetics & 
powerful treatment do hurt here. The vapour
bark is good.
“Croup sometimes recurs several nights in 
succession A. Laryngea is more apt to do so”
“When crop assumes a chronic form
emetics irritate inhalation of vapour blisters
opium diaphoretics & expectorants”
“In chronic croup the inflammation 
in erythematic and not membranific. The 
vapour bark often does wonders Tartrate of 
sanguinaria in ¼ gr. doses Tinct. hyoscyamus
gtts x
N.B. Dr Woodwd treat of subacute ([S?bertonic]) & typhoid croup the latter contraindicating
tart. em. & requiring sanguin. turp. mer. calom. etc. & sometimes
capsicum, ammonia & even perhaps wine & alcohol.




“One of the most extraordinary examples
on record however of the effect of disease in 
developing of perceiving a certain class of relations
is that of [Zerab] Colburn His history 
is well known When quite a child in his sixth
year, without any previous instruction, he
could by mere intuition perceive the relations 
of numbers with so much readiness and
precision, as to solve almost without reflection
questions in arithmetic which would
require a long calculation to enable others 
to answer. How he obtained this result
he could not tell. The answer seemed to 
present itself to his mind with the same
readiness and conviction of its truth, that
the proposition tow and two make four
does to us. These facts I saw are well
known, but it is not so well known, that
this power was the effect of disease. That
such was the case I have very little doubt
This was the opinion of a very distinguished
physician who saw him at the time, and
who ascertained that he was then affected with 
a peculiar nervous disease the same
(chorea) which Jane had a few years 
since. In conversing with Mr Colburn 


about a year ago I asked him if he
retained the power of calculation which 
he possessed in his childhood. He said
no, and attributed the loss to the want
of its exercise. But why should exercise
sustain a faculty in existence which 
was spontaneously developed?”
“Account of Jane C. Rider the
Springfield somnambulist; by S 
W Belden MD. Springfield 1834”
p. 108
“The discovery of Zerah’s power 
of calculation was purely accidental 
Zerah not having yet completed his 
sixth year was overheard by his father, as
he repeated to himself in his play, parts
of the multiplication table. The father
surprised proceeded to examine him & 
[found] etc.


























































1 Diseases of children




[B illegible 31]
Proposed plan
name – history symptoms & causes
[Regar] plan of treatment minutely described
Other modes of treatment
Miscellaneous remedies
N.B. Collect all his remarks on 
art of practising medicine


Contents page
Introduction
Tumour of the head from difficult parturition 5
Cutting the frenum linguae 5
Congenital hydrocele 5
Management of children – as to 
Particular appetites – Preventive medicine 5
General nature of the diseases of children 6
General operation of remedies in children
Diseases within the month
Retention of the meconium 8
Jaundice 11
Acidity, Flatulence, Hiccough etc. 12
mothers milk & cows milk 12
Costiveness & its consequences 12:a
Vomiting 12:d
Diarrhoea 12:f
Prolapsus ani 12:l.
Aphthae 13
Eruptions in general 19
Strophilus interlinctus or Red gum 19
Strophilus candidus 21
Crusta Sactea 22



Eruptions of Dentition 24
Eruption resembling the itch 24
Venereal Eruptions 25
Infantile Erysipelas (Rose rash) 27
Sore ears (Intertrigo) 30
Tinea capitis 
[???phlicus]- [illegible] [illegible] on [illegible] [1821-2] 32
Dentition 34
Cholera Infantum 40
Infantile Remittent 55
Mesenteric Fever 61
Tympanitis 66
Worms 69
Volvulus 86
Nervous Rheumatism Infantile [remedy] 89:a.
Convulsions 90
Epilepsy 96
Catalepsy 99
Chorea 100
Ulcerated mouth 103:a.
Gangrene of the mouth 104
Parotitis or mumps 112
Tonsillitis or Quinsy 115
Rosalia or Scarlet fever 120


Croup or Bronchitis 132
Laryngitis 139
Epidemic catarrh resembling croup 141
Whooping cough or Pertussis 144
Rickets 158
Scrofula 162
Mesenteric fever
Hydrocephalus 164
Chilblains 176
Painful aff. from cold without
discoloration 177
Burns 177
The cause either is to be found in [???uctural] [illegible] for the 
[illegible] This will [illegible] men to trust their lives to 
unknown men, or to fictitious names in the newspapers, where
they would not trust property even to a small amount
# Formerly prescription of an experienced physician
very often set aside for that of the nurse or a 
negro woman


1
Diseases of children
1  In this part of our course I direct your attention 
to the history of man in relation to his habits, diseases, & their
remedies in his infant state
That this subject has occupied the attention of the 
learned less than any other branch of the medical
profession, is universally acknowledged
2 – It is unnecessary for me to enforce
the importance of the subject, by any remarks which 
might be made concerning the evil to society from 
a neglect of a part of the practice in which the community 
is so deeply interested
3 – I need but advert to the evils which must
result from the practice of committing the
management of the diseases of infants to a class in society
which is the lowest in point of intelligence
6* [the opinion of the nurse is sometimes taken 
in opposition to that of the physician – On this subject
the world seems to desert its principles of reasoning
on other subjects. If a point of law is to be decided men 
will not trust to a petty of the court, in 
preference to that of an experienced
If a text of scripture is to be explained, men 
apply to a learned divine in preference to the mere
servant of the church & on the subject of wearing apparel
it prefers the opinion of the master to that of the 
apprentice.]



4 – That this subject has occupied the attention of
the learned less than any other branch of our profession 
is universally acknowledged. (The French & Germans
however, have neglected it less than the English;
and the American physicians have been in the 
habit of paying more attention to diseases of children
than the Europeans)
8 Great attention has been paid to diseases of children
within the last 30 or 40 years
It has been most neglected in Europe, but less by 
the French & Germans than by the English
17 European practice differs from ours – but less so 
at present than formerly because the constitution 
of our countrymen are coming to resemble those
of Europeans
12 It is also the case that European diseases differ from ours on account 
Disease, here is [illegible] more violent owing probably to the greater
of climate etc. Angina [Trachealis] is much 
milder with them & requires much milder treatment
# vicissitudes of the weather



2
5 - The causes which have excluded physicians
from the treatment of [infantile] diseases infants, having ceased to exist
the subject is now receiving the attention which its
importance demands
6 – These causes may be enumerated in few
words – viz. the exclusion of the faculty from the
practice of midwifery – from the difficulty of
obtaining correct ideas upon the subject from its
obscurity – the prejudices of the public on this subject – 
attributing as they do intuitive skill to nurses 
and matrons * vid. page [illegible] & perhaps also the indifference
of the profession
7 – At the present period, however, the enlightened
physician watches the mother during the
whole period of gestation, receives the child upon its 
first introduction to the light, & prescribes for its
diseases from infancy to old age
9 – As knowledge however must on this subject, as
on every other, be progressive, it follows that this
part of the profession having but recently received 
the attention of physicians, has not attained
the perfection of the other branches
10 – American physicians need American treatises on this as on other medical subjectds
13 – European practice, as exhibited in 
their works, is too slow and mild to meet and
overcome the morbid excitement of acute diseases in 
our climate. [Chronic diseases may be treated 



They practice no deceit


3
with mild remedies, but acute diseases are made
worse by remedies if those remedies are not sufficient
to overcome the disease The action 
of the remedy falls in with the diseased action
and aggravates all the symptoms if it is not 
powerful enough to overcome the diseased action
IN such cases disease is to be taken out of the 
hands of nature. The powerful [enemy] is not to
be irritated unless there is a prospect of overcoming 
him]
14 – The difficulty of acquiring a knowledge
of the seat of the diseases of children, on account 
of their being unable to communicate their
sensations by language, has been made an excuse
by some physicians for neglecting the
subject of infantile diseases We may 
remark however that the difficulty of attaining a correct 
knowledge of a subject, cannot be given
as a reason why it should not be committed to 
men of intellect & science
15 – Though children cannot communicate their
sensations by language, yet the other symptoms by 
which we determine the seat of their diseases are more uniform
in their appearance & more certain in their indications than 
those of adults
16 Children are under no restraint from feeling
fear, [delicacy] or from false modesty In the infant, the 


mind does not react upon the stomach & destroy 
its function 
When Dr Harris published his essay on the
acute diseases of children Sydenham said to him
“you are the first man I ever envied and it is
my firm belief that your little book will be more
useful to mankind than 
# Adult patients also will often deny the existence of
dangerous symptoms; for fear they shall be considered as
very sick
The subject has not yet been thoroughly 
investigated. No regular course on it has been [illegible] until 
quite recently in [illegible] of the European schools. I recollect
the embarrassment under which I laboured under
at the commencement of my practice Cases frequently 
occurred which were not described in any of the books [&]
I was obliged to acquire all my knowledge on the subject from 
older physicians or from experience. My students have often
expressed to me the satisfaction they experience from an examination 
of my notes and they have often quieted the anxieties
of parents by reading extracts from them
# In my embarrassment upon being first called to a sick child
though familiar with the treatment of adults & having attended the first schools in the country I found my information 
& in books as to [illegible] nature or treatment and was
obliged to have recourse to the older physicians
29 [Dewers] is popular addressed to mothers, very prolix
& not intended for a text book but perhaps able [work] & is the
30 [illegible]
# Parents think a young physician will do well enough for a young 
children and are much more apt to call one in for such patients


4
mind does not react upon the stomach & destroy
its function We are at no loss how much to attribute to disease & how much to [illegible] #
17 – Still with all these advantages & notwithstanding the importance of the subject
it has been neglected & has received less attention than any other branch
18 – When Dr Harris published his essay on the 
acute diseases of children Sydenham said to him, you 
are the first man I ever envied, and it is my firm belief
that your little book will be more useful to mankind
all I have written” This opinion was not founded
upon the merits of the book but upon the fact that the attention 
of physicians would be drawn to this part of their
profession, not the least useful though the most neglected
25 Authors on this subject & their merits
26 Underwood 
Still the department has received less attention than
any other branches of our profession
27 Dr Rush in his works, has many remarks
28 Periodicals contain more or less upon the subject
21 – No courses in any of the schools
19 – Some physicians of the first respectability have acknowledged
their ignorance & given up to nurses
20 – I recollect the embarrassment I suffered upon 
this subject # It is a common complaint
22 Since I have lectured upon this subject, our students
at parting have expressed their satisfaction.
23 Young physicians are first called to children
because the older ones neglect them # hence its importance to them
24 Parents however seem, as a matter of fact, to prefer
a young physician, for a young patient! #



34 – I shall first remark upon a few surgical cases 
which occur to the young physician soon after the birth 
of the child
[illegible] cutting the frenum. I have never seen a case in which this operation 
was necessary. It is very common for nurses to insist that 
children are tongue tied. Dr [Eneas Munser] was called in such 
circumstances he remonstrated the nurse was instant until 
finally he drew the back of a knife across the frenum & the child
he told [illegible] [illegible] hurting and this with this [result]
was relieved to the great satisfaction of the nurse. If there is
a false frenum it may be divided.” this [illegible] [frenum] is never 
so short as to confine the tongue & cutting it is a dangerous operation
# They will tell you that this particular appetite is indicated
by the natural crying of the child
The mother will set herself to recollect some former
longing of her own
[illegible] 6 Hydrocele
Young physicians are often called on to prescribe for congenital 
hydrocele in young children The complaint is apt to excite alarm but
neither troublesome nor dangerous. It is readily distinguished from [illegible]
by its transparency, insensibility, & not yielding to pressure. In the course 
of my practice I have had to operate in but one case in children. Dr [Dewers] recommends
pouring considerable quantities of cold water on the part. I myself
have frequently cured it by washing the part with cold water in the morning
and applying camphorated spts in the course of the day. You [illegible]
direct the application of spirt & water, camphorated spirits, [muria??]
of ammonia, [opium], spirits of nitre, in short every discutient
Or you may direct astringent lotion, as a strong decoction of
maple bark, spriaea Fomentosa Geranum, Rhei etc.
Case in which I had to operate year old  probably neglected 2 or 3 inches long 
about as large as a small egg. Operate without a cannula  - with a lancet & catheter
& injecting syringe – water 1/6 or 1/8 port wine – children more irritable - vomiting



5
Tumor on the head
35 Children are sometimes born with a tumour
on the head occasioned by difficult labour
This may be distinguished from a tumor caused by 
a deficiency in the bones of the cranium, by a uniform 
hardness. “We may apply mur. amm. or spt & water”
36 – Cutting the Frenum
37. Hydrocele
31 Management
Appetites 32 A prejudice prevails in some classes of society 
with respect to a point in the management of children
Some children are thought to be born with a strong
appetite for some particular kind of food, which 
was possessed by the mother previous to the birth of the
child & inherited from her. It is thought that the child will [pine] & ultimately 
die, if this [illegible] appetite be not gratified #
It is probable that a belief in this doctrine has caused
many children to be killed by the administration 
of improper food A fact of this kind occurred
in Humphreysville, which nearly proved fatal to 
the child. Vide next page
Preventive
medicine 33 As a general rule medicine is not to 
be given to children in health for fear they should be 
sick. Some are nursed to death, while some die for want
of nursing. Some are fed to death while others are starved
Some are physicked to death while others die for
want of medication
injection immediately with [draw] healed [illegible] with swelling


The child cried much # - a council of females was
called who set themselves to make out what the
child needed Finally the 
mince pie was concluded to be
the article the child sucked down the inside & the 
report was that this effected a cure & saved the life of
the infant. Prof. I inquired of the attending physician who 
informed him that the child was indeed alive and well at
present but that it was made very 8ll by the mince pie
& came near losing its life. The crying of the child in 
this case was probably nothing more than a trifling increase
of the ordinary crying of very young infants, which 
is a natural and wholesome exercise # 
The al. can is large in proportion to the [illegible] of the whole 
system
# The above is a good example of the various prejudices
which have prevailed among [nurses] respecting the management
of children. Owing to the influence of enlightened physicians 
these are no disappearing. (examples to be given)


6
38 – Diseases requiring medical treatment
General considerations
39 – In investigating the causes and seat of the
diseases in infants the mucous membranes claim
particular attention
40 The action of this membrane is greater in 
the infant than in the adult constitution
Its secretions are often morbidly increased & are sometimes
diminished. It is subject to spasmodic action 
and to inflammation [illegible] with [illegible] or decomposed with effusion of 
coagulable lymph. “It is subject to turpidity & to
spasmodic action which by sympathy extend to the whole system 
41 The liver is much larger in proportion to the body the infants than in adults “& its secretions are much of [illegible] as to quality & quantity than in adults”
42 The secretions are much concerned in 
their diseases. They are changed as to quantity 
and quality
# Prescott child no ducts lived 3 or 4 
months and was excessively emaciated – there was no bile
in the stools There was no [previous] duct for the gall bladder
into the disorder



# There is greater susceptibility to action & tendency
to conversion
# Just as emetics are given to a stomach [complaint]
from excessive quantity of food


7
42 The nervous system of infants is more easily excited,
and more affected by the various causes of irritation
such as dentition worms acrid substances in the 
first primae via passages etc.
43 – The blood vessels are more rarely the seat o f
disease in infants than in adults – particularly, primarily 
so much as irritative
[acid] if they were affected the action is not [illegible]
44 – Consequently their fevers are fevers of irritation, rarely 
enteric or those of inflammation 
45 Operation of medicines
Children bear evacuation better than adults
witness the long continued diarrhoea without much 
debility following, or the salivation for mouths during 
dentition without a waste of vital energy
In operating upon the abdominal viscera it should be [illegible] it is
not for the purpose of mere evacuation, it is to produce
an excitement for the purpose of overcoming a morbid
excitement also to produce healthy excitement a case of 
torpor # The milder purgatives should be used, the
drastic being irritative.
Emetics
Bleeding
Do not bear narcotics vide p. 11


2 – In general the evacuation of the meconium should be
effected by the [colostrium] or first milk of the mother
which has a laxative property # The child should be
put to the breast within 2 or 3 hours from birth # unless [illegible]
Instead of suffering the nurse to feed the child for the
first 2 or 3 days the breast should soon be presented
for if the child feeds it is in danger of losing the 
instinct to suck If the [colostrium] does not bring
away the meconium we may begin with soda as
mentioned below or with cold sweetened water 
Some give a little cold water at first vide [infra]
5 – In strong children cold bathing may be employed
with advantage, but the bath should be made
tepid for weak ones & gradually used colder as the 
child can bear it
# “If from the exhaustion of parturition the mother be unable
to suckle let the nurse commence feeding at the end of 3 hours” vide infra
Give a grain of carborate of soda in a teaspoonful
of water until iii qts [have] given
# The meconium is frequently evacuated during parturition.
After birth also the al. canal is set in notion by the crying
and mother of the child and the stimulus of the
air upon it vide p. 10 skin. # Colostrium is of a yellowish colour
probably contains bile & is cathartic
# It was formerly supposed that the child
should not suck at first. The consequence often was
that the child lost the interest to suck



8
Retention of Meconium
1 – The first diseases of infants which claim the attention 
of the physician are those which arise from retention of the 
meconium. The meconium is a matter always existing
in the bowels at birth & having a dark green colour
when evacuated. It resembles tea but is more mucilaginous # 
It will ordinarily be sufficient to give a little molasses 
and water to the child until it receives the [illegible] or first
milk from the mother which has a laxative quality 
6 – If it is suffered to remain a train of diseases may 
follow. In the diseases which occur within the 
first moth after birth the retention of the meconium 
is always to be suspected as the cause
7 – The diseases caused by retention of the meconium 
are Severe paroxysms of pain in the bowels
indicated by crying & writhing – Tumefaction of the
bowels. Convulsions. Epileptic fits. Trismus
nascertium or Locked Jaw This last disease is
very common in some of the West Indian islands, but
I have never seen it in this place
8 – Whatever disease may arise from 
retention of the meconium the principal indication 
will be to remove the irritation by evacuating the 
bowels. This is effected by cathartics. A teaspoonful
of castor oil is generally sufficient. If [illegible] necessary


1st indic to remove meconium
2nd obviate effects
# IT will be sufficient to pour on boiling water instead of boiling
the materials in the water The strength however is of little consequence
Sometimes the most powerful remedies are to 
be used beginning with mild. These used
full doses of calomel, scammony 2 to 4 yrs – [illegible]
assisted by injection, & warm bath until the bowels
were moved Wait how long for the operation of each?
# By emollient injection, irritation is allayed, and if the
lower part of the bowels is excited the rest will be
Dose 2 to 6 pills each pill containing 1 gr. of 
(calomel)
# Chalk & calomel is a substitute for blue pill – perhaps
the chalk qualifies the cal & at least it
corrects acidity
Antimony should scarcely ever given to children
within the mouth
# A great part of the calomel has no effect
[illegible] it does not come in contact with the coats 
covered with mucus In cases where there was great
quantities of [mucus] I have given full doses of cal.


9
the dose may be repeated every 4th or 5 hours 
until half an ounce has been given
8 – If the oil is rejected from the stomach Senna & Manna 
may be given – zi of the former to zss of the latter
boiled in gill of water # & administered freely until 
the bowels are moved once in ¼ or ½ hour
“ Rx Sennae zi [illegible] ferv. 1 gill 1 or 2 teaspf every ½ hour”
9 – The operation of the cathartic
should be assisted by emollient injection #
10 – Fomentations to the bowels will assist the 
operation of cathartics & if spasms exist, will always
be needed for their relief
11 Cathartics of various kinds
12 The best cathartic which I have used
for infants within the first month after birth is the blue
pill (or [mellated] pill It rarely offends the stomach
and never produces griping By it the action of the 
liver & the secretions from the mucous membrane
of the intestines are excited more than by any other
cathartic except perhaps calomel. In my 
practice I have never known an infant salivated
by it. # 
13 In severe cases where the blue
pill is insufficient we must have recourse to 
calomel, which may be given in doses of from two 
to 10 grains. It is often necessary to give as large 
doses of calomel to children as to adults owing to the 
great quantity of mucus in the intestines by which 
they are defended from its action. # The meconium 


scammony or jalap as a laxative & had them
operate mildly If the cots were [naked] [illegible]
a dose would prove fatal for irritation
# This is a mild cathartic and supposed to act chemically.
# “Evaporate the [illegible] over the fire stirring it until 
thick then add chalk till it is of a consistence suitable
for pilling Each pill may contain 1 or 2 gr. of
Dose from 2 to 5 gr. Or it may be dissolved in herb
Fish, gall has been recommended [illegible] gall 
Rattlesnake has been thought to have specific
properties especially in fevers. This article
is bitter, tonic [illegible], laxative, & [illegible]
Continued from page 8
“The infant may be put to the
breast in one or tow hours from birth This course will 
produce permanent contraction of the [uterus] & tend to stop [hemorrhage]
& prevent milk fever” When an infant is first
born it is well to wet its mouth with half a teaspoonful
of coldwater and give it nothing else until it is applied
to the breat


10
while retained will likewise prevent the operation 
of the remedy by involving it in its viscid substance
14 Chalk & calomel may be used in doses
of 1 gr. cal. to 4 or 5 chalk repeated once in 2 or 3 
hours
15 Other cathartics which may be used are
or as recommended by Dewers
1 gr. carb. sod. to a teaspoonful of water repeated every 
“it operates”
15 minutes until 10 gr have been given. # Decoction 
of the flowers of the dandelion & the mullein 
Senna 2 dr. to with 4 dr. of aromatic herbs or seeds 
The bile of animals (ox gall) is a good cathartic
Perhaps we may consider it as acting as a substitute
for the childs own bile. It may be given in 
[catnap] tea milk etc. # 16 An injection of bitter or 
16 aromatic herbs will allways assist the operation of 
whatever cathartic you use & in mild cases frequently will be 
sufficient of themselves – superceding the necessity
of giving anything by the mouth
Continued from p. 8 The stimulus of sound upon 
the child, crying, irritation of the air upon the
skin, and especially muscular motion, excites the peristaltic motion 
of the child. The influence of muscular motion upon the
peristaltic action of the bowels, is considerable, as is seen in horses
while travelling, the costiveness of sedentary persons etc.


“The warm bath at the temperature of 98 or 100 assists the 
operation of cathartics renders their action more mild 
equalises the action of the system and nervous irritation
It is especially useful when convulsions are present and may 
be used at any period except in cases of extreme exhaustion”
# It is the most powerful antispasmodic for children
[have] acting upon the extremities of so many nerves
Jaundice
“Jaundice sometimes appears at birth indicated
by the yellow colour of the countenance and arising from obstruction
of the liver etc. Such cases are generally incurable.
The first remedies are the mild deobstructant 
plant, small doses of calomel etc.”



11
When convulsions are present the warm bath should
be used to assist the operation of whatever cathartic
is used, to render the operation mor mild, to equalise 
excitement and to remove irritation. This remedy
may be safely used at any period after birth #
After the cause which excited the convulsions has been
removed, if the morbid irritation of the
nerves continues, the bath will again be serviceable
18 Antispasmodics may likewise be used
such as valerian, aqua ammoniae, elix. asth.
artificial musk infusions of catnip etc.
We may use aqua amm. 3 or 4 drops
or carb. amm 3 or 4 gr.
or asafoetida a teaspoonful of the tinct.
in milk & water, or camphor by enema
Be [cautious] of giving narcotics to children
Some are more susceptible than others. And some children
are accustomed to [them] from birth. Case of 
a mother who had inured a child of 3 m. to bear
30 dr. of SS. I proposed to give paregoric, beginning
with 8 or 10 drops, and found that the child had often
taken with impunity 31 dr. of SS. to produce sleep



4 – “Child bed women are generally to be treated with 
mild diet for the first week after delivery, unless their
strength has been much reduced by parturition, when 
they may take port wine in moderate doses”
# “If light stools indicate a deficiency of bile the administration 
of oxgall will be found very serviceable 
vide [illegible]
If acidity is produced, add limewater, 
If diarrhoea is produced, use arrow root
instead of the water, or any other [fecula]
Children are apt to receive too much food; hence cow’s
milk should be diluted with water. Milk may sometimes coagulate
in the stomach of children, in large quantities and occasion much
uneasiness Meat should not be given under 6 mo. unless in 
particular cases which are exceptions to the general rule, where
milk disagrees or perhaps in the case of some scrofulous children


12
Acidity Flatulence Hiccough
1 – Very young children are often troubled with 
acidity, flatulence & hiccough These affections 
may be removed by a free use of magnesia, lime
water, or aqua ammoniae
2 – It will not always be sufficient safe? to 
administer these articles to the child alone. The 
mother or nurse must often take them likewise
3 – Sometimes the mothers milk disagrees
with the child. This will be known by the constant
disorder of the bowels of the child. by the evacuation 
and pain suffering after nursing both child
and [illegible] mother may seem to suffer without a cause
The stools may be slimy# The child may cry obstinately
5 – If the mother’s milk continues to 
disagree we may use cow’s milk diluted with one
third or one half water & “sweetened” or with arrow root mixed
first with a table spoonful of cold & then with one of hot
water, in order to make a homogeneous mixture 
6 – Children fed on cow’s milk are more apt 
to be costive. To prevent this give a little magnesia, decoct.
of dandelion etc. Peach tree blossoms are much 
used, but are too violent in their operation 


The injection will start the machine again 
The injection may be made of Eupatorium, catnep,
elderflowers mallows etc. etc.
Apply first whatever can be first prepared
counterirritants for instance. Spirit or 
mustard to the fat ammonia etc. ammonia to the mouth
and nostrils etc. endeavouring to rouse the patient
4 – [A young physician should be careful to know what to do in 
sudden cases (much depends on a favorable impression 
at first) Neighbors and friends usually assemble around
a child and the expect the physician will be able to prescribe
at the moment. In such cases set some of the bystanders 
to preparing a warm or tepid bath – no matter if 
eventually if it should not be used. Set others to preparing 
some other thing and so on. Thus while the attendants are
all employed he will be able to devise some course to 
pursue] I recollect an old physician in this situation
who was pressed what to do & replied “stop 
let us think about it”


12:a.
Costiveness & its consequences
1 – Physicians are frequently called upon to prescribe for
infants who are in health except that they are costive
Children fed from a spoon or bottle are mor to be thus affected
than those who are nourished from the breast. If costiveness
is produced by improper quantity or quality of the 
food as is sometimes the case, the diet must be changed
2 – Costiveness if not attended to in time produces
flatulence, watchfulness, startings, hiccough, diarrhoea
vomiting & convulsions
3 – A physician is frequently called to children
I fits, who have been apparently well until the convulsions
come on The safest and most efficacious prescription 
that can be made, is an injection & indeed is 
all the treatment that most cases will require. Let
a warm bath be immediately prepared & the patient put in 
it if the enema does not relieve. While the convulsions
continue the mouth is closed & we can operate on the system
mainly by the rectum & the skin
5 Be careful to make your directions for administering an
enema very definite, unless you know that the family are 
familiar with injections Case of a mason’s man hands & 
knees shooting somewhat off fright rolling over murder
The enema may consist of simple warm water, or milk 
& water, or of tea of thoroughwort or catnep etc. a table 
spoonful of salt may be added finally castor or other
oils may be thrown up in extreme cases the rectum has been filled with lard The water for the tepid 





12:b.
bath should be about blood warm. Be careful 
to bathe the child, & not merely to scatter or sprinkle
water on it. The length of time during which the child
may be kept in the bath may be from 5 to 20 min.
While the patient is in the bath if it is
sufficiently relieved to be capable of swallowing give a 
dose of calomel for a child of 6 months 6, 8 or even
10 gr. If improper food is the cause 20 gr. are not 
dangerous, for infants will bear full doses of cathartics
though very small ones of narcotics
In bad cases of convulsions the means to which 
we have it in our power to resort, are external irritants
such as garlic draughts to the feet, injections of [nervines]
the most powerful of which will be a teaspoonful 
of tinct. camphor thrown up in a gill of milk & water & the
warm bath until we can administer articles by the
mouth
“If the child be feeble & exhausted upon coming 
out of the bath give cordials or tonics”
Any quantity of food in the stomach & bowels
which is not congenial, interrupts the process of digestion 
& the peristaltic motion functions whose importance is 
second on ly to that of respiration. When these functions 
are interrupted the muscles are brought into convulsive 
action to relieve the system



Be particular in your enquiries about food for those who 
have the care of children are very careless and children
will swallow whatever is put into the mouth. I recollect
being called to see a very strange worm which a child 
had voided. The imagination of the attending physician 
& parent were excited. To me whose imagination was
cooler the worm appeared to be a piece of bark I enquired
if the child had had no slippery elm bark & found that it
had been chewing some. Then the supposed worm was accounted for
Rye flour is more apt to become acid than 
oatmeal
# Cal. sometimes by its irritation produces convulsions I have
known a family, all the children of which were thrown into convulsion 
by cal. & I was obliged to be very cautious & use blue pill injections etc.
There are several milk remedies such as dandelion
which is tonic laxative, & deobstrument acting on the 
liver, mullein fl. elder [blo??] tea
“The pollens of most plants has a laxative quality”
I have seen no danger from the prussic acid of the
[illegible] flower & it is much used [illegible] from [illegible]
also among the French they hold a place the French Pharm.
Wild liquorice [gal??] [Circa???] resemble
the dandelion
Moderate friction excites the bowels
Sometimes alkalie or chalk, though generally they are
rather constipating, prove laxative probably on account
of the acid combining


12:c.
II II Where is a tendency to costiveness, the use of oatmeal gruel
or porridge will be beneficial or a porridge made of wheat
flour with the bran, strained through a cloth & mixed with 
the milk with which the child is fed also rye meal gruel or 
rye bran gruel
If the health is not affected by the constipation 
be cautious about giving much medicine. It is always better
to cure this affection by food than by medicine. #
Castor oil from a teaspoonful to a table spoonful
is the best cathartic magnesia given with the milk is a good
remedy but not always sufficient. Elixir salutis is one of the 
most common family medicines. This article with castile soap
dissolved in it has been found very serviceable. The gall of 
animals may be recommended. The blue pill operates gently 
as a cathartic & is useful in changing the habitual disposition 
to costiveness. I have prescribed with advantage decoction 
of the flowers of the dandelion, or mullein. The flowers of the 
peach tree are much used for the same purpose but
“are rather too powerful for ordinary cases” “They are powerful even for adults”
& sometimes gripe unless combined with aromatics
Calomel may be used with safety # “In severe cases
mustard and ginger may be applied to the abdomen”
Mechanical manes in the form of suppositories 
are much used by nurses such as a piece of molasses 
candy or a roll of paper moistened with oil. They are
beneficial.
# If the child has been weaned pay particular 
attention to its food. Nurses are very careless.



# “No serious evil will arise unless young & anxious
mothers should give medicines and thus make the
child sick”
“If vomiting arises from dentition we must
remove the irritation Give laxatives, as magnesia, & 
narcotic
Children should be early accustomed to the reception of 
enemata to prevent subsequent prejudices upon the subject.
I recollect the case of a child about 12 who was suffering
from an obstinate constipation caused by an affection of
the lower spinal nerves which produced a partial paralysis 
of the rectum and bladder so that a catheter had to be introduced
& injections were [illegible] demanded. But all the
efforts of the nurses (women) were unable to administer an 
enema Calomel had been given until the mouth was affected, yet
without producing an evacuation. Finally the patient went
into an insensible state, and injections were given & 
produced free evacuation. I have heard adults say they 
would die before submitting to receive an enema.



12:d.
Vomiting
Spontaneous vomiting in infants arises from over distention of the
stomach. The discharge is made without nausea & almost without
effort, & consists of pure milk or milk coagulated. The mother
should simply be cautioned not to allow the child to nurse
so long at a time. # Children and old people vomit with 
more facility than the middle aged
If vomiting arises from the sympathy of the
stomach with some other part of the system which is in a morbid
state, the primary disease must be first cured & used for the irr. of stom.
For the vomiting itself in palliative we may prescribe lime water & 
milk. a teaspoonful of each; soda water, or any 
liquid affording an abundance of carbonic acid.
Vomiting from irritability of the stomach
or free [illegible] requires particular attention. The attendant symptoms will 
be paleness of the countenance, quick & feeble pulse, & cold
extremities. Irritants must be applied over the region 
of the stomach. They may consist of ginger, mustard, horseradish 
leaves, mint etc. aqu. amm. [illegible] essent oil dissolved in alcohol” The alkalies such as pearl ash, also 
soda water “lime water” may be given internally. Excite a discharge
from the bowels by injection or a calomel cathartic to remedy the irritated action of the stomach “[illegible] counterirritation”
The warm bath will be very serviceable, soothing the nerves
of the skin & by sympathy producing the same effect upon 
those of the stomach nervines also may be given We may try putting a little brandy
into the mouth or a small quantity of capsicum tea. Hot
cloths & fomentations may also be applied externally.
A large bulk of warm water water may be thrown up the rectum
in obstinate cases, use stimulating injections..


One of the most convenient modes of administering a large
injection is by a pipe fastened to a large ox bladder
Press the fingers against the end of the pipe which 
the bladder is fastened so as to make a valve and
prevent the escape of the fluid contained in the bladder,
until after the pipe has been completely introduced
into the rectum
# I used to carry this recipe about me when I practiced in the country
Frequently irr. of stom. is overcome by irr. o f
the rectum by an enema of salt & water or by a large
injection to produce a peristaltic motion downwards


12:e.
Ren “Remove the cause, which is frequently 
indigestion. If it proceeds from the teeth, lance the gums
The following is an excellent recipe # in these cases
Rx Cret. ppt zii sem. card. zi bi carb. potas. zfs grind
aqua bullientis 0 fs Give a tablespoonful every half hour
I am inclined to the opinion that the alkalis, such 
as pearlast act by creating an excitability
Emetics are particularly safe for children
much more so than for adults. Ipecac is generally 
the best unless the disease in which the emetic is indicated
is very threatening, when antimony should be used
Squills are indicated in emetic doses in complaints of the
chest “with [illegible] [illegible] but should not be administered when there 
is much inflammatory action in the system.
“Warwick’s powder a preparation of antimony,
was once popular and often administered without 
the advice of a physician. I have known it endanger
life Nurses should never prescribe antimony”


Some situations are more liable – low situations
[seashore]
Children shut up in low dark apartments suffer
from want of amusement.
If a diarrhoea from teething is suddenly stopped
the brain is apt to be affected. This affection of the brain 
is peculiarly liable to occur in children. There is no 
outlet to the brain


12:f.
Diarrhoea
This complaint sometimes affects children for months & even
years Some families are more subject to it than others & I
have known those in which all the children would be affected 
with diarrhoea from a period soon after birth until they 
were three or foru years old. The children who have this predisposition 
to the disease are born with diseased liver and bowels
& have indeed all the chylopoietic viscera in a disordered 
condition. Hence among the causes of diarrhoea we may 
rank a bad constitution. Other causes are want of 
cleanliness, bad food “want of sufficient clothing” bad air damp rooms, confinement
& want of exercise. Exposure to cold & moisture
A bad air probably causes diarrhoea mainly by 
its depressing influence. The effect of confinement and want
of exercise is very great. Young animals suffer in the same way 
Even vegetables seem to need motion for I think I have observed
a great deficiency of fruit & a sickly appearance of 
fruit trees after a season uncommonly free from wind. Confinement
is injurious in another manner Children need
mental stimulus from a variety of external objects. I have
known surprising cures effected apparently by the operation 
of this very principle.
Teething is a frequent cause & whenever
it is we must palliate & check, but may not stop the diarrhoea
From the sudden stoppage of a diarrhoea during dentition you may 
expect an affection of the brain to follow. The discharge from the 
bowels in this case is similar to that of tears from an irritated 



This will be convenient in many cases as in travelling
Other mints may be used spearmint is most agreeable
I have given this in the latter stages of the diarrhoea of
adults with advantage
Almost any cath. will often check a diarrh. Cal or 
blue pill is generally best
Judgment is to be exercised whether to prescribe an
emetic or a cathartic & as to the choice of a catheter
Ipecac however is almost always safe children bear
emetics well
Put the parents & the nurse upon investigating as
to [diet] Persons are apt to very careless about giving
things to children And they may have wrong notions as 
to particular articles
Prohibit solid oily food, crude
vegetables and esculent roots. Potatoes are very 
bad in diarrhoea so are the analogous roots. They 
contain indeed much fecula, but also much 


12:g.
eye, or of mucus from the lungs
The expressed juice of mentha vulgaris, boiled
skimmed and mixed with white sugar is an agreeable, & useful
article for the cure of a diarrhoea, which has continued but a 
short time & is not severe.
In the early stages of a diarrhoea, which 
is sufficiently severe to demand the attention of a physician
it will generally be best to commence the treatment with a
cathartic; though if fever accompanies it an emetic of ipecacuanha 
should be the first article administered.
Judgement must be exercised in the choice of a cathartic. Calomel
will be best if the child be not particularly feeble or of a very 
delicate constitution & for a feeble child the blue poll. I myself
was for formerly many years unable to take any other cathartic than the 
blue pill without being griped. Generally it will be best to combine
chalk with the calomel, as the latter is indicated for its deobstruent, 
rather than for its purgative effect. The dose may be about
2 gr. cal. with 5 or 6 of chalk
If improper diet is the cause the food must
be changed; & it will generally be necessary to be particular in 
our enquiries with regard to the diet for the parents may 
consider many things a safe which would be strictly forbidden
by the physician. Especially will it be necessary to attend to 
the diet if the child feeds instead of sucking. Every thing 
hard of digestion, such as salted & oil food should be prohibited
The diet should be arrow root and in case of diarrhoea this 
article will be improved if prepared with a little laudanum 
or wine sago taipica, which is probably a hydrate of 



besides They are apt to become acids & acrid in 
the bowels. In the Polyn. islands The inhabitants
living upon taro are very liable to diarrh.
West of the Rocky Mts Lewis & Clark found the 
inhab. subject to diarrhoea for living on a root [illegible] [illegible] men suffered in the
same way after they arrived among them
In the evacuations & the evacuations of children shd always be exam
[may] [illegible] that potatoes remain undigested
Cullen & Rush thought different of potatoes
The evac. of chil. should always be [illegible]
Pies cakes articles containing much sugar
hot bread should be prohibited Bread shd be toasted
The juice of meat will often be beneficial
No gravy (i.e. artificial or carbonized fat with flour etc.)
Potatoe starch, pure, is perhaps not 
inferior to the tapioca etc.
Boiled flour becomes s hard as stone
almost hydrate It is an old practice It is an
excellent preparation make a porrige of it grated
Tapioca I suppose is made by sprinkling
casserva root, powdered, with water & baking it
making a preparation what appears like gum arabic. I have not 
been able to learn how it is made, but have made
it this way a similar substance of arrow root
Arrow root & the tapioca are cooked
by first dissolving them with a small quantity of cold water
& then adding hot water. In this way [illegible] are avoided


12:h.
flour or roasted or baked flour made into a
porridge with equal parts of milk and lime water. The bread
should be toasted and butter should be used very sparingly 
gravy not at all. Casserva sago etc.
An article similar to tapioca, if not the same 
may be made in the following manner. Tie up a quantity of 
wheat flour tightly in a clean cloth & boil it for 5 or 6 hours
The result will be a hard substance which is to be grated &
“[illegible] milk & water or with lime water” 
made into a porridge this will be palatable & good Rice
in gruel, or thoroughly cooked by boiling 
The worst cases of diarrhoea are attended
with feeble pulse, cold extremities, dry skin, & 
generally a rise of fever once or twice in the 24 hours. Soften
the skin by the tepid bath which is [illegible] etc. and keep up an action on it by 
flannel unless there is fever & in such cases use also absorbents freely with 
tonics & aromatics. The chalk julep or white decoction will 
be as good a preparation as any. Rx Chalk [illegible] zfs to zi pul. cinnam. to zii
zii, bum arab zi carb. potas. zi water lb I. boil ½ hour Sometimes
[illegible] a similar recipe shd be used” The Europeans add [illegible] use [illegible]”
a little laudanum may be added. Of this feed freely, giving
say a table spoonful from ½ tab sp. to I once in an hour sometimes. As a tonic the
vitriolic or tonic solution of Moseley is inferior to none in such
cases Rx zinci sulph ziii alum zi water lbi Give from 
four to twenty drops. Tonics must sometimes be combined
with absorbents
Opium is always safe in cases where the 
bowels have been thoroughly evacuated. It is generally 
better to combine it with ipecac, which will determine its
action to the skin and act as a gentle tonic & laxative


The tepid bath is [illegible] as it may be called) 
relieves the irritation of the bowels through the 
skin
Chalk does not act mechanically or chemically it
has a specific action upon the stomach as much as
bark
Make white decoction in various ways if cinnamon
offends use some other spice Sometimes add
astringents or [illegible]
Tonic sol. sulph [illegible] ziii al. zi Mosely sometimes
used al. zii In 3 or 4 gtt it is anti emetic
In larger doses it may be emetic & cathartic
This is a state of the system similar to the collapse
of cholera Asiatica It is a collapse taking place
during diarrhoea. I have found advantage from
stimulating or acrid injections as salt & water, mustard
In chronic diarrhoea opium is often
invaluable. Some families are obliged to give it 2 or
3 times a day for along time to their children until they are so 
old as not to be liable to continual diarrhoea
The stools may be green clayey from deficiency of bile sour curdled [illegible] or very
fetid, so much so as to be very offensive turning the
stomach of the attendants.


12:i.
In cases of chronic diarrhoea where there is attending it
much sensibility and irritability of the bowels opium combined
with diaphoretics cathartics or tonics is an invaluable
remedy
Sometimes violent symptoms supervene vomiting supervenes & the diarrhoea 
stops the patients hands & feet grow cold his pulse
grows small, & if the most active measures are not
take used the patient dies in 24 hours. When this change
of symptoms take place we must resort to the most
powerful means of exciting counterirritation such as application 
to the epigastrium of mustard, horse radish leaves
ol. monardae punctulae, ol. turpent. etc. Such articles 
as pimento will be grateful and stimulating given internally
We may give calomel, opium & the carbon. acid, and use 
stimulating injections. “Effervescing mixture with SS. [illegible] appt”
Particular attention should be paid to the
kind of They may be sour & curdled, or mucousy, [illegible] clay colored, water
stools for much may be learned from their inspection.
Acid is often formed in the whole alimentary canal, producing 
sour and curdled stools which will indicate lime water
or other absorbents, with aromatics. The acid may 
arise from fermentation or more probably from secretion 
Such cases I have often cured by the expressed juice of the
spear mint prepared as above mentioned & given freely.
When the stools are green white, or clayey, give
opium to allay irritation. Ipecac to equalise excitement, & 
the blue pill as a deobstruent, the latter in small doses so as 
to move the bowels, but once or twice in the 24 hours. 
Alkalis are useful as 


# Noel’s plaister was made of white lead red lead castile
soap and olive oil, boiled till the red lead was so far decomposed
by the oil that the mixture was of a cream colour It is a 
smooth plaister and is less stimulating than [illegible]
Use soft charcoal by burning cork, which is
the popular kind or cedar Dose teaspoonful
to a tablespoonful in a convenient liquid
Lime water & other alkalies may always
be given They may be mixed with the food
without [injurious] the taste
When the disease has continued long & 
patient is [illegible] phlegmatic temperament we may 
bandage the bowels, to give mechanical support 
[Opium] also will be useful applied externally in this way
Adults from the Wt. I. with chronic
diarrhoea will look like a mummy
Bog water is a very soft water & contains
carb. hyd.
Astringents [illegible] tinct. vitriol
decoct. of oak bark with milk & sugar & spice
Bandaging & plaisters Take any adhesive
plaster and mix about ½ opium Or soap and opium
Acetate of lead is not a new remedy 1 2 or 3 gr a day
1 gr at a time continued as long as the relaxed state of the bowels
continues as long as they last lead [cholic] cannot take place for 


12:j.
are also enemata formed by dissolving castile soap
in mallows or catnip tea. If there is much griping with 
tumefaction of the bowels injections of camomile tea give
great relief. In diarrhoea of this kind the following is also 
a good stimulating & correcting laxative Rx castile soap zi
elix. sal. zi dissolve & give it 3 or 4 times a day of teaspoonful or ½ teaspoonful doses.
If the stools are fetid give charcoal
internally. It will correct the fetor & it sometimes cures
the disease. For sour stools vie last paragraph of this lecture
During the long continuance of chronic
diarrhoea it will of ten be advisable to apply mechanical
support to the abdomen. We may apply a plaister of
white diachylon [illegible] plaister alone or with opium or of lead and soap & a bandage.
In chronic diarrhoea the skin becomes 
brown, of a dark & dirty appearance, & very dry and husky
If the tepid bath does not relieve this symptom, we may apply 
water from peat swamps, which contains carburetted
hydrogen. Vide Duncan’s commentaries
In the last stages of diarrhoea we must 
resort to tonic solution to astringents, absorbents & aromatics
we may also use opium with cathartics, emetics & absorbents
& If we met with a great craving for salt food it should be 
gratified. The gratification of such an appetite will prove 
a stimulus, especially to the mind & consequently the more
powerful. We meet with similar cases among adults also. Case
of a man who could retain no medicines upon his stomach & 
finally recovered upon bread & cheese, given at his request
In the latter stages also of chronic diarrhoea, acetate of lead 



the [illegible] [become] very lax and there is generally a prolapsus ani
patient being [semiphlegmatic] I saw this article
much used in this way when a young man and though expecting
bad colic no injury resulted.
Prof. Smith was very fond of chocolate [illegible]
It sometimes acts like a charm
Spiraea may be given in decoction or
extract. [illegible][illegible] is not so good being unpleasant
having a fishy taste & offending the stomach Ger. mac. & [illegible]
[arom.] are pure astringents & unobjectionable on 
this score. I have prescribed sometimes one, or another,
according to convenience of locality where I 
happened to be
The root of typh. latif. is used as food by the aborigines
European physicians give [althea] [illegible] which 
is the true marshmallows
Usually when diarrhoea has continued 
long the kidneys become affected. Mucilage will then 
prove diuretic probably by their [illegible] affect. The terebinthinates 
will then be useful. The most common practice in 
this neighborhood is a decoction of white pine bark especially 
with a little milk it is called healing to the bowels. There is
also nutriment in it for the aborigines, sometimes live on it
When mucilages to wear out we may resort to terebinth.
The species of [polygnomic] knot grass are 



12:k.
may be given internally. There will be no danger
of the production of colic, by this remedy, for the bowels are
too much relaxed.
The astringents just mentioned may be various 
We have at least fifty indigenous vegetables, which may be used
given in decoction of milk or water such as the bark of the
currant, the raspberry, the various species of oak, of viburnum
chocolate of acorns etc. white pine bark in milk etc.
the roots of the [illegible] of the [geranium] etc. The viburnum
Especially deserving of recommendation are the spiraea tomentosa
& cornus circinata. The latter of which equalises excitement
Of mucilages we may have occasion to 
use a variety for irritation for any one article may become worn out & another be more grateful
We have typha latifolia, twigs of sassafras, hibiscus, malva
bran, flax seed, slippery elm, gum arabic etc. all the mallows, all the [illegible] marshmallows hibiscus palustris
called rose of [illegible] in the gardens root is [illegible] [illegible] & sub astringent 
Sour stools Be particular in forbidding the use of animal
food. If there be want of bile, give ox gall, lactescent plants
dandelion etc. with mild mercurials; e.g. calomel 2 gr. with 
6 gr. chalk. Aromatics also may be combined. Astringents
elg. [illegible] speraea cornus & geranium do well. Also the following
Rx calc. magn. zfs rhei palm. gr. 8 acaciae zi ol. anisi gtt vi
aquae purae zi Give a teaspoonful at a dose. “once in 2 hours”
In bowel complaints with griping attended with green
or sour stools Rx magn. ust zfs pulv. rhei grs viii pulv. gum ar. zi
ess. menth pip. gtts vi water zi dose, teaspoonful Spiraea & cornus




used – they are mucilaginous sub astringent & diuretic
Articles of a stimulating kind are often needed in 
the latter stages especially erigeron canadande (colt tail) [illegible]
The bitter [illegible] which grows in similar situations (ambrosia [elatio??]
is also used as a bitter apparently nervine in diarrhoea
Roman wormwood) [Cupron] is acrid, sub astringent & diuretic much 
used in the middle states improper when there is entonic action
case of cholerine cured last summer by this garden young
man called etc. chewing the plant etc. The other species
of erigeron have similar properties espec. E. phil.
Various recipes are given for diarrhoea in 
children Ex mag. zfs rhei gr. 8 [illegible] zi ess. pep. gtts 6 gum ar. zi
The popular remedies are generally absorbent [illegible] mucilaginous
astringent etc.
Much benefit may often be derived from 
copious mucilaginous injections mutton broth is the most popular
probably other broth (fat meat) would answer still mutton 
suet is less apt to become rancid. It is thought to be 
useful also as nourishment I have not though much 
of this may of nourishing
Laudanum may be added Also
laudanum & starch injections may be advisable to check the
excess of the discharge It will generally be best to begin with 
about 10 drops of SS. though a teaspoonful may be required
vide p. 2 [illegible] 2



12:l.
Prolapsis Ani
This is a troublesome symptom which sometimes occurs in 
diarrhoea. The protruded intestine should be immediately 
replaced. Most writers recommend to do this with a 
dry cloth, but this will irritate the sphincter ani & make
it contract. The smoothest and least irritating article
within my knowledge, is the crop of a fowl, or the neck
of a bladder, turned inside out & filled with warm water # 
Afterwards we may apply astringent washes & injections
of white oak bark or other similar articles, or
of acetate of lead. The latter article may also be given 
internally in doses of from 1 to 2 grains. It will 
have a tendency to overcome the relaxation.
Astringents are multitudinous
& have had a specific [illegible], which proved to be the
bark of [?strea] virginica At another time I had a specific
sent me which proved to be viburnum sentago all
the vib. are astringent
Prolapsus ani “The part is relaxed
and passes down and is then strangulated by the sphincter. For a
permanent cure we must resort to astringents & tonics, but the
part must be [illegible] by mechanical means If 
the intestine is not replaced, [illegible] or suppuration 
will be the consequence” “Take 1 bladder, cut
off the neck, turn it inside out, fill it half full of 
warm water, and tie up the neck”


“This disease was very common at the commencement
of my practice but is now rare. The change has arisen in a great
degree from the more correct notions respecting the proper management
of the mother and child which now prevail. It is possible
however that it may appear in [epidemics] and that case we
should expect that it would appear for a time and the disappear
# It frequently follows other diseases both in children
and adults
# According to the law of contagious diseases and
that it is of no use to prevent it
# Heat is a stimulus but too much of it produces a 
debility which may be [illegible] perhaps in direct debility
“Since a free ventilation of nurseries has been practical the
disease has been rare. laying aside the use of the preparations 
of alcohol has also been beneficial.” 


13
Aphthae or Thrush
White thrush from [illegible] (to inflame)
This disease often appears within the mouth 
is then generally unaccompanied with fever. In some
cases it is idiopathic but it more generally is a 
consequence of morbid affection of the primae viae #
It is frequently found in adults of robust constitution 
which have been very much debilitated by previous that disease
infancy and old age are most subject to it & in infants,
as was just mentioned it is often an idiopathic affection
In some families every infant is several with this
affection. The vulgar error however, which very generally prevails
that all children have the thrush at some sooner or late period other #
is contradicted by the fact that many children as I have
known never have the least appearance of it 
at any time “and it may probably in all cases, be prevented”
The most feeble and delicate children are affected with the most violence, hence & from the fact of
its being an affection of old age & a frequent sequel of other disease
in adults, it may be inferred that this is a disease of 
debility & this [illegible] will be confirmed by the predisposing
causes which we find to be, confined air, a
very hot room & improper food# It is caused among
the poor by bad air & among the rich by too great warmth 
& confinement. The fever likewise which accompanies it
in many cases is of a typhoid character.
# “Caused by neglect of the nurse by want of cleanliness
& is often the effect of costiveness”


# And have been led to prescribe remedies to prevent 
the thrush
“commences on the inner part of the lower lip & corners of the
mouth & extends over the tongue & inside of the cheeks & gums
sometimes all these parts are affected & sometimes only one of
them”
“It appears in small eruptions or vesicles containing a whitish
fluid resembling a coagulum of milk these vesicles
often coalesce so as to form patches”
“extend down the oesophagus to the cardia & here in all
known cases it has stopped”
Prof. Tully has seen p.m. [illegible] which the thrush the al canal [illegible]
“The feces are sometimes covered with aphthous sloughs”
“in its severest the eruptions are of a dark brown
or deep red colour”
“The alvine discharges are very acrid”


14
Symptoms – The disease is preceded by languor and sleeping
This is so generally the case that it is common for nurses to 
say that the child is sleeping for the sore mouth
In adults I have observed the same fact, & have predicted
the appearance of thrush from the drowsiness of my patient #
The symptoms of thrush are very obvious. It commences
with white specks upon the lips #, angles of the mouth, & 
tongue effervescence. # In severe cases the specks in crease in number
and size until they cover the whole inside of the mouth
the throat & are found indeed upon the 
stomach x & throughout the whole intestinal canal
though this is disputed. One thing is certain, whether these
specks or flocculi extend throughout whole alimentary 
canal or not, viz. that they are found upon the rectum,
agreeably the law that the orifices of tubes are
most affected The white crust will 
fall off and be succeeded by one of a darker colour.
The coats of thrush are often many times renewed
& in this case the formation of a new one is preceded
by unusually protracted sleep. A typhoid fever
may accompany.
It seems to be an eruptive disease
determined [illegible] the al. canal.


“In its milder form it is confined to some particular
part of the mouth or to the mouth itself. The eruption is
white & the mouth appears “as if a stratum of coagulated
milk were spread over it” & but one separation of
the curd like crust will take place. The general health
will be but little disturbed”
“In severer cases two or three successive crop
are formed & the habit being unhealthy, the food innutrient,
& the frame weak and atrophous, the under [surface] ulcerates
and spreads & a low typhoid fever ensues”
# “Your principal object should be to produce an
excitement in the bowels by some mild medicine”
# Because it is an eruptive disease however diaphoretic
seen to be indicated & those which [illegible]
action “The treatment is ordinarily a gentle laxative
but there is a choice in the kind of laxative. Some practitioners 
recommend oily medicines, as butter, goose oil, pigs foot oil
etc. But these articles do mischief As the vital powers of the stomach 
are weak, these oils will become rancid”
# In such circumstances the oils become rancid & 
consequently irritate. I never allow oils to be
given, yet it is a common practice to swab the
mouth with oils, especially goose oil (or [illegible]?)
# Chalk shd generally be preferred the other articles
dissolve more slowly & may act in part
mechanically”


15
It is thought that this disease has often
been prevented, by giving soon after birth a teaspoonful
of cold water & repeating the remedy every
morning, for some time taking care also that the bowels
be kept open There may be some foundation for
this belief inasmuch as the disease is brought on 
by heat and debility. “In families where the children
have uniformly been subject to this disease. I have recommended
cold water as directed that the room should be well ventilated
and the child not covered with too much clothing”
In mild cases & where the constitution 
of the child is robust, a gentle laxative will be sufficient
to remove the complaint # 
Castor oil is very often prescribed for it
& it may be proper to five it to assist the operation 
of other cathartics But there are several objections to 
this article. It does not affect the secretions so much 
as other cathartics. It does not evacuate the contents of
the bowels so thoroughly as others & it tends to 
# relax the coasts of the intestines, already in a state of 
morbid relaxation “It will not remove the mucus of the intestines”
For mild cases magnesia is the best laxative 
where it can be given in sufficient quantities. If the
bowels should not need a cathartic chalk or some one
of the other testacious powders may be given “as [illegible]
oyster shells, crabs eyes, crabs claws etc.” #
Because it is an eruptive disease however, diaphoretics 
and articles which translate action seem to be indicated 



# “Give at first the clear liquor of this infusion and if this does
not operate stir it up and give the substance
(1) “After the stomach and bowels have been evacuated the
ipecac should be given in small doses ¼ to 1/6 of a grain, to 
keep the bowels open, to produce a tonic effect, to determine
to the surface & to prevent convulsion Ipecac has
more claim to be considered as a specific than any thing
else. It obviates the morbid secretions of the bowels it acts as
a tonic never produces unequal excitement or other tonics
& it does not like astrigents produce constrictions Whenever
there is a tendency to unequal excitement it must be
obviated or tonics will do no good”
# I rely upon the ipecac though I use [illegible]
sometimes especially white root asc. tul.
# Indeed “if diarrhoea is present, prepared chalk is a
good remedy as is also charcoal: the best form of which 
is burnt oak for this can do no mechanical injury”
# “I have found this almost a specific” Since I have
used this treatment I have not lost an infant by 
this disease” Ipecac in small doses as an alteration 
approaches as near to a specific in any remedy can
# which is not to be expected
# Astringents must be avoided, though tonics are indicated
because they produce unequal & local excitement & 
stricture they must be given in the latter stages after excitement
has been [equalised]
A little borax may be given
Moseley’s solut. zinc ziii al. zi [illegible] 1 pt


16
In the commencement of the disease if the symptoms do 
not indicate the probability of a severe case an emetic
of ipecac is the best remedy Antimony has been recommended
but it is not a safe emetic for children within
the mouth Infuse [illegible] of ipecac in 6 teaspoonfuls
of warm water & give a teaspoonful every half hour
until the patient vomits or purges. # Ipecac has the advantage
over antimony in its tonic and antispasmodic
properties & in the mildness of its operation, never producing
alarming symptoms # 
If the ipecac empties the stomach and not
the bowels, a blue pill should be given of the size of
from 2 to 8 grains. If this be found insufficient, it may 
be assisted by a dose of calomel, or magnesia or an enema 
(1) After the bowels have been thoroughly cleansed
the ipecac should be given in small quantities a fourth or 
a sixth of a grain to determine to the surface & to prevent
convulsions # If this dose moves the bowels too much, we
may add “[illegible] or 1/6” one sixth of a 1/8 drop of Laudanum to each
dose The absorbent powder or the white decoction may 
be given at the same time#
Astringents should be cautiously avoided
until the stomach and bowels been thoroughly 
evacuated # “& if there is much fever” Where this has been done we may make
use of Moseley’s tonic solution, or cornus [circinata] [illegible] alba, or sericea or saffron safely & with advantage


It is to be remarked that chemical action is prevented by the
vital principle acting upon the food or articles introduced
introduced into the stomach, and putrefactive or [acetous]
fermentation if the vital powers of the stomach are [vigorous]
This principle applies to vegetables Plants taken up in 
full blown in August and packed in live [sphagnum]
will be preserved by the life of the sphagnum
In thrush the powers of life are weakened & not only
substances taken in but the secretions themselves are
subject to fermentation hance the use of obviating the 
effects by alkalies limewater magnesia, chalk [illegible]
absorbent powders
white decoct. Rx.
“To prevent the increase of vesicles of effervescences, syringe
off the acrimonious fluid as well as you are able, by some diluent 
or detergent gargle and expedite the separation of the
sloughs by invigorating astringents” vide Dr Good vol [illegilble] p. 30
“A little borax & ergot may be put into the mouth. But if the mouth
is dry & parched, this and other astringent shd not be used. In such cases
we should give mucilaginous substances as gum ar. slip. elm. or sassaf
X 5 or 6 gr a drachm? of each in a gill of water
# or viola pedata (parsley violet) or comfrey
We must be very cautious about administering it to infants


17
To correct the acidity which often attends this disease
we may administer prepared chalk or lime water
& milk Or Rx magn. usta 10 or 12 fr. elix. pareg.
xx gtts water zi given in teaspoonful doses every hour
If the stools are watery and the child is robust give
coct. ppt # vi gr. cal. 1 gr or the compd powder
of chalk in doses of vi gr. or a small quantity
fo rhubarb instead of the cal.
For watery stools give dal. 1 gr & chalk 6 grs or compd powder of chalk
It is too much the practice to scratch or rub 
off the aphthae in a violent manner with a brush
or swab. As well might the cure of any other
eruptive disease be attempted by violently rubbing
or scraping off the pustules. Rubbing the mouth with
a brush or swab until the bleeds is a cruelty which  
ought to be deprecated
Still something must generally be done
to the mouth in order to satisfy the importunity of 
nurses & prevent their mischievous attempts
A little borax and sugar X is as safe as any thing
If the mouth is dry it may be lubricated with 
muc. gum arab. slippery elm or sassafras twigs
When the mouth is in a very high state of irritation 
probably a small quantity fo sugar of
lead would be serviceable. I have not myself
ventured to administer it to infants within the mouth 
For the proper local treatment of ulcers vide ulceration 
of the mouth


From the sympathy which exists between these parts
and the surface, tonics should be combined with diaphoretics
I have given [illegible] [has] or [illegible] it is [illegible]
observed by tonic and determines to the surface
# It is mucilaginous sub-emetic & diaphoretic. It
may be given freely as a wash or administered
freely internally laxative diaphoretic soothing
antirritant “The other [illegible] may be as good”
The disease of which we have been speaking is 
a local disease


18
Ipecacuanha in this disease is emetic, tonic, diaphoretic
etc. alterative & since I have used it I have not lost
a single infant with thrush
The viola pedata (parsley violet in some 
degree resembles ipecac is its qualities & may be internally 
administered in its stead # “give a teaspoonful of 
of the decoction”
The peculiar kind of thrush of which I have been 
treating is a local eruptive disease of infants
but as it appears in children more advanced it
a critical determination of diseased action. It
is not unfrequently a favorable symptom, particularly
when it succeeds strong morbid action & 
[illegible] early in the disease In the latter stages & 
when the system is exhausted it is unfavorable
For instance in hydrocephalus, when the whole 
mouth will sometimes become sore, and the disease
seen to be translated to the mouth “from the brain to the muc. memb”
In the latter stages of any disease not
so fatal as hydrocephalus it is a very dangerous
symptom of exhaustion “In cholera infantum
it is a dangerous symptom. [illegible] there is not
translation from [illegible] essential part”


18 ½
Eruptions in General
Children of all ages are subject to various eruptions
These are generally occasioned by the quantity or quality
of their food. They are frequently cured by change
of diet alone & the greatest attention should always
paid to the diet is managing them Oily food particularly
nuts, must be strictly prohibited, as they often
cause eruptions. I have known some adults invariably
affected with eruptions about the lips or other
parts of the face after eating freely of walnuts
Fish & poke week may likewise [illegible] the eruption 
We may use the tepid bath for the purpose of 
cleansing the skin. The frequent use of the [illegible]
bath is important especially in chronic eruptive
diseases of children & adults vide p. 21 & p. 20
For infantile [illegible] [illegible] p. 1831-2 of Good
Case of a peculiar eruptive disease
vide [illegible] [illegible] P. 1831 1 [illegible] art.
The eruption was periodical, appearing at a certain hour every day
At first a light coloured opaque elevation of the skin about half an inch
log & a quarter broad like the sting of a bee or wasp. Soon after their appearance blood began to ooze
from them & producing a drop which concreted into a scab, & at the end of 3 days
fall off 8 or ten eruptions came out daily. Treatment was ineffective 
until a change of air & diet, which effected a cure
“Child 8 or 10 yrs of age about 5 p.m. it would complain of a pain
in the face then would appear elevation of the skin to the number of 10 or 12 
the issue was treated as if [illegible]
bark was tried also nit. sil. sulph zinc. arsenic & other minerals
emetics cathartics new diet finally fruit was recom ate freely 
of oranges & was benefitted. Then change of air & travelling were tried
or the first day the eruptions diminished & on the third disappeared
In such cases try changes of mineral waters & dieting”



19
Red Gum
Allied to thrush is that eruption called red gum
The original word was red gown (from a sort of spotted
red calico) which has been corrupted into red gum
It is called by [Willa??] strophilus intertinctus
It is a populous eruption & said to be peculiar to children
but this last is doubtful
The eruption is sometimes confined & sometimes
diffused over the whole body. The papulae rise
above the skin are distinct from each other & of a
rarely contain lymph
bright red colour. The vesicles contain by [illegible] only & 
terminate in scurf. Afterwards subsequent eruptions
makes their appearance. The constitution is rarely 
affected. Physicians are not usually called 
unless the nurse is inexperienced Nurses give saffron
Some physicians suppose this disease 
to be the same with aphthae. Dr [Willan] thinks they 
alternate. Dr Russell remarks “I think that aphthae
of infants is of the same nature with those
eruptions called red gum & differs in this respect
that one disease affects the skin & the other the internal
surface of the alimentary canal. Dr [illegible] thinks 
that this affection, preceded by sickness, arises from 
causes similar to those of aphthae, such as confinement,
heat, irritable state of al. can. indigestion [illegible]
If the disease be suddenly repelled
from the surface, vomiting & spasmodic affections 
take place. Hence the European physicians 


Belonging to the primary [page]
Probably the patient was not dieted so strictly as was
intended & I recommended change of air Oranges
however were beneficial. The was too fond
of good living, fond of oily nuts
There was a slight reappearance after it
but of short continuance
It was called [illegible], but improperly
The eruption was preceded by a warming sensation
of pain in the part.
“Red gum is an eruption of fine pimples of a red
colour affecting infants [illegible] within the mouth. It 
is a disease that rarely requires the advice of a physician
The cure is much better effected by diet and [regimen]
by the exhibition of medicines Still the physician
is frequently called in and he must prescribe something
if for no other object than to satisfy the friends
In order any case give a decoction of saffron & 
snake root to keep the eruption from [striking] in 
& keep the bowels soluble with tinct. rhei compd tinct
sennae magnesia, or other mild cathartics”



20
caution is not to expose infants with this eruption upon
them to a current of cold air, or to plunge them
into a cold bath. It is said that fatal consequences
have resulted from such imprudence
The child should be kept clean & 
be subjected to daily ablution of tepid water.
Particular attention should be paid to the quantity 
& quality of its food. If the eruption should be repelled
from the skin the tepid bath will be the best remedy
This disease often occurs within the mouth
& rarely requires the attention of the physician. [illegible]
tone of the mildest of the eruptive diseases
“We may give a decoction of saffron crocus? & snake
root to prevent the eruption from striking inwards 
& keep the bowels soluble by mild cathartics such as 
magnesia & rhubarb. Still more will depend 
upon diet than upon medicine. Wine & water or
one part milk & three water may be given”
[belonging] to p. 18a
“In managing most eruptive diseases more
attention should be paid to diet than to medicine. In 
most cases it is requisite that the quantity of food should be diminished.
If the food is milk, let it be three parts water, or
substitute whey. Infants should take no animal food & 
no crude vegetables within the year. Oily food and the various
kinds of nuts should be prohibited even for 2 or 3 years. A strong
child in the country, with abundance of air and exercise
might be indulged in such excesses with impunity
when a feeble child in one of our cities would be destroyed by them”


The eruption is so small as not to be observed
It is not my object to treat of eruptions in general
with minuteness but to give the general principles of
treatment food etc.
There are many eruptions met with [illegible]
children which cannot be classed or be found described
There is an affection of children appearing
within the weak, which is not described at all. In three
or 4 days after birth elevations of the true skin not of the cuticle upon the 
hands and arms & various parts of the body containing pus and [illegible] or as large, some of them as ½ dollar 
high [illegible] [fever] I have seen but few
cases they were mortal.  The books in such affections
direct bark & tonics. The practice proved
injurious. The disease as I have seen it has been 
inflammatory and required antiphlogistic treatment
It may however be typhoid sometimes perhaps.
If so it should be treated accordingly. I have seen but 3 or 4 
cases. There were inflammatory. I prescribed in all these cases & from an analogy more fancied
than real, between this & [illegible]
Eruptions are generally caused by 
improper quantity or quality of diet. The remedies
frequently get the credit of curing the disease when 
the amended diet cured the patient
Oily & highly stimulating food should be 
avoided. All the nuts one of the worst is the pea nut


21
Strophilus candidus
In this species of strophilus the papulae are larger then 
in any other of the genus. They are not surrounded with 
an inflamed base. They are very distinct smooth and shining & appear
like little pearls under the skin of about 
the size of half a millet seed. They may continue 
for some time. A close examination is necessary for
their detection. They appear on the bosom & chest
They may accompany other diseases
I have seen them accompany cholera infantum in the 
last stages & considered a fatal symptom
[illegible] dyspeptic consumption a dangerous
symptom The chest appearing to be covered
with an oil surface, looking like particles 
of water I have seen persons attempt to wipe 
them off as if water had been sprinkled on the part
Belonging to p 18 ½
Apples pears and fruits etc.
Cleanliness also shd be strictly practised [enjoined]
robust children, much in the open air, may have eruptions
about the face mouth etc. with impunity
when with the same diet delicate children, much confined, would have
fatal eruptions, diarrhoea cholera infantum etc. 


The appearance of the [former] [have] [illegible]
and the parents are often much alarmed. The disease is not
dangerous however, & leaves no scar behind
A scab is formed & the margin continues to suppurate
and matter forms underneath
“There is a thin [illegible] discharge from the part & the scab
comes off leaving a thing pellucid [illegible]” The disease continues
& this film is thrown off & the process is repeated 2 or 3 times 
It is sometimes occasioned by dentition
sometimes it is an effort of the system caused by 
disturbance in the al. can. “A prejudice sometimes prevails
with respect to this disease that it is an effort of nature 
& ought not to be checked It is a loathsome disease extremely 
unpleasant to both to the patient and the nurse & if allowed to continue
some time it would not be safe to stop the evacuation, at 
least without keeping the bowels open” 
Some [Phys.] recommend partic [illegible]
as specifics. Cal. or blue pill occasionally 
may be advantageous
Buckthorn has been much celebrated in 
this and other eruptions It is drastic& hydragogue
It is perhaps milder in form of syrup. Many families
keep it. Half a dozen berries will operate
If there is much plethora, the
neutral salts may be given Magnesia also both
for the indication & as a corrector
I have known the muriatic ether
much prescribed, but have not used it much
myself, substituting for it mur. ac. as below 


22
Crusta Lactea
This is the [illegible] larvata of Bateman
It appears on the lips, forehead & scalp in small pustules
yielding pus, which eventually coalesce & form large loose
scabs & perhaps extend over the whole face, down the neck
and over the whole body. This eruption never leaves a scar
behind it however long it may have continued. The skin is left smooth It is
more unpleasant than dangerous, as the children affected 
with it are fleshy and otherwise health. When it has
continued a considerable period of time, we must be 
cautious of checking it, as it is like a habitual discharge
from an ulcer
Treatment It is very common to give
laxatives, such as syrup of buckthorn, neutral salts, magnesia etc.
The sweet spirits of sea salt (diluted muriatic 
ether) is a very popular remedy. IT is given in doses of
from 5 to 10 drops, diluted with water & repeated 2 or 3 
times a day. I have seen this medicine given in 
hundreds of cases & am inclined to think it sometimes 
of service. It, at least give satisfaction to the parents 
& does no injury. If there is great irritability give 2 or 3 gr.
of cal. with chalk. In cases where I have thought proper 
to remove the eruption. I have given the muriatic
acid instead of ether, prepared in the following manner
Rx mur. ac. zi alcohol zi Give [3] drops night & morning
diluted with water


make [oxyg.] oint. by adding the nit. ac. to
lard until decomposition ceases, and the resulting
ointment is tasteless. It has about the consistence
of wax. Some add sulphuric acid but this is 
not decomposed & is acrid
Sometimes the ointments seem to irritate & 
then we use [illegible] The best is the sulph. pot.
zi to a porter bottle of water. Sulph. of soda
does not materially differ, but it is unpleasant smelling 
like bilge water.
In different cases apparently similar I have tried ointment
& succeeded in one, but failed in another, & succeeded 
by waste
I was led to adopt the use of sulphuret of
potash from the analogy between its solution & the water [of]
sulphur springs
“We may with advantage make application
of dry powders arrow root roasted flower hair
powder taking care to give a cathartic when we check
the discharge. We should pay particular attention to the diet
both of the child and mother making the food weak & [simple]
Laxatives will commonly be removed; a little magnesia
& sulphur so as to move the bowels once or twice a day
“A discharge like this may be checked with 
safety at the commencement, but when it has become habitual
it should not be stopped unless a drain is made
& kept open in another part.”


23
For this eruption I have found the oxygenated 
ointment, very efficacious in removing the scabs & healing
the sores It is always safe if well prepared. ‘It is made
by decomposing nitric acid with
lard’ Perhaps the [citric] ointment (nitrate of mercury
with lard) may be equally efficacious, but it is less
safe. A good ointment may be made by mixing
calomel zii with simple cerate zi or mutton suet zi
The sulphuret of potash is one of the best remedies 
for this & other similar affections Dissolve zii in a
pint of water & give a table spoonful night and morning
also let the part affected be washed with a solution of 
twice the strength “It sometimes [illegible] two or three days and [illegible] [illegible]” Some prefer sulphuret of soda
sulphuret of lime would also be equally efficacious
Such solutions small like bilge water & are analogous to the water of sulphur 
springs I have sometimes used the sulphuret of pot.
as an unguent. Sometimes liquid applications & 
sometimes unguents will succeed best, & if one fails we
may try the other “Calomel ointment may be applied
about the edges”
If the eruption should suddenly dry up 
& fever ensue, a dose of calomel should be given & be followed
by a few drops of antimonial wine 3 or 4 times a day 
or a small quantity of ipecac. White hellebore may be
given
Sometimes the eruption degenerates to a phagedenic
ulcer. In such cases I have used charcoal 
eternally also a variety of poultices. I have seen much 



The const. irr. may expend itself upon the skin
or upon the gland. syst. or upon the al. can. etc.
We must be cautious about suspending
them suddenly
“It is important in all kinds of eruptions
to keep the skin clean and soft & to effect this
we should prescribe the warm or tepid bath, every day or 
2 or 3 times a week. It removes itching and irritation, is always 
safe and almost always beneficial”
May be caused by teething or by food etc.
Such things often withstand various remedies & 
hence are prescribed for very empirically


24
benefit derived from the application of roasted flour. It 
absorbs moisture & excludes the air
Eruptions attendant upon Teething
Children are very commonly affected with eruptions 
when teething. They generally put on the appearance of a
fine rash, but sometimes consist of distinct pustules containing
matter
As they are symptomatic merely, they require
no particular attention to be paid to them & will 
disappear when the teeth get through. The worst consequences
might result from their sudden suppression; as
if this mode of action by which the system relieves itself
from the irritation of the teeth, be interrupted, there is 
great danger that the system will relieve itself by 
morbid action of the brain, or other parts more essential to life
Eruption resembling the itch
Another kind of eruption appears on children of one or 
two years of age. It sonsists of distinct pustules like
those of chicken pock, which form a scab, continue to 
inflame about the edges & contain a watery fluid
It usually makes its appearance in summer & if not cured
disappears spontaneously at the commencement of 
cold weather
It has often been mistaken for the itch, and 
attempted to be cured by [?dock] root, but without success.
The sulphuret of potash used as above is a good remedy 


The tepid bath is apt to be neglected but shd not
Dock root often fails in this. It is
often very successful in children’s eruptions. It is
a very old remedy (centuries) Sometimes goes
into oblivion & is again revived
Prof. Smith thought most highly of R. patientie 
6 feet high in gardens. Woodville mentions
R [aquaticus] I know not that either is better than 
our [common] [illegible] I prefer the [Robtusifoli??] or [horserock]
It is acrid and acts well when ext. [applied]
and is good int. like rhub.
R. crispus also has about the same properties but is
milder. R. sanguinea is kept by many for it is
as a specific for cutaneous eruptions. called also 
jaundice root & used in jaundice I have
used them all and cultivated than all The leaves
of the R. sanguinea have all red veins.
You will often have such cuticles
exhibited to you in families and be [illegible] of about
them. Hence the importance of a knowledge of their prop.
I have never known them in any but
the children of [foreigners] I am inclined to 
think the taint may be dormant.
The eruption at first resembles what
is called “horn pock” “sometimes resemble a [illegible]” The nurse was changed 
& though the new one was
health yet the ulcer appeared on her nipple


25
I think this kind of eruption might be cured by diet
and the warm both. In all cutaneous affections the 
warm bath is very important to relieve the skin
from every thing that may obstruct perspiration
Eruptions & other irritations of
the skin translate action from the viscera. Where irritated
action exists in the viscera they are symptomatic
Gutta rosea of drunkards is an instance of translation of 
action from the liver “When a cutaneous eruption appears
we may generally apprehend that the al. canal is disordered”
I cannot too strongly enforce attention 
to diet. Nothing will avail without it
Venereal Eruptions
These appear infants born of parents tainted with 
syphilis, though they may have no symptoms of it at the
time of the birth of the child. Some physicians are of opinion 
that this child may inherit the disease from its ancestor 
the parents having been apparently free.
The eruption appears in smooth hard, circumscribed 
elevations of the skin of about half the size of a 
pea 7 resembling a wart before it has seeds. They continue
to increase slowly in size for two or three weeks, & become
soft, containing a watery fluid in [honey] like substance Subsequently the skin
gets rubbed off & leaves an ulcer with ragged edges & sometimes resembling a chancre which
is very difficult to cure. I have known one instance
in which the ulcer was communicated from the child to 
the breast of the nurse. Children affected with this 


Eruptions sometimes depend upon morbid state
of the liver analogous to gutta rosea of drunkards
Prescribe to the liver
“The disease often proves very obstinate”
Mercury does not seem to act as in the
primary disease
Corr. sub. given in this way is as
safe as any other article
The bowels should be kept free
“I think the sublimate acts more on the skin & is therefore
preferable to other mercurials”
The plantain was once celebrated for the cure
of cut. aff.
I have known the plaintain in this
way apparently cure after mercurials had failed
Still the mercury might have prepared the system
The plantain is an old English remedy for bites of spiders etc.
It is treated of by Woodville & [Willan] It has as little acrimony 
I have some confidence in its efficacy. There is an old story about a snake & [spider]
I have known nondiscript eruption
which had resisted the prescription of several phys.
cured finally by diet & change of air



26
complaint have a pale & bloated appearance & the powers of
life are feeble
Treatment. Change the nurse if derived from her
Give corr. sub. in doses of 1/30 or 1/40 of a gr. Give the blue
pill in moderate quantities but it subl. is better Give the tepid bath. Try
the preparations of iron, such as the mur. ferri, or 
tartr. ferr. or the alkaline solution of iron. This complaint
is not so easily cured as the primary [illegible]. Sometimes
it will resist the operation of mercurials & all 
the treatment for scrofula. In this case send the patient
into the country & try simple vegetable articles especially 
the expressed juice of the plantain (plantago major) externally
and internally. It is a popular remedy for poison & is apparently 
valuable. I have known patients cured by the use 
of this, and of the air of the country. Still I think its 
main virtue to consist in its bland & mucilaginous quality
[In these cases the whole lymphatic system is
disordered & deobstruents are indicated. Now the expressed
juice of most green vegetables id deobstruent. For instance 
the farmers make use of green rye in the spring
for this purpose] Perhaps the expressed juice of the green
plantain is deobstruent


Infantile Erysipelas is an improper name
vide Gray [illegible] of Erysipelas
Good’s is an entirely different disease and his account 
will completely [illegible] Corresponds perhaps to the 
rose of the W.F. Goods account of the rash may do pretty well
The infantile erysipelas of Europe described in 
the books is a different thing # 
Resembles shingles this is accompanied with fever 
The primary affection is of the al. can. therefore
the attention is not to be directed exclusively to the skin
I commences with [illegible] [illegible] you are to prescribe
to the fever [illegible]
This disease is distinguished by the eruption 
resembling a rose in the shading off of the colour from 
a dark rose to a light colour & in the concentric circles As I have seen the disease
the rash has appeared in patches about the [illegible] thighs 
principally & the local affection gave no [illegible] and was
trifling while the constitutional fever was severe and dangerous.
The fever if not broken up in the commencement will
resemble a severe case of [autumnal] remittent
I have found no satisfactory account
of the disease in the books, not even in the W. P. writers. I have
however been informed a conversation with W. Indians that the 
rose is one of their most severe and dangerous infantile diseases
fatal in a week
and is treated by a vigorous administration of calomel
# I have never seen the infantile erysipelas described as occurring
in the European lying in hospitals contagious & terminating 
in gangrene I have seen common erysipelas upon infants 
however


27
Infantile Erysipelas
The classification of this disease id doubtful. It answers tolerably 
well to the exanthesis roseola of Good “but [illegible] febrile” there is no species in 
Bateman & Willan which corresponds to it
Efflorescence in blushing patches, gradually deepening
to a “dark” rose colour, mostly circular or oval, alternately
fading & growing brighter chiefly on the legs with irregular
appearance somewhat like concentric circles if the patch is not circular the general circumference
This is a disease of rare occurrence with us
I have met with three or four cases.
It is a severe and dangerous disease, apparently 
the same with the dangerous rose of the W.F.
As it appears with us it is very different from 
the erys. that described by European writers & which is sometimes 
epidemic in their hospitals. In children in this country
it is generally a disease sympathetic with a morbid state
of the bowel
The elevation of the skin is less than in erys. of 
adults the discoloration less deep in colour & the skin though
a little tumefied is as smooth to the touch as if not
diseased In the cases to which I just alluded, the erysipelas
began upon the thighs & extended all over the legs. It was accompanied
with considerable fever & a hot dry skin The colour of the 
efflorescence was purplish rather than red ‘We rarely see
watery or bloody vesicles, as in other erysipelas’ I evacuated 
the bowels thoroughly with calomel (for the sake of the excitement
rather than the evacuation) & rubbed the part affected 


The fever will much resemble that of infantile
remittent
“The spots are in patches from the size of a
dollar to 5 or 6 times as large They are shaded in concentric
circles from purple in the center to a lighter colour”
“If the disease is not checked there will be 
increase of fever, constipation and tumefaction of the
bowels irritation of the stomach affection of the brain, [illegible]
death”
Administer a full dose of calomel in the first place
and repeat it once or twice. Work off the cal. with other 
cathartics. The secretion excited by the calomel is
what we want. The cathar. subsequently given bring away 
Antimony in small quant. & nitre may be given
until the liver is subdued
“When the febrile symptoms run high
pulse tense, tongue furred skin hot it is a very dangerous
practice to apply discutients applications to the eternal
affection Acetate of lead applied externally will probably 
translate the disease to the bowels”
“Treatment I first give colored in full
doses to alter the secretions to change
excitement and promote evacuation, but do not depend
upon it as a cathartic I then give [illegible] or [illegible] & [illegible]
etc. to move the bowels I afterwards use the absorbants
or alkalies, or ant. or iped. in small doses, as the case
may require


28
It is attended with constipation & tumefaction
& [illegible] of the bowels; with hiccup & severe fever, & may 
terminate fatally with severe coma
“Pulse small & frequent child dies usually 
on the 5th or 6th day”
“Dr Dewers says that in the cases he has
seen the disease was not local but would spread rapidly 
over the body disappearing in one spot without leaving a trace
behind it & breaking out in an other & perhaps a remote
part thus changing from one end of the body to the other”
Treatment. “Evacuate the stomach with an emetic, as
ipecac” Clear the bowels thoroughly with cathartics, for the
sake of the impression on the system. Give calomel in a 
dose of from 5 to 10 grs. If it do not operate within three
or four hours repeat the dose. If necessary , work off the
calomel with senna (or scammony?) adding aromatics
if the stomach is irritable or with castor oil if the senna
fails using also some laxative injection & the warm bath
to assist. Then keep the bowels open with blue pill & 
“use some mild diaphoretic as aqua amm.” or  give antimony
from from 1/20 to 1/16 of a grain
Pay little regard to the eruption and direct
your attention to the bowels I have letters from physicians
who have followed my directions & treated the disease not as a 
local one but with cathartics which testify the complete success
of this plan of treatment. In the W.F. also where the


“As palliatives after a strong impression has
been made on the bowels by calomel, we may give sweet 
spirits of nitre, aqua ammoniae etc.”
I have tried various either applic. without benefit
I have
“In those cases when the treatment wa local only 
the patients have uniformly died. I have not lost a single
case to which I was called with commencement. I have
conversed upon this subject with medical [illegible] out from
the W.F. and find that the practice there coincide with
mine”
“When called to cases of some standing I have endeavoured 
to arrest the progress of the disease by a blister
as [illegible] in gangrene & in the erysipelas of adults. The 
disease would extend beyond the blister just as if none
had been applied”
There is an erysip. affection which occurs about the
head of children which resembles that of adults which 
I have treated with lead water


29
disease is frequent it is treated by the physician with 
calomel & cathartics. They give calomel 10 gr. & repeat
it in 5 gr. doses until 20 gr. have been given
I once saw a child with a swelling on one
ankle supposed to have been produced by the sting of a bee or bite 
of a spider, which had resisted the operation of poultices & lead
water. I gave cathartics but they did not operate, & the child
finally died
External applications of any activity
should not be used, Still it may be necessary to apply something
in order to satisfy the parents. The best will be roasted
four “dried [illegible] [illegible]. Warm bathing will be very useful. If treated
with lead water & cathartics not used, probably every case 
would be fatal. I have blistered in imitation of Dr
Physick, but never with any advantage
‘If the disease be followed by diarrhoea
give absorbents & aromatics such as compd powd chalk or white
decoction. If followed by weak pulse etc. give tonics’
I have not lost a case when called early 
‘This disease is supposed by some to be hereditary 
I have seen it affect infants on the scalp when it appeared to 
be a local affection merely In cases of this kind I have used
lead water with [illegible] continualy advantage & without any evil consequences’
Cathartics however should be more or less employed
in conjunction “afterward aromatics or tonics as the case may require”
‘It sometimes affects the brain’


[illegible] a more [illegible] or [illegible] intertrigo an attenuation
& sometimes abrasion of the cuticle. The vessels forming
the cuticle are diseased and the skin is formed
in an imperfect manner It occurs also about the
nates, [illegible] etc. where the skin folds upon itself & the
air is excluded sometimes an acrid discharge Cullen
thought it a very thematic affection. The skin looks
like a new skin upon these parts. it arises from 
want of cleanliness & from confinement. The stomach
may in a state of indigestion secrete an acid and the
skin may secrete an acid. Exercise cleanliness
treatment in general of eruptive disease 
When [illegible] flax they would
burn a rag and put it in an axe & rub their finger
on to harden the skin when chafed. A scorched rag is
beneficial & use absorbent powders first nit. [illegible]
might be used keep dry the parts
Nurses apply “powder post” which is made by [worms]
Sometimes it is a vesicular eruption
which upon the head is called [farrigo] & in some situations
is called ring worm
To the [illegible] or intertrigo occurring in 
various parts the nurses sometimes apply the membrane
from suet which is smooth keep off the air, prevents farther
chafing and does well. The absorbent powders as starch
alabaster etc. do well


30
Sore Ears
This forms a very important subject in treating of the
diseases of children. Nature has chosen the part behind the
ear for eliminating irritation from the system. Under this
head I shall speak of purulent discharges from the cavities 
of the ears & nose
Slight blisters and ulcerations behind
the ears of infants are very common & are in most cases, so mild 
as merely to require washing with cold water weak soap
suds & with cold water, & being covered with a scorched rag
or with roasted flour, to prevent irritation from the cap
Frequently the discharge is acrid & excoriates
the adjacent skin. Often a miliary eruption at the part
commences the disease & is followed by excoriation 
Affections of the brain are sometimes relieved
by a discharge from this part. The discharge is very important 
to children in time of teething & when affected
with bowel complaints.
If suddenly stopped fever may follow
with full pulse, tense constipated bowels & fulness of the fontanelles &
“often nearly all the symptoms of hydrocephalus”
cold extremities Blisters behind the ears will generally 
restore the child to health
When an infant is suddenly attacked with 
symptoms of hydrocephalus [illegible] disease, enquire whether it has had sore ears which have 
suddenly dried up, & if so, apply blisters behind 
the ears, for without them nothing perhaps will cure
the new complaint. The same is true of old sore legs stopping of the [illegible] & other charges
The theory of this, in all such cases, is the necessity, not 



The quantity of evacuation will not amount perhaps 
to more than a teaspoonful & the fullness of the fontanelles
[rain] in the head & plethora is not owing to the quantity of
fluid. The same plethora, pain in the head etc. will 
result from cessation of catamena which discharges will 
not amount to more than a table spoonful
So you may bleed to the amount of pounds 
in cessation of a slight discharge for an old sore leg
with out relief. while if you start the ulcer again 
by [illegible] or [mustard] the symptoms will be relieved
Case of a man with ulcers on the legs of 10 to [20] years standing
discharge stopped [illegible] pleurisy & aff. of liver the
discharge restored by [illegible] blisters caustic etc. cure affected
Sulphate zinc 10 gr. to oz or 2 oz
may be applied Solution [illegible] sil. is one of the mildest application for irritated surfaces vide infra
Oxygenated [illegible] is mildest & 
less apt to become acrid Sometimes when the aff
is of an erysipelatous kind [illegible] relax the parts & 
are injurious
Change the nurse also if necessary
If the child is fed upon milk by hand, add perhaps
a little magnesia or lime water 
Similar affections may affect the 
cavity of the ear & the cavity of the nose. If the 
cavity of the ear is affected in this way & neglected ulceration 
is apt to take place & the small bones affected
causing deafness. First reject milk & water or
carb. soda etc. [illegible] Finally if these means fail use
stimulating injections myrrh finally [vit.] sil.
In the use of [illegible] sil. external began with 5 grs to the oz & increase if necessary 
to xv or xx to the oz


31
of the evacuation, as is generally said, but of the habitual
action of the system.
This affection sometimes degenerates into a very 
troublesome ulcer, extending down the neck, accompanied with 
much pain & yielding a discharge so acrid as to excoriate the 
skin wherever it touches it Deep sores will be formed
& the affection may terminate in gangrene & death
In such cases it may be proper to apply 
emollient poultices of bread & milk; to which may be added
poppy leaves, or pulverized stramonium seeds or ac. plum.
Powdered gypsum is one of the best applications Alabaster gypsum
is the finest kind Some apply red precipitate but gypsum is far better. Case in which this alone cured;
Another physician advised red precipitate The oxygenated ointment if well made is a smooth
dressing for them & is the best kind of ointment, where 
ointments do not disagree, as it sometimes the case. The 
bowels should be kept open with cal. or blue pill.
It will sometimes be necessary to correct
the milk of the nurse by administering magnesia & confining
her to a simple diet
Troublesome & sometimes fetid discharges 
on the internal surface
from the ear arising from a kind of eruption may follow this eruption & may cause deafness if neglected I have known also the 
cavity of the nostrils & the frontal sinuses affected in the 
same manner. A cure may 
be affected in either case by exciting the discharge behind
the ear though it may be necessary to keep it open for some time 
If this fails use (in addition?) milk & water Milk 2 part water 2 part lime water 1 part Tinct. of 
myrrh if the discharge is fetid & troublesome a teaspoonful to a gill, as an injection for the ear
Sol. nit. sil. 1 or 2 gr to oz. water? externally


Be very careful in watching the symptom Case of a 
young man who had had such a discharge for years 
checked by astringents [delirius] inflammatory fever
ertc. bled cathartics etc.
Porrigo galeata ([helvetea])
Cuticles below the scales dotted, shining
Said to be contagious. I have never happened to see it so
though I do not doubt the fact. I have never seen more
than one in a family have it
A very troublesome complaint The 
hair becomes pale, perhaps the roots are affected in which 
case mercury is indicated.
Salivation seems to do no good I have 
seen it practised without any benefit
Recent cases I have cured very speedily 
with oxyg. ointment. Any smooth substance applied
to the part & excluding the air, will often cure as for in stance
a bladder, or the membrane of suet what is useful
also for [fret] Poultices do well, whether upon this principle
or moisture changing secretion
When a student I recollect there appeared 
a strong recommendation of poultices A physician of my 
acquaintance prescribed a poultice & left his patient. It adhered
the hair grew into it and the hard
crust formed a helmet indeed. It [was] a long time a
period of week, before it was removed When it came off
however, the disease was removed!



32
Tinea Capitis. Scald Head porrigo
This is a local affection & yet much influenced by diet. Sometimes
however it affects the system, or is sympathetic of a general affection 
of the system.
The disease consists of scaly eruptions, eventually 
covering the head with a hard & generally brownish
coloured crust. The hair often comes off.
Cleanliness holds of course the first place
in the list of remedies; the head should be carefully shaved 
and washed repeatedly with soap and water. Perhaps as
successful a mode of treatment as any will be to shave the
head closely and apply a bladder or affect skin in close contact with the
skin. It excludes the air. Sulphuret of potash zfs or ai to a porter bottle used as a 
wash & given internally tablespoonful 3 times a day has cured the complaint in a 
few days mercurials or corrosive sublimate will be useful, but do not always cure.
Sulph. prt. internally zii to lb i [illegible] ext zii to lb is [illegible]
The ueast poultice is good, but care should
be taken that it do not become dry on the head, which should be 
first shaved. The oxygenated and the citrine ointments
have been found useful, as had also the tar ointment which 
is made as follows Rx tar ziv wax zfs sulphur zi or is
Mercurial cathartics should be given from 
the first and particular attention paid to the diet. # vide last par.
The practice in this complaint has been 
quite empirical & a great variety of remedies, have been 
popular. Veratrum viride & v. albus & [apocynum] [androsaem??] 
olium have used for external washes. Syrup of 
buckthorn is recommended as a cathartic. Muriatic acid


Lunar caustic about 6 grs. to zi of water (rain water)
well water may decompose it
Decoction of cocculus indica, is given
internally & externally.
Cal. zii al burnt zfs red lead zfs z6 zifs spermaceti cerate head shaved & washed with soap sude every
night and afterwards apply this ointment. It is given by 
[illegible] & Bates [illegible] & called
Diet must be attended to 
Terebinthinate ointment as tar ointment
Tar ointment is made of tar and lard or tar & 
simple cerate
There is no difficulty in the diagnosis of the
disease. You will be called to prescribe for scalled head
and you will find that the nurses have not mistaken the
disease. It begins with small pustules the matter
[illegible] which is acrid and soon forms a scab over the whole
head.
The treatment must be principally local. But
mercury may be given occasionally. I have not derived much 
benefit from the common mercurial ointment. Citrine ointment
is good however. Also cal zif lard zi


33
has been used 3 or 4 drops in a wine glass of water
Finally the sorts of the various species of dock (rumex patientia, crispa
obtusifolia, sanguinea, aquatica etc.) have been much used
All the species have about the same properties, being acrid
purgative etc. They are given internally as cathartics, & 
externally applied, made for instance into an ointment, by 
pounding up the fresh root with lard. The following
is a recipe Rx yellow resin zii
best ale lb i finest flour ziii mix the all & flour thoroughly 
together & add them gradually to the melted resin.
# The tepid bath may be used when this is used always
take care to have a supply both of hot and cold water
in order to keep up the proper temperature. Ipecac may be 
administered to equalize excitement in some cases, & as a 
valuable substitute for this article we can use the
root of asclepia, tuberosa, which is expectorant, diaphoretic 
and laxative.
“Vary the remedies according to their affect
soften use decoct. rumex particularly r. obtusifol. 
called horse dock. It at firs increase, the 
irritation & secretion. Use it externally & internally”


The excitement of the al. can. is affected also of
the nervous system
Various cutaneous aff. different kinds also of
local inflammation, or erysipelatous phlegmous gangrenous 
scrofulous the inflammation varying according to the 
constitution scrofulous gangrenous
I have frequently heard Pres. Dwight
speak of the pain he experienced in cutting his wisdom teeth
suffered extreme pain for a whole summer
She did not appear to me to look like a person in the consumption I was puzzled [illegible] [illegible] I looked into her throat and mouth
and found she was cutting r wisdom teeth
# The irritation may continue for mouths, from 
the pressure upon the gum
Those who commence cutting teeth at 10 mo.
to a year or even later do not necessarily suffer more
Delicate & scrofulous children suffer more


34
Dentition
Among the causes of infantile diseases no one more
claims the attention of the physician than dentition. The bowels
and the nervous system are always more or less affected by it
& to this cause we are frequently to refer affections of the lungs
of the brain, of the ear, of the skin, of the glands, & of the cellular
tissue in general. On this subject there is however a difference
of opinion, for it is said by many medical men that children which are
healthy # well teeth with as much ease as adults. Allowing
for the peculiar irritability of [illegible], no doubt they do,
but in granting this we concede nothing, for adults often
suffer extremely from dentition. I well recollect the case
of a Mrs Waters perhaps about 20 or 21 a married woman and the mother of 
said to have a [illegible]
several children, who was supposed to be in the last stage 
a good deal of cough etc. had raised a little blood
on consumption & upon examination & found was cutting
the four wisdom teeth. The gums were divided & 
antispasmodics administered, when she recovered perfectly.
# Case of Mrs Purcell’s child had been sick
with diarrhoea and fever for some time a flush of fever 
coming on every day. I had previously extracted defective teeth
from the [illegible] mouth. I now looked into the mouth lanced
the gum over a double tooth gave no remedies
The period of dentition commences at different
ages times in different children, varying from the fourth to the sixteenth
mouth, but most commonly in 
the sixth. The two central incisors of the lower jaw appear
about the sixth month and are followed in about a month
or six weeks by the corresponding teeth of the upper jaw.


very [illegible] [illegible]
[illegible] cases I have known a double tooth cut
first in others an eye tooth in others all the teeth at once
You must always examine to see what teeth are
cutting You will perceive the gum swollen and harder 
Some children are born with teeth but
such teeth re merely attached to the gum and are useless
and should be removed
Sometimes there is too much anxiety about
dentition generally however not enough Case of a 
child mother called me insisted upon
# irregular distributions of temperature are [illegible]
[illegible] hot 5 [illegible] cold


35
Next come the inferior lateral incisors & after these the corresponding
teeth above About the twelfth or fifteenth or 20th month
appear the anterior molares & are soon succeeded by the 
cuspidati those of each kind in the lower jaw cutting
through before those in the upper. Next we have the posterior
molares. The last molar teeth are not found in the child & hence
their name, dentis sapientiae. They appear from the 18th to the
25th year.
The above is the order in which the teeth 
commonly appear, but they often come irregularly, sometimes
the lateral incisores, sometimes the molares, & in
a few rare instances the cuspidati appearing [illegible]
Some persons never have more than two incisores in each jaw
Occasionally we meet with families who are said to 
be destitute of teeth. I have known a family from Charleston,
who had this peculiarity. The fact however is in such 
cases that the teeth exist but not rise above the level
of the gums, so that they are not ordinarily seen 
Such teeth have this advantage, that they are not subject
to decay & are also very serviceable.
Whenever between the fourth and the eighth
2nd year? month symptoms of irritation exist, the cause of which is
not obvious, the state of the teeth must be examined. The 
symptoms of difficult dentition are fretfulness 
inclination to bit hard substances, putting the fingers into
the mouth, slavering, starting in sleep eruptions about
the face & on the scalp, flushings in the cheeks. # hot head


pupils contracted sometimes dilated sometimes
losing their brilliancy
In delicate children the eff. will be more
chronic & in vigorous more acute
The system relieves itself often by evacuation 
and this is considered often a good symptom as [illegible]
there is a great flow of saliva. The system relieves itself
by diarrh. by salivation by sweating [illegible]
by every mode of equalizing excitement which 
is the great principles on fevers & indeed in most diseases


36
and cold feet, irregular paroxysms of fever, remitting
fever vomiting diarrhoea irregular & green stools wine
small in quantity & voided with pain or in large quantities 
and of a pale colour bloating of the hand feet and 
face contracted pupils. All the symptoms indeed of extreme irritation
may be met with & we likewise find in many 
cases a tendency to phlegmonous inflammation suppuration in various parts of the
body particularly in the ear. Case of a child who was
thought to have an affection of the brain. A tumour was
found under the arm.
Sometimes dentition is accompanied with 
phlegmonous local inflammations in different parts of the 
body & suppuration of the glands about the ar by which 
relief is afforded
Ricketty children cut their teeth more
slowly than others but not in general with greater difficulty.


The child must be held, and the fingers
keep in the mouth to keep it off the tongue
# The guard being made with a spring, so that when 
pressed upon the guard will yield and permit the
lancet to descend (in the slit of the guard)


37
Treatment. The first and most important indication is 
to divide the gums with a gum lancet or other convenient instrument.
The operation is not usually painful the child will 
even press against the edge of the lancet. The relief is often immediate and permanent
Some relief may indeed be afforded by rubbing the gums with 
a hard & polised substance & by giving the child something
of the same kind to bit, but the most effectual relief will be 
afforded by the lancet. The chief difficulty in the performance
of the operation consists in confining the child. It
may be done while the child is asleep & often without
waking it. We must also be cautious not to cut the tongue
To prevent this it would be better to make gum lancets with 
a guard # For the double teeth two incisors
should be made & it may be necessary to make a transverse 
one in order to divide a band of a sort of ligamentory
substance which confines the tooth.
It is sometimes objected to cutting the gums
in particular instances that, if it is done too early, the
cicatrix formed by the healing of the incision will subsequently 
render it more difficult for the teeth to push themselves through
This is not true for the cicatrix though apparently harder [illegible]
less vitality in it than a part which has not been wounded and will be more easily broken through
Solution of continuity is more easily made by disease in a cicatrix
than in a part which has not been wounded vide J. Hunger. It is a 
common maxim that an old scar is apt to break out in to a sore
The gums should be divided as often
as there are any symptoms of irritation, until the teeth 



Some other diseased action may exist in the
system, and the irritation of the teeth be superadded
the lancing will only relieve the latter
# For the gums having been exposed for a long
time to irritation because [illegible], and perhaps
ulcerated and are kept irritated by contact with 
the hard tooth


38
get through I have repeated the operation three or four 
times upon the same teeth. In some cases however cutting
the gums relieves the symptoms only in part. Indeed the irritation
sometimes continues after the teeth get through # “use astringents”
If any disease from the causes attacks the child
during the period of dentition it will be very important to 
remove all irritation from the latter source, for otherwise
all the symptoms may be aggravated & a disease be rendered
mortal which would otherwise have been mild.
In children of a vigorous constitution dentition
is often accompanied with inflammatory symptoms which require 
an antiphlogistic plan of treatment. Lancing the gums
will then be useful as local bleeding & it may even be advisable
to bleed from the arm though a few leeches behind the ear
are preferable.
It must not be forgotten that in 
infants, the bowels afford a great outlet to diseased action
and to irritation: hence the frequent occurrence of a spontaneous
diarrhoea. If the patient is costive or if it has a 
diarrhoea, a dose of calomel should be administered & if
the bowels are soluble a milder mercurial, as blue pill
may be given. During the whole period of dentition the
bowels should be kept open by such cathartics as the state of 
the system may indicate, such as magnesia, rhubarb etc. adding
aromatics if the system is relaxed and debilitated & chalk
if there is acidity
If a diarrhoea suddenly stops and
vomiting supervenes, externally irritant to the [illegible] [surface] generally, injections, calomel


The skin shd be kept moist for diaphoresis
is one of the most powerful means of equalising excitement etc.
If there is much perspiration you may 
depend upon op. alone but whenever there is much 
[unequal] excitement opium alone will not do well and
ipecac shd be combined with it in small doses
# Also by drafts to the [illegible], by local irritants 
to the skin generally also keep the bowels from 
remembering that there is no outlet to the brain 



39
and the warm bath are to be used, as has already
been mentioned under the head of diarrhoea
Another & a powerful mode of equalizing excitement & relieving 
irritation is by diaphoresis. For this use the warm bath & 
small doses of ipecac & opium or of antimony and opium.
Opium will always be useful to allay irritation & particularly 
if combined with ipecac or antimony, & always safe when 
there is no determination to the head
Small blisters behind the ears relieve the 
symptoms of dentition & prevent the disease from terminating 
in hydrocephalus. # If these cannot be kept behind the ears
mercurial ointment or cantharides may be applied to the 
same part. Nervines may be employed either with our 
without ipecac
During dentition exposure to dampness & 
to currents of air should be carefully avoided & the patient
should be kept warm


X summer & autumnal epidemic
Indeed the effects of it sometimes continue through 
the winter
The desire often resembles spasmodic
cholera in the premonitory diarrhoea & the sudden
collapse 


40
Cholera Infantum
This disease appears in New Haven in the month of July 
August September & October. It rarely commences until 
the latter part of July & in October there are few cases except
those which have commenced in one [illegible] other mouths & continued
until this. Indeed cases are sometimes prolonged till 
the middle of November
Symptoms. It begins in various ways; most commonly 
with diarrhoea, which may continue for days & 
even weeks without any very alarming symptoms; At other 
times times with violent vomiting & purging accompanied with high
fever.
The discharges from the bowels very much in their
usually [illegible] from natural colour [illegible] [irritated] [secretion]
appearance. Sometimes they are yellow, brown or green, sometimes 
in small quantities & slimy and bloody & at others in 
large quantities & watery, smelling like water in which 
putrid meat has been washed. Worms likewise may be
found in all these various sorts of discharges “dead in the advanced stages”
The disease is usually accompanied with great
restlessness & often with severe pain, which increases
by paroxysms at intervals of from 
fifteen minutes to two hours
The pulse is usually quick and weak, the
head hot and the extremities cold. The fever is ordinarily remittent
but the exacerbations are frequently quite irregular
The disease is attended with thirst often [illegible]
and after drinking the child vomits.
The eyes often appear languid and hollow  


During the whole progress of the disease [volvulus] may 
occur Be on the look out for it
“The termination of this disease in hydrocephalus 
I have reason to think is more rare than is commonly 
supposed. Many cases of this kind occurring in my 
practice, I have reason to believe were cases of volvulus
Or varying from cholera morbus of [illegible] [remittent]
bilious fever sometimes putting in the form of cholera of [illegible]
at others that of remittent bilious fever


41
while in other cases they may have an unnatural
brightness as in pulmonary consumption indication a high
degree of mental [illegible] excitement “of bad symptoms” Sometimes the eyes are half
open during sleep, as is indeed the case in various bowel complaints 
of children when severe we often find the diseased action 
translated from the bowels to the head and terminating in 
hydrocephalus. Volvulus also may be another termination.
Sometimes the vomiting ceases
for several days and then returns, while the diarrhoea
continues the whole time
Duration As to the duration of the disease, it may 
be very rapid in its progress & terminate fatally in forty eight hours, or continue for
months, & the symptoms may vary very much during the 
progress of the complaint. A damp hot atmosphere will aggravate 
all the symptoms, while cool weather with the wind 
from the northwest will mitigate them. In different
seasons also cholera infantum will have symptoms peculiar
to the year, varying in this respect like other epidemics
Finally when it proves mortal, the child is
carried off in convulsions, or is worm out with emaciation 
& dies with aphthae while in some cases death is ushered in by hydrocephalus,
volvulus & other diseases
Causes. We may consider the cholera infantum 
as an epidemic sometimes an endemic confined to a particular season of the year
analogous (in its grade of action) to the cholera morbus o f
adult “This disease is perhaps most analogous to a remittent
bilious fever varied by the peculiarities of the 


[illegible] [illegible] will see in [Jackson] all that can be said in 
[favour] of the opinion. The very fact that it is often [illlegible]
disproves the opinion besides the fact that the disease does
not occur at all seasons during the period of dentition 
The disease is affected by the state of the atmosphere
being much aggravated by a damp state of the air 
always minded by a cool bracing northeast wind
The kind and gentle excitement produced by 
nursing is important in chronic disease
“Children should not be weaned till dentition is complete or till
1 ½ years & in the fall”


42
infantile constitution”
Dentition has been considered by some as the 
cause of cholera infantum but to this opinion I cannot assent thought it is held by Dr Jackson & many of our most respectable physicians
Dentition may indeed be an exciting cause; it often aggravates
all the symptoms & accelerates the fatal termination 
yet in the winter spring & months it does not produce the disease of
not unfrequently children are affected with cholera infantum
without any appearance of dentition
Worms sometimes make their appearance during 
the progress of the disease but they cannot be considered as
a [illegible] or cause of it. When they exist during the complaint
the irritation which they produce must be obviated by 
such anthelmintics as are not contraindicated by the state
of the system. “I think I have seen the [illegible] productive 
of unfavorable effects.”
The cholera infantum probably arises
from the same remote causes as the (cholera morbus) & the
bilious remitting fever of adults such as damp hot confined
air (which can be counteracted only by exercise in 
the open air) want of cleanliness & bad diet. Improper 
food may be both a remote & an exciting cause & the same
is true of a bad state of the atmosphere muggy or [illegible] of inequality of temperature & exposure to cold. The predisposing
cause produced by these remote ones is debility
Children weaned in the spring are mor apt
to have this complaint, & do not bear the disease 
so well as those at the breast. I would therefore advise
that in places where cholera infantum prevalent.
children should be weaned in the fall




43
Some consider malaria the cause
Like dysentery this is a disease translated from 
the surface to the first passages. The fever is of that kind which 
Sydenham calls febris introversa the action being of an 
irritated kind in general & rarely of an inflammatory 
Commencing at the skin & breaking up the balance of the
system by obstructing the perspiration the morbid action is
transferred to the mucous membrane of the intestines & involves
the liver, pancreas & all the glands immediately sympathizing 
with them.
Indications. The indications are
1st To evacuate the first passages; if this has not been already 
done by the disease itself
2ndly To translate action to the surface & in general to equalize 
excitement
3dly To excite healthy secretory action and regular peristaltic
motion of the bowels
4thly To avoid the causes of irritation and to remove irritation 
when it exists
5thly To restore the tone of the system & particularly of the
stomach and bowels
1st When the disease comes on like the
cholera morbus of adults, the stomach and bowels are sufficiently 
evaluated by the disease generally when the phys. is called and no evacuation s
are to be used. It is to be treated like cholera morbus
with aromatics as essence of peppermint, with Laudanum 


We must be careful not to prescribe for the [name]
of the disease nor necessarily pursue the plan of treatment
generally proper. Often you will find the patient so
much debilitated at first as to require stimulants & acrids
When we have the collapse stage and
a collapse may recur in any disease then the practice
of the nurses is correct in acting on the skin
Some recommend large doses of cal. [illegible] much 
smaller the [common] Dr Jackson recommends large doses
common in the commencement. Dr [illegible], 1 gr. doses
and salt & water I recommend cal. from 
1 to 10 gr Though sometimes small doses repeated may change
the secretion better than large, yet often a large dose 
will operate more kindly, then a small one [which] merely
irritates
“Dr Dewers recommends injections of salt & 
water 2 or 3 teaspoonfuls to a gill, instead of cathartics. Repeat
the injections till full catharsis is produced the morbid
action is changed, by translation of excitement from the stomach & 
small intestines [illegible] [illegible] with cal. ¼ gr. every [illegible] to alter secretion


44
with counterirritants, as mustard, horseradish & brandy on 
the epigastrium & abdomen with the tepid bath & with injections 
of starch and laudanum. But when it attacks
with a diarrhoea, accompanied with occasional vomiting
unless the constitution is very feeble constitution [illegible] extremely delicate the stomach should be evacuated
by ipecac and the bowels by calomel or blue pill
To vigorous patients & often give in the commencement 
six grains & would not hesitate to give 10 grs of calomel & an hour after give from one 
to ten grains of ipecac according to the age and vigour
of the patient for in this way the stomach and bowels are
more thoroughly evacuated than by giving the calomel
after the ipecac has ceased to operate In some cases
a single dose of calomel will thoroughly evacuate the
bowels, but in others it will only remove the contents 
of the stomach and small intestines into the colon & 
a dose of castor oil must be given or one of senna with 
aromatic seeds
The southern physicians, make less use 
of cathartics and depend much upon stimulating injection,
as of salt & water 3 teaspoonfuls to a gill. This 
practice does not succeed well with us. They also give
smaller doses of calomel. This also I cannot approve for
a large dose of calomel, ten grains for instance, will 
evacuate the bowels copiously and kindly, when small
ones produce scanty stools, with irritation of the stomach
and tenesmus. I may mention also that the French expectant 
plan of treatment adopted in Philadelphia will 
frequently be utterly inefficient.


Where excited has not been equalized, calomel
or any other cathartic may act upon the duodenum only 
and not produce
Such facts as there have been given rise to the
opinion that the disease arises from stricture but then 
the al. can. may be subject to unequal action as much 
as the skin
# a castor oil with elix. sal. aa zi every 2 hours
# Yet this practice shd not be adopted indiscriminately
where there is weak morbid action accompanied 
with coldness of [surface] etc. the exhaustion of cathartics
will be injurious 
This is the most important principle in the cure 
of diseases
Sometimes cath. cure the diarrhoea, where
the action is unequal. For instance the lower intestines
may be torpid and the feces accumulate, the bowels above
may be irritated and a diarrhoea of [small] liquid 
stools may pass by the feces



45
If calomel or any other cathartic produces watery stools
in which are small pieces of feces of an ordinary appearance,
and there have not previously been copious evacuations,
we may conclude that a thorough evacuation of the
bowels has been prevented by a spasmodic action of the
intestines which has constricted them in places, & confined, perhaps
a large quantity of fecal matter. Indeed this may be
proved by the success of the treatment, which should be 
the administration of a dose of opium with a little calomel to change action followed at an interval
of one or two hours by a dose of z ¼ and z ½ castor oil or elixir
salutis teaspoonful #. It is of the first importance in all typhoid 
diseases, particularly in those affecting the bowels, that 
thorough evacuations should be made #
2ndly so translate action to the surface and equalize 
excitement This indication will be answered by an emetic
at the commencement, as already directed & by small 
doses of ipecac, repeated throughout the disease, & also
by small doses of mercurial medicines opium being conjoined
in many cases, as will hereafter be mentioned. In 
some calls where there is much arterial action antimony is 
preferable to ipecac & the lancet or leeches may be indicated
but such cases are rare This indication is also answered
by applications to the abdomen of fomentations,
with decoctions of aromatic herbs sinapisms, blisters, burdock 
leaves, horse radish leaves, ginger in spirits aq; amm or the 


Ulceration of the bowels is generally preceded
by aphthae both are effects not causes of the disease
“An [epispastic] should not be applied after 
aphthae have made their appearance. If the pat. is languid
& sleepy we may suspect aphthae.”
Diluents may be used
Obviating irritation by opium is often necessary to have
the proper effect of cal. for instance Give opium first & follow
with cal. & often you will succeed in obtaining the effect of
the cal. when you had failed before
“Ipecac when it acts as a cathartic
is more apt to produce fecal stools than any other article


46
terebinthinate oils An epispastic upon the epigastrium 
is very useful to relieve irritation of the stomach & to prevent
ulceration of the bowels and aphthae. The warm bath 
will tend powerfully to equalize excitement will relieve
vomiting, quiet restlessness, produce a uniform perspiration 
& if used at evening, procure a quiet nights’
rest. It may always be used and at any time, unless 
the patient is in a state of exhaustion.
As a substitute for ipecac, the root of the 
asclepias tuberosa may be used. It is much used in 
infantile diseases as diluent, to determine to the surface
& to promote expectoration.
3dly For changing the secretion of the stomach and 
bowels and keeping up a gentle peristaltic motion I have found
small doses of mercurial cathartics with ipecac of opium
superior to all other remedies. If any article deserves the
name of a specific in any disease, it is ipecac judiciously 
administered in cholera infantum. It relieves this disease
with more certainty as certainly as than cinchona does intermittents. It
may be observed however that a man successful with one
remedy only m ay be compared to a mechanic, very skillful
with a pen knife! My method of administering the articles
is the following. For a child four months old, mix 4 gr.
of ipecac & 5 drops of laudanum in twelve teaspoonfuls 
of water & give a teaspoonful every fourth or fifth hour
& at the same time give so much of the blue pill as to 


You will know when the blue pill begins to have
its appropriate effect by the change in the color of the stools
Pills of blue pill may be given without much difficulty to children there is little
taste except of the saccharine matter. They may be given in food
[illegible] dried huckleberries which I have often called for in the
country where there was difficulty in administering remedies. There
is often great difficulty with respect to this. A child will
often scream at the sight of the doctor
Opium to allay the irritation of the stomach
and prevent the ipecac from being thrown of Ipecac
to equalize excitement & determine to the surface Ipecac
also, to qualify the opium
# Or if this cannot be done, introduce a paste of opium just within
the sphincter
# Case of a child in a family where 3 or 4 children 
had previously died of chil. inf. [Lax] & [illegible] habit
etc. I commenced the treatment
with the pill and ipecac 
I treated it mildly giving blue 
pill instead of calomel N.B. For such cases [illegible]



47
procure an evacuation from the bowels two or three
times in [never twice] in the twenty four hours. For a child a year old
take twice as much ipecac & laudanum with the same
quantity of water and give it in the same way. Sometimes
three times the quantity of laud. will be necessary; for instance
if the child has been in the habit of taking it or if the diarrhoea is very urgent
If the diarrhoea is urgent, it may be necessary 
to administer injections of starch and laudanum & 
to apply to the abdomen ginger & grandy volatile liniment poultices or other irritants
The enema may be made with three table spoonfuls of flour
& about 3 or 4 times as much laudanum as you give by the
mouth say 10, 15, or 20 drops. # I prefer flour to starch 
because the foreign starch often contains acid. The chalk 
mixture or white decoction may also be used.
# “Children of a bucophlegmatic temperament 
and lax habit are very apt to have this disease & with 
them I have sometimes commenced the treatment by administering
blue pill & ipecac.”
The success of this plan of treatment will be strikingly shown
by the following case. A child 10 months old was taken sick in this town
last summer, with cholera infantum, grew worse and was
directed by the physicians to be carried into the country
Unfortunately the child was carried to a situation not more
elevated than N. Haven & while there its strength decayed
and all its symptoms were aggravated. The parents despairing 
of it recovery returned with it to N. Haven & sent for me with 
a request that I would do something to alleviate its sufferings 


On recovery from the disease they usually crave [salt]
food and salt is a grateful stimulus


48
I found it in a state of emaciation, with hippocratic countenance
frequent vomiting, urgent diarrhoea, with stools fetid, watery 
and containing some slime and mucus, & leaving streaks of
blood upon the cloths. The countenance and gestures, expression 
of great anxiety, and there were frequent paroxysms of extreme
distress. I directed ipecac 5 gr. & laud. 10 drops to be put 
in 10 teaspoonfuls of water and a teaspoonful to be given once in 
four hours flannel wet with ginger and brandy to be applied
to the bowels & gave 5 oz. blue pill, & ordered the diet to be of
arrow root flavored with a little brandy. After the second dose the vomiting stopped, the
stools became less frequent & within 24 hours the complexion of
the stools was much improved. The next day the same medicines
were continued and four drops of the tonic solution with 
a little brandy and water. On the fourth day from my 
first visit, the child began to relish salt fish, which was allowed 
Capt. Dennison’s children
To correct fetor in the stools we should give
charcoal. Carbonic acid, by injection, is given for the same
purpose. The mode of injecting carbonic acid, is to place chalk
& vinegar in a bladder, and 
force the gas into the rectum, as it evolved. “This is 
recommended. I have tried it but not very thoroughly”




But if vegetable food undergoes the acetous fermentation
it shd not be used. The putrefactive fermentation 
however is more injurious than the acetous


49
4thly The most common cause of irritation is dentition 
The gums should be often examined, & be divided if they appear
at all swollen. All kinds of food that is hard of digestion 
should be carefully avoided though for children
somewhat advanced perhaps a small quantity of ripe fruit
may not be injurious If the child has not been weaned
the milk of the mother will be the best food; for those children’
who nurse are more apt to recover than those that 
have been just weaned. The act of sucking is highly soothing
and gratifying & operates like a nervine medicine.
The best food for children that have been weaned, will be arrow 
root, with a little brandy or wine as a condiment & as a substitute
for this & similar articles from the shots, we can
direct a porridge made of roasted flour. If in the latter 
stages of the disease the child craves any particular of food, as
salt fish, or salt meat, or wine or brandy, it should be given, & 
all kinds of medicine laid aside if the stomach leathe3s them; for 
strong disgust will debilitate by exciting nausea. Frequently 
however we can succeed in preventing this effect, by a different
mode of administering the medecine the sight of the spoon for 
instance may may give rise to the loathing & nausea.
With respect to food we may lay it down as a general
rule in such cases that when the powers of the stomach are
so weak that food must undergo fermentation in it, vegetable
diet should be preferred to animal.
For local irritations, various applications should be made
& various articles administered, especially in the latter stages 



“Tea juice? boiled beef a teaspoonful with pepper & salt
is grateful frequently & checks vomiting but at
first vegetable preparations are better”
vide supra
The chalk mixture made with a little opium 
in some cases or with astringents etc. a valuable [illegible]


50
of the disease or when we are compelled to try a variety
of remedies. When there is unequal excitement & unequal temperature
blisters may be used. Blisters sometimes produce perspiration.
To relieve irritation of the stomach effervescing mixtures
may be drunk, they are often more grateful. [illegible] we may 
fill the stomach where there is vomiting and dilute its contents with a tumbler of wine whey 
I have often succeeded with it
with a teaspoonful of aqua ammoniae in it as being thrown up will be no objection. If the disease commences
with much irritation in the stomach, it may be useful
to overcome it by counterirritation in the rectum produced by an
injection of soap suds or of salt and water 3 teaspoonfuls of 
salt to a gill of water, for a child a year old. Dr Dewers
relies must upon this latter article in the commencement of cholera 
infantum and repeats the injections until the bowels are
fully evacuated. He likewise recommends small doses 
of calomel, a quarter of a grain for instance repeated once in 
an hour until the bowels are evacuated. In cases of irritation 
of the stomach & torpor of the liver & portal system, this 
practice of salt & water & small dose of calomel does well. In chronic cases he gives magnesia
rhubarb & opium. With respect to small doses of calomel
it may be further observed that they will not answer when 
the intestines are much coated with mucus & that in some
localities they do not answer so well as in other places. On 
the shores of lake Erie for instance the physicians are obliged
to give large doses of calomel than we give
There are cases in which small doses seem
to irritate & large doses operate kindly 


“In the latter stages Rx magnesia grs 4 SS gtts
Rhei gr i.”
C. Florida not so pleasant but loses its mawkish & 
herbaceous taste by keeping (like peruvian bark)
The spiraea is though less inclined to act unequally 
in this state than most other astringents
If one astringent wears out try another
Oak barks
Rose [illegible] (salix [illegible} “A valuable popular remedy” 
has mucilage combined
seeming to resemble ([illegible]) [illegible] was formerly 
much used but is now superseded by native articles
It is well known that because These astringents are often prompt up is specific
[illegible] virginica was specified good [illegible] & [illegible] it
e.g. viburn. lentigo, raspberry, blackberry, [illegible] [illegible] root decoction
recommended by Dr Rush thought to deter to [illegible] used by many) [illegible]
bark has [mucilage]
There is apt to be a paucity of [urine] in this disease
as well as in Diarrhoea & dysentery and then diuretics
are indicated and are highly valuable


51
5th When in the latter stages of the disease the principal 
indication is to restore the tone of the system & particularly of the stomach
and bowels we must make free use of tonic and astringents.
Moseley’s tonic solution will be one of the safest and best articles
in this stage. If the bowels, by a habitual action keep up the 
diarrhoea, astringent will be more specially indicated such
as the compound tincture of vitriol. I prefer however, the 
cornus circinata to all other articles
C. servicea (red [illegible]) C. [illegible] C. alba nearly allied
Of astringent vegetables we can make choice
from a great variety which are indigenous & common. All
the various species of viburnum all the [potentillas] & the 
roots of the strawberry to say nothing of the bark of the oak & 
indeed most of our forest trees, are astringent & may be used
The spiraea tomentosa is much used in decoction or extract 
All the species of [illegible] are astringent & the C. [rivale] is a most
valuable article; as is also the geranium maculatum, which 
may be be given in wine & then we shall have red wine.
The sttici limonium (marsh rosemary) is not so agreeable but
is frequently more efficacious specially if the mouth is sore. Its taste resembles that of salt
mud. When given internally, it is boiled sweetened & has a 
little wine or brandy added. It is also used as a wash in 
case of the supervention of aphthae.
The erigeron canadense, called colt’s tail
& strangury weed has been found a valuable article in the 
latter stage of this complaint and of dysentery given in decoction.
It is acrid pungent like [illegible] bitter & stimulating & acts also
upon the kidneys as a diuretic. It seems likely to prove a 


Give it in decoction or in milk which will cover 
the taste of it
Balsam of copaiba or turpentine cannot be combined
with mucilage so thoroughly as in the white pine 
bark in milk & water diuretic & [sheathing] to the bowels
I have often used the expressed juice of spearmint
as in diarrhoea q.v. It is important in long continued bowel
complaints of children that the medicine shd be grateful
The diuretics are useful both in children and adults
(dysentery diarrhoea & cholera infant) because there is a
paucity of urine and acrid irritating secretions
In some cases of exhaustion we give opium constantly
in small quantities to keep up the [illegible]
Mucilages marshmallows or substitutes for
which hibiscus palustris hib. syrica hib. [illegible] hib.
(rose of [shora])
Mucilages by stopping irritation are
diuretic


52
a valuable article in the latter stages of bowel complaints 
provided there is not too much vascular action. It has been 
long used, vide Barton, the N.Y. Medicophys. Transactions etc.
In 1790 an itinerant came through N. Haven offering to 
cure the dysentery; and attracted a good deal of notice.
It was found that his [illegible] consisted of this article. The 
other species of erigeron have similar properties.
In the latter stages of the diarrhoea mucilages
should be given. They made of any of the various in articles in 
use, but perhaps the most valuable mucilage, will be that made
from the inner bark of the white pine, which will furnish a terebinthinate 
principle in addition to its mucilage
Often in the latter stages of the disease, great
benefit will result from supporting the abdomen by a bandage
and a plaister of white [diachylon] and opium or
a soap plaister (of [illegible] & soap) 2 parts sp. 4 pts plaister
In extreme exhaustion & debility from the 
long continuance of the complaint with cold extremities, aromatics
and stimulants may be required & we may give spiced tea
spiced wine or brandy in small quantities, or the white decoction 
and apply cloths dipped in brandy to the abdomen & to the extremities


Nothing has more affect upon complaints of the 
stomach liver & bowels than the state of the mind as
we see in dyspeptics
The
We are apt to suppose children not subject to 
notice of [illegible] children [illegible]
mental impressions. When the matter has been dissolved
in grief & abandoned to despair
I told them to tray as a last resort carrying
the child in a hack out of town the excitability was entirely 
gone the child might as well die in the back
as any where strange advice On the top of the [illegible]
about two miles out lifted up the child [sound] trees
grass birds, etc. opened its eyes before this had lain
with eyes half closed noticing nothing 


53
Finally when every form of medication seems to fail, our
only remaining resource will be change of air. This is a
most powerful remedy. The physicians of N. York and Philadelphia
are continually recommending it. We are apt to suppose 
that in children it can be only the purer air 
& the exercise of travelling that produces a good effect, when they 
are carried from home for their health, but on the contrary 
the change of scene seems often to have a more powerful effect
upon them than it would upon adults. Children that
have lain sick for weeks, instead of pursuing their accustomed 
amusement even though mere infants seem of ten to settle into
a state of utter despondency from long confinement & the
constant sight of the same unvarying objects around them, & 
appear to loath every thing offered to be done for them. This morbid
condition  of mind seems to be one directly opposite to that of
nostalgia or homesickness & is to be relieved in a corresponding
manner. I well recollect a child apparently 
in articulo mortis cold & vomiting nothing wd [illegible] the vomiting
entirely beyond the influence of medicine
or food. It was carried in a hack to the top of a hill
without the town N.Y. [illegible] where it had a view of the sound, & the
scenery of the country around. While there is brightened up
vomiting ceased and took food staid an hour or more & then was carried back to town, where it
finally recoverd.




54
The symptoms attending cholera infantum very very 
much and give rise to considerable variety of practice
It is probably owing principally to this circumstance more
than to any other that physicians differ from each other
in their mode of treating it.
Post mortem examination show that this disease
affects principally the mucous membrane of the stomach & the
small intestines; rarely the large ones. Sometimes coagulable
lymph is found in the intestines but less frequently than in 
other diseases. Sometimes the mucous membrane of the intestines
is thickening & according to Dr Jackson ulcers are occasionally 
found both in the small & also in the large intestines. The 
liver is usually enlarged without derangement of structure
Ordinarily the brain exhibits no morbid appearances, unless
the disease has made a determination to that part constituting
hydrocephalus 
N.B. The remarks upon asclepias tuberosa
introduced under the Head of [illegible] capitis probably 
belonged here


Fever of the bowels Acute [illegible] of [illegible]
Different writers give different names and do not always give
the same symptoms. The European disease differs somewhat
from ours. It is our infantile winter epidemic.
Typhus infantum of Prof. [Tully] “Disease of the bowels
bowel complaint, plague of the bowels, winter epidemic 
& [illegible] epidemic. Remittent bilious fever
(at south) Musgrave’s spurious [illegible] fever Duncan III or IV”
There is some [illegible] action but more of the
character of irritation like other infantile fevers
Rarely vomiting never diarrhoea in commencement
The morbid excitement often extends to the lungs
putting on the for [illegible] what is called in adults bilious pleurisy
The disease is not common at this time
though it was very much so formerly Probably it will 
return It is almost the only winter infantile disease
& so common has it been also that the nurses call almost
every disease in winter, of childr, by this name 
of choler.
The dis. is to be broken up in its [illegible]
by means various in various patients by a strong impression 
upon the stomach in a strong constitution but by 
an impression upon the whole system in the delicate
constitution Comparison to a weight upon a [illegible] If applied upon one part only it will break it not if applied to [illegible]
It is desirable that vomiting or at least
nausea should talk place from the cal. In enteric 


55
Constipation with Fever
or
Remittent bilious fever of children Musgrave’s spurious worm fever
marasmus acutis
This complaint has been known in N. Haven for more than 50
years by the name of choler. It is called in some places at the 
“It is unfortunate that we have no better [illegible]”
eastward, the plague in the bowels. It is a common bilious 
“It affects however the duodenum & small intestines rather than the liver”
fever produced by causes which operate upon the bowels a 
part of the system which in children more particularly invites
Children are attacked by it from the age of 3 mo. to 2 or 3 yrs.
febrile action. It is often inflammatory in its commencement
Sometimes it [illegible] in the form of typhus
Symptoms The pulse in the commencement of the disease is 
full, frequent & sometimes tense, the skin is hot and dry 
face flushed, respiration, short and laborious, tongue covered
with a white fur, the abdomen fuller and harder, than in health, & the bowels costive; the urine small in quantity
and high coloured & sometimes the fever is attended 
with cough & expectoration. This disease is a fever
which often affects the lungs and always the alimentary 
canal & liver, the secretions being suspended and the 
bowels constipated.
Treatment. This will be antiphlogistic in the commencement
of the fever & the first indication will be to evacuate thoroughly 
the stomach and bowels. This will best be answered by a  
single dose of calomel of from 5 to 10 or 15 or even 20 grains for a child 
from four to twelve months old We shall thus produce a strong
impression upon the whole alimentary canal & upon the
system at large. In entonic cases and vigorous habits a
little tartar emetic may be added to the calomel
Usually the calomel excites both vomiting and purging, but 
sometimes it is retained on the stomach and has no immediate 



cases it may be beat to conjoin tartar emetic for this
purpose.
Sometimes the cal acts upon the stomach & 
duodenum & excites the action of the liver, and spends
itself there, without producing catharsis
Sometimes it is necessary to repeat 10 gr
doses of calomel once in 2 hours until 40 or 50 gr have
been given and cause them to follow with liquid cath.
a [illegible] or jalap or scammony
N.B. If there is great difficulty in giving medicine
repeatedly, we may give powder of jalap in 
coffee or fermented liquor or we may give a teaspoonful
of the tincture of (not briony root but pure jalap
in milk & water which will not be tasted
Feeble constitution must have the warm’
bath. # Rx senna zjs man zi senega zii anise seed zis
liquorice zfs [illegible] ½ [illegible] This I have held the child with. remember large doses are needed
Rx scamm. grs 2 or 3 chalk & diaphoretic antim. this
was called Earl of Warwick’s powder & was kept in the shop
here. Tart. emet. would be a more certain prop. of art. It 
produced violent vomiting. Scammony is better united
with cal. however. # 
# Cautiokn about covering the [illegible] with a blanket
vide
# Cal. was finally substituted for the [diaph.]
ant. This Warwick’s powder used to be a shot preparation
in this town and parent would send for it. From the uncertainty 
of the strength of the diaph. ant. however, [dangerous]
vomiting sometimes occurred from the use of it 


56
effect. In the latter case a second dose may be
given two or three hours after adding from an eighth to a quarter of a grain of
tartar emetic for a vigorous patient Fifteen or twenty 
grains of calomel will often empty the stomach and
bowels freely & remove all the symptoms. The calomel
may however evacuate the bowels but partially & in some 
instances not at all merely moving the contents of the 
small intestines into the large ones. In such cases another
cathartic is needed for completing the purgative operation 
If the calomel appears to have no effect, it should be repeated
in 5 gr. doses every three or four hours, the patient
put immediately into the warm bath & we should
commence feeding the child as freely as the stomach
will bear with the following R fol. sennae zfs, mannae zi
steep in ½ pint of boiling water & if there is a cough, add
senedae zii & rad glycyrrizhe zfs. If the stomach
will not retain the mixture of senna the powder
of jalap or scammony mixed with tea coffee or milk must be substituted, giving 4 
or 5 grains in the intervals between the doses of calomel
Injections vide p. should be given to assist the operations of the
cathartics and repeated every 2 or 3 hours until the 
bowels have been thoroughly evacuated taking care
however not to commence with injection until the cathartics
have had time to operate
When we have succeeded in procuring stools
we shall find them to consist of viscid green mucus mixed
with half digested food. Sometimes in the progress of the disease they exhibit the 
appearance of small pieces of membrane, of 


There is a membrane [illegible] inflammation of the duodenum
similar to that of croup. This indicated by pieces of 
membrane preceded however by pain in the part
obstinate constipation etc. This is a strong indication for
calomel which however will not operate as a cathartic
until the violence of the disease is broken Warm bath
& injections will also be more particularly
In some violent cases of the fever where
calomel seemed to have no effect. I have known acid
as lemon juice advantageously combined with calomel
Among the cathartics and laxatives used in 
the second stage we have the wild liquorice or [illegible] [circa???]
which was formerly a popular article and kept in families. It is 
diaphoretic and laxative and possesses and also deobstruent properties
It is said that with this the Indians formerly [died] their porcupine quills
# The acids are sometimes used in combination with 
mercurials I should not use them unless when
mercury fails
Sometimes it affects the ear & produces suppuration 
& discharge. It may terminate in effusion into the ventricle
of brain. It may terminate by exhaustion Or may 
terminate in thrush “in which case there is a double translation 
1st from the bowels to the head & thence to the mouth oesophagus & bowels



57
& of about the size of petals of peach blossoms, 
floating in a liquid of the same colour. Such stools
as these latter are a sure indication that a farther evacuation 
from the bowels is needed vide p. 207 They are frequently 
evacuated by adults in bilious (or common cholic.
If such continue it is well to vary the cathartic and give
magnesia, or soluble tartar (peerlash & cremer tart.)
or phosphate of soda, or any other neutral salt.
generally the violence of [illegible] [illegible] & The blue pill may be substituted for the calomel & given
three or four times a day, until the stools change their
appearance or the mouth is affected, though this rarely 
happens to children under four years of age. These
stools rarely have any smell & as they indicate a want 
of secretion I the liver & glands of the abdomen, mercurials
are peculiarly appropriate. In some states of 
fever attended with stools of this kind I have known
the free use of acids with mercury very useful # 
After 48 hours the fever generally 
remits, and sometimes it continues in the form of a remittent
for six or eight weeks or more. Very frequently 
however it changes its seat in the course of 15 or 20 days
& terminate in a phlegmous swelling of some of the glands or in phlegmon
or is determined to the head
& puts on symptoms of hydrocephalus, which are best 
relieved by blisters behind the ear, a place which is the natural 
outlet of diseased action in children. They may terminate
naturally by a discharge of purulent matter from the 
cavity of the ear or fatally by effusion into the ventricles of 


I recollect two cases early in my practice, which 
continued 6 or 8 months. They were very violently attacked
They continued 6 or 8 months coma 
Hence we should never despair
In the latter stages it may be proper to 
give tonics or those articles which are called tonic
very unlike the vegetable tonics however. They produce a
[illegible] excitement
Giving arsenic is no new practice 
It is a safe and efficatious remedy, when the dis. continues 
as a remittent It comes after cal. & tart emet. producing 
liquid secretions. If long continued it must be followed 
by bark to restore tone and obviate the debility caused 
by the arsenic Arsenic can only be called a tonic
as it removes disease. It would never be given as a 
[illegible] is pure debility #
# I have used digitalis, in the latter stages to allay irritation
# In many cases the fever continues from habit
& medicines have little affect. There will be an accession 
of fever every afternoon. Here give sol arsen 2 drops
twice a day which is a full dose for a child ½ years old
If this has no effect give it [illegible] times a day”



58
the brain; in two cases I have known them relieved
by a thrush.
If the disease continue a regular remittent
without symptoms of hydrocephalus, it will be proper to give
tonics, such Moseley’s tonic solution or if the fever intermits or remits Fowlers solution of arsenic
the latter in doses of two or three drops the former
from 4 to 20 drops, 3 or 4 times a day. I have known a child
18 months of age cured in this stage of the fever, in the course o f
two or three days by taking 2 drops of Fowler’s solution 3 times
a day. This article however is liable to produce edema or dropsical
effusion & if it does we must substitute the tonic solut.
(beginning with about four drops) or some preparation of
bark. The dose of the tonic solution will depend upon the
irritability of the stomach If irritable from 3 to 6 drops will 
be as much as can be borne
After the inflammatory action has subsided
narcotics anodynes are necessary to remove irritation and
to procure rest We may use opium, either alone or 
better combined with ipecac or antimony # Indeed as the
skin is usually dry antimony is indicated in almost every 
stage. The warm bath also is indicated in every stage except
in the low typhus state of the fever when it would be too debilitating.
Epispastics & irritants are useful in the progress of the
disease, to translate action from parts essential to life & in 
the last stage also perhaps to keep up the action of the system. They 
may be applied to the abdomen if it is much swollen to the
head behind the ears where there is danger of hydrocephalus & 



Avoid too much heat to prevent tumefaction of the
bowels.
Terebinthinates a [illegible] oil may be needed proper 
If pneumonic symptoms blister etc.
“If the lungs are much affected, apply a blister to the
chest, give expectorants, and pursue the treatment required
in pneumonia. Senega & squills are good, but
are too stimulating for the earlier stages liquorice anise”
By this disease it is sometimes proper to do nothing 
and omit all medicines in mania etc. In those cases
as I have had difficulty to persuade parent to do nothing.
I have applied aloetic plasters 
to the bowels I think they have produced evacuations
injections also can sometimes be given
Case of a very [illegible] child
[furious] parents passed in review before him with 
roasted apples pears etc. after 26 hours he snatched
an apple relapsed in 26 hours they probably had over 
loaded his stomach however the same management 
finally succeeded afterwards of the patient recovered. vide p. [20?]
The same season I had 3 or 4 more such 
cases of mania which required to be cured by fasting


59
a large one to the chest if the lungs are affected.
“This disease is sometimes followed by thrush
when an emetic of ipecac will have a good effect. If the stools
are fetid charcoal should be given. If in the latter stages
there should be tumefaction and pain in the bowels, the
abdomen should be supported by a bandage. In the latter
stages also a decoction of the inner bark of the white
pine be useful. It possesses some tonic properties”
Sometimes in diseases of children the mind is 
affected, the patient will take neither solids nor liquids & struggle
till it is exhausted whenever an attempt is made to administer
any thing. If that is the case in this disease we must use
the tepid bath & we may a apply for purpose of moving
the bowels, a large plaister of aloes and ginger to the 
abdomen Frequently this derangement & morbid revengeful
disposition (according to Dr Rush an affection of the moral
faculty is so great that we must wait even for 24 
hours or more without administering any thing. It may 
require great prudence and judgment in such cases, to 
satisfy the parents.
Before leaving the subject I may observe,
with respect to the propriety of the course I have directed
in the commencement of the disease, that if the cathartic which 
we administer first produces emesis we may be sure that
the alimentary will be operated on, & also that we often 
require a remedy more powerful than the disease, just
as in croup.
“As to diet meat must be forbidden but sometimes salt food is craved. The weak chicken broth is good.



The dis. is something very rapid & violent
Fever as violent as the constitution could bear
Collapse from the violence of action
Parents considered the patient & dead
After the mustard was applied as soon as the
skin was reddened a blister was applied, which 
produced a sore 2 or 3 months in healing
“In one hour pat. revived”
Nervous system affected
Irregular action such as after collapse of
cholera Strong clonic spasms once in 15 min.
“Pat. kept under a constant [narcosis]”
Antispasmodics & tonics finally In two or three weeks [illegible] recovered some strength
It was called the child that died & returned to life again
The above is account of the disease as it
most commonly appears. It is different however in 
different years sometimes effecting one part of the system
sometimes another A practitioner keeps this [illegible] [illegible]


60
Case of a female child 2 yrs of age. The disease ran
the most rapid course I ever witnessed. 
The whole system became
affected; the pulse was full & frequent, the skin hot & the
tongue furred. In 24 hours the disease came to a crisis
and exhausted the excitability of the system; the pulse
grew faint, the skin cold and the respiration languid
the patient became insensible & was apparently dying
sinapisms were applied to the abdomen, ankles & wrists & 
heated bodies put into the bed, to restore warmth. After
the sinapisms had been on an hour and excited some
redness, epispastics were applied in their stead.
Ammonia & ether were put into the mouth & caustic ammonia
was applied to the nostrils to excite 
Inflammation so as to blister. Ether was also put into the mouth
In about two hours the system was resuscitated. Immediately a train of most violent nervous
symptoms followed the chill became convulsed
almost instantly. After trying antispasmodics in vain 
the convulsions were checked by laudanum, 6 drops,
every two hours. The laudanum lost its effect in 
two hours & needed to be repeated. The blister on the 
chest produced a deep ulcer which was difficult to cure
Finally tonic solution was administered. The child recovered
Child of Mrs “Moulth???]
Child of N. Beers’s vide p. 208
diseases and consequently meets with no new disease
For they do not make sudden transition as in botany plants
he is guided by symptoms & by the operation of remedies



Appendix to Mes. fever acute marasmus
This disease sometimes appears in an acute form
with great irritation Sometimes terminates in hectic Patient will run down
very rapidly [illegible] appearances enlargement
& [illegible] of mesenteric glands “Called” consumption 
of the bowels” or Marasmus”
Mesenteric fever is thought to terminate
in hectic Probably it does especially in scrofulous
patient and in those bad cases where the tubercles with a mesentery ulcerate
“The pain in the bowels is no usually very severe 
but of a continued aching kind generally better
removed by [camomile] injections than by anodynes”



61
Mesenteric Fever
Marasmus tabes [illegible] [illegible]
This disease arises from obstructed glands in the mesentery 
& is accompanied with morbid secretions of the stomach & 
liver bowels. It is sometimes the consequence of some other
fever. It is often connected with scrofula, & it is apt 
to be attributed to worms. The disease attacks children
of from two to ten years of age.
Symptoms. The fever is of the intermitting remitting kind, with 
irregular paroxysms attended with tumefaction of the abdomen, 
costiveness, indigestion, loss of appetite & very irregular
appetite & with paroxysms of pain in the bowels. The patient
complains much of its bowels, but the affection seems to be rather 
distress then sharp pain & is neither constant nor regular. The 
countenance is very pale except when the cheeks are flushed with 
fever & the limbs are emaciated
This is generally a chronic disease, but 
sometimes it is acute, & exhibits strong marks of irritation in 
the system. It may terminate in hectic. Dissections exhibit
an enlargement of the mesenteric glands.
Causes. It is sometimes as has been said above, the effect of
another fever. Among the poor, with whom it is most frequent,
it is caused by coarse and unwholesome diet. Children 
born of scrofulous or gouty parents are more subject to it
& hard labor by the mother during the period of gestation 
may have some influence in predisposing to causing this disease in the 
child.



Patients in this disease are subject to paroxysms
of pain


62
The indications are 1st to empty the bowels and to keep 
up a gentle peristaltic motion in them 2nd to change the
secretion of the chylopoeitic viscera.
3d to remove paroxysms of pain
4th to remove the obstruction in the lymphatics.
5th to impose the digestion & to invigorate the system generally 
1at To move the bowels and keep up a gentle
peristaltic motion mild mercurials as blue pill or calomel & chalk should be given & at
the [illegible] time friction as in almost all chronic [illegible] complaint should be employed, upon the
abdomen, and persevered in by the attendants. A very good
mercurial preparation, will be a pill of four parts gr. blue
mass and one 1 or ½ gr of ipecac adding a little opium ½ or 1/8 gr of the bowels
are very irritable. If this preparation 
is not sufficient calomel may be substituted in 
a dose of 4 to 6 grains. The tincture of rhubarb has 
in some cases answered well as a laxative & corrector
combined with neutral salts and aromatics
2nd For changing the secretions, we must rely 
upon the articles just mentioned, and also upon those
to be mentioned under the 4th head
3d For alleviating sudden paroxysms of pain injections
of a gill or a half pint of camomile tea have been found serviceable.
If these fail give a camphor injection
The pain is relieved by opium plaister



There is but a small quantity of iodine and [illegible]
effect appears to be produced than shd result from 
the small quantity of iodine
Neutral salts in connexion with tonics have
undoubtedly [illegible] deobstruent powers


63
4th For removing obstructions of the mesenteric fluids
burnt sponge has been thought very efficacious. I formerly 
questioned whether it had any superiority over soda.
Now it is supposed that all the virtues of the article are
owing to the iodine continued in it. It would probably be [illegible] better
better to give tincture of iodine in doses of 2 or 3 drops.
Still the burnt sponge containing carbon & alkaline matters
may have peculiar properties The neutral salts given
with tonics have some influence in removing these obstruction 
It has been proposed to use mercury by injection for this purpose.
I know not that it has ever been tried
For the indication I have been in the habit of
employing the muriate of lime & here given it in connexion 
with the mercurial pills mentioned under the first head 
It may be made by adding muriatic acid to chalk 
or marble & the dose for a child of 3 or 4 years, should 
be from 5 to 50 drops, given in tea coffee or milk.
It is best to begin with a small quantity, say 3 drops & increase 
by one drop at every dose until the stomach
is offended remembering that the stomach bears the article
best if much diluted. The muriate of barytes might be 
used; also the carbonate of barytes is used in dose of but
2 or 3 grains, it being a powerful article. But iodine is
probably the best article that we know of
Other articles containing iodine, have been 
used besides burnt sponge, as [fucus] [nodasus] & vesiculosus
[reckoned] vide scrofula



mur. [illegible] dose 4 or 5 drops in milk & water for a child of
3 or 4 years increasing to 50 even 100 perhaps
This [illegible] is not to [illegible] [illegible] it iodine as to be substituted
by the latter We are apt to neglect an old remedy as 
a new one comes on
The tepid bath shd not be used when the system
is too much debilitated
It excites the action of the mucous membrane
and of the skin not affecting particularly the blood vessel 
add a little spirit to make the opium 
[illegible] if necessary 


64
Muriate of lime has the important advantage of exciting
the action of the skin which is generally torpid.
Hence also the tepid bath has been used with 
success in this disease The flesh brush too if thoroughly 
applied several times a day will have a powerful effect.
5. To improve the digestion and invigorate the general system
Carbonic acid is a most grateful stimulant to the stomachs 
of patients in this disease. Hence soda water and other effervescing
mixtures, may be recommended spruce bar also & 
similar articles, if they agree well with the stomach. Aromatics 
as ginger & spice may often be added to them with advantage 
Among the tonics which are used to invigorate
the system. Iron is very often employed & frequently with good
success. The mildest preparations least irritating are the best, such as 
the tincture of the muriate, the martial flowers & the
alkaline solution. Still iron is apt to cause irritation
Cold bathing is a good remedy for invigorating
the system but if the patient is much debilitated, a cordial
should be administered previous to using it
When the patient is much debilitated I have found
anodyne plaisters upon the abdomen
give great relief (where opium did not agree) I have 
used Noel’s plaister (similar to dyachylon) with soap mix
opium zii with zfs of this plaister & spread it sufficiently
large to dover the whole abdomen


Children are very fond of potatoes but they should 
not be allowed, unless cooked so as to be dry and [illegible]
and then thoroughly mashed
Some vegetables as spinach, [illegible] & asparagus
may be allowed but only in moderate qualities
Preparations of meal of [illegible], especially fried, are bad
Rx dough roll it in flour and then cut
into thin slips, twist & bake them for [some] hours An excellent preparation
for dyspeptic batter than crackers called twisted bread
In making broth avoid adding rice, flour, etc. which 
will make the compound approach the nature of pastry 
and be more indigestible. Make broths as simple as possible
& season with pepper & salt


65
Under this head may be ranked the use of the terebinthinates
which have a valuable effect upon the mucous membrane of the alimentary canal
The best article is a decoction of white pine bark, which is
milder than any preparation of the turpentine of the shops
Regimen. Flannel should be constantly worn next the skin
to keep up an action in it. The patient should take exercise in 
the open air whenever the weather is good & damp
easterly winds should be carefully voided as they have great
influence in all chronic affections particularly glandular of the bowels. Friction & 
cold bathing have been already mentioned.
Diet. This should be carefully attended to Raw fruits, 
potatoes and other garden vegetables, corned beef & in short all 
articles which are not of the easiest digestion or which have any 
tendency to ferment & become acescent in the stomach should be 
forbidden & caution should be enjoined that the stomach
be not distended with liquids, so as to interrupt digestion.
The diet should be dry consisting of toasted bread & farinaceous
vegetable substance, as arrow root etc. well boiled & seasoned
with a little wine & spice. If meat be given it should 
be broiled & eaten, with condiments. In some cases a piece of 
lean beef that has been partly broiled & then boiled, makes
a broth that is grateful & sits well on the stomach. But if
there is much dyspepsia, broth of any kind a not good
If this fever terminates in hectic the mineral acid shd be used 



Undoubtedly however the affection may be produced 
by excessive purging vide next page
low states of fever in adults also for the 
state of the bowels occurs much oftener than some phys. are
aware of
“The gases may arise from the ingestion, from a 
fermentation of the natural secretions, or, as I think from a
direct secretion of gas by the intestines. this alone would see
to account for the rapidity of its production”
sometimes small watery stools


66
Tympanitis
In diarrhoea dysentery & constipation with fever & typhus fever
after these diseases have passed the first stage, the bowels of 
children affected with them, are liable to be affected with 
tympanitis. a troublesome symptom This state of the bowels may occur of itself about
the time the febrile action begins to subside, or it may be brought
on at an early period by the use of astringents, or by heat
produced, either by too many bed clothes or by hot articles
applied to the body for the purpose of exciting perspiration
it is important to examine daily the state of the abdomen in 
children affected with bowel complaints, that a tympanitic
state may be obviated, as soon as it begins to appear
The abdomen is [swollen] and elastic to the touch
feeling tense like a drum head under the fingers
We can tell as soon as the hand is applied whether the
swelling proceeds from inflammation, or from imprisoned
air, for in the former case the pressure will cause pain
The proximate cause of this state of the bowels 
I believe always to be a relaxation of the villous coat of the
intestines & a deficiency of peristaltic motion in consequence
of both which the villous coat falls down & forms a 
valve which confines the gas, while at the same time there
is a morbid secretion of all the chylopoeitic viscera 
which [illegible] the evolution of the gas
In the first stages of tympanitis, the alvine
discharge usually cease even if there had been diarrhea
& dysentery before & the little patients exhibit signs
constant [illegible] not acute pain
of great uneasiness from the unusual distention of the 



“It is thought by some that tympanitis is always 
occasioned by bad treatment in not giving cathartics enough at
the common [illegible] Such persons probably do not examine
the abdomen of their patients with sequels of severe bowel
complaints. Tympanitis comes on whether cathartics have
been used or not and nothing is more likely to bring it on 
than an excessive of cathartics at the commencement of the
disease”
The temperature had been raised above it
secreting [illegible] & the child might have died
“I am very partial to diaphoretic measures in general
but must confess it is often abused If carried to excess 
it rapidly exhausts the patient also if excessive heat as aplied
and the pat. does not sweat.” 


67
bowels. In the progress of the disease tympanitis the child frequently 
comatose. The tympany is not always to be regarded as 
a dangerous symptom it sometimes indicates a favorable
crisis, yet if it is accompanied with coma, there is danger
that the brain may become seriously affected. If symptoms 
of congestion in the thorax exist, the disease of the thorax
should claim our first attention, and the tympanitic
state of the bowels be treated as a [illegible] complaint
Treatment. The indications are to evacuate the flatus 
and excite healthy action of the viscera of the abdomen
If the disease has been produced or aggravated by heating
applications too many bed clothes or too 
confined an atmosphere, the heated substances should 
be removed, the bed clothes thrown off & air admitted
freely to the patient. In the summer of 1814 I was
called to a child sick with dysentery whose bowels became
extremely inflated in consequence of filling with 
the steam of boiled potatoes in [illegible] the bed in which he lay
The child because if much [illegible] & [illegible] was so difficult that it 
was thought to be dying; but upon removing
the potatoes throwing off the bed clothes & opening the
doors, the symptoms were at once amended & in the
end the disease was completely removed by the use of a little [cajeput] 
oil in water and laxatives
For removing the flatus of the bowels 
we may use enemata of the decoctions of aromatic plants or 
suds, such as catnip, camomile; the seed of fennel caraway 
or masterwort seeds or the essential oil of such suds may 


I prefer camphor to any other articles 3 or 4 [illegible]
IN colicky complaints etc. I have known more benefit [illegible]
injections of camphor in milk & water than from any [illegible]
articles and that too after the most violent purgatives
had vailed. I know of no article which operates
so well in relieving irritation of the pelvic viscera
[Anodyne] balsam Rx vol. [lin] zi [illegible] camph
“Sometimes blister the abdomen”


68
be injected in milk and water. But I think I have experienced 
the greatest benefit in the case of children from the 
injection of a teaspoonful 2 or 3 of the tincture of asafoetida in a 
gill of warm water. It unites more readily with the water
of a little milk is added
A pipe of ivory or the pipe of a common 
injecting syringe may be introduced into the rectum as is
recommended in hysteria, for the purpose of evacuating the
flatus. I have sometimes used an elastic catheter with success
The peristaltic motion of the intestines is
to be excited and healthy secretions induced For this purpose
we are to apply friction with dry flannel to the abdomen
and mild cathartics are to be given. The latter may be jalap
aloes rhubarb etc. with castor oil to work them off
If frictions do not succeed, we may apply volatile liniment
camphor, oil of origanum & finally epispastics
We may likewise give internally cajeput oil in 3 or 4 in sugar oil 
of mint, oil of caraway, asafetida zfs to si etc. which is [illegible]
to offer [illegible] its stomach & is not offensive to the taste
and magnesia with [illegible] & cubebs [illegible] [illegible]
or guaiacum 


Dr Good classifies [worms] according to their locality
yet he makes mistakes as to their locality
Much has been under the subject, and the
remedies are almost innumerable. It is rather difficult to select 
the most important parts of the subject


69
Worms
This subject naturally follows that of bowel complaints
From testimony which cannot be invalidated it appears that worms
of various sizes and forms have been found in almost every 
part of the human body. It is only in the alimentary canal
however, that they occur with any frequency and give rise
to symptoms, from which we are led to infer their presence
Those worms which are of anomalous kinds, or
are found in anomalous situations (oftenest perhaps in the lungs
& frontal sinuses) as they are of rare occurrence & as the indications
of their presence were either very obscure or altogether unknown wanting 
are interesting only as curiosities and will be passed over,
without any notice, except an occasional reference to 
the fact known with regard to them
“Worms in the alimentary canal are so 
common, as to have given rise to a class of diseases called
verminous & a class of therapeutic agents called anthelmintics.
The kinds of likewise of worms which occur in 
this part of the body have been thoroughly investigated & we
are in possession of a large mass of information upon the 
subject
I shall consider this subject under the following
heads 1st The kinds of worms found in the al. canal
2nd their origin & that of worms in general, found in the body
3d the general effect they produce on the system & the general symp
5th the morbid effects produced by each species, with their treatment
4th the general treatment of verminous diseases




70
II. The genera of the common intestinal worms are three; toenia ascaris & tricephalus
Of the tania there are two species. Tania solum or cucurbitana
& t. lata or vulgaris. Of the ascaris there are also 
two specis of a. vermicularis & a. lumbricoides.
1st Tania This a long flat worm varying much in breadth
and thickness which is formed by a chain of flat articulations,
united by a border or edge. The accounts of the length 
of this worm are almost incredible from thirty to a hundred
feet. Taenia solum (called also cucurbitina
or gourd seed worm & the armed taenia) is distinguished
by having the head forked and surrounded
with papillae or long fangs (holders) by which it fastens
itself to the mucous membrane. The broken off joints have
when discharged the appearance of gourd seeds. hence 
its name of gourd seed worm.
Taenia bata (or vulgaris the unarmed taenia) has an 
external form like a ribbon joints scarcely perceptible
& is white and seen transparent. The head is
narrower & smaller & the papillae not elongated
2nd Ascaris vermicularis & a lumbricoides
The first, a. vermicularis (thread worm, pin worm & when
existing in number called ascarides) is filiform, slender at
both ends & from half an inch to an inch in length & of the diameter of a small thread found
generally in the rectum & though not confined to that part of
the intestines. It feeds on the mucus of the intestines & produce
its young in immense quantities. It is found in the stomach 
& called maw worm





71
Ascaris lumbricoides (or [illegible] long round worm) is perfectly 
round & from four to ten inches in length bearing a striking 
resemblance to the common earth worm It is said sometimes to perforate 
the intestine with its mouth 
3 The trichocephalus now called [tric???] is a small capillary worm from 
an inch to an inch & a half or two inches in length. The body 
is about half an inch in length & Is terminated a tail which 
is twice as long & end in a fine hair-like point
In addition to these worms have been reckoned
two others the vesicularis & the gordius. The former is a 
small vesicle found in the brain (sometimes in great numbers)
& containing many small worms. It is now considered a 
hydatid & is excluded from the subject of worms & verminous diseases The gordius (horse hair worm) is found in soft
stagnant waters from four to six inches long & twisted into 
various knots & contortions” Good. They are sometimes found
in the earth in great numbers they turn black on exposure
to the air & resemble horsehair, hence their name
of horsehair worm They are very common in our vicinity They are rarely found in the human
stomach. I have known them coughed up in abundance from the 
lungs; when they had probably come from an abscess in the
liver. It gives rise to a severe disease among the [lapladens]. Vide Good. 
The maggots of the common house fly & the’
larvae of many other insects, have occasionally been met
with in the alimentary canal of the human body vide Good
What were formerly called vesicular worms
are now considered as hydatids. [Brera] or worms recommended 



An attempt has lately been made to revive the doctrine
of [equivocan] generation. The learned advocate has
attempted to fortify his opinion by the analogy of 
vegetables. But where the experiment has been made the 
seeds of the forest trees that come up as [illegible] may 
be found at the roots of the young trees
Hyoscyamus formerly was common here
but is not now However when the gourd is broken in the 
college yard Hyoscyamus springs up. It has also in the
soil brought from a cellar in Chapel St.
Leeches & a variety of insect are undoubtedly taken in in water etc.
In Duncans [illegible] we shall find an account of
a number of caterpillars [illegible] by a child produced by eating cabbage leaves
I think I have never known an instance of worms
in children while nursing


72
II II. The origin of worms in the human body
Worms arise from eggs. Some multiply by depositing
their eggs to be afterwards fecundated by the 
male. Others are propagated by copulation between the 
two sexes While a third kind of the taenia fecundate themselves.
I have spent much time in investigating
the origin of worms in the human body but must confess
that I cannot satisfy myself upon the subject.
It has been supposed that worms found in the human 
body are produced from eggs deposited by flies about 
the rectum, at the time of going to stool. Were this the
fact, they ought to be more abundant in summer 
than in winter, while the reverse is the fact. I am 
inclined to think that the rudiments of worms are 
contained in certain kinds of food as apples pears, cider
water & unboiled fruits and vegetables. In infer this
from the fact that worms make their appearance, oftenest
when such articles have been taken & disappear
when they are avoided. If confirmation of this view 
of their origin we find that children are rarely if ever affected
by then when under three months of age & seldom
while they are nourished from the breast. For though
some have asserted that they have seen worms in the
bowels of children within the mouth & even before birth 
yet the fact is not well ascertained.


Breras opinions, also adopted by Good speaking of the
fluke worm
There is no doubt of the fact of worms within [fetus in uteri]


73
Brera thinks that the minute eggs of worms are absorbed 
into the circulation He says “when we consider that the
eggs of worms are so small that they are not perceptible by 
the microscope of Hoffman and these eggs themselves are masses
of small eggs, nothing is more probable than that the eggs of worms
are absorbed by the lymphatic vessels, pass in to the circulation
pervade the system with the blood & are deposited in the various
parts of the body, where they enlarge and unfold themselves when 
circumstances favour their development.”
If worms are found in the foetus, the fact
will favour this idea that the eggs of worms are carried 
into the circulation. It may be remarked also that
the parts of the body which favour the development of their eggs
are those abounding with mucous
The hypothesis of equivocal generation 
is neither specious nor probable. It derives no support
from analogy aid from reason, nor countenance from fact
In its operation it is worse than useless as it tends to obscure
truth by substituting conjecture while it disregards with 
the most vague and licentious imagination the boundaries
between the animal and numeral kingdom & ascribes 
to chemistry what pertains only to animal life
When the creator first gave being to 
the natural world, every part of the vegetable and animal
system was brought into existence by 
an extraordinary exertion of productive power. They  were
not moulded by the slow operation of time & the cooperation 





74
of mechanical and physical forces, but he spake and it 
was done. But since that first act of creative power, we
find are that these creatures are propagated and perfected by processes
more gradual successive and [operose], many of
which may be traced by human wisdom and admit
of being regulated and controlled by human culture & ability
Rosenstein says “from the eggs of a fly proceeds 
a fly, from the egg of a hen a pullet and not a 
serpent, from the egg of a goose, a goose and not a fish
So from one worm is produced a worm and nothing else”
II II II. The effects of the presence of worms in the body
When the seed of worms are once developed in the human 
body, the health is more or less affected, and the morbid
symptoms which then appear are in proportion to 
the number of size of the worms the sensibility of the part
they occupy and the general morbid diathese which
takes place at the time, whether the cause or the effect of
the worms
Worms in the alimentary canal are less
frequently the original cause of diseases than is generally 
supposed, inasmuch as in many cases of disease where 
they exist, the disease was merely aggravated & not originated
by the worms & all the symptoms of worms from which it is 
common to infer their presence, may be occasioned by 





75
undigestible substances for a diseased state of the bowels
Worms are often also found to have existed & that too in 
great numbers, where the general health has been apparently 
good. I well recollect the case of a child in 
North Milford who fell from a height & was taken up in 
a state of coma from the concussion. A dose of calomel was
given him which brought away twenty or thirty large
worms. The child had been healthy to all appearance previous
to the accident.
Some physicians go so far as to say that worms
are necessary for the health of vigorous children that they 
are nature’s scavengers a natural provision to destroy the
superabundance of food taken into the stomach. Dr Rush
was of this opinion. The opinion supported by Dr [Parr] It is a fact beyond controversy that
very healthy children have worms with out manifesting
any symptoms of their presence until the supervention
of some other disease causes them to make disturbance 
in the system. It is but seldom that they are the excit. cause of dis.
The following are some of the ways in which 
worms are injurious to the system. They may be injurious
from their number obstructing the bowels and consuming
too much food. They are particularly hurtful by 
the irritation which they produce when the irritability
of the bowels is excited by fever. They sometimes threaten
suffocation by rising in the oesophagus & in one instance 
a single worm I have known to lie in the fold of a volvulus 
of the intestines so as completely to obstruct the passage 





76
Linneus attributed the dysentery to a worm or insect [illegible] dysenterical
[languis] the measles to a similar origin. Various
authors the itch, sigler, petechiae lusitanus the syphilis
martin the elephantiasis nyander, eruptive
& contagious diseases in general lancissi, plague, remitting & 
intermitting fever considering miasm [it] being a collection of insects # some authors, toothache Dr [Adam]
observes cancer itself is nothing more than an animalcule 
a worm or an insect. It would seem from 
such speculations, that a great part of the diseases
which flesh is [illegible] to result from a superabundance
of vitality and that as Good remarks in his [illegible] corruption is no longer the triumph 
of death over life, but of life in one form 
over life in another. Such fancies lead into the 
wildest speculations of equivocal generation & relinquish 
all principles & all limits in natural 
history.
# Vide N.Y. Rep. about the year 1815




77
Symptoms of worms. Those children are most frequently 
troubled with worms whose powers of digestion are weak.
The symptoms of the presence of worms in the alimentary canal
are very equivocal, for they may all proceed from other
causes. They are countenance pale or flushed sad and dejected 
livid around the eyes, eyes sunken
eyelids swelled pupils dilated itchings in the nostrils, head
ache after taking food, mouth water [illegible] filled with saliva, breath
fetid, great thirst, grinding of the teeth in sleep, starting
in sleep fainting vertigo, palpitation of the heart, irregular
pulse & cold abdomen bowels flatulent
costive or loose colic throbbing in the bowels severe from [illegible] the small [intestines & umbilicus] appetite irregular
& craving loss of appetite pain in the stomach when empty, which is relieved
by food urine increased or diminished turbid and milky, stools irregular,
containing much mucus nausea & vomiting Sleepiness particularly
after eating, bloated countenance swelled nose & upper
lip, paleness of the lips, irritation about the mouth, rubbing
the nose, itching at the anus irritation about the neck of the bladder dry & convulsive cough
difficult respiration sense of suffocation paroxysms 
of suffocation body emaciated frequent flushings of fever with irregular pulse convulsions, epilepsy
and partial palsy. Of course these are not all present
at any one time
Chorea catalepsy & epilepsy are produced
sometimes, by worms
Dry convulsive cough Diff respiration
In addition to the other symptoms there may be these of irritation
of the lungs producing cough also irritation of the brain




[772]



It will be impossible to class all the articles inasmuch
as we do not certainly know the modus operandi of many 
articles which yet have sustained their reputation for [illegible]
Much stress has been laid upon the operation of cathartics
in evacuating the [illegible] which the worms generate by their irritation, 
just as irritation in the lungs produces [illegible]. But then
the [mucus] although it forms [illegible] for them, an effect more 
than a cause, and the worms will make [mucus] enough for themselves
Probably many caths act by their acrimony upon the worms
themselves. Others by the violence of their operation dislodges 
them. “Aloes are beneficial in mild cases as a tonic
when there is no excessive irritation. If there is excessive sensibility
& irritability they are improper as they irritate the
rectum they may be given by injection When there are
symptoms of worms though no worms exist aloes are serviceable
in the form of elxiir prop.”


77:a.
IV.
[general
treatment]
In the treatment of patients afflicted with worms two 
general objects seem to have been pursued both in popular
practice & in that of physicians 1st to destroy & 
expel the worms themselves & 2d to obviate their effects
upon the system & at the same time by the improvement
of the general health of the patient, prevent their recurrence
and increase This second indication will often coincide 
with the first, inasmuch as a diseased state of 
the body is the most favorable for the multiplation of
worms
Of those remedies which destroy or expel 
the worms themselves we have three kinds
1st those that expel them by strong cathartic operation
2nd those that act mechanically upon them
3d those that are prisoners to them.
1st Although strong & even violent
purges may be used to drive out an accumulation of 
worms in the bowels yet they should not be often repeated
as they would increase the weakness & irritability of the 
stomach & bowels to such a degree as to favour this increase.
In general calomel will be the best cathartic 
inasmuch as it will tend to promote a flow of healthy bile 
& to restore healthy secretions. In Europe the gall of 
animals has been administered. One of the best forms 
for the administration of cathartics is that of alkoholic
tincture, for the sake of the joint effect of the alcohol
hence elixir proprietalis in teaspoonful doses & the tinct.


“The bark of the button wood taken from the north
side of the tree has been recommended. It is a nauseous bitter
& a cathartic good” #
“It is a question whether cowhage acts mechanically 
or whether it contains an acrid principle like that which 
exists in the nettle”
# One of the remedies that I have most 
reliance on for ascaride in tinct [illegible]. Fill a
bottle with the young inner bark fill the interstices
with [prosp] spirit & give I to zfs night & morning
It is an old remedy and better than tinct aloes
It is tonic & deobstruent”
Some of the acids to be narcotic, are more probably active
merely by their pungency, odour etc.



77:b.
of hickory bark or buds have been found very serviceable
Podophyllum peltatum is much used but is probably not better
than other cathartics. The best form would be that of a tincture
2 Mechanical remedies are not now used. Cut hair
has been given cowhage though some doubt whether the operation 
of this is wholly mechanical. I have thought that the root of
osmunda given in pieces acted mechanically The filings of
tin, formerly were much employed as was also an amalgam
of tin & mercury. There is a curious account in one of our
journals of a man in Kentucky who took a pound of the 
amalgam & was unable to expel it from the bowels The 
mass lodged in a part of the intestines & could be felt externally
It was very troublesome to him when riding.
Oil has been given with the intent that it should fill the 
respiratory pores of the tape worms & thereby destroy its
life. In Madame Nouffeurs recipe The supper of
panada is intended to act mechanically by its bulk.
3d The remedies which destroy the worms seem generally 
to be narcotics All articles of this class however do not
have this effect opium for instance. Particular animals
are sensible only to particular narcotics as for instance
swine are poisoned by stromonium while sheep eat it with
impunity. The most valuable article of this class
are the two species of spigelia s. [ma??ndica] & s. anthelmia



A strange notion has existed about a little innocent [illegible]
was considered as the narcotic agent
Similar reasoning has been used with respect
to denarcotising the opium Opium denarcotised would
be not better than bread
Spigelia zii in ¼ pt water to a child may be given in divided
doses. It is better to give a cath. e.g. cal. or ruhb
Spegelia from zfs to zf for an adult
Sometimes but rarely it operates itself as a cathartic
Sometimes convulsions are produced
Our pink is bad because it is gathered by [illegible]
packed in hogsheads & the rotten saved & the rest [illegible]
The emigrants from St. [Illegible] brought what they 
called worm syrup which they said shd be given in the
night because it affected the eyes
S. [anth.] is [illegible] S. [illegible]
about zi if S. anth.
“Pink is given more especially for the [round worm] & sometimes
for the tape worm”
[illegible] [illegible] & [areca] [oleacea] zii to zfs
“The French use the syrup of peach flowers & seeds 
They first give sulph either zi in [illegible] decoction male
form & an injection of the same. They probably act by 
their prussic acid”


77:c.
The former is the one commonly used in this country
and in England It is called Carolina Pink. This is a most
valuable article and is useful not only for its operation 
upon the worms but for its effects upon the system, in allaying
the irritation which they occasion. I have prescribed it for 
a cough & other symptoms of irritation where I had no reason 
to suspect the existence of worms Then given for its effect
upon the worm from half an ounce to two ounces should be 
given in decoction in the course of the night, accompanied with rhubarb
or some other cathartic to drive the worm off while in a state
of intoxication. It may be given in powder in a dose of from 
10 to 20 grs The French W. Indies s. anthelmia is used
& called wormgrass. It is a stronger article than ours
The French use the article in form of a syrup & give a 
teaspoonful at a dose.
Veratrum subadilla & helleborus [fetidis]
belong to this class and have been given in doses of 2 to 6 grs for
children In Europe the most famous article
of this description has been the Felix mas
Other articles of this class are camphor, prussic acid & tobacco
The bark of the cabbage tree (of which there are two species
vide Good) is found highly valuable in this way by the
West India physicians
Other articles which have been said
to be successful in cases of worms owe their success apparently 
to their acrimony in whole or in part, such as
the terebinthinate oils Oil of turpentine is the one commonly 


Various aromatics have been used, as chenopodium 
[illegible], rue tansy
“The leaves of cedar juniper & [illegible] powdered
20 grs They are acrid stimulating and tonic & may have
a mechanical action. It might be used to add to the
powdered leaves some aromatic as rue ol. tansy [worm]
wood etc.”
“Melia [azidurach] bark of root or plant
zfi to zi act as emetic cathartic & narcotic. Acts
more effectually at the south where the recent article is
used”



77:d.
employed should be given in large doses, when it will
prove cathartic. A concentrated solution of salt has been
strongly recommended given by the mouth or by injection 
Ether is much used by the French & perhaps has an effect
upon the worms. Some of the other antispasmodics 
which have been popular may also have some effect upon 
them such as asafoetida, petroleum the essential oil of
the chenopodium etc. Perhaps arsenic poison intestinal
worms I have known it cure. Ammonia may perhaps act on them
2 Of the remedies which are designed to have an effect
upon the system. In severe affections from worms our first
attention must often be directed toward quieting the excessive
irritation of the system, by antispasmodics. Various popular
remedies for worms seem to have little other virtue
The chenopodium anthelminticus & c. ambrosioides called 
worm seed & the c. botrys. or [juris]
oak ar probably valuable, mainly if not entirely a
nervine. They may be given in decoction or the essential
oil may be used. The garlics are used in syrup or decoction they are nervine
7 have considerable effect as condiments upon the intestinal canal. The 
ictodes fetidus is of this class & so are the empyreumatic
oils, petroleum given in a dose of 10 to 40 drops barbadoes tar etc.
For giving tone to the digestive organs
and exciting their sluggish action the tonics
the bitters & the aromatics are indicated while mercurial


[Artemesia] ][santonica] is no better probably than the
other bitter tonics Some confusion results from the appellation 
worm seed being applied both to this and to [illegible] botrys
c. anthel. & “Indeed anything which tends to [procure]
healthy secretions of the viscera. Of this kind are the
mercurial which produce healthy bile which is especially [illegible] 
to [illegible]”
# “Indian corn or maize has been supposed to 
favour the generation of worms in the body. The aborigines
of this country have been peculiarly subject to them perhaps
from this cause”
Worms are far less common now as are also colic dysentery et. than formerly when cold
water & cider were drunk instead of tea and coffee AT the
south likewise the negroes who feed more upon crude and raw
articles are more subject [illegible] of the plantations it is a 
rule to give a decoction of melia to the black children once
in 3 months #
Though you can cure worms generally by calomel
yet sometimes they will resist all treatment
Eupatrium perfoliatum is used for worms
Flowers of [zinc] are antispasmodic so also sulph zinc 
Dr Rush thought well of [sugar] especially when given in the
morning
Petroleum seems to be a valuable article a substitute
for turpentine It may be supposed dangerous, but I have
used it for many years without inconvenience I began with 
small quantities from fear of danger, but now I give 10 30 or 60 grs
It very often to produce no violent effects. Yet we must not conclude
hence that it is useless. Asafoetidae for instance produces 
nothing but a little [illegible] in healthy persons


77:e.
preparations & other deobstruents will be valuable 
adjuvants. The metallic tonics as the preparations of iron
& of zinc, the mineral acids, myrrh, bark, the various bitters 
& the astringents have been found useful I have used alum whey with advantage. Among us the geraniums
& all the indigenous aromatics & bitters have been given
in popular practice. Alcohol from its stimulating effect
upon the digestive organs will be a useful vehicle, for the
exhibition of medicines. Condiments used freely with the
food, will answer to the same indication
The diet of patient troubled with worms
should be dry & stimulating, rather than liquid & cold
raw fruit, acids cold water & all indigestible articles
should be avoided & in extreme cases I would advise that
neither food nor drink be taken but which has not been
subjected to heat. I have apparently cured patients by this
means. “[illegible] toasted bread [illegible] [illegible] vegetable
[illegible] though they occasion [illegible] dyspepsia”
A multitude of heterogeneous articles have been 
used as anthelmentics, besides those already mentioned; some of 
them are sugar; worm-wood; rue; peach flowers; bark’
of prunus virg; valeriana selequa used by the French; muriate of
barytes; injections of mur. of tin (Alibert); oxide of tin grs iii with
etr. of juniper (Alibert) mur. of amm. of linseed; mur. of amm.
[illegible]I with jal. or rhub 10 gr.; all the forms of ammonia; crude
mercury; merc. boiled in water; aethiops mineral; artemisia
[illegible] [illegible] ([illegible] [illegible]) & a. [illegible] [illegible]
[s?tonica] worm seed bitter & of some value; melia azedarach much
used at the south; butternut bark intensely bitter dose a tablesp. full of decoct cathartic & said to be narcotic;
allows asclepiadis I think I have seen the a. [illegible] then beneficial; etc. etc. 


Garlics seem to do well how it is difficult to 
say perhaps operate upon the worms. Garlic also 
will relieve the eruptions of worms. It is though also
that garlic prevents worms
I have a very good opinion of sulph ether
introduced into the rectum used by the Germans, Italians
nervine & antirritant. It is valuable both in cases for worms 
& in those of irritation & affections of liver severe pain in bowels etc.”
½ oz or 1 oz. iron filings taste by [illegible]
remedy worse than disease
Wherever leaves of [illegible] are recommended
you may give our common juniper For the imported [illegible]
loses its strength by keeping & drying
Rosenstein recommends cold water during the
operation of a cathartic He recommends effervescing mixtures
to destroy the worms by carb. acid
An old remedy of the tonic kind is alum whey
Rx milk & water equal quantities & put in [illegible] [alum] to [illegible]
give the whey [illegible] children takes it pretty freely; It is a 
given in cases of relaxation of bowels and for ascarides & round worm
It is of consequence often to have a remedy [illegible] and not require
to be forced down


77:f.
Various external applications have been prescribed
Oxgall & venice soap aa zi made into a liniment with 
oil of tansy or wormwood;
Aloetic plaisters; ether oz vi, bruised garlic zi, camphor 
zi (used by the German Brera) for a liniment; petroleum mixed with gall;
Most of the patent medicines for worms [illegible] or both contain calomel,
Storr’s lozenges are calomel with sugar & gum. These
are his white lozenges. His brown are resin of jalap,
gum tragacanth & calomel.
Good on the authority of the Germans recommends 
[illegible] milk
Electricity 
A popular article (cath.?) is decoction of [plantanus]
occidentalis strong bitter
For ascarides I rely as much as any thing upon a saturated
tincture of the juglans [illegible] & [illegible]
All the indigenous bitters as cherry bark [illegible]
melia [azedarach] zii of recent root is divided
doses ½ pt water. When dried & long kept it is apt to 
disappoint here.
It is acrid [as the] narcotic & cathartic
a powerful article The berries are also narcotic causing
lard to fall down not from [choking] as has been thought
The [planters] think it too powerful for [white] children!


Tape worms frequently produce headache 
[illegible] about the umbilicus
yet generally produce a sense of weight. Yet I have known 
persons evacuate them when they had not been suspected
Case of a man who had kept taking remedies for a catarrh
Finally a medicine ? brought away to his own surprise 
and that of his physician a tapeworm
Perhaps vomiting occurs oftener from tape worm
than from any other species
# “When the worms are very numerous, there is a sensation 
of something falling from side to side on a change 
of posture”


78
V. Symptoms of each of the kinds of worms with the treatment.
1st taenia solum. This worm generally inhabits the upper
part of the intestines & adheres so firmly as to be removed
with difficulty It is sometimes solitary but commonly in 
considerable numbers. When brought away from the bowels
many of the joints are separate & have the appearance of gourd
seeds hence the name. 2 T. lata or vulgaris This likewise
inhabits the upper part of the intestines and is usually in families
of three or four
Both are called by the common name of tapeworm
They may exist without any apparent symptoms of worms
or they may give rise to the severest affections In general 
they are attended by severer pain in the bowels & more violent
symptoms in general than the other worms. The diagnostic 
marks of their presence in great quantities, are
sense of weight in the abdomen, # irritation of the stomach
nausea & vomiting loss of appetite, irregular appetite
weakness of the chylopoietic viscera, bloated countenance
emaciation of the body etc. All these symptoms however 
may arise from mere irritation of the stomach of a child
Adults are more generally affected with
tape worms but children sometimes have them.
For the taeina solum t. lata or vulgaris or cucurbitina the
gourd seed worm the spirits of turpentine has been 
very successful. Though not prescribed by the physicians
it has been used as a popular remedy here for more than
T. lata
fifty years. I have known a man of intemperate habits 


No cautions are given about the use of the article (so far as I know)
But if it does not act as a cathartic immediately, it will produce
great irritation especially of the urinary organs
I recollect the case of a lady who had been treated
with aph turp. in N.Y. taking 2 or 3 ounces Violent vomiting
& catharsis had been produced and the tone of the 
stomach and bowels seemed to have been permanently destroyed
Worry had indeed been brough away, but then they would 
come away themselves & the relieve was fallacious
In delicate cases it had better be combined
with castor or sweet oil
In the case of the lady cath seemed to do no 
good, they would indeed bring away large quantities but
they would return in a few days. I put her upon arsenic 
but she left town and I have not heard from her
It is difficult to tell how arsenic operates whether 
upon the worms or producing healthy bile
For the t. lata the spts turp. seems to do 
better


79
take a wine glass full of spirits of turpentine to expell a
tape worm Though an habitual inebriate, he said he never
had been so drunk in his life & large tape worm of this kind? came
away # It is said sometimes to intoxicate & sometimes to produce irritation
T. solum
2d The t. lata is the most difficult of all 
worms to manage. Spts of turpentine do no good at
least in those cases in which I have tried the article In
T. solum
one case I gave zfs. In another I gave it in teaspoonful
doses. In the latter it operates freely as a cathartic
a single teaspoonful procuring as many as ten stools 
Worms were evacuated but they would make their appearance
again in as large quantities as before. Indeed
any medicine may bring them away for the bowels
are sometimes so filled with them that they come away 
T. solum
when the patient is walking, or is asleep. I have known
two quarts to be brought away in a day, & then a fresh
supply in a few days after!
T. solum
# Arsenic has succeeded better for this kind? with me than any other
remedy, which I have used. In the case of a child
5 or 6 years of age who had both the round & the gourd
seed worm the common cathartics were given with some
advantage, as some worms were brought away; but the
symptoms still continued and the worms passed occasionally
with the stools. Fowler’s solution of arsenic was 
administered in doses of four drops three times a day. In a 
few days worms ceased to be evacuated the symptoms 
disappeared & the child has once had no recurrence of the worms



[Osmunda] cinnamonea is bitter, subastringent
and perhaps deobstruent. So is polypodium vulgare
and perhaps more decidedly so
The polypodium vulgare & felix mas They 
are used in chronic affections of the stomach & bowels & thought 
they have not obtained much reputation for worry in 
this country yet they have sustained their reputation for
2000 years. It was used by Galen
“The [form] is tonic”


80
I recollect case of one patient, a woman, who kept 
passing tapeworms, in great quantities, for months. After failing
with medicines I threw them all aside & tried diet
All the food taken was roasted or boiled even the water
used for drink was boiled. She was cured. It must be 
remembered the healthy bile & gastric fluid will destroy 
those worms & from this fact results an important indication,
which I shall presently dwell upon.
Felix mas the male form has been considered
in Europe, as a specific for this worm. With us the
osmunda cinnamonea [illegible] ([hog brake]) has been used as a substitute for 
it. It is bitter, astringent & sweet. The polypodium vulgare,
which is tonic & deobstruent, & other forms may 
probably be used also
The famous fern remedy bought by the king of France of Madame [Nouffleur]
is as follows. Take a super of the following panada
Rx water lbi [illegible] fresh butter z 2 or 3 bread cut into small pieces
zii add salt zi & boil thoroughly. If the patient is costive
give an injection of water lb is in the evening olive oil zii salt gr. s.
The next morning eight or nine hours after the supper the
specific is to be given viz. Felix mas ziii in powder, mixed 
with 4 to 6 z of the distilled water of the fern or the
flowers of the linden tree the whole to be swallowed at a
dose. In children the dose is reduced to zi of the fern
Two hours after the fern is taken the patient is to swallow 
the following bolus R. cal. & scamm. aa grs xii
Gamboge grs V powdered fine & made into a bolus to be 
given at one dose to a person of vigorous constitutiokn


Ether acts especially upon the nervous system
on which account it has been used as an anthelmintic 
Alibert for taenia gives about zi in a glass of the
decoction of the male form in the [illegible] an hour
after his doze zi of the ol. ricini are to be given
in syrup or in composition the dose to be 
repeated twice & sometime three times a day
The worm is usually evacuated after the first doses 
Mr [Bonadier] directs an injection of the decoction 
of the male form to which zii of ether are 
to be added Mat. Med. art. ether


81
Mathieu adds to Mad. Nouffleur’s remedy the filings
of tine & the sulphate of potash
The French & German add ether to the same
remedy
Rothier’s method is Rx powdered savin grs xx
seeds of rue 15 cab. grs x oil of tansy gtts xii syrup 
of peach gr. s. make a bolus Take half in the morning 
& half after dinner, drinking with each dose a glass of 
vin. tincture of peach kernels
Dr Baurdier gives the following 
Rx sulph. ether zi decoct felix mas 1 gill taken fasting
4 or 5 an injection of the same decoction with 
zfs of ether an hour after zii ol ricini or zi of
the syrup of peach blossom the worm is discharged 
half organiz
Oil is used in order to kill the tape worms
by filling their respiratory foramina. Ol ricini has
been given for taenia & other worms in doses of 3 or 4 z
Liquid carb. amm. might be given for taenia
The German physicians are fond of giving 3 or 4 
ounces of castor oil They are fond likewise of peach flowers
Within 5 or 6 years the bark of pomegranate has
been recommended. Paris says bark of the root [illegible] probable
however the office preparation is meant viz rind of 
the fruit which is the most astringent substance to 
the [illegible] which we have [illegible] also cathartic! I have
not [illegible]
N.B. The male form is astringent, and is given
to enable the bowels by the tone it gives, to bear the [strong]
cathartic afterwards. Hence the union of these give in [illegible] [illegible] may be useful



I have seen the worm occasionally in rain water
I recollection one man of 60 who informed me he had been
troubled with then nearly all his life until he removed his [illegible] Change of place
may effect a cure by change of water
Probably [illegible] of our cholera are
troubled with this worm delicate children only suffering much
children troubled with them will be faint, have
turns of colic etc. you will be called [illegible] Give an injection, and no worms will 
come [illegible] yet give afterwards a strong cath. & or repeat
the injection and worms will come away proof that they 
were not in the rectum They probably breed in the duodenum
I have known but one case in which they were vomited
up. The subsequent cath. will bring away 
smaller worms 
More is done by diet int his worm than by 
any thing else
Alcohol in this morning especially its bitter
tinctures. Condiments are useful. Worms are less common 
now because condiments are more used. It is said that
the aborigines when they cannot get salt used potash ashes
by a condiment The aborigines are said to be very subject 
to worms
# Ascarides sometimes produce severe pain at the 
umbilicus and colic
# “Ascarides though often found in the rectum
are generated in the stomach & small intestines. Hence they 
are sometimes no discharged till the second or third operation
Hence they are sometimes thrown up by vomiting. I have examined this point carefully 


82
3d Ascaris vermicularis. This worm is always troublesome
when it exists in considerable numbers though it is but seldom
that they exist in healthy persons in such numbers as to 
give rise to morbid symptoms. They are very common in 
children, and not rare in adults & are called by the
generic name ascarides
These worms are commonly found in 
the rectum & hence are often said to inhabit that part 
This is a mistake they multiply abundantly & lodge in 
the rectum as they daily pass void by sphincter. Sometimes
they exist in the stomach in vast numbers (hence called
maw worms) so as ever to threaten suffocation by rising
in a ball into the esophagus & sometimes they 
cause severe griping pains by their presence in the 
small intestines #
They pass in the stools & sometimes come
away spontaneously at night, they are said even to 
make their way to the vagina & urethra of females producing
troublesome symptoms X Ascarides are most troublesome
in the latter part of the day & the first of the 
night, when they excite an intolerable itching 
at night [illegible] probably than feeding They give rise to symptoms of general irritation
& sometimes to a cough # Ascarides are particularly 
injurious to dyspeptic patients & they themselves may give 
rise to the symptoms of severe dyspepsia such as craving
appetite, indigestion, faintings. Flatulence, cold
extremities pale & sallow countenance, cough etc. The irri


“They are attended with violent itching
about the rectum general irritation convulsions
irregular appetite pale urine flatulence want
of vigorous action of chylopoietic viscera increase of mucous
secretion darting pains in the abdomen stomach 
& chest faintness cold extremities the symptoms of
dyspepsia sporadic cough”
Tobacco injections & tobacco smoke injected are
very useful and will often cure. It is not safe for children
I have seen great prostration produced in children & I have
known an adult killed by a tobacco injection #
A physician who had been much troubled
with ascarides told me he had tried merc. oint. externally 
with advantage. “I have used it but was rather disappointed
# When the ascarides are in the small intestines, tobacco
smoke will do not good & by its debilitating effect will
favour their existence
“Injections of camphor and milk 
have done more to remove ascarides
than all other remedies I have used. The injection 
immediately removes the irritation produced 
by the ascarides & the ascarides themselves. It
may be made of milk ziv to spts camph. zi
This is the form in which I have used it, probably 
an emulsion is as good, perhaps a
better form” M. M. 


83
which they cause sometimes, in children brings on convulsions
Whenever, finally, they exist, in the alimentary canal
they are accompanied with great quantities of mucus in 
this part. They feed on the mucus of the intestines, the flow
of which they excite by punctuating the mucus membrane
Treatment It is very difficult to cure a patient
troubled with ascarides. The most immediate relief is
given by injection. If the worms are in great quantities & too much 
“Tobacco smoke is one of the most powerful means we possess for the
involved in mucus, they may be completely removed by 
cure of these troublesome worms”
injecting tobacco smoke. Injections of warm water or milk & water will
relieve for the time being by washing out the rectum & if
a quantity of aloes zis to ½ pt is added a still better effect may 
be expected though camphor being a nervine & a poison to the 
worms would be a still better addition. Injections of milk 	
and water, with camphor zii tinct camph to ½ pint, 
will if preserved [illegible] destroy them 15 grs of [illegible] [saladilla] have been injected. Still the frequent injection,
required in bad cases may debilitate the bowels
& consequently invite the return of the worms.
For internal administration. I have found
a tincture of the buds or bark of the hickory given in doses
from a tea to a tablespoonful one of the best articles both
for removing the worms & for preventing their return
Drastic cathartics should not be depended upon 
for they weaken the bowels & increase their irritability & 
hence favour the production of the worms. On the contrary 
calomel & tonics should be given to restore healthy secretion
Aloes if given should not be in large doses, for that will
irritate the rectum still further, but in smaller ones as a tonic


Oily articles shd be avoided as butter, because
they relax the [illegible] of the intestines Potatoes, vegetables 
All kinds of pastry avoided
All the metallic tonics are useful as tonics
They are thought also to be unfriendly to the worms
It is said that forth ascarides a pint or a quart
of sea water has been drunk with advantage, producing
vomiting & purging. Salt is a good remedy. Dr Rush proscribed
a teaspoonful of salt in the morning to a gentler one
much troubled with ascarides. He told him after trial than 
the remedy would not do. Dr Rush gave him, then, for worm
powders # 
For the worm the [illegible] the pink shd be the remedy vide [illegible]
“Rhub & cal. are the best cath. but all are useful For children Rx
tinct. [illegible] Fowlers solut. cold water” 
“Common salt ground up with cochineal to colour & disguise
the article. The gentleman reported that the last prescription 
had answered well. Dr Rush also believed
in sugar. This more doubtful
The asclepiasis have been much used especially 
for this worm especially A. incarnata called wild hemp It is 
dried pounded to a fine powder mixed with molasses & given in doses of a teaspoonful
Or [illegible] down and make a strong decoction [illegible] the [illegible] with it
molasses and give freely until it moves the bowels
This much used by the practitioners of the state more than any 
other article after calomel. it is an article which may always
be obtained growing in clayey situation and is safe
The other asclepians are similar & may be used S syriaca
is the most laxative


84
To prevent the return of ascarides, condiments should be freely used
such as pepper, ginger etc. in short all warming and bitter things
In extreme cases let the diet be so regulated that nothing shall be 
received into the stomach which as not been subjected
to heat. Mercurial ointment has fasted in my 
hands.
4. Ascaris lumbricoides the long round worm is perhaps
more commonly found in the alimentary canal than any other
This worm more than any other is found to have existed in 
the stomach or intestines while the general health has been good
is the presence of worms not suspected.
Strong purges may be used to remove
them & alcoholic tonic tinctures given to prevent their increasing.
For this latter object the carbonic acid has been recommended 
in the London Med. & Phys. Journ. & in confirmation 
of the idea I have used soda water with advantage
Melia azedorach or pride of India a decoction of the bark
is much depended on at the south for their young negroes
who are much subject to worms. It loses much of its virtue when dried. The spigelia is also
sued but of this I shall speak under the head of general 
treatment.
I recollect with an aff. of the liver
wh often vomited up dark [gravous] blood, which had evidently been 
long in collecting. Finally he was said to have thrown at 
a snake. Many eyewitness testified to the snake & to its eyes 
& teeth. I saw it. It was a very large round worm of the kind


To be distinguished only by the violence of the
symptoms. The same itching at the arms will exist as of the
ascarides, but non violent etc.
“Treatment similar to that for ascarides. It
is more common than is generally supposed. Many 
of disease & death by irritation from an unknown cause, are probably 
owing to this worm. In examination the contents of 
the bowels should be placed upon linen cloth and then
this worm can be seen.”
For the gordius Linnaeus recommended the angelica
Archangelica (not our viz the [atropur????])



85
5. The tricocephalus is but seldom met with 
The irritation produced it may be so great as even to bring
on delirium & will be manifested by screaming
throwing of the hands & [fat] etc. I have found this worm in a 
fold of the volvulus of the intestines vide Volvulus.
I should try narcotics for this worm, but 
cannot speak from my own experience. I should recommend
also an injection of a table spoonful of ether in a gill of
water or mucilage. Ether given in this way will undoubtedly 
pass the valves of the intestines in a state of vapour 
Vesicular worms, according to the old division of verminous
diseases, are met with commonly in the brains of adults & 
are attended with the symptoms of vertigo, convulsions
apoplexy & hydrocephalus.
Cases of worms & of colic are much less frequent with 
us than formerly; owing to the change in our mode o f
living. They are said to be very common among the 
aborigines of this country



One volvulus may be received within another
a second, a third and fourth time & [illegible]. The whole may 
then become inflamed, the vessels may run
from one to another, and the whole become one complete mass 
of organised matter or sometimes [illegible]
“It may occur in any part of the intestines except the rectum
though the colon is often received into the rectum”
The symptoms of the two kinds [illegible] [illegible]
owing to the different susceptibility of these two portions of the 
al. canal, and the diff. ages of the subjects of each
Nor located in books vide Ed. med. & surg. J
where the best account of it is given. Good merely mentions it
as an accident that is found sometimes to have occurred in ileac
passion
“Predisposing of exciting causes”
The cavity of the natural stricture may not be large than a goose quill, & such 
children will be very liable to an occurrence of volvulus
This is not a primary disease. It occurs more
in some families of [illegible] fibre & [illegible] phlegmatic
temperament
It may occur from debility of constitutional
or that of the bowels [illegible] by bowel complaints etc.
Local violence One instance, in here the child 
was apparently thrown into it by being carried over the shoulders


86
Volvulus or Introsusception
This is a disease with which I was at first very much perplexed
especially as I derived little satisfaction from the books
Volvulus or introsusception is the reception of one portion of
intestine within another. It doubtless exists often in a 
slight degree, when there is a strong action of the bowels
& are inverted peristaltic motion & the bowels disengage
themselves. Sometimes there is a double involution, or one
involution within another. In some cases likewise the 
cavity of that portion of the intestine is entirely obliterated by 
the tumefaction of the coats. I have always found in post 
mortem examinations, that the upper portion of intestine was
received into the lower & not vice versa the involution having been caused apparently 
by inverted peristaltic action
This affection of the intestines occurs oftenest
in children though adults are liable to it. It would seem also 
that some families of a leucophlegmatic temperament & 
delicate constitution are particularly liable.
It may be caused by a natural stricture
of a portion of the intestinal tube when it will be incurable
It may arise from extreme irritability; local violence
& injury may occasion it, & the irritation of worms may 
bring it on. Drastic cathartics may bring on volvulus
& hence should be cautiously avoided where there is a liability
to it. Bowel complaints, as colic, cholera, dysentery
etc. sometimes terminate in one or more volvuli of the
small intestines. The disease is more frequent in the 
summer, when debility is greater & bowel complaints prevail 


“Symptoms incessant irritation one or two copious evacuations
but usually these have ceased entirely before the physician 
arrives constant efforts to vomit, resembling hicup constant
efforts to pass stools & nothing passes but mucus streaked with blood
Generally mistaken for hydrocephalus
In bowels complaint of delicate children look out
for volvulus It is much more common in some seasons than 
in others. About 10 years ago they were quite common. I had
many letters from our students, who met with the disease
& disagreed with the phys & gained [reputation]. They 
frequently sent me such accounts.
Sometimes there will be a partial involution of the
large intestines [illegible] to relaxation of inner membrane what descends
like a funnel & may be felt by the finger #
In the large intestines there is not very much irritation
than is torpor of al. can. not much vomiting except upon 
the administration. There is no purging
You may sometimes determine that of the
large intestine by heaving the peristaltic action discard
& stop at the [illegible]
This is most common in adults. The symptoms
are more mile
# It occurs in females who have had long continued effetion
of uterus, occurring in females about cessation of [catamen]
and from long continued bowel complaints. The [inner] membrane
will descend like a funnel An injection will perhaps 



87
Symptoms These will be different according as the 
affection is of the small or of the large intestines
1st Where the small intestines have one
or more volvuli the symptoms [illegible] vomiting or
Symptoms like those of violent injury to abdomen vide case 1st 6.89
a constant endeavour to vomit as often as once in ten 
or fifteen minutes the matter thrown up being a greenish 
fluid or simply mucus. In severe cases the vomiting is 
attended with a discharge from the rectum at the same 
time. The stools are fecal at first & copious but afterward 
they are small in quantity & consist principally of white mucus streaked with blood
the blood not being diffused throughout the mucus as
“no fecal smell generally”
in dysentery, but in streaks or specks. These symptoms 
are attended by others which indicate great inquietude or irritation
such as throwing the h ands & feet, rolling the 
head paleness of coutenance This set of symptoms resemble those of hydrocephalus
& hence volvulus is often mistaken 
for this disease. The pulse is small and frequent
“[illegible] usually occurs in 24 or 36 hours”
2 A volvulus of the colon or rectum 
is not usually attended with much vomiting unless this
is excited by cathartics. It is attended with the ordinary 
symptom of constipation. There is no evacuation 
from the bowels unless at times a little blood and
mucus. If the passage be not completely closed, an 
enema thrown-up will remain & not come away if
completely closed. it either cannot be thrown up 
or it returns immediately. Blood often follows the introduction 
of the pipe. Indeed the inflamed part is often 
so low as to be reached by the pipe & admit of being felt
by the finger.



come away immediately. [Schyl?la] of feces may come away 
And large quantities of mucus may come away sometimes 
½ a pint. This is not apt to be fatal. Treat by a strong
inject prescribe for the [illegible] with conium [illegible] etc. mechanical 
means
The more cath. you give the more the unsolution is
increased therefore give more
Give mucilaginous injection, in involution of the 
small intestines, sufficient to fill the intestines. If it is
said that the injection will not pass the valves. I answer 
that whether by sympathy or in whatever manner, I am satisfied
of its utility # 
Give [illegible] enough to allay irritation 
I have treated # patients for 8 or 10 days without 
evacuation & cured them 
Not long since I had a case in what
I suppose there was such a volvulus, for the attendants
could not make the child receive injection. “thought
the bowels were swelled” The child was suffered to 
get 8 or 10 days without evacuation & eventually died
of another disease with which this was connected
# In the incipient stages, filling the intestines
with warm water [illegible] recovered. I was led to it from 
its [illegible] strang. hernia I am satisfied it acts well as a 
local nervine etc.
I would recommend the injection of ether 
in cold water table sp. to a gill warm wat. will make it fly off. The inject of it
is practised by the French & Germans. Other antispas. might be [injec??]
is asaf. petroleum etc.


88
We may often hear a rumbling noise proceed as far as 
the stricture & then stop.
Treatment The indications of cure are principally,
to relieve the excessive irritation both constitutional & 
local & to attempt the restoration of the involved intestine
chiefly by mechanical means
When the small intestines are affected we
must give opium and aromatics & depend mainly upon
these as internal remedies, until the intestine restores 
itself. As an adjuvant the warm-bath will be valuable
& fomentations or irritants, as mustard & horse radish
leaves may be applied to the abdomen. Soothing injections 
also may be copiously given. The quantity of opium 
which will be safe at a dose may vary from half a drop to 30 
None but the mildest cathartics are safe, as blue pill
and aromatic tincture of rhubarb I have succeeded in giving 
only a decoction of senna & the blue pill [Savage]
When volvulus is in the large intestines
all our remedies must be given by injection. The 
warm bath etc. may be used & we may also attempt
the restoration mechanically, by means of copious 
injection repeatedly given & thrown up with force
Two cases are related of young men cured by inserting
into the rectum & keeping these for a considerable time 
as spermacete candle with a quantity of opium at 
its extremity.




The first case which I had I treated for constipation 
with repeated cathartics, which are thrown up etc. The
attendants complained that they could not give the injections when
I ordered I was ignorant of this case Tried warm bath & 
every remedy for colic constipation etc.
Upon examination at first the colon was
apparently wasting at the sigmoid flexure where there
was a large tumour which we thought to be a malformation
It proved to be a repeated & insolution of the intestines Inflammation 
had taken place & the whole was adherent, some
[illegible]
Afterwards I was called too late, to a similar
case which upon an examination showed circular appearance
Afterwards called in consultation to a child
said to have hydrocephalus all the children of which family 
had died in a strange way. I pronounced the disease
not hydroc. but some could not say what was the matter.
No treatment was serviceable. Examin showed volv.
of small intest. Symptom is above. vide p. 204
The children of the family were subject to 
diarrhoea & were leucophlegmatic. I afterwards 
[illegible] the family and was very cautious about cath.
giving nothing stronger than blue pill or tinct. rhub. The
family raised 5 or 6 children afterwards
Case of a student [unaccountable]
Dr Munson & Dr Smith at a loss. [Cath.] retained & yet
not thrown off by vomiting Sitting by him I observed
a rumbling noise Which he said upon my enquiry, he
felt & which stopped. I felt the stricture. Spermacite 
candle, sharpened, opium at [end]. kept up about a [illegible]
[renewed] afterwards injection passed up 
Case of a gentleman on the wharf similar cured


89
Cases. A man over whom a cart had passed without
leaving any external injury, died with all the symptoms 
of volvulus of the small intestines. On dissection the duodenum 
was found cut entirely in two. One remarkable
physiological fact occurred in this case; a cathartic
was given by the mouth & produced a regular 
evacuation from the anus, although the intestine
was completely severed.
An interesting case occurred to me
in which the worm ascaris tricocephalus was found
to be the cause The worm lay in this fold of the intestine. Grace Linsey, a delict schoolgirl
on was taken with slight in disposition for 3 or 
4 days the rejected her food by vomiting then came
on constipation with vomiting attended with great
restlessness & throwing off the bed clothes, cold extremities,
low & small pulse the tongue not much furred,
little or no thirst, no tumefaction of the abdomen
no determination to the head. She was visited on 
Tuesday and died on Saturday. A blue pill was
given & followed by 15 or 20 grs. of calomel in divided
doses No effect was produced though they were 
not rejected. Opium and stimulant were tried but
were not retained. There is no pain but faintness & 
an uneasiness about the alvine & urinary passages.
Both copious and small injection pass up well but
produce no evacuation. On Wednesday injections produce
stools which are clay coloured. Black vomit came
on two days before death. P.m ex. liver very pale
little bile in the gall bladder no marks of inflammation cavity 
containing the intestines very dry as in cholera. Two volvuli were found one in the
ileum which was disengaged with difficulty, & one in the jejunum 


In other cases with similar symptoms I have had supposed 
there was volv. caused by worms, but have had no opportunity 
to examine Vide p. 204
[illegible] Lindsay’s case continued. After the examination 
we accidentally observed some of these worms minute 
& coiled up among the mucus on the cloths. The worms seem
more calculated to irritate the bowel than any other “If it
could have been known that the worm was there, perhaps tobacco should aught have
succeeded
# It is called leg ache in slight affections 
alluded to by DR Rush
Affects the legs, calves of the legs
[illegible] continues extends up to the [illegible]
coats” It is a disease manageable in its commencement
Being a severe disease it calls for 
decisive remedies
The indications are to allay pain 
equalize excitement & promote peristaltic action
by opium by diaphoretics by cath.
Cal. in full doses some would call 5 grs a
full dose some 10 But if 5 gr. should be given
every hour it would amount to a full dose. You 
may give 10 gr. 2 or 3 times repeated. AT the
same time apply warm bath & fomentations
not regarding your giving cath. Put drafts
at the feet. Follow the cal. with senna, salts etc.
But do not be too anxious about the calomel’s operating
immediately It is better that it shd lie sometimes in 
[illegible] vessels
With the cal give opium also guiacum 
& guaicum with dovers powder the latter
to act on the skin and the whole to produce a 
decided [nerve] action affect on the al. can. and on the whole system


89:a.
Nervous Rheumatism
Infantile neuralgia
This is a disease which has never to my knowledge
been described in the books, though it may have existed unnoticed
I first met with it some years ago, but it is [not] some years
since I have seen of a case. It may occur again
It occurs in the winter and spring mouths & 
occurs after exposure to cold especially after the feet have
been in snow water.
Children are the only persons that I have
known attacked # 
This disease is in its symptoms allied to neuralgia
acuta. The affection leg ache is probably allied
The attack is sudden after exposure to cold 
with excruciating pain in the inferior extremities sometimes
rigidity of the whole muscular system more or less disorder
of the digestive passages (apparently the muscular coat of the
intestines is affected) abdomen frequently tense
and full stomach sometimes irritable. If the disease advances
there is nausea, vomiting, tumefaction of abdomen
(appearance of tetanus?_ (coma?) etc. and the patient dies
in 4 or 5 days
The indications of treatment are to equalize
excitement by acting upon the whole surface of the alimentary
canal and skin at the same time introduce new action in the system
commence with a full dose of calomel 5 to 10 grs or 20 & follow
it by senna and manna, or castor oil and enemata
“I do not expect that cal. [illegible] I as above will operate at 8 years therefore follow it.


Immediately after administering the calomel I put the patient
into the warm bath or the feet in to the tepid bath,
wrapping them afterwards in flannel or boil cedar boughs
in water, roll them in cloths and apply them to the body & 
feet. Irritants also may be applied to the extremities and
to the abdomen
Sometimes it will be best to repeat the cal
in the course of 2 hours. The stools will be fetid and
dark but this must not be considered as an indication 
for further evacuations as the appearance may be caused by 
the calomel, and is a sign that secretion is beginning to take
place. After producing free evacuations by your cathartic
you must keep up a regular course of exciting the secretion 
by cal. & guaicum with Dover’s powders, especially if 
pain continues & keep up a diaphoretic action by Dover’s
powders calomel and camphor alternately increasing 
doses if necessary. Calomel and gum arabic, as an emulcent, 
& calomel and decoction of cedar twigs, as a diaphoretic
may be given
Give the calomel first in divided doses
If cold applications are made to the extremities, to 
discuss the inflammation the disease is translated to the
stomach and death is the consequence
I called in the first stages, & am always successful in effecting
a speedy cure



The irritation of the system is so great that secretion 
is prevented hence the production of
secretion
I have been called to patients with [illegible]
where little had been done the abdomen was
swollen the patient went into a comatose state
& died and that too where the disease
was not of the most violent form
After the bowels are thoroughly evacuated
depend upon diaphoretics camphor guaiacum and 
[illegible] etc. giving so as not to offend the stomach 
and beginning gradually 
It is a violent and excessively 
painful disease and it is a great satisfaction to the 
phys. to cure it
Dark stools [illegible], satisfied
“The pain usually begins in the calf of the
leg and extends to the contiguous parts. Sometimes it is attended
with tetanic spasms & a constant rigidity of the abdominal
muscles. The stomach becomes in these cases irritable,
and nausea & vomiting prevail. In the progress
of the disease the abdomen becomes full and tense, with 
constipation.”
“It should be our leading object to make the
muc. men. of al. can. & the cutaneous system active [concert]
After the operation of cathartics, if the pain is severe give diaphoretics 
with opium, as Dover’s powders. Camphor & cal.
in small doses as an alterative. If the stools are watery & fetid
give opium ¼ gr. guaiacum 1 or 2 grs. camph. 1 gr. Ipecac ½ gr.
with cal. repeated till some effect is produced not to salivate, but
to this children are not so liable as adults”


Young physicians are often called in a case of convulsions
as their first case The neighbors & friends (women) have assembled
in great numbers and their sympathies are excited. Hence
an impression is made with respect to a young physician’s talents which 
will be of great service or detriment
Morbid condition to brain so that ordinary stimuli
produce convulsive action
Convulsion fits may continue 5 m or from 1 to 2 hrs


90
Convulsions vide costiveness 12:a
This is a very common disease of infants. The mortality from 
it is truly appalling nearly one seventh part of the whole
number or deaths of patients under the age of puberty
by the bills of mort. in Phil in 20 years
Medical writers commonly make two 
kinds of convulsions idiopathic and symptomatic, the
former arising from some morbid condition of the brain 
and nerves and the latter from some other disease, or from 
irritation. Children are subject to both kinds & most
of the diseases of children may be expected when they prove mortal
to terminate in convulsions
The causes of symptomatic convulsions
are as various as the agent capable of producing irritation
though the causes of convulsions in one child will not 
necessarily produce them in another. The susceptibility to 
them varies with the age of the child and the peculiarity 
and degree of delicacy of the constitution.
Convulsions may arise from the sudden suppression 
of evacuations to which the system has become
habituated. Irritation from teething is a very common 
cause. Worms in the alimentary canal may excite convulsions.
But perhaps the most frequent cause is the 
presence of indigestible substances in the primae viae.
irritating the nerves of the stomach & through them those of
the whole system. Over distention of the stomach, even with 
food of a healthy quality interrupt the progress of digestion
& the food undergoing action [illegible] fermentation 


“Or the excessive quantity of food may produce
convulsions from the mere stimulus of distention”
“Dyspepsia is a cause”
This is an important maxim in the first children of 
young mothers Their anxiety of mind will often affect their
milk


91
in the stomach, becomes noxious matter & excites convulsions
In the season of fruit we may always suspect this as a 
cause in children old enough to eat it. Calomel has been
known to be so irritating to the system as to bring on convulsions
Costiveness also is a cause of convulsions in children
A change in the quality of the milk of the
mother or nurse, produced by improper food or
by strong affections of the mind, in some instances
is the cause of convulsions in young children. Hence 
not only the diet of nurses should be regulated, but their
minds kept tranquil. It may be observed also that the 
countenance of the mother or nurse as also those of the bystanders
has more influence upon children than is commonly 
supposed. Even a child but 3 weeks old, will be strongly affected.
In some families there is said to be an hereditary 
predisposition to convulsion among the children.
For the treatment we have two indications
1st to remove the exciting cause where this is local & 
2nd to relieve the irritation of the system
1st We must enquire into the causes with 
with care. If evacuations are found to have
suddenly ceased they must be restored. The guns should
be lanced. Anthelmintics should be given if there are worms
If improper food is suspected we must be particular 
in our enquiries, or we may be misled by a [vague] & 
general answer. When the convulsions have been brought
on by improper food or by food in large quantities
recently taken the stomach should be evacuated by an
emetic of 5 or 6 grs 4 to 8 of sulph of zinc or of ipecac.


# How long should we wait after giving one cathartic
before we try another? the child being in convulsions 
all the while?
The equilization of temperature will do a great deal
to remove convulsive action Besides the soothing of the [nerves] etrc.
Some rely on one and [illegible] or another
Oil of a amber is not in my opinion better than many others
The oil of amber apparently is the [illegible] the oil of [capal] brought from its E. [illegible]
It is recommended to dissolve the oxyg oil in [illegible]
[but] it is slow of solution It dissolves readily in either


92
If the offending substances have probably passed the stomach
& the irritation is in the bowels, these must be evacuated as
speedily as possible giving and injection to begin with [illegible] it to [illegible] cathartic. Sometime
it will perhaps be best to give a dose of calomel
large enough as to operate both as an emetic & cathartic.
Frequently large & repeated doses of cathartics
will be needed in order to overcome the torpor produced
by an excessive quantity of food. The food also diminishes
the cathartic operation is the case with the French
[dinner] pill. We may give calomel, 5 to 10 grs. or scammony 
3 to 4 gr. jalap 2 to 3 gr. senna & manna, castor
oil, neutral salts etc. If dry cathartics fail to produce
the desired effect, the liquid should be tried. Sometimes
will be acted on by one kind when they will not by the 
other # If one fails after 3 doses try another & assist with injections
Begin with cal. & follow with the others
2. If the convulsions continue after the removal of the cause we must
rely upon antispasmodics or even at the commencement. Of these the warm bath must
be considered the most powerful remedy in convulsions
of children always [illegible] & often efficacious. Its influence is immediate and extensive.
Antispasmodics, as pearl ashes or aromatic herbs, may be
put in to the water of the bath
Of antispasmodic articles a great variety are 
used. Oil of amber Dr Rush called his sheet anchor in 
spasmodic diseases. It is useful internally, and applied
as an external irritant along the spine. The artificial
musk a preparation of amber is in my opinion a better
article than amber itself, for all cases where amber is 


“# Seneca oil is more limpid & pure & approaches nearer to naphtha”
Soot is a [illegible]
Soot is efficient as a nervine tonic & deobstruent
It is sometimes very efficacious in jaundice & dyspepsia It was
very popular in Philadelphia with ashes for stomach complaints
“The British oil is manufactured in this country from 
Barbadoes ter & spts turpentine”
The nostrils may be rubbed & it may be given
internally “also rubbed on the skin”
Though so offensive to the small yet children taking 
the tinct readily
potash [illegible] & [illegible]
All the alkalies & alkaline earths are antispasmodic.
They are not nervine properly. There yet
seems to be abundant testimony to their antispasmodic
properties. They are to a certain degree tonics. i.e. they 
have a specific action on the mucus membranes. I have maintained [illegible]
they operated by generating excitability a view supported by Jobe
vide Hufeland’s Journal in Lond. Med. & Phys.


93
indicated. The mineral oils from whatever source obtained,
such as petroleum, seneca oil, British oil, are
little inferior to the oil of amber I prefer the seneca oil 5 to 30 drops #. The eympreumatic oils
are useful antispasmodic and soot is often given by nurses in 
decoction
Ammoniae in any form is a good antispasmodic 
A solution of ammonia in spirits often contains an empyreumatic
oil of this solution we may give to a child from 2 to 
6 drops in an ounce of water. Either the spirt, the carbonate
or the aqua ammoniae will be useful in alleviating spasms 
in children either applied to the nostrils, rubbed
upon the skin or given internally. Dippel’s animal oil, a
very fetid substance distilled from bones in a state of putrefaction owes to antispasmodic
virtue to the presence of ammonia. It is too disgusting
Castor and valerian are good articles
of this class, but in cases of children they are too bulky & a sufficient quantity
cannot be introduced into the stomach. A more
powerful article than these is the asafoetida fetid gum 10 or 20 40 
drops of the tincture. This is a very valuable remedy to 
give by injection using for this purpose either the tincture zii
or a decoction
all the alkalies are antispasmodic & 
are proper for children. The most powerful is 
pearlash given by injection, zi to zii in lbis of water 
I have seen more sudden and permanent effects in cases
of spasm produced by injection of this kind, than by any 
other remedy. It has been successful in cases both of 



In for [illegible] who have [resumed] in convulsion 2 or 3 days
when a variety of narcotics had been given. I have seen
surprising effects produced by the injection
These applications sometimes fail & we 
cannot tell to what sort of cases they are Yet we must have
a variety of resources if we would be able practitioners
Opium is powerful, but though it
frequently relieves, yet it sometimes aggravates the symptoms
I have given it with great success in paroxysmal convulsions
anticipating the paroxysms yet in these it will sometimes
fail



94
infants and of adults. Sometimes however this remedy 
fails & I am not able to point out in what particular
“We are compelled sometime to practice [illegible]”
instances it is indicated. All the narcotics
are antispasmodic. Opium is a powerful antispasmodic
and may be given to patients of any age when the condition
of the system does not contraindicate it vid. lect on m. m
I have given opium
where the convulsions were violent & returned
at stated periods with fever preceding. When the
convulsions appear at regular intervals, as once in an
hour, or day, opium in repeated doses may be considered
a specific.
Counter irritation may be valuable adjuvant
in the treatment of convulsions. Oil of [origanum]
& similar articles may be rubbed along the spine
 drafts may be applied to the feet and wrists & mustard
horse radish leaves etc. to the abdomen.
When the convulsions are frequently repeated
in children and become in any degree periodical, a
cathartic of calomel given once or twice a week, rarely 
fails to prevent their recurrence. If this fails I give
stramonium or other narcotics
If convulsions arise from organic affections
we can expect to effect more than to palliate
instead of curing the disease.
“Counterirritation by mustard, horseradish etc. may be
useful”


An injection can do no harm can always be administered
and if one cannot administer articles by the mouth
Irritants may be applied immediately e.g. mustard
horseradish garlic N.B. we do not need powerful vesication
for the tender skin of infants. Even garlic sometimes vesicates
Ammoniae to nostrils & in mouth
Be sure that you have [water] enough to [illegible]
the child completely for the nerves are apt to think that it 
is sufficient to half [illegible] child & then sprinkle
or scatter water over producing an equal excitement
Friction may be applied while in the bath & after
coming out [illegible] with dry flannel
If the irritants have been applied before
the bath taken then off when [illegible] about to immerse in the
bath & put them on again if necessary after coming out
If the child seems to be in a state of asphyxia 
the emetic may not take effect; then irritate the fauces
the child being lard on its abdomen supported by the
hand of the nurse



95
When you are called to a child in convulsions, without 
previous sickness, direct an injection to be immediately
administered and the warm bath to be prepared. if the
injection does not relieve, put the child in the warm bath 
previously adding pearl ash in proportion of zfs to a gall.
of water. Let the child remain from 5 to 15 minutes taking
it out when it begins to grow exhausted. When taken out
of the bath let it be wrapped in flannel & put into a 
warm bed. Then apply irritants as mustard, horseradish
garlic, or aqua ammonia to the abdomen feet and wrists
Apply aqua ammonia to the nostrils and temples
As soon as the child can swallow give a dose of calomel;
If the countenance is pale or livid the
cause may be suspected to be some offending matter in the 
stomach & an emetic ipecac not [illegible] generally should be given. We may often
succeed in exciting vomiting by irritating the throat with 
the finger or a feather & this method should be tried
when the patient cannot swallow & is known to have taken
improper food or when it is desirable to hasten the 
operation of an emetic. The child will vomit with much
more ease if it is held lying with its belly upon 
the nurses’ hand, which this supports the abdominal 
muscles
If the child is much agitated at the 
sight of the water which it is to be immersed, let
the tub be covered with a blanket & the patient gradually 
lowered into the water there will then be 
no difficulty




96
Epileptic fits are very frequent among children
Epilepsy is defined by Good A “spasmodic agitation & 
distortion, chiefly of the muscles of the face; without sensation
or consciousness; recurring at periods more or less
regular.” One side is generally more affected than the opposite
The limbs may be fixed and rigid with twitching 
of particular parts. The pupils may be contracted or dilated
& the attack may be followed by coma. The attack may 
be abrupt and without warming or may be preceded by 
hilarity, or a giddiness or other unpleasant sensation.
Sometimes there is what is called the Aura epileptica, a
sort of formication, creeping up the body for which the 
ligature may be applied
The fits may be kept up by the constant 
presence of the cause such as malformation of the brain etc.
or, by habit & while in the former case the disease
will be incurable, in the latter habit will be very 
difficult to break up.
The causes of epilepsy may be, malformation 
of the brain tumours of the brain derangement of the system 
produced before birth by syphilis & rickets or the same
causes as those which produce the rickets & in children oftener than after preventing the disease
may also arise though more rarely from mere excessive irritability of the system, even’
without any exciting cause of irritation such as indigestible substances
in the alimentary canal or suppressed evacuations
Among children however epileptic fits are
most commonly excited by teething, suppressed evacuations
& the irritation of a morbid condition of the bowels or of 


In scrophulous children remedies for scrofula
may be given. [illegible] rickets I have often
found advantage from blisters behind the [ears]
I have found the cath mode of treat successful 
for children within the year especially calomel
In some cases the most powerful cathartics are
required
If there is acidity of the passages so that cal. seems
to gripe much [illegible] chalk any quantity from 5 to 10 
It is immaterial whether the action is chem. or certainly 
the effect is good
The system being very irritable ordinary stimuli
or rather a little more than ordinary brings on [illegible]
Hence improper articles improper exertions of mind & body
etc. Careful management & [illegible]


97
indigestible substances in them.
The treatment of epilepsy must vary
with the causes which produce it but does not differ materially 
in the case of children from that of convulsion fits
In epilepsy from rickets I have used the
cold bath with advantage. In children our attention 
in the treatment of epilepsy must more especially be directed 
to the alimentary canal. Cathartics are far more valuable
with them than for adults. I have almost always succeeded
by means of a course of mild cathartics & 
joined with one of tonics, such as the tonic solution 
& the different preparation of iron
When called to an attack brought on 
by offending matter in the stomach and bowels, we should
commence the treatment with a strong cathartic in 
order to thoroughly clear the alimentary canal
calomel is the best article but if the bowels are loaded with 
mucus so that calomel fails to operate we may conjoin 
1 or 2 gr. of gamboge & of scammony & 5 of jalap & this
though powerful, will yet operate kindly. In 
the subsequent treatment calomel should be given 3 or 4 
times a week; though if there is a deficiency of mucus
in the bowels an abrasion as it were the blue pill will
be preferable or chalk may be conjoined.
Among infants most cases are curable
by careful management, both of the physician of nurse
The diet should be regulated with great care Generally 
however there is a morbid appetite, & a sub-[insanity]


There is often a difficult, particular waywardness
[illegible] like into [illegible] etc.
In children more than a year old I have given stramonium
so far as to dilate the pupils keeping the child under
the operation of it I have not prescribed it to children
under 2 yrs or 18 m. I recollect one case in which 
the convulsion begun to subside as soon as the pupils began to 
dilate
I would not prescribe to [illegible] but to [all]
symptoms e.g. tonics all the nat. ton. tinc irr. cap.
lead
I would give the lead where cathartics, from 
the excessive irritability of the al. can. aggravate all the 
symptoms Lead will produce a torpor or sub paresis
contrary to this Narcotics also will meet this condition
Opium will occasionally, but not generally 
Why it is we know not but the fact is that phys. do 
not depend on [illegible] ep. seems to cause a determination
to the head


98
with regard to food. This subderangement of the mind
manifests itself also in other ways by oddity of appearance
gesture & action. A strange propensity for climbing for
instance is met with & epileptic children will often be so 
active & so artful as to be very difficult to manage
For more particular treatment see my 
lecture on m. medical articles stramonium & nit. silver
[illegible] turpentine from 10 gtts to zi diluted
stramonium, camphor, opium atropa belladonna
& most of the more powerful narcotics Arsenic
zinc is one of the best of the metallic tonics
Actual cautery, [moxa] etc. have been highly extolled
“In epilepsy caused by rickets or by the same
causes as those which produce ricketts. I have used the 
cold bath with advantage”
“Mercurials followed by mild cathartics
[Seontod??] etc.”


The child will be still breathing languidly
The parents think it dead If you look at it carefully 
you will perceive as languid treating & looking at
the eyes you will often perceive a little convulsive motions of 
the balls pulse not much disturbed
The child continues a few [illegible]
with paroxysm & comes out with a scream like
an adult from nightmare
Not dangerous
In a few instances [somerset]
Case adult patient [illegible] a chair stands fixed eyes fixed
come out with a stare irritable & sub derangement
for a few days Afterwards [somersets] “asleep
once a sleep twice”
Case a girl last year gather up [illegible]
[somerset], even 50 times than cataleptic then exhausted
This case changed from chorea to catalepsy Repeated
bleedings did not change the emaciation etc.


99
Catalepsy
This affection when it affects children, is called in 
poular language still convulsions. It is a very rare disease 
among adults, but among children I have met with several
cases of it
In catalepsy the muscles are universally 
or partially affected with a tonic spasm. The patient remains
fixed in the position in which it happened to be
when seized appears asleep, is insensible and scarcely 
breathes. The eyes are commonly fixed, but sometimes have
a little motion. The paroxysm may terminate with common 
convulsions. The length of the paroxysms I have known
vary from a few minutes to three hours & in some cases
they are frequently repeated
The disease arises from the same causes
in general & requires the same treatment
as epilepsy & convulsions. Cataleptic convulsions 
sometimes follow other convulsions & in some instances
have been brought on by drastic cathartics
In adults catalepsy is often followed by irritability 
& a degree of mental derangement.
“Catalepsy arises from the same causes and
requires the same treatment as epilepsy chiefly 
by cath. & antispasm. Sometimes children are
affected with catalepsy without it being observed
When I commenced practice I thought the notion of
still convulsions a mere whim”


Dancing before the [illegible] of St. Vitus
Dance [illegible] 3 or 4 well persons
Comes on gradually parents complain that
their children are getting into bad habits Awkward
motions
The dis. is not benefit. by [illegible]
I recollect a gentlem. 40 or 50 yrs told
me he had chorea when a child & recollects perfectly 
the indignation, horror & disgust when so long as to be 
unable to speak [illegible]
Hand carried not to the mouth
Sometimes the motions finally become regular
“The dancing master” feet blind [illegible] then 
hands then body then stop like a statue then begin 
one foot like a [falling] [illegible]


100
Chorea Sancti Viti
This is a disease not to be mistaken in its ordinary appearance
the voluntary muscles are but partially subject to the well
and their motion is convulsive. It occurs oftenest in 
females of relaxed habit & about the age of puberty
especially if they have grown rapidly or been much 
confined to the needle or to study.
In children this disease is often caused
by irritation in the primae viae Chorea also arises in 
some cases from a peculiar irritability of the system in 
which ordinary stimuli produce convulsive action
This irritability may be accompanied with 
relaxation, or with increased action together with a
determination to the head. Indeed it is said sometimes
to be connected with inflammation of the brain 
 & hydrocephalus. With those who are predisposed
to this disease, particularly if they are females
about the age of puberty affections of the mind may bring it or
epilepsy sometimes runs into chorea, or alternates with 
it. Finally, the disease may come on in a very gradual
manner, so as not to be suspected, causing a strangeness
in the gestures walk etc. which at first is attributed 
by the friends to the formation of bad habits.
This disease is rarely fatal and is not
difficult to cure in patients under the age of puberty after
that period it is seldom cured. When the disease is
of long continuance a great variety of remedies are generally 


“When I give cathartics in chorea it is not for the 
evacuation but to produce a new action. All cath.
will not act favorably. Hamilton’s views in prescribing 
cath. are not generally correct.”
There sometimes irritation of al. can. from accumulation
of feces about the coecum. Hence Hamilton’s
plan of purgatives Purgatives will cure but [general]
by impression on system
It is said to arise from a tonic infl. of 
brain I have read periodicals have not so
I have seen all kinds of treatment tonics, cath
narcot. electric. galvan. cold bath etc. etc.
Perhaps no disease prescribed for more [illegible] periodically
We find one and another article fails and are obliged 
to go the whole [illegible] off [illegible] narcotic etc.
# “In one case of chorea I tried the arnica until the
head became affected. The patient began with a decoction of zii
the flowers & increased to zfs without any abatement of the disease”
Prof T’s [illegible] [illegible]
Nux vomica has been used with success in many 
cases but there are other narcotics which act more powerfully 
& more certainly I have not used it deterred by [Ba??]
[Surrey] who found it injurious for some convulsive cases 
“Stramonium succeeded in a case following
epilepsy”



101
tried and the one last given is apt to be considered
as having effected the cure; but I am inclined to think that 
in many of these cases the disease instead of being cut
short by the treatment and run its course and then ceased 
of itself
The most common indications are [for] narcotics
and tonics with antispasmodics as palliatives & 
permanent counterirritation along the spine in some cases.
In children however cathartics are commonly indicated; though
in general the plan of treating chorea by cathartics, has not
succeeded very well in my practice. Dr Hamilton however
depended upon cathartics and had better success, though it may be remarked that those who act on that treatment are also the metallic [illegible]
When there are symptoms are symptoms of worms, of hydrocephalus, or of
inflammation, of the brain or when the disease follows epilepsy
we must treat as for those diseases; & if it the chorea
is the result exclusively of the peculiar irritability above
alluded to, narcotics must be our chief dependance. 
The principal articles which I have employed
in my practice are conium, conium & iron
sulphate of zinc, sulphate of iron & other metallic
tonics. Various narcotics are used, as the nux
vomica in doses of 1 or 2 grs of the seed in pill or 15 or
20 drops of the alcoholic tincture; and antispasmodics
as valerian musk etc. may be used as palliatives
Cullen’s favorite tonic was the ammoniuret of copper 1 to 4 gr.
I have lately used it with advantage in pill 2-3 hours in creasing
other tonics are mineral acids, nitrate of silver, bark
& the arnica montana #, which is a narcotic & tonic & 
was successfully used by Dr [Monsen] in chorea” Dr. T’s copy [M. ?]




“Sulph zinc 1 gr. may be given 3 or 4 times a day
nit. sil. 1/6 to ¼ gr. succeeds best in relaxation of the blood-vessels”
“Evacuate the first passages and restore the healthy
secretions & irritability of the system by tonics & antispasmodic
“I have rarely effected a cure by cathartics though I generally 
begin with them The cure with antisp. & tonic is slow 2-3 [illegible]
with narcotics more speedy but uncertain”
A good deal may depend upon the careful management
of the patient keeping him quiet & amusing him especially 
avoiding the irritation of the [pressure] and the impertinent
curiosity of strangers
The young man in a debilitated 
“So camphor has sometimes been given in mania to 
such an extend as to produce epilepsy & sub-apoplexy & this 
sometimes cures the mania”


103
double the quantity, when the head began to be affected still
there was no considerable relief The patient was finally cured
by taking the bark in substance zi a day.
One case which came on in the gradual
manner above described & was brought to a high degree
by a dysentery proceeded so far at least as to present
the peculiar symptoms of hydrophobia such as horror of
water etc. convulsives perfectly [like] that frothing of the mouth etc. died in coma exhausted
narcotics tonics etc. no effect excitability exhausted by [illegible]
This disease may affect the mind causing
it to run upon particular subjects especially upon that
of numbers & calculation. I once travelled a short
time with a book pedlar who had the odd gestures of 
chorea & had also this facility in calculation, being
in this respect fully equal to the famous [Serah] [Colbourn]
[Serah] [Colbourn] though furnished in Europe with 
the best advantages for education never improved
and this result I ventured to predict, when I first
heard that he was to be educated. I have seen several
such cases. # They have a peculiar articulation & expression
of countenance; and are deficient in memory and
judgment. Vide [illegible] 12 [illegible] for [Serah] [Colbourn]
Case girl at stool good talents studied
hard [stand] out of schools [illegible] Cal. narc. cath. tonics
operated but
[Elateri.] 1/16 gr. once 4 hr in about 24 
hours deadly sick nausea prostration vom. purg.
disease broken up. It may be diff. to class this
A year after similar causes brought on a second attack #


Connected with acidity gives great pain not
dangerous
“This is a troublesome and not unfrequent 
complaint, arising often from improper food 
and that stab of the stomach which causes acidity. In 
a torpid state of the stomach when the healthy action 
ceases or is feeble, chemical action commences, and
the acetous or putrefactive fermentation, prevails according
to the contents of the stomach”
“If our remedy fails try another for there are no two
exactly alike & the judicious physician will discriminate as
they are indicated”
Among the astringents should be mentioned the rose
willow It is one of the pleasantest astringents & is a popular 
remedy in canker It seems to combine a mucilage
Almost any of our wild willows may be used
Nitrate of silver may be used It is often however
difficult to touch the ulcers and we may then use astringent
washes.
Rhus glabra and R [typhina] are good astringents
vide hosp. [illegible] sub. [illegible]
The poison of R [vernex] I have more than once known
communicated in more than one instances by using the wood as
fuel. I recollect a man’s [illegible] to me on account of an eruption 
on his legs. I told him he was poisoned. He replied that
there could be no cause for it but a pair of the pantaloons
lately dyed black. Upon investigation I found that
the poison species of sumack had been used by the dyer
by mistake for the common one. Young persons are more 



102
Cold bathing is sometimes advantageous tepid is seldom proper
Electricity has been used. I have seen little benefit from it
Setons, issues, tartartar emetic ointment along the spine & 
other modes of counterirritation, are employed & may be advantageous
but where the irritability is great they do injury
If the disease is not translatable it is made worse by counterirritation
In the treatment of patients affected with 
this disease, we should bear in mind, that they are the
subjects of great mental sensitiveness & irritability
The presence of strangers in injurious & the remarks of bystanders
upon the patient may cause an amount of mental
irritation little suspected.
I have succeeded in curing chorea by 
elaterium though this is an article not mentioned by writers
as applicable to this disease. A young man debilitated
by confinement as a clerk in N. York was thrown into
convulsions and derangement of mind, by a sight of distress
while on board the packet for this place Elaterium was
given to prostrate the system & break up the habit. It was
successful & this led to its employment in chorea. I have
completely broken up the latter disease by an eighth of a grain
of elaterium & this is the only case which I have broken up
vide end of this article
Case a female delicate 14 yrs of age had not menstruated had been
treated with cathartics, epispasmodics and narcotics, which 
palliated the symptom. The patient then took arnica for
10 or 12 days beginning with moderate doses (zii to a pint
of boiling water being given in 24 hours) & increasing to 


I have found [illegible] which however was Dr [Rush’s]
favorite remedy in females about the cessation of the [illegible]
useful
Friction antispas. electricity etc. had merely palliated
The case then [illegible] to indicate tonics
[illegible] the other remedies had [illegible] effect or not recovery
rapidly upon bark
Sometimes connected with pneumonic affected
or with [organic] eff. of the heart In some of these cases 
[illegible] of copper 1 to 3 gr. rarely more than 2 gr. nauseating article [illegible] in such cases more
especially
As the [disease] advances sometimes [illegilble]
difficult [illegible] swallowing dark [tongue]
# [illegible] of them the book pedlar and [Minot]
[Sheri] [illegible] [illegible] Both these had this facility in [calculating]
# At this time there was not excitability enough left to enable
the elat. treat. El. shd not be cont. more than 


103:a
Ulceration of the mouth in children
This is sometimes a troublesome complaint and one that
does not readily yield to remedies. It is commonly called
canker. The complaint consists of one or more ulcers, which 
commence with an inflamed point or with a white slough
situated commonly near the frenum but sometimes extending
over the whole inside of the mouth. The edges of the ulcers are
inflamed & elevated & their surfaces excavated, as if they had
been eaten out with caustic. The child drools much
and nursing is evidently very painful to it. A febricula
attends the first stage. The bowels are slow and digestion
not vigorous indeed the complaint often arises from improper
food and is connected with that state of the stomach
which causes acidity
Treatment. First excite action of the bowels by magnesia, 
if there is acidity, blue pill, if there is torpor, or calomel grii & chalk grvi. After this give
tonics & astringents as Moseley’s tonic solution 3 to 12 2 to 10 gtts 4 to 6 brak compound
tinct. vitriol 4 to 5 gtts & the vegetable astringents as geranium in a [ter] spoonful of water
statici spriaea cornus etc. a little laudanum may be added
For topical applications we may use the
vegetable astringents just mentioned, catechu, kino etc. or
the following which has been recommended as very efficacious RX sulph. cupri grs x, cort. peruv. zii acad. gum zi
mellis et aquae aa zii make a soft paste to be applied to the ulcers with a 
pencil. A weak wash of corrosive sublimate may be used
Sometimes a mild caustic is serviceable, as nitrate of silver
A wash of opium or of opium & corr. sub. is sometimes the best
viola pedata makes a valuable wash. Asclepias tuberosa is
escharotic. [Post] [illegible] case


affected by this poison than old. When young I have often
been poisoned myself by boing near the plant
merely. Now I can brush past it with impunity provided
it does not touch my hands or face. Some
persons are not affected at all. The uncertainty of its
operation is the only reason why it is not used in 
medicine. Corrosive sublimate is a good application
for the affection of the skin. Yet the disease is
a specific one and must generate run through its
regular course. A similar disease is produced by 
the oil of the shell? of the cashew nut
Ulceration of the mouth continued “The disease
sometimes attended with severe pains, as severe as in tooth ach
in which case opium is serviceable. Case of an adult use
veg. astring. copper, zinc, opium, nit. silv. & at last corros.
sublimate. This last would not be safe in the case of children.
Intense pain was produced, which was remedied by holding
it in the mouth There was a profuse salivation but it soon 
ceased and the disease was entirely removed. The surface of the
ulcer was destroyed by the sub. & the dis. being local this effected a cure
# I have turned my attention particularly to the question whether
cal. produces it. I have known the dis. to allow dysentery
It was an old notion that cal. broke down the crasus of the
blood and it produced a tendency to gangrene. But 
in the venereal wards of hospitals you will see patients 
with sloughs all over the mouths and yet no gangrene 



104
Gangrene of the mouth
This is not a primary disease but a termination of other
diseases making its appearance soon after their abatement
I have known it follow dysentery and other affections of the
bowels, but not any disease in which the blood vessels
have exhibited an inflammatory action. It seems to follow
diseases of the nerves rather than of the vascular system
Children are generally subject of it.
This disease is sometimes accompanied 
with much pain & at others with none ordinarily with little or more. One of the first
symptoms is a constant inclination in the child to pick
some part of the mouth with the fingers where the gangrene
first commences either the teeth gums, less or cheek 
That part becomes spongy & has a fungous appearance in 
the course of a few days discharges a [illegible] matter, has
 a livid appearance & finally becomes black and dry 
the adjoining parts of the face become tumefied and indurated
and the disease continues until a considerable part
of the face becomes completely [sphacelated] when the 
patient dies It may continue sphacelatal in [illegible] etc.
the sphacelus being hard dry & black like a piece of leather
This disease has been attributed to the 
use of calomel, but it is entirely unlike that produced 
by this article, and occurs also in cases where no 
calomel has been given. # In those cases where calomel has been freely 
given the disease is not so apt to occur vide case 4th
I have known a similar affection occur
in the leg of a child, & an irritative fever preceded by rheumatism.
Commencing with a spongy and orange coloured spot
which afterwards become hard & black, the gangrene 


livid purpled as though the blood had settled
pulse small not much disturbance of the circ. syst. except that it was large
# & Prof. Smith & myself could not get down much medicine 
and were obliged to [illegible] [illegible] with external applications
We [illegible] injections and a great variety of external application 
blisters
“When the disease appears with tumefaction I think
leeches might be of service. This was called by Dr Smith congestive
inflammation. In other cases of gangrene, leeches would not be of service
It is not easy to [class] the operation of charcoal It
has been called a tonic, but it does not much resemble peruv.
bark and we do not gain much by classing it with it
It seems to act by generating an excitability
Charcoal shd be made of soft wood or of lamp black 
burned over again in crucible, as is sometimes done by the
apothecaries


105
extended up the leg and the child above the knees on both sides died [illegible] No applications 
seemed to have any effect. The child was irritable &
The disease under consideration is nearly allied to 
that called swelled tongue, but the latter oftener attacks
quadrupeds 
The treatment should be stimulant & antiseptic.
Acrids as capsicum may be used & the arum 
triphyllum accidentally has been known to cure.
In one case which I shall relate charcoal appears to have
effected the cure.
Case 1st The first patient that I saw affected
with gangrene of the mouth was an adult female who had the typhus 
fever. The gangrene commenced on the inside of the 
cheek & when I first visited the patient a portion of the
cheek as large as a dollar had sloughed off out? Great
part of the food taken into the mouth passed out at the
hole in the cheek. The patient continued in this state
for eight or ten days & then died The attending physicians
informed me that she has received the ordinary
treatment for typhus fever.
Case 2nd The next patient affected in a similar
manner was a girl seven years of age. Previous to the
gangrenous affection she had had a most excruciating
disease, which affected the knees legs and bowels I have
called it nervous rheumatism & shall notice it in another 
place. For this she had taken large doses of purgatives




106
calomel & opium, with diaphoretics & tonics. In three
or four days the pain ceased and the fever almost
entirely disappeared. The guns presented no symptoms
of salivation & there was no increase of saliva.
In five or six days after the fever subsided 
the patient complained of severe pain situated in the right temple
& extending down to the shoulder like that which had been in the extremities. This was removed by opium
to complain of the teeth
Soon after she began to work at the molar teeth of the upper
jaw, on the right side, at the same time she had a cough
which was accompanied with an expectoration of white
viscid mucus, and the breath became very offensive, resembling
the effluvia of an anatomical room where 
subjects have been kept a long time. The appetite
was tolerable, however the patient took animal food, with 
relish, and the bowels were easily moved with a little
rhubarb
the patient world at the teeth until she had removed two 
of the molar teeth with her fingers, she still continued
to pick at the gums. The cheek of the side affected
became hard, swollen & red. In forty eight hours a 
black spot appeared in the centre of the swelling. This 
spot the patient immediately began to rub with her fingers & 
soon made a hole through her cheek. The gangrene 
continued to extend, for a week & at the end of that period
had proceeded as far back as the angle of the jaw
affected the throat & perhaps the aesophagus The patient then died, having taken
food and medicine will until within forty eight hours
of her death.




107
Peruvian and oak bark, opium & camphor were
very freely given the affected side of the mouth between the 
teeth & the cheek was filled with superfine bark & poultices
of bark were applied to the face In the last stage affected
perhaps the lungs
Case 3rd Another case occurred in [illegible] subject a child etc.
A female child, about 5 years of age was attacked,
in the winter of 1813 with “constipation with fever”
the complaint being principally confined to the bowels The 
attending physician gave a dose of calomel and worked
it off with senna and manna. A considerable quantity 
of matter was discharged from the bowels, but from its appearance
further evacuations were deemed necessary, and several
doses of castor oil were given. On the fourth day I was
invited to see the patient. I found her with considerable fever 
of the typhoid grade, attended with pain in the bowels and
head. There was also some swelling of one cheek & the child
complained of one or two of the double teeth of the upper jaw
on that side. These she frequently attempted to pull out
with her fingers & finally succeeded in extracting one of them
The cheek afterwards became swollen, inflamed, and hard to the touch
& in a short time an orange coloured spot, appeared, upon
the outside near the centre, which soon became livid,
and the gangrene spreading rapidly, the child died, in 
eight days from my first visit. She became delirious previously 
to the cheek becoming livid & afterwards, was comatose.
In this case the disease seemed to affect the brain 
as it does in some cases
Bark, opium and camphor were truly given & antiseptic





108
poultice applied to the face as bark [illegible] [fermenting] [poultice]
Prof. Smith saw this patient
soon after my first visit & agreed with me in the opinion 
that the case would terminate fatally. He informed
me that he had seen but one case of the kind before & 
that he had attributed that case to an injudicious
use of calomel After seeing this patient however, he considered 
his former opinion as incorrect since in this case
there were no marks of the effects of calomel & there was no 
probability that the single dose of calomel, given in the
commencement of the illness, could have produced such 
an effect, especially when repeated doses of other
cathartics, had subsequently been given & 
had operated freely 
4th Case. The next case which I met with was that
of a female 12 or 13 years of age, who had the dysentery,
in the summer of 1815, accompanied with much typhoid
fever & rather a larger discharge of blood by stool than 
is common in dysentery.
The child had been sick for some days
before a physician was called. I did not succeed in 
my attempts to determine the diseased action from the
bowels to the surface by diaphoretics & the warm bath, & 
the disease ran its course and nearly exhausted the patient
When it began to decline, the stools to present a fecal appearance
& the appetite to return, the friends were 


There had been some aphthae and I was on a 
careful watch


109
much encouraged I, however, began to expect a fatal
result for I observed, between the anterior incisors of the
lower jaw, a fungous enlargement of the gum, the apex of merely a slight discoloration [illegible] & swollen between two teeth 
which had a purplish appearance somewhat as appears in salivation sometimes. I apprehended gangrene
in the case (perhaps from the countenance) and on the first
symptoms of it informed the parents, who however, could see 
nothing alarming in the small swelling between two of
the front teeth. I began early with oak & peruvian 
bark, and at the same time gave freely of brandy and
porter. As this course had no effect I applied 
bark and diluted sulphuric acid to the part affected
& also covered with the lunar caustic. Still the treatment
had no good effect the gangrene extended under lip and chin became
black and the child died
Case 5th A child about 3 yrs of age cousin of the previous one [illegible] had a dysentery,
in the summer of 1815 [illegible] as there was another
member of the family sick in oil uncommon & interesting
manner viz the case of chorea resembling hydrophobia was much neglected Her fever was typhoid
& the stools sometimes bloody and sometimes of a 
green mucus. After a course of 15 days and amendment
in the symptoms took place the stools
became less bloody, the green stools more rare & though
the patient was extremely weak but no reduced low as the previous one, the appetite returne
After convalescing gradually for six or eight days, there
came on a samous discharge from the nose, small in quantity
but very fetid which reminded me of gangrene


# In this case I examined the gums to see if there
was any appearance of salivation and found the gums etc.
Two teeth and a piece of the alveolar process came out
The disease did not spread so rapidly as the other ones
In addition to bark, tonic solution etc.
I gave charcoal


110
of the mouth which I had not been on the look out for AT this period the patient inclined to 
keep her fingers I her mouth. # The gums were very clear
and bright & adhered firmly to the teeth, except on the 
left side of the upper jaw, where the gums of the biscupides
appeared discolored and discharged a samous
matter. I declared the parents that in my opinion 
the case would terminate fatally. The child complained
of pain in the face and teeth. The cheek opposite the teeth 
became swelled and hard and of an orange colour. I declared to the friends
that mortification had taken place 7 pointed to a black
spot on that cheek which happened however to be accidental. I was mistaken for the next day
it was found that the black spot was produced by a piece
of burnt apple skin, which was washed off This encouraged
the friends; yet within 24 hours sphacelus took place 
the apple skin was
in the very spot where I had supposed that I had seen
it. This gangrene ceased to spread after 
the spot became as large as the end of the little finger
 A circular piece sloughed out and left a hole in through
the cheek of about a quarter of an inch diameter
The disease abated, the affected teeth and a piece of the alveolar
process came away the lips of the wound produced by the sphacelus
healed up & the child recovered
I recommended the same treatment in this case as in 
the preceding, but having no confidence in it, & abandoned
it and gave charcoal to the amount of perhaps a pound
or a pound & a half a day I h ad pudding made of 
half charcoal & half flour, sweetened with molasses & sugar
& fed to the child for the appetite was good. Tonic solution 



When the disease commences of itself
# At the time when the disease called the scalled
tongue was very prevalent affecting cattle principally with 
swelling of the tongue & salivation but to some extent human 
beings with swelling of tongue cheeks etc. It was found that
acrids as [arum] were the best remedies
pulse 120 tongue then [brown] fur, considerable pain



111
and compd tinct. vitr. were also given & I commenced
the treatment with white oak & peruvian barks & yeast
poultice. I attribute the cure, however, to charcoal.
Case 6th This was an idiopathic affection. Martha Denison
a delicate constitution about 12 yrs of age was attacked in 1819 with symptoms of gangrene
of the mouth. There was severe pain in the teeth and jaws
oppression at the stomach and symptoms of fever. I discovered
the purplish spot in the cheek & “the gums soon put
on a spongy appearance” In this case I commenced
the treatment with an emetic, which operated favorably 
I gave it to [illegible] the excitability of the system
& gave relief. I then gave stimulants, bark, brandy & 
opium & kept in the mouth between the gums and cheek a paste made of powdered
bark wet with brandy and laudanum. The patient
recovered, but the two front teeth of the lower jaw became
very loose and there was occasional pain & 
suppuration for nearly a year. It was about a year before
the teeth became firm. [Superfine] bark was occasionally 
used.
Case 7th In 1820 I visited a black child in the last
stages of this complaint. At the time when I saw it, it
could not swallow. It lived however in this situation for several days
I have seen several children in the latter stages 
Even if there is no chance for a cure it si desirable to be able
to give a correct prognosis Trouble has sometimes arisen
from the opinion that such cases were produced by calomel
A student of this school in [Litch.] cty from notes of 
my lectures



It is known by an [illegible] swelling in the throat
some fever etc. etc. 
In some seasons it prevails extensively & 
affects persons of all ages. In some seasons these diseases
which are called contagious affects one description 
of persons in another another owing to mode
of life etc. “It rarely affects a person the second time. It is said
that if it affects the parotid of one side only it may occur again”
I have treated cases of this disease with 
great anxiety. I have never known cases of greater 
irritation than from this disease
“It is milder in children than in adults & is
seldom translated to the mammae or testicles till after puberty”
“Sometimes the swelling of the testicle is simultaneous
with that of the parotid gland or [previous] I have seen
several such cases”
“The first symptom observed is sometimes
a soreness of the testicles. They at length become 4 or 6 times
their natural size a suspensory bandage will be 
necessary”
“In some cases there arises suddenly, [illegible]
pain in the head pulse full and tense eyes red & all 
symptoms of phrenitis”


112
Cynanche parotidea Mumps
This disease is an inflammation of the parotid glands & is generally 
moderate in its symptoms Sometimes however it is translated
to other parts & is then a severe disease endangering life. It is milder
in youth than in adults & in general it is only after the age of puberty 
that it is translated. The parts to which it is translated 
occasionally, are the testicles & the prostate gland in males
the mammae of females more rarely & sometimes the brain or stomach
I have never myself seen a case in which the inflammation was
transferred to the mammae but do not doubt the fact
Sometimes it appears first in the testicle or at least simultaneously in that
& the gland This disease has been considered contagious
In my opinion it is not, but on the contrary is liable to be
epidemic. When its prevailed in college, the students who 
left in order to avoid the contagion were attacked as early 
and is certainly as those who remained. I have noticed 
that it made its appearance pretty regularly once 
in seven or fourteen years
The fever which accompanies the severer
forms is either of the inflammatory or the typhus grade or may be merely irritative & 
should be treated accordingly When the testicles are affected
they are painful swollen sometimes to an excessive degree & 
sometimes so highly inflamed as to indicate venesection 
When the stomach is affected “it puts on crythomatic inflammation”
and there is hiccough, subsultus tendinum, irritability
of stomach and frequent vomiting. # When the brain is affected
there is pain of the head & eyes, with hard and tense pulse
When the parotid glands only are affected the
# These symptoms may come on after the affect of test. [illegible] continued, some
[illegible] begin to subside.


Dr Rush observes that applying a blister
directly on the infl. prevents the system from being
affected. I do think blisters keep the aff.
in one part “In some seasons an emetic at the commencement
or a blister will prevent a translation”
Having [learned] the importance of attempting 
the breaking up of diseases I cast about
one year for means to interrupt it & found emetics
quite efficacious
Stramonium
After the testicles have been affected some time 
and the affection begins to subside the symptoms sometimes change 
There is subsultus tendinum the stomach become affected 
vomiting is frequent with hiccough etc. In this case apply 
mustard to the stomach & feet etc.


113
a generally mild and more inconvenient than painful
A translation makes it worse; more so when the translation is
to the stomach than to the testicles & most of all when to the
brain. Sometimes the complaint is very severe, the fever lasts
three or four weeks and the patients are many years in recovering
from the disease
Treatment. The disease is often broken up by an emetic
in the commencement It is best to stop it in the first stages
if possible. Mild applications to the inflamed parotids
we generally sufficient, such as ammonia or volatile
liniment. Dr Rush however recommends blisters to the parts
affected, in order to prevent a translation.
When the disease effects the testicles & give emetics
and apply discutients to the local affection. I also 
apply blisters to the inside of the thighs. They relieve the 
testicles when they are swollen & prevent translation to the 
stomach For a discutient was we may take the following
Rx mur. amm. ziii; camph zi; brandy or vinegar 1 gill;
water 3 gills. When the inflammatory action is high, bleeding
may be practised. It will be well also to use a suspensory 
bandage.
If the stomach is affected in the manner above
described
we have a difficult case to manage. Epispastics must be
applied to the scrotum, counterirritants to the epigastrium
to ally vomiting, with effervescing mixtures internally for the 


Ether is best given in effervescing mixture (carb amm. & 
lemon juice) Carbon ac. makes stimulants more diffusible
& hence causes them to be [used] gratefully and often to be well borne when 
otherwise the would not be
Case 18 grs plethoric parot. gland & testicles swollen
head affected Relieved by bleeding decidedly entonic
the only entonic case which occurred In the 
progress of his case stom. became very irritable abdomen
sore & tender excessive irritability Did not 
recover his health completely for years was left dyspeptic
& with nervous irritability.
To correct irritability of stom. lem. juice
[illegible] is most grateful add [doses] of aromatics
lime water also external blistering etc.
Tonics or metallic tonics myrrh 
asafoetida (nervine also) hops lettuce
These cases are so obstinate and will 
give you an opportunity to try a great variety of
remedies cajeput oil on sugar ol. valerian
Though the cases may be apparently alike
yet you may find one article best for one & another for [another]
A very distressing hiccup, accompanied
with spasms might have been mentioned in connection 
with the vomiting give ether lavender cajeput
oil also & valerian which are called terebinthinates 


114
same purpose diffusible stimuli as ether given
to rouse the system opium ipecac, as tonic stimulant, diaphoretic
& nervine 7 finally to allay irritation of the system 
in general antispasmodics as castor & counterirritants to the
extremities effervescing mixtures absorbents, also, as chalk & magnesia, cathartics
cantheride & occasionally emetics may be indicated.
When the brain becomes affected, the lancet
should be freely used, cupping, leeches & blisters, applied
to the head of the neutral salt given as cathartics
Antimonials nit. [illegible] cal. & neutral salts # 
Some cases will require a vigorous antiphlogistic 
course of treatment, others with typhoid fever
will require in the [illegible] a stimulating & supporting one, while others
again will have symptoms of irritation chiefly & require 
a corresponding treatment
In the progress of the disease uniform
perspiration will be valuable
Angostura serpentaria, qualified
with cardamom or cubebs The old writers
recommend also [contrayerva] I have much used it
atonics of a peculiar character resembles much 
agrimonia eupatoria which I have used for it
in the country where it is easily obtained the latter is non 
astringent
# “Cold to the head and warmth to the feet avoid mental
irritation recovery is usually speedy adults most
liable to this translation”



I consider [quinsy] an affection of the mucus membranes
and [tonsils] nearly allied to catarrhal aff. There
is a catarrh aff. nearly allied in which there is a
thickening of the membrane. This diathesis may also 
run into croup
Good classes angina maligna with 
quinsy Here is the evil of nosology For scarlet
fever gradually runs into quinsy. We must have
science and nosology but still we ought to 
know the errors which nosology is apt to lend [illegible] & 
the imperfection of science
I have the advantage of not [illegible]
having seen the disease but of having had it myself
often
[illegible] with an unpleasant sensation
a relaxation a disposition to hawk and throw off
[illegible] In this stage it may certainly be cured
After the symptoms comes on swelling, or moderately 
succeeding to this a chill then swelling with 
pain perhaps extending to the [illegible] The tonsils enlarge
The fever is considered enteric or a common but
unless among the labouring men in the country it is 
more usually subacute
One tonsil is perhaps more enlarged
than the other perhaps one goes on to suppurate & 
the other becomes of the natural size and appearance 
The uvula and fauces swell and respiration and deglutition 
are prevented. Sometimes ulcers from at first
upon the tonsils. Examine each case and do not be
too positive in calling it quinsy for this & scarlet
fever do blend
These symptoms continue 2 to 36 or 48 hours
I do not know that I have ever seen a fatal case of 


115
Cynanche Tonsillaris Quinsy
This diseases has been called
“I include also under the term quinsy all effections of the upper
part of the aesophagus and pharynx which resemble quinsy in 
their grade of action”
Quinsy is an inflammation seated in the larynx glottis & fauces
The characteristic symptoms is swelling of the tonsils
Sometimes it is seated lower down in the pharynx than the tonsils, but this 
does not alter the nature of the disease
In some cases it is complicated with catarrh. Those who have once had this disease are very liable to a return of it
“The disease common at the age of puberty that before or after”
Quinsy may be divided into two stages
1st Predisposing debility indicated by relaxation of the uvula
and tonsil, irritation about the fauces, weak deglutition,
general languor, with cold chills and uncommon sensibility
to cold. This usually continues from 3 or 4 to 12 hours
the progress of the disease being sometime rapid and sometimes
slow
2nd As the disease advances we find, soreness, pain, redness
and swelling of one or both of the tonsils & an inflammation 
of the mucous membrane of the pharynx; deglutition
in exceedingly difficult; there is a severe cough & especially 
a spasmodic one upon taking food or drink, there is
much heat about the throat and about the head & sometimes
pain in the head, with a pulse so full and tense as to 
indicate bleeding. Sometimes there is an excruciating
pain in the ear. “rarely cough unless complicated with catarrh”
This stage may continue three or four
3 to 7 days days. It terminates either in resolution, or suppuration.


of quinsy though I have seen many that I thought 
would prove fatal. I have known a patient
continue unable to swallow for 3 days and yet recover
When however it is in the form of swelled tongue it may 
prove fatal. “An entonic fever may attend, with fullness
of pulse much headache excruciating pain extending to the 
ear; but for more commonly at least in my practice, the pulse
is little affected, and the disease is almost not entirely local”
# riding on horseback and having the snow melt on 
his throat & [conduct] off the [caloric] rapidly
# and shd carry a piece of alum in the pocket
“It is important to distinguish this disease from 
roseola (scarlet fever) There is an erythema of the fauces
distinct from both which yet may terminate in either
[illegible] The diagnosis is generally easy but there are cases
where it is extremely difficult & indeed there is no definite
line believed the two especially in the first stages
We must bear in mind that quinsy is commonly 
more inflammatory that it is not apt to ulcerate
& we must be guided somewhat by the prescribing epidemic


116
The suppuration is generally in the tonsils, but in some cases
where the disease is seated lower down, a part of the aesophagus
suppurates. “The tonsils often remain permanently enlarged”
Causes. Quinsy occurs must often in the latter part of autumn
& in winter. It is caused like catarrh by alternations of heat
and cold by exposure to cold & especially by exposure
to cold storms of rain or snow. # Sometimes it is connected
with dyspepsia & it may be brought on by irritating 
substances, as acids, acting upon the mucous membrane
of the stomach. I recollect a case of a young man who 
was attacked with a severe quinsy in consequence of drinking
freely of cider made cold with ice
Persons who are subject to quinsy should be very cautious 
about exposing themselves to the alternative of heat and cold # 
Diagnosis. This disease has sometimes been mistaken for 
scarlet fever. It is not difficult however to discriminate
between them by attending to their prominent symptoms the
quinsy being as inflammation of the mucous membrane etc.
The first stages however of scarlet fever, resemble those of
quinsy, and the difficulty of discriminating between them 
is at that period much greater. In deciding upon any 
particular case we must be governed by somewhat by the nature
of the prevailing epidemics


Chewing camphor will also but not so well break up quinsy
in the forming stage but chewing this article
is apt to produce pleasant symptoms in the stomach 
and head Other stimulating applications 
would probably answer as [guaiacum] & any 
alcoholic tincture “The prophylactic plan of carrying
alum in the pocket etc. has succeeded in hundreds of cases. Indeed
when called in the latter stages I often tall them I can do 
little except to prevent it in future”
When the dis is fully formed and when 
there is much pain in 
the neck running up into the [illegible] fomentations
and the vapour of warm water, the steam bath 
by throwing over the patients head a blanket and
having a teapot of warm water
A blister also in the above circumstances
will relieve the pain and give great relief 
An emetic also will be often very 
beneficial in the commencement of the second stage
There is often an excessive quantity of acid in the stomach 
Case A young man in very hot weather [illegible]
a large quantity of cider made very cold with ice was taken at night
with great pain and difficulty of swallowing
The patient was very anxious to be cured that night
A large quantity of tartar emetic was given in excessive
doses until a severe orgasm was produced then seeing
to [illegible] stricture of the upper orifice of the stomach the 
[illegible] & secreted from every pore from the violence of
the action of the system finally he [illegible] away, and
continue in syncope for 10 or 15 mins came out of his 
fainting fit, the tart. ant. acted as a cath. and the patient
was entirely relieved of the difficulty of swallowing [illegible]
was merely feeble and exhausted from the prostration of the [tart]




117
Treatment In the first or forming stage. Quinsy may 
be easily broken up by keeping a small piece of alum say 
of the size of half a pea in the mouth, and swallowing the 
saliva until the symptoms have left. Various other astringents
may be useful in the first stage. I have given the astringent
barks and bitter roots, catechu etc. & have also combined
with them the mineral acids chlorine etc. “But all these things will be injurious in the 2nd stage”
When the disease if farther advanced a more
energetic treatment is necessary. If the tonsils are largely swelled astringents will merely aggravate. IN this stage it may often
be broken up by a strong impression made by nausea
and vomiting. A strong emetic 3 grs tartar emetic with 8 grs of ipecac # may be given & when the 
disease arises from a chronic affection of the mucous membrane
& acidity of the stomach, an emetic will remove it. In one
case I gave half a grain of tartar emetic once in 15 min. 
until the system was affected, I succeeded in conquering
the disease. The patient was in extreme pain & exhausted 
he fainted previous to fainting he was unable
to swallow after coming to, he could swallow & the
disease was removed. “But if the case has advanced a 
little farther, emetic will do no good”s
Gargles will in general do harm 
rather than good, where there is much inflammation.
If the irritability is extreme mucilages may be given, and 
when there is great difficulty in swallowing a cloth wet with 
spirit and water ay be applied over the mouth and 
nostrils. Cold water applied externally & internally has
been recommended but is dangerous. It may be used however
as a preventive.
# Eupatorium etc.


I have known some phys. generally successful [illegible] breaking
up quinsy with cold water but as I predicted
there was danger of the translation to the brain he lost
one patient in this way “It may be used as a preventive”
When the trails are much enlarged it is
customary to bleed I would bleed it there was
much fullness and strength of the pulse I have often bled
and seen it done without the beast benefit still however 
without any injury as I could perceive “V. S. is important
when there is danger of affection of the brain”
Scarifying is generally practised. It is
sometimes beneficial but often it increases the disease
as is the case when a boil is scarifyed I do no t
know that I can point out the circumstances
which it is beneficial but if there is much irritation 
I think I would not scarify I have often
had my own throat scarifyed without benefit
Perhaps it is as often as once in 20 cases
that the disease proceeds to suppuration. But if 
you puncture the swelling be careful 
to see where you introduce your lancet Case of [young]
an opening was made which subsequently caused a troublesome sore the
swelling burst of itself
In various cases astringents was useful 
Lister’s [scoriae] (devils bit button snake root) it acts 
a little like seneka stimulating the fauces it operates considerably 
in a decoction It has been much used not of
much consequence
I have not much confidence in gargles
The patient cannot gargle
But you will give great relief
by washing out the mouth with warm water or with 
mucilages or with a little old spirits and water which 
is very grateful to the patient Wash off the [illegible]
which [illegible] Great advantage is derived from 
injecting with considerable force with a syringe & washing on 
the parts Spirits & water will be grateful & reviving


118
When there is redness and swelling but not extreme
irritability, scarification is beneficial. If there is irritating
soreness or inflammation scarifying will aggravate it
After the inflammatory stage is past, blisters
may be used I have not been successful in scarifying
Bleeding may be necessary, if so it will 
be indicated by pain in the head and a full & tense
pulse.
When suppuration is about to take place
poultice may be applied externally & vapor inhaled The 
latter remedy may be administered, very well in 
the following manner. Put a vessel of hot water in the
bed, by the side of the patient & cover him with a sheet. # 
Touching the tonsils with nitrate of silver, is 
highly useful
If the ear is affected, wet a piece of cotton 
with strong ammonia and apply it to the dear. it produces
a pungent sensation and often gives relief
The [liatris] scariosa is used in quinsy
in the form of a decoction of the root. It is expectorant, diaphoretic
& diuretic. It is called “devils bit”
“After the inflammatory stage is established
apply blisters”
“If the irritability is extreme apply mucilages”
“[illegible] & diaphoretics have been used 
in the early stages and are undoubtedly serviceable”
# If you cannot well distinguish where suppuration has
taken place, you had better not attempt to open the tonsils 


When the swelling is great poultices are very beneficial
Dove’s [Dury] poultice Devils dung asafoetica
Album graicum blown through a quill!! much used
by my predecessors in this place
Cathartics are proper early in the disease
neutral salts if the fever if phlogistic
Diet & regimen
Give while the patient can drink, nitrous
ether & water or a acidulated drink etc. Feed
with arrow root etc. for the diet
When the inability to swallow has 
continued sometimes the action is not enteric & the
patient shd not be bled nor exhausted by cath.
The disease is at this time principally local & 
from want of food etc. the pulse becomes feeble spirit
and water injected into the throat will bring grateful and 
reviving [illegible] exhausted patient “Apply poultices keep the bowels
open with enemata” “Inhale vapour of ether”
Various gargles are recommended
such as chlorine muriatic acid & water etc.
but when there is much action they are apt to irritate
Camphorated gargle vapour of camphor
etc. There are a variety of these things which are
mere palliatives
The difficulty of swallowing is not caused 
so much by the swelling as by the soreness and pain 
for I have seen patients declare themselves much relieved
and able to swallow when upon looking into the throat
I could perceive no change in its appearance



119
“Scarification is recommended but I could never succeed
with it. If the disease were pure inf. scarif. would be of service 
but it is an irritation infl. & scarific. increases the pain & 
infl.” In [illegible] case a free scarific. made the case worse in 
every respect” There is a stage when scarifying is beneficial
when there is redness & swelling but not extreme irritability”
“Leeches have been applied in the inflammatory
stage externally and to the tonsils. It is difficult to make
them take hold on the mucous membrane, but they would
be more effectual there”
“Suppuration does not take place in one 
tenth part of the cases. There is free secretion but no solution 
of continuity upon extermination” “When suppuration
is likely to take place use poultices and inhalations of vapour 
poultices of bread and milk with stramonium are serviceable
Gargle or syringe the mouth with spirits & water or
camphor”
“When the disease is seated farther down 
in the larynx it is essentially the same”
“White dry pigeon’s dung in a poultice with 
bread and milk was used by Dr [Monson] He thought the
phosphate of lime of service” I prescribed it in one
case and they mistook for it devils dung (asafoetida) 
& it did wonders. I did not tell them of their mistake”



[illegible] state of fever is a better
classification than Good’s. Good separates the disease
under different classes making one part are [illegible]
disease another an aff. of the blood vessels
“Scarlatina & angina are sometimes considered 
as separate diseases, but they seem to be only different forms
of the same disease”


120
Scarlet Fever
This disease has been called by various names, among
medical writers, though the popular English appellation
has been scarlet fever with little or no change. Canker
rash however has been its common popular appellation in 
New England, until of late. Under the name scarlet fever 
I include both scarlatina mitis & S. maligna & likewise the
paristhmitis maligna or ulcerated sore throat called also malignant
sore throat & malignant quins. Other names that
have been given are Scarlatina mitis & maligna 
cynanche maligna paristhmitis maligna 
scarlatina anginosa 
Enanthesis rosalia is defined by Good
Rush a scarlet flush appearing about the second day 
on the face neck or fauces; spreading progressively over
the body; and terminating about the seventh day; fever
a typhus. This author divides rosalia into two varieties
simples or mild scarlet fever which he considers as
being slightly contagious & paristhmitica with an ulcerated
throat & a rash not so regular
as that of the other variety. This he calls highly contagious
Under the name scarlet fever I included
both the common mild scarlet fever with a rash & nothing more and the most malignant forms
of ulcerated sore throat with the intermediate varieties
considering them all as being but different degrees of the same
disease
This disease with its varieties a naturally associated 
with pneumonia quinsy influenza etc.



Quinsy is an exception persons who have had
it are more liable to another attack
So too in tropical climates even have what
is called a seasoning
As a matter of fact this disease is theoretically 
considered contagious practically not so no precautions being
taken the patient not being separated nor the friends and
neighbors refraining from coming “The notion of contagion
may sometimes be useful in keeping away idle visitors
case in Guilford”


121
Scarlet fever often appears as a sporadic and
sometimes as an epidemic disease. In general it affects children
and women more than men. Dr. Rush’s opinion Some say that the disease never 
persons over 40 years of age. When epidemic however it attacks 
persons of all ages, though even then the majority of cases
are among children and persons of delicate constitution.
In general persons who have once had the 
scarlet fever are not attacked with it again, still this
rule is liable to many exceptions for I have known repeated 
instances of a second appearance of the disease in the
same person. This partial security from a second attack
is met with in various epidemics & we may say in general 
that a person who has had any one of several different
diseases the same general diathesis is less liable to have another
Scarlet fever is said to be contagious especially 
in its severer forms The fact is disputed but this is 
the general opinion. Some fevers are perhaps contagion & among
them some forms of this may be so. It certainly, however
appears to follow the laws of epidemics and I am inclined
to think that the facts which have led to the opinion 
that it is contagion are better explained by reference
to those laws. It is said sometimes to go through the country 
like the influenza.
Like other epidemics, those of scarlet
fever exhibit appearances
in different seasons, being sometimes milk and
harmless & at others highly malignant & dangerous
It has occasionally been as 



# And because blisters applied produced
mortification
It swept off whole families
The fever considered a typhus It is not always
so It is sometimes [sub-entonic] always however
of a typhous grade



122
as the plague. About a century ago this disease prevailed
in this state in its most malignant form, sweeping off whole
families. It was called the black canker because the sloughs
in the throat turned black & this name, though the influence
of tradition, inspires terror in this town even to the present day
Since that period the disease has probably been growing 
milder up to the present time. In 1794 however it
was very severe in this town in Litchfield county & over the state more malignant than it has
been since. Subsequently to that period adult males have
been less affected. The last severe epidemic in this town was in 1803.
Though sometimes attended with inflammatory 
symptom. Scarlet fever as a general rule, is of the typhoid
or typhus grade & when malignant puts on the form of typhus 
gravior or gangrenous state of fever
Symptoms. This disorder, when not malignant, nor
irregular, commences with ordinary febrile symptoms general
disturbance of the functions of the system, chills alternated
with flashes of heat & pulse in most cases frequent and soft
In severe attacks there is much nausea, sometimes
vomiting, pain in the head back and limbs & great prostration 
The tongue
of strength. In 1803 the disease frequently commenced
with pain in the teeth or in the ear is the first symptoms
In the progress of the disease there is more
or less tendency in proportion to the violence of the
disorder. In severe cases there is often great heat and dryness
of the skin & perhaps the color mordax. In such cases also 
we frequently with an acrid discharge from the eyes & 


“When delirium is present it arises rather from inanition 
than repletion IT is accompanied with subsultus”
Swelling of the tonsils is rather a favorable
symptom Swelling and suppuration of the
glands in the neck
haemorrhage for the [illegible] & petechiae
may occur


123
nose which excoriates the skin wherever it touches.
Irritability of the stomach & vomiting are common & sometimes there
is a troublesome diarrhoea. Petechiae may make their appearance.
Case at [Hotchk??] town Haemorrhages sometimes take place; & in case of 
heat on the surface and what Armstrong calls congestive state
of the system, a slight haemorrhage from the nose will be
beneficial. Finally in the ordinary malignant forms of the disease 
the breath is very fetid.
The epidemic of 1803 was characterised by 
great irritability of the stomach vomiting & diarrhoea pulse
very low and feeble. In this epidemic after obviating the
inverted action (of the stomach) stimulants were indicated.
The throat is more or less affected from a 
slight redness to a deep slough. Sometimes there is a high degree 
of inflammation of the uvula & tonsils at others a relaxation 
indicating astringents both conditions accompanied
with a high degree of tumefaction.
A common appearance, in the commencement of the severe form
of the disease is that of a white coat upon a part of the tonsils
In the progress of scarlet fever, the affection of the throat 
may be more or less troublesome. It often terminates in ulceration
& sometimes in gangrene
In three or four days from the first appearance
of febrile symptoms or rather on the second day of 
the fever the eruption appears in the form of a fine rash
as described in the definition. In about as many days from 
its appearance about the seventh day of the disease it disappears 


Peculiar dulness of the eyes hollow sound
of the voice patient appearing much like a night walker
The first case of the kind which I saw I had no doubt 
about The friends had doubted whether he was sick enough
to send for a phys. I declared at once that he probably 
would die. This was a case of pneumonia notha
Most resembles measles Ordinarily distinguished 
readily sometimes with difficulty
If scarlet fever is accompanied with 
a running of the discharges from nose with catarrhal symptoms, and is somewhat 
distinct in its eruption (hard under the touch under
the skin) and such cases occur it cannot be distinguished 
from measles except by the general character of the epidemic
I used to notice in the first commencement of my practice
that on the first breaking out of the epidemic the older phys. used to 
wait and observe several cases before they decided upon the name 


124
with branny scales & in ordinary cases the patient is then
out of danger. The eruptions, however may vary much & even
be altogether wanting the local morbid action being determined 
wholly to the throat. Ataxic cases will have no eruption.
The worst cases of scarlet fever are those
which transcend ordinary febrile action. In these the patient 
is scarcely sensible of being ill, appears dull and languid, his
countenance indicates torpor of mind, he has little irritability of 
mind and is indifferent to surrounding object, his extremities
are cold & his pulse small frequent and feeble & 
perhaps intermitting. Upon examining the throat ash coloured
sloughs are found upon the tonsils and uvula. In these
cases life is extinguished without any reaction 
of the system in the course of 24 or 48 hours, unless the tendency 
to death is obviated by the most powerful treatment.
These ataxic cases resemble the ataxic cases of yellow fever
pneumonia typhodes etc. which have sometimes been called 
walking cases
The scarlet fever is liable to be confounded with 
measles, the disease which it most resembles. The marks of 
discrimination are these. In measles the eruption is less diffused
is in pimples or circular dots more pointed & partly distinct & partly in clusters & the pimples produce a palpable
roughness of the skin. In scarlet fever the eruption is diffused
like erysipelas & consists of innumerable points or specks under 
the cuticle, intermixed with minute pupulae In some
cases the eruption is in irregular patches & in others are uniform flush 


“Symptoms of pneumonia rarely attend scarlatina”
This is one of a series of epidemics. It is usually followed
or succeeded by measles & is followed by hooping cough
For only it probably existed only as an epidemic now
we meet with sporadic cases continually 


125
while no roughness is felt, except in a slight degree upon 
the arm. The two diseases differ also in the time at which 
the eruption appears. In scarlet fever it shows itself
upon the face and arms on the second day, but in measles
it is not seen upon the arms till the fourth day.
The scarlet fever is distinguished also by the absence of the
catarrh, cough & determination to the lungs, suffusion
of the eyes & the red and swollen state of the eyelids, which generally 
attend upon the measles. The latter disease also
is generally accompanied by an inflammatory fever instead
of the typhus which characterises the former.
Still these two diseases of ten blend together
so as to make the discrimination very difficult. It is barely 
 possible that they are the same disease, though it may 
be objected to this view, that scarlet fever likewise is occasionally 
seen to blend with influenza # 
Epidemics of influenza are followed by [measles & scarlet]
The prognosis in this disease will be obvious
upon attending to the malignancy or the severity of the 
symptoms. In its severer forms it is always a dangerous
disease & in its highest malignancy one of the most fatal
while in its milder forms there is but little danger.
# It is sometimes difficult to determine whether a particular 
case should be considered as one of scarlet fever, or of quinsy
A case of scarlet fever in which there is no eruption & the
tonsils are inflamed &swollen can be distinguished from one
of quinsy only by attending to the state of the pulse, the prevailing epidemic etc.


I have known it appear as an epidemic
when it required nothing more than nursing
One idea which I wish to impress particularly 
upon your mind, is that you must investigate the particular
epidemic which you have to treat for no previous one
will probably have been similar


126
The treatment of this disease must vary according
to the diathesis. Epidemics of scarlet fever will differ
widely in different seasons & different places & require very different treatment
In a country where intermittent prevail the treatment will 
be different
This has been some dispute about using the
lancet in this disease. This will depend the degree of inflammatory 
diathesis. As a general rule emetics are indicated, 
but not always. Cathartics are generally improper 
but sometimes are required. In short indiscriminate treatment
is as improper in this diseases as in any other.
In this milder forms of scarlet fever, we
may employ the usual treatment for typhoid fever, & administer 
those remedies which translate & keep up action 
and equalise excitement, as diaphoretics, the warm
bath etc. For the mildest form it will be sufficient to 
give mild diaphoretics such as wine whey & elder flower
tea, with perhaps a little antimony, acidulated drinks
& gentle laxatives
As the fever is generally of a typhoid or
typhus grade, emetics are of especial importance in its 
treatment. They affect particularly the mucous membranes
and may be repeated in the course of the disease, for the
purpose of throwing off the accumulated mucus. The violence
of the disease may often be completely broken by an emetic 


“In some epidemics when there is considerable action cath. of cal. are
important especially in intermittent districts Rx cal. & 
jal. as for remittent bilious fever”
“When there is tremor paleness, cold sweats, vomiting
diarrhoea, cathartics might destroy the patient We must
rouse the patient by counterirritants etc. and then we may go on 
with the treatment by emetics of ipecac etc.
“Dr Rush bled but f.s. is very rarely indicated 
and in such cases as approach to A.  tonsillaris” “Still it
[illegible] all forms entonic atonic etc.
“If malignant give bark & the min. 
acids. If the system does not respond give cantharides 
& capsicum oil of cinnamon cloves or cajeput”



127
at the commencement. All writers agree in recommending
them. [Witherin] advises ipecac grs vi & tart. ant. gri for
an adult followed by a strong decoction of senna
Dr Rush recommends the turpenth mineral 2 to 6 grs with the view
of strangling the disease in its birth. Sulphate of zinc is a
good emetic & is preferable in the latter stage. It is local
in its action & tonic in its effect. It operates speedily and
produces less exhaustion. Vomiting by snake root has
been practised
In the irregular forms of scarlet fever, this
practice is more questionable & if emetics are given they must
be preceded by stimulants to rouse the powers of the system
Cathartics are sometimes needed & calomel
is to be preferred The judgment of the physician however 
must be exercised & the character of the epidemic studied, 
for great caution must be exercised that the system be not weakened 
by them & in extreme debility they should be preceded
by stimulants. In some epidemics they will destroy the pat.”
In some epidemics bleeding may be 
proper, but the apparent indications for it will generally 
be better answered by leeches about the throats and [temples]
In malignant cases where the powers of life
are very feeble no evacuations are to be used. External 
irritants are to be applied to rouse the system such as ginger
mustard brandy a paste of mustard spts. turpentine & 
aqua ammoniae etc. Internal stimulants must be given 


Ammonia with bark opium etc.”
“Tinct. canth 20 drops once in 2 hours till
there is some effect.”
“Serpentaria with ammonia acts as a tonic
and diaphoretic”
Where there is a prejudice against cold affusion
with water alone spirits or [illegible] or camphor
may be added


128
[illegible] to 4 [illegible] 3 or 4
such as capsicum Capsicum especially when the stomach is debilitated 4 to 5 grs [illegible] Cantharides in 20 drop doses. Ammonia
camphor quinine, mineral acids etc. Carb. amm. & cantharides 
may be given to excite the system & be followed by 
bark and brandy to keep up the excitement.
Diffusible stimulants also may be required, such as chloric
or sulphuric ether 20 gtts to a teaspoonful of water
for a child. In small children if there is difficulty in getting down
medicines the bark may be given by injection, or the body covered 
with it, by means of a bark jacket.
In severe cases, not of the most malignant
form, the heat and dryness of the skin are often very 
great & calor mordax may exist. Cold applications to the 
skin, especially those of stimulating kind will then be beneficial. The cold bath
cold affusion, or sponging with vinegar & water or spirits
& water may be used according to circumstances. The cold 
bath or affusion of cold water may be superseded in case of 
prejudices on the part of the [illegible] or objections from other
causes, may be superseded by sponging the body with vinegar
& water If the case is attended with extreme debility 
and relaxation of the system or if
any chills are present sponging must be used
& [illegible] with caution. If the cold applications produce a chill or
if the eruption comes out irregularly. I should advise 
the tepid bath to determine to the surface. In the advanced
stages of the disease when debility & relaxation are
great the vinegar & water should be made tepid & spirits
may be added. The rules with respect to these applications 
are the same as in typhus. In the atonic form of 


“In children with disturbance of the stomach
and pain in the bowels at the same time the eruption not
coming out well use the tepid bath It obviates the tendency
to convulsions and makes the disease regular In the most
malignant forms it is inadmissible”
“If there is irritability of the stomach give chloride [illegible]
4 grs 2-3 hours absorbents counterirritants”
“In the latter stage of protracted cases emetics of 
sulphur zinc or copper are very useful”
“Withering advises in the typhoid state, after evacuating
the stomach & bowels to give senega freely This 
would be injurious in a malignant case”


129
scarlet fever, the cold bath or cold affusion must not be used
IN 1803 I used sponging with vinegar and gave internal
stimulants at the same time as min. ac. alc. brandy
For children the tepid bath is invaluable in scarlitina 
particularly in the early stages of the disease and 
when the eruption is not fully out, or where the eruption is 
irregular. It is questionable however, how it would succeed
in the most malignant form of the disease
If there is great irritability of the stomach
with vomiting, absorbents and counterirritants are to be used
& in malignant cases capsicum, tinct. canth. & care to be given
In cases of vomiting saffron & snakeroot
If there is much diarrhoea we may 
give # white decoction with opium, injections of laudanum
etc. astringents etc.
In ordinary cases, when the eruption has been 
regular & ends with branny scales, about the seventh day
the case is out of danger But when the disease is protracted
sulphate of zinc or Moseleys tonic solution is
to be given as a tonic. The latter article in a dose from 
a teaspoonful to a tablespoonful is an emetic in cases 
of great morbid action. Emetics of sulph. zinc & sulph.
of copper have been recommended also of acetate of copper 
The latter article is also escharotic tonic & caustic. The chlorides chlorates are adapted 
to this stage of the disease
[illegible] [chlorate of potassa]
grii to vii


“In those cases that require stimulants blisters
may occasion gangrenes”
“When there is tumefaction of the tonsils use
blisters paediluvium & gargle with the mur. ac.
especially the [oxymorestic] diluted with 6 parts water”


130
The treatment of the local affection of the throat is of two
kinds, external & internal When there is much inflammation 
about the throat, with the uvula elongated, the
tonsils enlarged an inflamed & the pulse full I apply 
epispastics externally. Blisters, mustard, oil of origanum 
ol. monard punct. etc. may be applied to the throat
Gargles are injurious in bad cases & perhaps
of little use in most. Still in ordinary forms of the disease
from four to six ounces of any mild astringent acidulated
perhaps with muriatic acid may be thrown in by 
a syringe. The marsh rosemary is considered better than 
any other astringent. The alum root (henchera amer.) is
useful both as a gargle & given internally. For the latter
purpose sweeten it & add a little brandy
When there is not much tumefaction & 
considerable relaxation of the parts stimulating garbles
are good, as capsicum & brandy astringents may be 
added. In gangrenous cases quinine is good if it can
be got down. In the latter stages of the disease it may 
be useful to touch the ulcers in the throat with nit. silv.
“Vinegar & lemon juice may be 
used as a gargle”
“If the ulcers are thick and leathery
apply nit. sil.”



“I have seen the brain affected and much spasmodic
action subderangement pain in the head 
and all the symptoms of hydrocephalus with a bloating
of the whole cellular membrane pulse frequent & extremely 
quick and all the marks of irritative actions
For 3 or 4 years I have used tinct. dose in 4-5 & sat. tinct.
canth. in 10 3 or 4 times a day giving also the tonic
solution and keeping the bowels open”
“It produces eruptions on the skin, heat dryness & 
soreness of the fauces febrile action & if continued 8 or 10 
days I think it would be useful. I would try it were the
disease severe and epidemic, whether I thought it contagious 
or not”


131
The sequel of scarlet fever is dropsy. In children
especially an anasarca and sometimes an universal
dropsy comes on after the disease has subsided. The 
first two cases which I met with were in the severe epidemic
of 1803. I treated them according to the direction 
of the books, with bark & brandy opium & lost my patients 
Considering this as an affection of the absorbent and nervous
system I treated the subsequent cases which fell
upon my hands with tinct. cantharides & tinct. digitalis
The digitalis allayed the morbid action of the exhalents 
& absorbents & the cantharides acted as a diuretic.
“Give of each 
2 or 6 drops every 3 or 4 hours It [opens] [illegible] in these cases the
effect of irritative action hence the propriety of digitalis
Hanneman proposes to prevent the recurrence
of scarlet fever by the administration of moderate
quantities of atropia belladonna an article which produces an
eruption upon the skin, similar to the rash of scarlet
fever. The influence of belladonna, upon this hypothesis
is similar to that of vaccination in preventing small 
pox.



The termination of the chain of actions in health
in some diseases & if we say nature cures the disease
then we may say when the tendency is [inevitably] to death
that nature commits suicide. The latter is true
of this disease Yet if this chain of morbid actions is 
broken up by a powerful impression the constitution
will take on its ordinary action
Scarce any disease is more curable
when taken in season yet it would not be proper
for a physician to say he could cure all cases
then pretending infallibility
I shd doubt whether Good had ever
seen the progress of a single case. He says nothing 
about the first stage.
The tendency of the disease is to destroy 
the patient not by infl. or irritation but by 
suffocation from a foreign body in the trachea
The stages run into one another, and 
yet a phys. watching the progress would naturally 
divide it into three stages
Always curable in the first stage unless complicated with some other disease
rarely in the second almost never in the last yet
I have known cases cured in the last stage
The peculiar sound of the cough is 
alarming (in the first stage) even to those who have never
before heard it
Dr [Hesark] I have been told divides the
disease as I have done into 3 stages and directs to give
2 grs. tart. ant. combined with ipecac. I shd give
for the effect not according to the quantity. I put out 3 or 4 gr
and give till the effect is produced
rarely over 10 grs


132
Croup
This disease has been called in America by the popular name
of hives which is probably a corruption of heaves called rattles
The name given it by Good is empresmia bronchitis. The 
most common scientific appellation has been cynanche
trachealis or angina trachealis
The persons attacked by croup are
I have never [illegible] 3 and [illegible]
almost exclusively children from 3 months to 12 years 
old # in one instance I have known it attack
a person 60 years of age When it occurs in adults it
succeeds other diseases I have known 2 or 3 cups of [illegible]
“Croup sometimes though less frequently than most diseases, blends with
other diseases as catarrh” Some have considered the disease as
contagious, but though a few facts appear to favour the
supposition, they are not numerous enough to establish a 
general law.
Croup usually occurs in the winter
and spring, when it is brough on by exposure to a cold
and damp atmosphere. Children upon the sea coast are
more subject than in the interior of the country, because
exposed to more variable weather and more frequent [thaws]
& notwithstanding the greater warmth of the climate on 
the seacoast For when the air is filled with 
vapour, the caloric of the body is conducted off with 
more rapidity than in a dry atmosphere, even if the
temperature of the latter is colder.
# It is principally confined to persons under 5 years of age
though it sometimes attacks persons of all ages, and 


It is not precisely entonic or atonic & hence
might be called specific in peculiar
It is said that in croup the exhalent
arteries are affected & in catarrh this [illegible]
vessels Whether the different vessels are affected or not there 
is certainly a different action
“I have thought croup might destroy life by 
coating the entire surface of the lungs with a mucous
or membranous coat thus preventing the decarbonization 
of the blood”
“I have never seen croup without more
or less spasm; & probably in fatal cases it is always a 
spasmodic contraction that closes the passage to the lungs 
which is only diminished by the membrane. I never
saw a case on the other hand of what is called
spasmodic croup which did not if neglected put on the
membranous & inflammatory form”
A similar [membranific] inflammation
exists in the duodenum


133
Croup is a specific disease of a peculiar kind and
is never malignant. It comes on with all the symptoms
of pyrexia and consist in an inflammatory affection of
the mucous membrane of the larynx and trachea, which
causes a remarkable shrill sound in breathing & a ringing
cough by which those who have seen the complaint
cannot fail to recognise it. The proximate cause is a 
peculiar inflammatory action of the system, 
determined to the exhalent vessels arteries of the trachea
and bronchial vessels, where there is produced an exudation 
of coagulable lymph similar to that which forms
on the membranes of closed cavities from inflammation & 
entirely different from secretion of the mucous glands
whether healthy or unhealthy. This coagulable lymph 
which is thus exuded, always forms a membrane which 
lines the larynx and trachea, if the disease proceeds
to a fatal termination, and causes death by suffocation. 
This appearance is always found in the
tracheae of those who have died of the disease.
The membranific inflammation distinguishes 
croup in its nature, from catarrh which is in all its
varieties, an affection of the mucous glands



Most diseases attack in the night
“Diseases are cowards, they mostly attack in the
night” Rush.
“The peculiar ringing sound of croup is made in 
[expiration] that of hooping cough is inspiration”
# As is the case when respiration is impeded
by any foreign body there is a great deal of
irritation
# when the nose discharges [illegible] [illegible] it
bronchial vessels secrete mucus and a new
action takes place the patient will be apt
to recover
# The patient was subject to asthma
and the croup was neglected until the latter 
stages finally died
+ “I have known this to happen only once
In this case the friends were not alarmed because the
child had been subject to catarrhal affections & the symptoms 
received no attention till the last stage”
# Frequently appears to be [illegible] in the
very commencement of the disease


134
This disease sometimes come on like a
catarrh and continues two or three days without any 
alarming symptoms, until suddenly, & often in the night
the peculiar symptoms of croup appear. At other times 
the first symptom of the disease is a severe paroxysm of 
suffocation attended with the hoarse & shrill ringing noise made
during expiration like air through a broken tube & the peculiar ringing cough. The cough
in its progress is attended with more or less of spasmodic
action. # It is always dry; and when it becomes loose
or when mucus is expectorated the disease is broken up 
and there is no further danger # It rarely continues so long as five
days and is sometimes fatal in twenty four hours. Sometimes,
though rarely the membrane of coagulated lymph is
coughed up. I have met with but one case + In this the 
membrane was thrown up three times, at each subsequent
time forming lower down than before # 
No disease resembles croup so much as
suffocating catarrh yet there are obvious marks of discrimination
The latter disease as I have seen it is not attended
with much cough and the difficulty of respiration is
not in paroxysms but constant & commence with the disease. The pulse is often quickened
and when the system is prostrated may be low. #  In suffocating 
catarrh the powers of life are to be raised by external
irritants & excitement equalized by the inhalation of the vapor
of [illegible] of warm water etc. “Mustard” “If pulse tense
bleed”



From the earliest of my practice I 
have been in the habit of dividing it into 3 stages
[illegible] that they are perfectly distinct, but [illegible]
person would naturally take this view
Quiet between the [per.] apparently 
not much affected during the paroxysms Between the paroxysms pulse natural & eyes bright. You will 
know this disease in this stage only during the par.
Parents in this place know the disease in this stage
and send forth phys. 
In this first stage, the disease 
must be broken up by a powerful impression 
upon the system This may be done many ways
Some are partial to a [illegible] & some to another 
“That which is best administered is best” A local
effect upon the stomach will not answer
I have relied more upon tart. ant.
than any other & found it answer all reasonable
expectations. I have preferred it to any other
I have occasionally used other [illegible]
I have found seneka better as an auxiliary
than as a commanding [remedy]



135
Croup may be divided into three stages each 
of them requiring different treatment. 1st The forming stage
2nd The inflammatory stage & 3d The last or suffocating
stage
1st In the forming stage, the cough
is severe & hoarse & occurs in paroxysms of from five minutes 
to have an hour in interval. “There is little or no fever” The
pulse is regular and small, & sometimes trembling. The patient
is often chilly. In this stage the disease may with
certainty be cured
“I have not lost a patient & have not saved one
in [illegible] when not called till the second paroxysm 
had commenced”
In the treatment of this stage we must depend
upon emetics. Large doses must be given moderate
ones do no good. A dose should be administered sufficiently 
powerful to affect the whole system and call into action 
every muscle. We must be regulated not by the quantity 
but the effect for we must calculate to overcome the diseased
action completely by the operator of our remedy.
I have given three grains of tartar emetic to a child three
months old, & kept up the action by the large doses of seneka
repeated every half hour for six or eight hours
Tartrate of antimony is the best emetic to 
commence with and may be given in a dose of from 3 to
six grains of strong tart em. After its operation a constant nausea must
be kept up by seneka or some similar article, for some
time in order to prevent a return of the disease. The seneka
excites a new action in the system. It may be given
in decoction. Take zfs or zi of bruised seneka to half a pint of
water, & boil away a quarter. Give a table spoonful for a 



It has so happened that with us the [serpentaria]
has not answered so well as tart ant. It acts 
on the fauces perhaps more [illegible] than tart. ant. 
but does not affect the system act upon the skin 
& determines to the surface so well as tart. ant. We have 
not used it however except in the latter stages & perhaps have
not given it a thorough trial
Sanguinaria vide p. 212 has been used 50 perhaps
a hundred years. Three generations of physicians
in one locality have used it and relied on it
in croup with as much success as upon other articles
These mode of using it was in strong decoction 
without weight & give a table spoonful until 
the desired effect is produced till vomiting is excited
or the disease is broken up There are however
forms of the disease where it fails even in [illegible]
“Much has been said of the good effects of calomel
Give in large doses 20 – 30 [illegible] acting as an emetic it is
serviceable but when catharsis is produced, the emetics 
would fall in with the catharsis. I never could in such a 
case make the strong impression on the system what I 
[illegible]”


136
does once in half an hour or as much as the stomach
will bear. Seneka has been relied upon by some as
a specific in croup, but it is inefficacious when inflammation 
is present, being a stimulant, and it is too slow in its operation
for the first remedy. After giving it as the first
article, other emetics seem to lose their influence; acting
as cathartics; but after the violence of the disease has
been broken up by other emetics, you may avail yourself
of the nauseating & deobstruent effects of the seneka & effect
a cure. Dr Rush preferred the turpeth mineral 2 to 6 grs
as the first emetic. The physicians in Wallingford for 5 years
make a strong decoction of sanguinaria, and give it
until emesis or a cure is effected. This article may be
used instead of seneka in the way above directed
In connexion with these means the warm
bath and fomentations may be used as adjuvants. Much 
has been said of the good effects of calomel in this disease
You cannot rely upon calomel for the cure of the disease
It is too slow in its operation. Never give calomel until 
you have broken the violence of the disease 
After emetics have operated and you have availed your 
self of the operation of seneca & sanguinaria and the disease
still exists, give from 5 to 10 grs of calomel
By this producing an orgasm in the 
system more powerful than the disease & continuing it until 
the latter be overcome, croup may be cured with more certainty
than most other diseases. All diseases should be attended



I know that there are some very respectable physicians who rely
upon calomel For this purpose they 
give very large doses and produce [illegible] & [illegible]
I should prefer it as an auxiliar. I have often 
used it but after the emetic or with the
emetic or before the emetic
A variety of other men [illegible]
India tobacco which though not allied in 
botany are so in their operations The common 
tobacco is generally applied eternally to the pit of the 
stomach. Lobelia acrid & emetic loses some of its virtues by drying
In its recent state 1 gr will often excite full vom.
Indeed I have known vom. prod. by merely 
chewing the capsules & [illegible] without swallowing
by the impression upon the mouth	
Dose of tinct. 20 drops to a t. sp. according to age
Other acrid narcotics as veratrum & colchicum
may be used
In this forming stage bleeding is not
indicative by the pulse, nor by state of the
system and you will obstruct your efforts to excite
a powerful effort of the system if you bleed
2nd stage
In this acrid emetics are injurious
seneka is too stimulating Sanguinaria had I have
seen all the symptoms aggravated by bloodroot in [illegible]
the high entonic stage
# “If the disease is complicated with a similar
affection of the stomach & duodenum give calomel & other
cathartics”



137
to in the beginning & it is owing to the imperfection of 
or our art that every disease is not broken up in 
its first stages. When however croup supervenes upon other
diseases, it is more dangerous. “Those who practice in the
country rarely see the disease in the forming stage. I had one
winter 20 cases of croup all in town recovered most of the in the country died”
2nd Country practitioners however seldom see
this first stage which I have just been treating of when the 
tongue is not discoloured, the fauces have a natural appearance
the pulse is unaffected respiration natural & ordinarily 
no inflammation about the tonsils. On the contrary 
they too generally arrive when the disease is in the
second or inflammatory stage the disease has effected in which the bloodvessels the skin is hot and 
dry, the face flushed, the pulse tense & sometimes full the
tongue furred, respiration between the paroxysms difficult
tongue furred, respiration between the paroxysms difficult
and the cough so severe as to threaten immediate death vide p. 213. In this stage 
we should immediately bleed from freely from a large orifice the arm or jugular vein
freely, even until syncope is produced put the patient
in the warm bath & let him also inhale the steam of warm
water, and give calomel and other cathartics. # Never
give emetics in this stage until after depletion by V.S. 
when we may give 4 grs. of tart. ant. in a table spoonful
of warm water & apply epispastics to the throat” in the commencement 
apply a blister” I dread to be called in this stage of 
the disease, for it is the almost always fatal venesection 
sometimes succeeds but very seldom. I would not apply 
leeches cupping would be better & perhaps friction might be serviceable.
Digitalis has been recommended, but 



In this stage inhale the vapour cover
the child & nurse in a chair with a blanket
In this stage cal. & cath. may be given
In the first stages I have conserved it very unfortunate
to find my patient under the operation of a
cathartic It feels as if my hands were tied
The excitement is of a different kind from what is wanted
And emetics are apt to produce hyper cathartics
Where the dis tends to the [illegible] the
[illegible] a specific. This is known by the
cough being less hoarse, by fever, by constipation 
fever more intestinal membrane
will pass off from the duodenum I was formerly 
disposed to cure this form of the disease [illegible]
& described it as such
In the second stage epispastics
over the whole chest also diaphoretics
and tepid bath When the cough is milder
and beginning to be loos after being principally 
broken up in the first stage give cal. in 2 or 3 gr
doses once in 2 or 3 hours
In the 2nd stage remedies have been
given to obviate the fever & digitalis has been used
with good effect It was used as a depressing agent
It operates by its narcotic power however. here refrigerants
are of little efficacy
In what may be seen to be the last


138
I have not used it. It is at best but a doubtful remedy
in inflammatory effections though calculate to remove more irritations. Sanguinaria diminished arterial
action like digitalis and operates powerfully as an
emetic. I have not succeeded with it in the last stages of
croup & have not used it in the first. [?ronchotomy] has
been proposed, but does not promise much benefit, as the
disease is seated below the place for operating. “Dr Smith did not recommend it”
After depletion and especially after the disease assumes
a bilious form you may give powerful cathartics
The pt. begins to thrown his head back death may happen any moment
3d IN the last or suffocating stage* you may give emetics
of turpeth mineral sulphate of zinc or even
corrosive sublimate to throw off the membrane. Something may depend upon changing
the emetics & sulphate of zinc may be tried. The cold bath
is said to have been successful in this stage, but the fact is
not well authenticated. I have used calomel and the
warm bath with advantage.
Child of Mr Culver
[last] in chronic stage
“I regret that I have not tried 
affusion of cold water in the last stage. It is 
said to cause the membrane to be thrown off & to procure
relief even in the very article of death”
vide p. 182
*”In the last stage respiration is constantly laborious
head thrown back pulse often irregular
& intermittent sometimes strong”
Chronic form “Sometimes though rarely the disease is only partially 
subdued I [illegible] on in a chronic form. Calomel
vapour best tepid bath are the appropriate remedies”




139
Angina Laryngea
Empresma Laryngitis of Good, q.v. for a definition & 
an account of the disease
In this disease the symptoms differ somewhat
from those of croup, though the cough is similar
The disease is seated in the larynx glottis and fauces & the
characteristic symptoms is swelling of the tonsils. The cough
is spasmodic and is excited by taking food with drink in this respect also indistinguished from croup. The
disease is more violent and rapid than croup, as the inflammation 
being seated in the narrow part about the glottis
produce suffocation sooner. The respiration is more difficult
than it croup particularly between the paroxysms
This disease more commonly affect adults
The first case that I saw was that of an old man in whom
the disease was brought on by exposure to cold after a pneumonia
From a relation of his symptoms I prescribed
seneca which only exasperated the disease, so that when 
I saw the patient he was unable to speak or swallow. A 
small red spot appeared on the tonsils. venesection, epispastics,
pediluvium, inhalation of vapor etc. were resorted to with 
no abatement of the symptoms. Venesection was performed a second
time & as soon as the patient was able to swallow, 4 grs. of 
tartar emetic were administered. Some nausea and vomiting
with considerable catharsis followed. The vesication 


“Angina laryngea is mor apt than croup
to recur several nights in succession”
“The slough were thick and leathery. Sloughing
even under blisters. In one instance blisters did not
heal in 4 mo. Lunar caustic applied to the tonsils & 
uvula & inflamed parts proved serviceable
# “In one case of A. laryngea I gave sanguinaria 
It was too acrid and increased the cough etc. It might 
do good if we could avoid the local effect of its
acrimony”



140
was extensively returned & the patient recovered.
Much the same treatment is required
as in croup but it should be more prompt and with earlier
venesection. For the inflammatory stage comes on earlier
and the disease runs a more rapid course
Last year this diseases differed in its appearance
from the former years
It has often followed certain affections
of the tonsils called black canker. The tonsils are inflamed
in black canker and sometime covered with a leathery
crust. This comes off and leaves an ulcer. If the inflammation 
extends to the larynx, symptoms of croup 
supervene
Case of black canker. Two called in the
last stage gave blood root with disadvantage # Still at 
this late period calomel and other cathartics in large
doses produced free evacuations and the child recovered 
Cathartics appear to do better than emetics. In one case after 
giving cathartics I used the vapour bath and applied 
a large epispastic over the whole sternum. Though at
so late a period the disease abated. A large slough however
was produced by the blister which required three 
months to heal. The morbid action on the skin being
similar to that of the tonsils
Vie p. 187


Sometimes comes on with a sudden paroxysm of
suffocation sometimes gradually 
“Distinguished in its commencement
from croup by the quantity of mucus in the bronchial
vessels”
“in the case which I have attended, 
not much febrile action attended the disease”
Proximate cause a morbid action of the lining
membrane of the lungs accompanied with a viscid secretion 
of [mucus]
By vomiting the disease may be relieved & apparently 
cured but may appear again in the course of 
an hour
The quantity of mucus is greater than in 
any other catarrhal affection”


141
Catarrhal epidemic resembling croup
Peculiar catarrhal affection resembling croup suffocating
catarrh
This disease is characterised by a severe hoarse 
cough, much resembling that of croup. The disease is distinguished 
in its commencement from croup by the excessive quantity of
mucus in the bronchial vessels which causes the suffocation 
The disease resembles croup likewise in the mode of its attack
which is sometimes sudden with symptoms of suffocation, and at
other times gradual with paroxysms of coughing and intervals
of perfect ease The turns of coughing are so violent in this
disease as to produce a livid colour of the face. The extremities
evident determination to the head
are cold and the head is hot from the quantity of blood
thrown into the vessel of the head by coughing. The evacuation 
from the bowels are healthy and among children with no disease which I am acquainted
affect the bowels so little ass this.
The proximate cause of the disease is a morbid
secretion of mucus on the lining membrane of the lungs & 
trachaea with obstructed perspiration. The quantity of
mucus thrown out by this membrane in this disease is astonishing After
the disease is fully formed, great quantities of viscid mucus
may be brought away by vomiting, to the great relief of the
patient for a short time, and yet within an hour the patient
will appear to be suffocating from the the quantity again 
collected in the bronchial vessels
In the commencement of this disease, the indication
is to break it up at once by a powerful emetic, of
tart. ant. unless the system 


The principal indication is to break up the disease
by a powerful action on the skin on the stomach
the duodenum and the fauces It is best affected by 
tart. ant. which is more difficult in its action than
[ipecac] though is very delicate constitutions ipecac 
may be practicable
# prevent accumulation of [mucus]
The bowels shd be evacuated not for the purpose
of curing the disease but for the prevention of an
accumulation of feces which would be irritating
In all diseases of the lungs examine
the state of the skin and particularly that of the lower
extremities for perspiration upon the upper extremities 
[only] may be a part of the disease
I have known the lives of several patients saved
by the use of the vapour bath
I formerly [illegible] and used [illegible]
for transmitting vapour by transmitting air through
boiling water
It was old practice to apply cat-skins
fowls split open (to the feet) etc. with the intention of
communicating vitality


142
is too much weakened to bear this treatment. This is a 
general principle viz, if possible to break a disease in its
commencement by means of a strong orgasm. Often the
emetic is to be repeated, and it may ever be necessary to give
four or five emetics 1 gr [illegible] tart. emet. each in the course of a day. After the disease 
is somewhat broken up, and epispastic applied upon the 
breast will assist much in allaying its violence #
If the disease still continues or if when first
called we find it fully formed and powerful emetics inadmissible
the primary indication will be to open the pores of the skin and
keep up a gentle perspiration, by small doses of antimonial wine
to which may be added in all quantities of camphor by elix. [illegible] & in 
some cases tinct opii by fomentations and especially by 
the warm bath and the inhalation of vapour. To affect the 
latter object the child may be placed in the warm bath & 
a blanket thrown both over it and the nurse, so as to keep
the child in an atmosphere of vapour. Long continued 
perspiration invariably relieves the symptoms. I have known
an instance in which the skin of a sheep warm from the animals
body was wrapped round the naked body
of the child with beneficial effect.
In small children when the stomach ceases
to be excited by emetics the throat should be irritated 
by a feather or the finger, when we wish to produce vomiting 
For we must never rest satisfied with merely endeavoring
to palliate the symptoms. In small children also the
mucus should be wiped out of the mouth by the finger or a cloth 
This disease prevails most in the winter and spring months & does not
occur every year. The first patient that I treated for the disease suffered
from it a year. I gave mercurials & finally the silver pill (nit sil)





143
I was puzzled with the first cases of this disease
which I met with. Some of them continued for weeks
and months I was obliged to use perspiration,
by warm bath to vapour bath emetics etc. I determined
to break up the next cases in the commencement
with tartar emetic repeated until full vomiting
was produced walking my patients. This 
plan was more successful
A s a general rule break up 
all diseases if you can
“The complaint is epidemic or rather
endemic. It has been mistaken for croup, but it
differs As croup formerly occurred no mucus was raised
in the earlier stages, and when there was an excretion
of mucus we considered the disease cured
But of late years the two complaints are somewhat blended.
Mucus is thrown off sometimes without permanent
relief”
“There is often in this disease a disturbance of 
the brain and nervous system resembling epilepsy or chorea
produced by the cough”


A distinction was formerly made by some
writers and some practitioners, between hooping cough
and [chin] cough the latter being a spasmodic cough
without the hoop. Such a distinction will not hold
good there is no difference
“Linneas and Rosenstein attributed it to an insect
others to malaria”
There had been a very severe winter & no one
had left the island for months


144
Hooping Cough Pertussis
Called also chincough
This is a disease which generally attacks children
yet occasionally, adults are the subjects. I have known persons
of 60 years of age affected with it. As a general rule also it
does not affect persons a second time. I have known about 
20 or 30 exceptions & among them was the late president Dwight at 60 years
Hooping cough generally appears as an epidemic.
With respect to its origin there is considerable difficulty 
in making up an opinion. It is said to be contagious 
to arise from a specific
contagion which affects a person but once. Dr [Dewers], however,
says “We confess that we are inclined to believe that it depends upon 
causes of a more general and pervading influence that 
contagion.” Dr Cullen asserts that he has said a disease which 
though evidently arising from chincough contagion never put on 
any other form than that of common catarrh. In the tenth
volume of the medical commentaries DR Willey gives an account of
the breaking out of the disease on Block Island under such 
circumstances that it would seem that it could not have originated
from contagion. When the disease prevails many become effected
where every precaution is taken” When the disease has been extensively 
prevalent I have not been particular about keeping patients
apart, perhaps however it is best for prudence’ sake to consider the disease
as contagious and to treat it as such. One fact I have noticed
that in particular seasons may have the disease who have had it
before.” Some suppose that it is contagious only in the first stage 
others in the second “Some think it caused by malaria or
animalcular”


“The stricture may be overcome by not
attempting to inspire, but to expire till the lungs are
emptied the pat. can then inspire without difficulty
I have known persons subject to this kind of hooping
without cough Adults are sometimes attacked in the night
with paroxysms of suffocation they start from bed when 
the recover their breath there is hooping but no cough, at
least at first The more they struggle to catch breath 
the greater the difficulty there seems to be a spasm of the
glottis Let them make no effort to inspire but expire 
the little air remaining in the lungs & they will bye relieved at
once. The disease is liable to recur bathe the feet at night 
give paregoric wine whey diluents The disease is not described


145
Some suppose this disease a peculiar inflammation of the
mucous membrane of the trachea and lungs, others that it arises
in the bowels
This disease often commences with the 
symptoms of ordinary catarrh & continues without alteration for
some days.  Sometimes the peculiar mark which gives this
cough the appellation of hooping & distinguishes this disease
from every other does not appear until the 3d or 4th week
It is impossible however to distinguish the disease until this
peculiar hooping makes its appearance. When the disease
is prevalent it will be safe to treat every severe case of catarrh
among children as one of this disease
The phenomena peculiar to this disease may 
be the described. Several frequent expirations are made in 
succession by spasmodic coughing, and a full inspiration is
then necessary to restore air to the lungs. The air as it passes
rapidly into the lungs produces a loud sound called whooping
The sound however is made more by the structure of the passage 
than by the rapidity with which the air is drawn into the lungs
I have known persons subject to this kind of whooping, without
having a cough caused by a spasm of the muscles of the trachea 
larynx? to which adults are sometimes subject. (Goods laryngismus?) 
A similar sound is also made in croup, when 
the air is expired after the passage becomes constricted
The patient is aware of the coming on of a 
paroxysm of coughing by an unpleasant sensation in the throat, & 



The cough is violent in proportion to the shortness of 
the paroxysm


146
it is common for children support themselves during its continuance
by changing to a chair or other support near them. During the
paroxysm the blood is returned with such violence to the head as to 
produce a livid colour of the face & often in 
bleeding at the nose. Very violent paroxysm sometimes
in young children terminate in convulsions or death The paroxysms continue
until a quantity of mucus is thrown up from the
lungs or the contents of the stomach are evacuated by vomiting
They are short in proportion to the facility with which the mucus
is brought up or rather in proportion to the rapidity with which it is secreted
It is the secretion of mucus, not its removal
which gives relief to the irritation of the lungs 
Many suppose that this mucus which is generally in considerable
quantity is the cause of the paroxysm of coughing instead 
of the effect of it. The peculiar irritation of membrane in 
a paroxysm of coughing produces a secretion of [illegible], and 
when a sufficient quantity has been secreted it is coughed up 
like the secretion of tears from an irritated eye
and the paroxysm is relieved “The mucus sheaths the part & the ceases”
The disease continues from one to six
months It is often kept up by habit. The cough is usually more violent by night than
by day. Violent cases are often attended with considerable fever
and in the worst cases respiration is laborious between the fits of
coughing. The disease may terminate by apoplexy or suffocation
or by ulceration of the lungs and hectic & sometimes by 
permanent visceral obstruction “or apoplexy or suffocation”
Whooping cough is not dangerous to adults
and I have never known a child over two years of age die
with it. It is most dangerous to infants and the younger the 


It is usually dangerous to children within the mouth
It is apt to wear out very young children especially 
if they are of a scrofulous tendency
It is frequently accompanied with a morbid sensibility
and irritability of mind and hence in the latter
stages a change of air and of place is salutary as in 
cholera infantum The same despondency of mind takes place
as in chol. inf. q.v.
The disease is a fever spending itself upon the
lungs and trachea, and affecting also the glandular
system
Some phys. think this dis. like common
catarrh, is always inflammatory in its commencement, and 
requires antiphlogistic treatment. But we know that
pneumonia may be highly typhoid & require treatment
opposite to [enteric] pneumonia. If infl. of the lungs exists
the antiphlogistic treatment shd be adopted in its fullest
extent I have seen antimony as efficacious in this dis
as in pneumonia. In general perhaps mild
antiphlogistic diet & treatment will be proper.
In some cases I have thought the
veins lost their power, and in such cases the
blood [illegible] has been prescribed & with advantage
It is a catarrhal fever at first and to be
treated as such


147
child the greater danger in children under the age two years
The anger, to be apprehended from the disease will also depend
upon the debility of the child when attacked. The cough may be
violent and attended with frequent vomiting yet of the patient’s
appetite be good there will not be much danger
to be apprehended. A moderate hemorrhage from the nose
is often salutary
Treatment. If the disease is mild and the constitution
good little need be done with the way of treatment. But if inflammatory 
symptoms supervene with a tendency to pneumonia
the antiphlogistic treatment must be adopted. Bleeding
will often be advisable. A small quantity of blood
taken from the arm proves serviceable. In general greater 
effects may be expected from the application of a few 
leeches to the breast or neck than from bleeding at the arm
but when decided symptoms of pneumonia appear, & the blood 
seems to be transmitted with difficulty through the lungs.
I would recommend venesection. In this case also the 
bloodroot will be the best article for internal administration
In most cases the disease comes on like
a catarrh, and should be treated as such, with mild 
antiphlogistic regiment [illegible] important part of the
antiphlogistic treatment of this disease is the keeping 
the bowels open. Costiveness frequently attends the disease & should
be carefully avoided. In general it is better to obviate 
this symptom by diet as far as it can be done 



Begin with antimony in small doses 1l or 2 drops ant wine & 
in [illegible]
For very delicate children however it may be better
to give ipecac
Almost all the writers recommend vomiting [Best]


148
rather than by medicine. The best cathartics for the
indication are those which excite the secretions of the stomach
and liver. Sometimes the disease has a tendency to produce
congestion of the liver and obstruction of the mesenteric glands
and in that case also mild mercurials should be given 
and their use continued as long as any symptoms of congestion 
exist.
All the medical writers on this disease recommended
vomiting in the first stage
Tart. ant. is in ordinary cases the best emetic. Sometimes
for a child from two to six months old two drops of antimonial
wine will be an emetic dose while for another
of the same age 20 or 3o drops may be required. In 
affections of the lungs children will bear antimony better
than in those of the stomach and duodenum. In some
constitutions antimonial emetics produce (in this disease)
a sort of spasmodic stricture other emetics also may produce
this effect a symptom which must be relieved by diluents 
and opium
In general antimony in small doses
may be given to children of any age, either by itself or combined
with a small quantity of paregoric or any other mild preparations
of opium. Given in this way it removes febrile action and 
congestion of the lungs, and determines to the surface
When the disease has proceeded with 


You may see the fontanelles swell in such 
cases. I recollect a child in the whooping cough going
into the country I told the parents not to suffer the child
to be vomited. A physician in the country said the child 
must be vomited of course all the books directed it
in whooping cough He vomited the child. It went into
convulsions and died
# Here insert the recipe for hire syrup or 
compd sys. of squills p. 150
I have known the lives of some patients saved 
by 
this antimony internally had lost its power produced no effect


149
violence for some time and there is much determination of
blood to the head, threatening convulsions or apoplexy from 
distention of the blood vessels, or when the patient has become
debilitated vomiting by emetics should not be practises
or but cautiously.
When the system and particularly the
stomach has become debilitated. Ipecac is preferable to 
antimony, given in emetic doses, or in small quantities 
as an alterative diaphoretic and antispasmodic. And in the
latter stages likewise on account of the debility, sulph. tinc. is a good
emetic using 5 or 6 grs. with as much of ipecac
If there is not much febrile heat, and there is much 
viscid mucus in the stomach and lungs, and emetic of
squills is often serviceable # particularly I [illegible] phlegmatic temperaments syrup of squills vinegar of [illegible]
In this disease if there is danger of convulsions 
from vomiting, blood root and similar articles should
be given. The hive syrup or compd tinct. of squills may be used
In children under three 6 months, whooping
cough may be much relieved (respiration being promoted)
by vesication on the breast. A blistering plaster may be applied but
I have more generally used the following. Rx common or mild
tinct. canth zi targ. ant zi Dissolve the ant. in the 
tinct. & apply a linen cloth with the mixture till [illegible] or partial vesication 
is produce & then dress with simple cerate In this way we have the vesicating & irritating
qualities combined. This external use of tart. em. was
recommended 20 years ago, in the Lon. med. & ph. Journ.


This disease may be cured in its first stage but it
ordinarily runs a regular course & the treatment is generally palliative 
brown mixture
You will perceive that this is a strong decoction
of seneka and squills, with a large proportion 
of tart ant. shd be given cautiously 4 to 30 drops 
Narcotics have been strongly recommended
e.g. atropa belladonna & hydrogen of the former
for 2 gr of the leaves in powder Alibert recommends
the fresh bruised root


150
A popular remedy in whooping cough in Godfrey’s cordial, made
of molasses and water with a little laudanum and oil of [illegible]
“Hive syrup” (or compd syr [illegible]) is made as follows Rx bruised seneka root & 
squills zz z8 water lb 8 boil and evaporate one half
strain and add honey 4 pts boil to lb 6 Add tart.
ant. gr.i to every ounce Give for an emetic 8 or 10 20 drops
to a child 4 mo. old & repeat the dose every 15 or 20 minutes
until vomiting is produced
The “brown mixture” is as follows elix. pareg. zi; ant. wine zfs;
ext. glyc ziii pul. gum ar. zii wat. zvi trit. & boil 
dose from ½ teaspoonful to tablespoonful
This has been very extensively used
This disease has been prescribed for more 
empirically than most others; a fact which proves the
difficulty of curing it It is a popular notion that it must
“run its course” & under the influence of this many parents
object to its being prescribed for. Undoubtedly this
like every other disease must “run its course,” if it is not
cured; but this is no reason why the cure should not be 
attempted.
Ammoniae asafoetida (especially if
the cough is kept up from habit)


1st antispasmodics 2nd tonics
# An emetic is occasionally administered with advantage 
“I have prepared this from seneca oil also
from gun copal”



151
2nd In the second or chronic stage tonics & 
antispasmodics are indicated. Sulph. of copper or of zinc
tinct canth. cinchona, arsenical solution etc. may be required 
to rouse and support the system & as antispasmodic
tinct. asafoet. petroleum Artificial musk etc. and also
the narcotics, as hyoscyamus, conium, stramonium, belladona arnica, opium etc.
When the cough is kept up by habit, # asafoet.
is often administered to children with advantage. It may 
be given in tinct. or decoct. & if it cannot be given by 
the mouth it may be thrown up in an enema, using 10, 20, or 
30 drops of the tinct. It is a valuable [illegible] the taste is less
unpleasant than the [illegible]
Artificial musk or oxygenated oil of 
amber was first introduced by Prof Hufeland of Jena
as a specific for whooping cough and has since been found 
very useful in other spasmodic diseases vid. Lon. M of ph. J.
vol. 1: p.181 van Swieten’s comm. etc. Rx nit. ac ziiifs
cl. succini zi. And the acid gradually, ina temperature 
of 100 [degrees] or in the sun. Prof. Hufeland triturated
x or xii grs. in a mortar with a few almonds & diluted with 
z 5 or 6 of water & gave a teaspoonful every 2 hours to 
a child a year old. This preparation was very celebrated 
and very effectual, for a time, but afterwards fail 
was thought to be ill prepared. The truth was the diathesis had 
changed. Probably it will be as affectual at [illegible] time
I have given the above article in tinct. Rx zii 
of the oxyg. [illegible] [illegible] lbfs alcohol dose 10 to 12 20 gtts
It is much more soluble in ether. I frequently dissolve zi 
of oxygenated amb. in zi of ether dose 1 to 2 drops on sugar 





152
It may be prepared indeed of any strength, to suit the
convenience of the physician. Probably gum copal oxygenated would
answer the same purpose as amber as there is every reason 
to suppose that the two are essentially the same
amber being gum copal mineralised Case of a vein of 
olibanum or Frankincense found in S. America.
Opium is not indicated in this disease
except when it is qualified and its action determined to the
skin by antimony ipecac or camphor. Hyoscyamus
is better than opium for in the cough it produces no constipation
and the tincture is very pleasant. I have not
however used it in this disease. Conium has been recommended
by writers of the first respectability, but later authors do not 
speak of it with much confidence. It deserves a trial
when other things fail. Alibert recommends atropa belladonna 
1/6 gr. of the root or leaves powdered & given in milk
I have used I have more confidence however stramonium in the [illegible] & think it preferable
most of the narcotics
to any other narcotic It is peculiarly calculated
to remove spasmodic action depending upon irritability 
of the system or kept up by habit From the relief obtained
by its use in asthma I was led to employ it in this disease
and from those cases in which I have tried it I am of opinion 
that it is a very valuable remedy in it 
The ripe seeds of the stramonium are best the full dose of 
these for adults is gr. ii for a child  1/10 gr. or more according 
to the age



Mercurials occasionally blue pill rhub & 
ipecac enough to keep up a gentle excitement in the 
bowels
Not unpleasant to the taste
An old [illegible] Chalmers ([illegible] of silver) recommends sulph. cop. & 
tinct canth in wh. cough
# [ago] more used than any other Lately the ox. bis.
has taken its place dose the same used  for irritating
cough & irrit. of stomach


153
Carb. potash is a good antispasmodic used externally 
and internally. It is not only antacid & antispasmodic but it appears to 
me to produce a peculiar excitement upon the stomach
and aesophagus, which makes the more susceptible to 
the impression of other articles. Pearlash zfs & water z8 with 
cochineal enough to colour the solution has been considered
relied on by some physicians
a specific. The cochineal merely colours the solution.
is an article from which I never could perceive
any medicinal effects when used alone. I have tried the
experiment & could perceive no medicinal effect from it
Tonics. I have given the sulphate of zinc
more than any other tonic in this disease, and have experienced 
the greatest benefit. Sulph. tinc given by itself,
sometimes produces spasmodic action, the effect I attribute
to its being used in substance & hence I always
give it in the form of Moseley’s tonic solution. This 
preparation is both conic and antispasmodic is easily 
taken and retained on the stomach of very small children
Sulph. copper possesses properties similar 
to those of sulphate of zinc. It is administered in the 
low stage of whooping cough. In this place the preparation
of it called compd tinct vitr has been used
according to the recipe in the 10th vol. Duncan’s Commentaries
in doses of 3 to 30 drops according to the age of the patient
The oxide (or flowers) of zinc & also bismuth 
formerly much used in spasmodic cough 30 grs
have been occasionally used 1 to 3 grs 1 to 10 to an adult
The Peruvian bark is a good remedy in 
the last stages. The only objection to it lies on the difficulty 


It sometimes happens that the physician is 
not called in until the latter stages. As one resort we
may have recourse to irritate along the spine
It is an opinion very extensively prevalent to that
it is of no consequence what kind of food a child takes
when he has the whooping cough But great attention 
shd be given
Removal from sea side to country 
and [illegible] country to sea side either is beneficial


154
of administering to small children, a quantity sufficient
to produce any considerable effect. This difficulty may 
now more be overcome by using sulph. quinine ¼ gr to 1 gr Dr Chalmers of 
South Carolina recommends a combustion of bark, sulphate
of copper and cantharides
Tinct. cantharides has been long since
recommended for whooping cough. It is useful when the system
requires an inflammatory diathesis to be produced. Its action on the stomach 
is probably similar to that which it has in cases 
of gleet and leucorrhoea the stomach being in a relaxed
state & requiring to be excited to a healthy inflammatory 
action
Irritants, as oil of capsicum canth. [illegible] or ol. orig.
or vol. lin. rubbed along the spine have been used in 
the latter stages. They should be tried when you have reason 
to suspect that the spinal marrow or the nerves proceeding 
from it are affected.
Attention should be paid to the diet of children
in the whooping cough avoiding potatoes, oily foods etc.
Change of scene & change of air especially by 
riding should be resorted to in bad cases, to tranquillise 
the patient & furnish mental excitement. Sometimes the little
sufferers will be excessively irritable constantly worrying and teasing until 
this is done requesting first one thing & the other to be done. It is the worst of such cases, medicine does
little good, even the irritation produced by administering 
it may counteract its beneficial effects.


violent palpitation throbbing of the heart
a soft flowing pulse and a jarring feel of the pulse under
the finger ([illegible]) (The French call an enlarged heart
hypertrophy I object to the [name])
For this I have given nit. sil. 1 or 2? gr.
(in the chronic stage of [illegible]) Digitalis & also
[languinaria] (tinct. 2 or 3 gtts.) This article is dangerous for
children because it accumulates in the system
Lead has been recommended 
I have been doubtful with respect to its propriety in affection 
of the lungs etc.
# Pneumonia typhoides 1815 the system seeming to lose the
power of [illegible] the blood and the bloodroot was
given to promote venous absorption The digitalis
might probably be given in such cases but is not as
well adapted. I used the blood root and found
as much benefit as could or [expected] from any article


155
If the patient having the whooping cough happen to be teething
the treatment recommended for dentition should be employed
The patients are very liable to have an 
inflammation of the lungs from taking cold in any stage
of the disease & in such cases the remedies for pneumonia
should be administered, such as antimony bleeding
epispastics, bath etc.
The disease I think sometimes determines to the
head & produce a relaxation of the sinuses & 
[illegible] likewise produces a relaxation of the ventricles of the 
heart the immediate cause being the violence of the cough
In such cases I have used lead, but not in sufficient
quantities to enable me to recommend it Iodine has been
recommended 2 or 3 doses 3 times a day Nit. sil. languinaria & digitalis
When in the progress of the disease
the circulation becomes much affected the pulse frequent,
soft, flowing with occasional intermission
respiration high frequent and laborious, with a bloated
and sometimes analogous to # a livid countenance, the blood root has
done more than any other remedy not failing in any 
instance to give relief & palliate sympt & in some cases the relief has been
permanent. I gave the bloodroot repeatedly, the last
spring, 1815 to my patients in the whooping cough. To a
child a year old 5 to 10 or 20 grs of the dried root, according
to the urgency of the case, infused in 6 or 8 teaspoonful of
boiling water. Give a teaspoonful every hour, until 
vomiting is produced or the patient relieved. Children 


Sometimes the dis. will be very mild and yet leave 
the system in such a state that a slight subsequent disease
will carry off the patient e.g. in 1815 the dysentery
attacking children would often be very slight and yet
would carry off every one who had had the whoop. c.
in the spring. The attack would be mild and insignificant
of dysentery and yet the pat. would go into 
a [illegible] very speedily like cholera
Elaterium has been recommended I shd
be cautious in trying it except in very vigorous children
I can speak with confidence of arsenic. Excepting
occasionally prussic ac. I know of no remedy which 
so completely cures the wh. cough except prussic acid in 
some cases.
Case child 2 gtts night & a [illegible] in a
weak countenance pale, eyes dull face bloated muscular
strength weak muscles soft & flabby Parents
much [illegible] cough gone recovered colour & 
strength upon bark I have known several such 
cases and have known no ultimate injury result from this practice
Yet parents are afraid


156
who had the whooping cough that spring were very liable
to be carried off by the dysentery of the following summer
none died in 1815 of the disease but many in consequence
of it, with hydrocephalus and dysentery
Prussic acid dose 1/3 of a drop to begin with and arsenic
occasionally cut this disease entirely short; and these are 
the only articles which I have known do so, without leaving
a vestige of the disease behind. The former is a dangerous
article to use, from its want of uniformity and strength
Fowler’s solution of arsenic gtt more [illegible] is safe but does not answer
so well in the first stages. If it makes the patient feeble
livid bloated & with swollen lips etc. it must be stopped & perhaps
bark administered. It has cured the cough in the 
second stage. Dose 1 drop 1 or 2 drops twice a day. Sometimes is only palliates
Case. June 1815. A child of Capt. Totten’s a boy 
of 5 yrs of age rather full habit had been affected
with the cough for a fortnight before I saw him 
I found his pulse very frequent soft convulsive & with intermissions
face swollen and livid, circulation much increased on 
slight palpitative [illegible] motion of the body in the symptoms aggravated to an
alarming degree by a paroxysm of coughing. Previous t the
disease a remarkably even tempered and pleasant child he
was not on the contrary very irritable. Trifles irritated his
mind, and when irritated, all the symptoms of his disease
were aggravated. He took an emetic of ipecac, with 


The sequels of this disease are numerous
Sometimes the heart is affected as above and continues
so for years. Sometimes the glandular system
is affection. Sometimes the lungs. There is a lady in 
Philadelphia who had (under my care) suppuration of
the lungs whoop. cough now healthy hence never despair
The stomach and abd. visc. are
sometimes affected in a chronic way requiring 
dandelion mercurials hop [illegible] etc.
It is very tedious to attend children in the 
chronic stage an account of the excessive irritability
When bath recommended
Cold bath doubtful. I have known patients killed
by being brought from the country and plunged in the
sea bath
“Good speaks highly of rhus [illegible]. It is
given to produce a distinct action on the system which shall
overcome the diseased action. It determines powerfully to 
the surface and has a powerful exciting effect on the
blood vessels while it does not produce a determination
to the brain. I should not recommend this article and 
it is so uncertain in its effect. On one person it will
have no effect at all, when in another it will cause
swelling of the eyes, blindness, fever, & great irritation


157
but inconsiderable & temporary relief. He was directed
to take the bloodroot every hour, as much as the stomach
In relieved the violent symptoms
would bear. It was continued for two or three days, and the
palpitation of the heart was much abated, the circulation
was less irritated, & the livid colour of the face was gone still did not cure
When costive he was benefitted by full doses of cathartics.
because the system was [illegible] deranged heart lungs etc.
I considered the case a fatal one and expressed that opinion 
to the parents. The cough and other symptoms continued
though in a less violent degree disease chronic an epispastic was applied
to the chest very irritating (changed clothes often in the day [child] run upon various subjects)
Patients strength began to fail and tonics were given
white vitriol bark cantharides Finally the patient refused
to take any medicine and was left to his own appetite
called obstinately for it took cake for food for several days then baked pears then [illegible]
Afterwards recovered but was unable to run “for some years”
without a palpitation
If this disease should again prevail
I think I should atropa belladonna as a prophylactic.
As the disease continues the stomach
may become very much debilitation and require 
compd powd of [contragerva] cat carilla etc. etc.
“Ledus palustra are narcotic”


It is not certain that the dis. did not exist before
It may have existed before but no general account
given of it. It may have been known in diff. places by 
diff. varies and it [illegible] have been known than the 
diff names meant the same disease Diseases are not
apt to appear suddenly. Still at this period, there
[illegible] cause operating for the increase of the dis.
Belly usually large and limbs small
Joints unusually large
Often morbid cravings of appetite
Yet the same causes operating in a higher degree
produce cretinism
There is no difficulty in recognizing the disease
You will be struck at first sight with the large size of the
head the blue [veins] of the forehead paleness of countenance as you cast your eyes
down you will notice the large joints


158
Ricketts
This disease according to Underwood was first noticed
in England in the year 1628. It is said to have immediately 
succeeded the increase of manufactures, when people left the villages
to settle in large towns, where they wanted exercise and a
pure atmosphere
Children are rarely attacked with this disease
earlier than the sixth month and not usually until after
that period. The symptoms are soft flesh muscles & cell. sub. relaxed general relaxation 
of the system paleness of the countenance unless the face
is flushed with fever, which when it exists is of the hectic kind a fever of irritation
pulse, usually quick and feeble,
tumefaction of the abdomen appetite and digestion bad tendency to acidity
veins of the head [illegible] and blue the sutures of the head not firmly closed head large fontanells unusually 
open joints large in bad cases all the bones of the system enlarged & softened
One effect of the disease is that the teeth are cut later than 
usual. Ricketty children are usually precocious in 
intellect. Their mental faculties are developped more early 
but are not capable however of so much improvement, as
those of others. Evolution of the mental faculties does not
proceed with the tardy progress of the assimilating function 
The child learns to [illegible] very early and exhibits an acuteness
of intellect beyond his years with the exception however of those
cases so severe as to have a tendency to cretinism It is a common 
saying that very forward children are not likely to live long
and the precocity of scrofulous & rickety children may have contributed
much to the production of this impression.


Too much heat may produce an indirect
debility
Undoubtedly aff. the brain & nervous system
Give mercurials occasionally Do not produce salivation
and do debilitate by mercury
Frictions are very efficacious exciting the skin
The reasons why friction are not more successful is that they are not perservered 
[illegible] the al. can. etc.
The cold bath is the only strengthening remedy which 
acts suddenly
No effect can be produced by any medicine
equal to the astonishing effect of exercise & amusement in many 
cases of chronic aff. of stomach & bowel.


159
The causes of this disease as in some instances a predisposition
transmitted from debilitated parents sometimes
a syphilitic taint of the parents In others bad nursing
the children being kept wet and dirty and confined in 
close & damp apartments or if the child has been carefully 
fed and kept clean debility produced by confined air
too great warmth, too great variety of food and as some think
too much saccharine matter in its diet. Inanition may be
a cause. The disease prevails among the Alps
and is perhaps there caused by the combined influence of 
cold and moisture
This is a disease of debility nearly allied to 
scrofula & cretinism affecting the viscera of the abdomen generally, the
lymphatics and the [isseous] system. The chylopoietic viscera
are probably first and afterwards the mesenteric & lymphatic glands generally 
the indications are to give tone to the system 
and excite healthy secretions
The diet should be dry and nutritious
and such as is not only easy of digestion but rather stimulating
and the bowels kept open by cathartics which act on the
secretions. A dose of calomel with a little ipecac will 
be useful. The cold bath should be used every day Take the child out of bed in themorning bathe & return. If the
Cold bath of salt water is [illegible] tonic
patient be very feeble it should be begun with at of a temperature 
of about 80 [degrees] and gradually used colder
The child bath is equal to all other remedies It is more tonic if made of salt water 
As a substitute for exercise, frictions will be very useful
But exercise in the open air should be like whenever the
weather is good in a carriage or on horseback and exercise
should be so managed as to afford amusement and mental 



The [guephalin] [polyapt] & also the gr. marg.
(which is less odorous) are also used Their agreeable odor
if there is no other advantage will prove grateful
stimulus & promote healthy secretions
Take the child out of bed and plunge him
in water (about 70 at first) and replace him in bed
Yet in exhaustion of fever the cold bath
gives a shock from which the system will not react but
yet in the debility the cold bath is highly beneficial whether
we can explain it or not.
It may be necessary to vary the tonic And 
it is desirable to have a variety of tonics to [chorea] from 
also carb iron & tinct. carb. iron ac. fer. alkaline solut
The sulph. zinc is not inferior to iron and is not subject
to the inconveniences of iron not producing inconveniences Mosely’s sol.
The compd tinct vitr. although apparently [illegible] is yet
certain in operation and has been long used in this vicinity
A tinct. of potash is thought very useful to 
rub the body with. It is a popular remedy & has sustained
its reputation in this neighborhood for many years
Lime water made of caustic lime is more tonic
than the carbonate That made of shells is thought better being
pleasanter than that made for stores probably not as pure
but containing muriate of lime. Be careful to see that the
shells are thoroughly burnt so as to fall in powder when 


160
stimulus by the sight of scenery vegetations, flowers etrc. The patient
may even be benefitted by being carried in the arms into the garden
and amused in this manner. It must not be forgotten
that this cheerful excitement has a powerful effect on the secretions.
Feather beds should be prohibited. They are too 
enervating, and hard ones should be used in their stead.
Beds made of the sweet fern (comptonia [asph??folia]) are
popular & do very well. They not only from their hardness
check the profuse perspiration of the hectic diathesis, but correct
the acid smell of the sweat which is very common. IN general 
heat should be avoided as too relaxing
I have rarely failed of curing the disease by 
the cold bath as the principal remedy, using tonics however as
occasion may require. The tonics which we may use are sulphates 
Phosp. & mur [illegible] 3-10 grs
of zinc & of iron muriate of iron martial flowers of iron
etc. and the plan has been tried of applying finely powdered bark eternally in a 
quilted jacket of flannel. It is difficult to give bark in substance to small children. Astringents may be indicated & 
there is often a degree of acidity so great as to indicate a free use
of absorbents
The alkalies as pearlash may be beneficial internally
& frictions with pearlash & water zfs to a pint may be recommended.
Of late iodine has been given in doses of from 
2 to 4 drops of the alcoholic tincture 3 or 4 times a day, given
mucilage or other convenient vehicle. This article when persevered
in has cured a great many cases. It should be [given] at first
in small doses & the quantity be gradually increased or 
a disgust towards it may be created


Phosphate of [illegible] was popular
Forgetting that the deficiency of [osseous]
matter may be defect in the action of the secretions
Though the theory was wrong yet the practice
was found beneficial absorbents
Give a solution of the acid of about the strength
of lemonade The phosporus is preferred to the phosphoric
quenches in the water you will then have, not as is
too commonly the case merely smoky water but lime 
water of full strength These preparations are called
tonics by Good called stimulants (too loose as use of the
word) Long before I had any explanation in [illegible]
I thought I observed that these articles created a susceptibility
to the operation of tonics apparently as generating excitability


161
It has been supposed that the proximate cause of this disease
is a deficiency of phosphate of lime with bones but 
this is an effect, caused by want of action as those vessels which 
secrete this substance. The proximate cause, as it is called, is in 
this case the disease itself. In consequence of this notion 
burnt bones have been much prescribed. They are probably 
useful not as supplying the matter of bone but as an 
absorbent & perhaps as a tonic
Acids especially the phosphoric have
been given. Phosphate of lime has been used with benefit
muriate of [illegible] and barytes were
formerly much prescribed.
The worst cases are those of children
born of syphilitic parents for these tonics mercurials and 
the cold bath will also be the treatment.
I give them corr. subl. 1/30 gr with
no injurious effect


Nearly allied to ricketts and often as sequel
of it ricketts often running into it Sometimes appears
with ricketts sometimes afterward Ricketts occur with 
the year. Scrofula occurs later. Ricketts children
are more generally of a scrofulous temperament
The tendency may exist in the parents and yet
be developed only in the children from the causes of 
bad food [illegible] pain etc.
These swellings may continue
in children of 5 or 6 [illegible] or within the year with little or
no change but increasing of size in spite of poultices filling the whole neck
I have found poultices apparently injurious promoting the
relaxation but blisters would stimulate and bring on 
a suppuration. The pus will not be healthy but curdy 
and whey like The edges will be ragged, not unite
readily, and will leave a bad scar. Scrofula,
ulcers are said to be distinguished by a smooth overlapping
margin. the disease may continue for months
and years with little or no change of it does not attack
a part essential to life as the lungs, producing tubercular
consumption attacking the liver producing a peculiar
atonic infl.
I have seen cases of scrofula that were [entonic]
They were injured by tonics and benefitted by cal. and ant. They 
would have borne bleeding



162
Scrofula
This is a disease of the lymphatics and affects persons of a peculiar
temperament this temperament is characterized by a fair, thin, translucent
skin, light hair, blue eyes, sometimes black hair and eyes delicate 
fullness of lips & nostrils usually texture of skin and cellular substance general laxity of
muscular fibre usually delicate organization mental faculties 
developed early on in ricketts. Person who have been affected with ricketts
in infancy are after affected with scrofula in after life.
This peculiarity of constitution, when a morbid action 
is superadded, gives rise to the following symptoms
First small swellings appear about the neck, slow in their 
progress & with an imperfect suppuration. Small holes
form in the swelling and discharge a subpurulent,
watery and flocculent fluid. These scrofulus 
ulcers when fully formed are distinguished by smooth spongy 
and overlapping margins & by very lax granulations. The disease forms tubercles upon the lungs, liver
kidnies & ovaria & causes a great enlargement of the mesenteric
glands
This morbid condition and action may 
be transmitted from parents to children. It prevails especially in cold and variable climates exists most in 
large manufacturing towns where it is caused by bad food
and air, want of cleanliness all of them debilitating causes
It is sometimes also in persons predisposed, a sequel of other
diseases particularly of small pox, hooping cough & measles
Treatment. more may be accomplished in 
the treatment of scrofula by diet, exercise, sea air etc. than
by remedies. Scrofulous swellings should be treated by 



Avoid cold vegetables & watery diet give animal 
food articles containing nitrogen as infants are said to 
abound more in albumen and adults to be [illegible]
“Iron zinc copper silver tonics & antispas. are useful”
“Conium 2, 3, 4 grs with carb. fer. 10-20 grs”
# “I have used with advantage mur. lime 3-4 drops increased 
to a tablespoonful & also mur. [illegible] 3-30 drops given
in milk & water or in coffee. They are tonic & act on the lymph. & gland. syst.”
Articles containing [illegible]
In [anthelmint???] vesicular [illegible]
F. idealis ([illegible]) (sea cabbage) has been given for worms and
some families learn their children to cut it
A mucilage may be made F [vesiculosis]
[illegible] which with bran has constituted a popular poultice
for scrofulous tumours
When there is loss of tone & an ill conditioned discharge 
cantharides with opium is a valuable excitant
Never continue any remedy after it debilitates
by exciting disgust and nausea
Mercurial plaister of the shops (gum ammoniac 
& blue ointment equal parts) has been much used 
especially for scrof. [swell.] of the joints In these [illegible]
become extensively effective and become spongy
A man at the westward was very celebrated for 
curing scrofula. He used wild violets but was not particular
as to which species he used



163
blistering van Heuvel’s child a round of remedies had been tried [illegible]
Occasional purging with calomel and rhubarb
and ipecac in a pill will be useful
Preparation of iron, carbonate of iron with conium etc.
muriate of [illegible] 3 drops or 6 and barytes in [illegible] you give a teaspoonful iodine
scrophularia mar. [Cistus] Canadensis uva ursi
Mr Daggett Havanna Dublin Eliza Collis
Vide p. 209
Iron no prep. perhaps are better than myrrh
mixture or Jenkins’ pills (carb. per. [illegible] camph.)
“Bark & quinine”
Different preparations of [illegible] & barytes # Now
superseded by iodine. I have seen more powerful
affects produced by 4 dr. tinct. iod. persevered 
in a long “5 to 20 gtts within the year 2-3 gtts ter in die”
Various vegetable articles I think very highly 
Rock rose or Cistus Can. (Helia [illegible] [pity] it is changed)
Some years since a person went to Long Island to be cured
of scrofula to a family famous for curing scrofula returned much benefitted should his remedies
they [illegible] [illegible] & [illegible] always used than 
afterwards, when [illegible]
[illegible] from Havan. neck filled up 
cured by [illegible] had been salivated W. I. without benefit
Eliza Collis scrofulous cough much [illegible]
cured by [cistis] vide p. 209.
Scroph. maril. has been popular has been
much used by empirics I have seen it sold at a great price 
brought from the west a very common plant It has been 
celebrated for accelerating parturition probably with out foundation
The article has probably little or no power. Yet it is advantageous
to know such articles in order to [illegible] [illegible]



Two entirely different diseases but are classed
together and may be treated together
“H. externus is correctly named hydrocephalus”
“No fever ordinarily attends. The disease
consists in loss of town in the absorbents”
Of late iodine has been recommended 
[illegible] two years since I was called to a patient with 
had enormously distended [illegible] [upon] gr. cal. & 
2 drops tinct. iod. [illegible] recovered
Tinct. canth. Face pale and bloated child sleepy and [illegible]
I know one child who recovered, but at at the ages of 5 or 6 years died of H. 
internus. If the patient recovers he is more liable to the acute disease
afterwards. Puncturing the membrane has been tried with success,
and the application of bandages then supporting the 
child. It is said that puncturing of the pressure
has [illegible]



164
Hydrocephalus
Divided into two species externus and internus
In H. externus the water is formed between the membranes
of the brain (between the brain and its membranes?) In H.
internus it is in the ventricles of the brain
H. externus make its appearance at birth
and is usually born with the child. # In its ordinary form
it is fatal (It is almost always fatal when it makes its appearance
immediately after birth and always so if born 
with the child)
Stimulating and discutient applications
to the head have been recommended. Epispastics are 
said to be serviceable. (Blisters have been found serviceable
they should be kept up for a length of time) Mild mercurials
cal. or blue pill & the muriate of lime or sometimes [illegible] pressure by bandaging . If
the disease is accompanied by rickets the cold bath 
is indicated and has been found serviceable
I have known one child recover from 
this disease and other who has been mending under
medical treatment for 2 years past. I do not know whether it recovered
# H. externus appears to be nearly allied
to those watery tumours which affect the spine.
In consequence of a partial opening of the sutures of the
cranium, or the absence of a portion of one of the
bones the dura mater and scalp are protruded by the
pressure of the contained water & form a swelling on the
outside of the head. Puncturing this tumour is suddenly 
fatal (is as fatal as the same operation performed on the tumor
of the spine.


Arachnoid inflammation, arachnitis, apoplexia hydrocephalica 
(Cullen) encephalitis phrenicula of Rush
cephalitis profundu of Good We might multiply 
[illegible] but perhaps this is sufficient
The disease different in different cases
A great deal has been written and great deal
of confusion exists
“In this species of hydrocephalus the effusion 
of serum is into the ventricles of the brain. This
serous effusion is the effect of the disease and not the
disease itself & hence it may follow diseases of
various kinds. I consider the name very improper”
# “The vomiting if it cannot be ascribed to improper 
food in the stomach is an important symptom in 
the diagnosis”



165
Hydrocephalus Internus acutus
Under this unfortunate name I propose to treat of all
those cephalic diseases which are less violent in their action
than phrenitis (or are less inflammatory). I shall 
principally confine myself to the disease as it appears 
in children
“Symptoms different in different cases”
The disease commences with the following
symptoms (one form of the disease is well described by Dr
Quin) vide [illegible] vol 2 p. 315 The patient is languid inactive and drowsy 
more or less feverish at times apparently free from any 
complaint (drowsy & peevish at intervals easy and
apparently free from any complaint) The appetite is
poor and irregular (week) & (Nausea &) in many 
cases vomiting # occurs once or twice a day. The skin
“Exacerbation towards [illegible]” 
is generally hot and dry (towards evening) and if a perspiration 
occurs it is partial. Soon after these symptoms. The 
patient is troubled with a headach. The seat of the pain 
varies in different cases, sometimes it is confined to one
side of the head (Soon after these symptoms commence
the patient is affected with a sharp headach either 
in the fore part or crown) It is a common observation 
that the headache alternates with the affection of the 
stomach, the vomiting being less troublesome when the pain 
in the head is most violent. The pain occasionally 
attacks other parts of the body (& sometimes principally confined
to the back of the neck and the space between the scapulae)
At this period the patient is averse to the light, cries
much & sleeps little While asleep the patient shows 



# “The tongue is commonly clean & in this respect this
aff. differs from remittent bilious fever, in which the vomiting
& febricula are attended with a yellow fur upon the 
tongue”
One side of the face body one arm or one leg more affected or moved often is perhaps
a severe a pathogen sump. as any other. This is an
indication of paralysis I have known [illegible]
patient recover from paralysis 


166
signs of uneasiness grating grinding the teeth. starting
and screaming in sleep as if terrified. The bowels are usually 
constipated though sometimes relaxed. The pulse in this early 
stage does not indicate much danger (These symptoms 
however are subject to great variations). These symptoms
are succeeded by affections of the eyes. One eye is turned
in ward to the nose its pupil is dilated The pupil contracted in this early & dilated in the latter stages. Sometimes both
eyes at the same time are affected in this way both turned
inwards & both pupils dilated. In this stage the 
vomiting becomes more constant and the headache
more excruciating, the pulse is frequent and the breathing
quick. # If these symptoms supervene to typhus fever,
the pulse becomes more slow Exacerbations of fever
take place towards evening. There is often a flush upon 
one cheek (flushing is usually confined to one cheek)
Perspiration if it appears is usually confined to the
head and chest. A discharge of blood from the nose
at this time relieves the symptoms of fever (& removes the
flush from the cheek) for a time & any favorable symptoms. Delirium often takes
place at this time and is violent in proportion to the age 
of the patient All this time the disease is undergoing a change. As the disease advances the pulse becomes
more slow and unequal & the patient becomes 
less sensible to (the pain in the head) his sufferings 
Lethargy succeeds the disturbed sleep and restlessness
of the early part of the disease. The strabismus and
dilatation of the pupils increase & the eye loses its sensibility
Loss of vision (The patient after sleeps with one or both eyes half
closed) The patient in this stage often takes medicine & 


# “Even in this stage patients have been cured
by the strong impression on the system made by tartar em.
pushed so far as to produce colic” vide infra
Sometimes when hemiplegia takes place the 
disease puts on a chronic form
In the


167
sometimes food will sometimes however
he obstinately refuses to take any thing. The bowels for
the most part continue costive. #
To these symptoms succeed a quick small
pulse (almost imperceptible) bad symptoms in 
the last stage sure forerunners of a speedy dissolution 
(a difficulty of breathing in many cases the flushing of the
face is succeeded by extreme paleness sometimes in this 
stage petechial eruptions appear on various parts of the
body & the patient dies in convulsions or sometimes a hemiplegia
takes place two or three days before death
The disease sometimes runs through its stage in 4 or 5 days
at other times it requires as many weeks. The dilatation 
of the pupils in some cases does not take place until 
the last stages & perhaps sometimes not at all. In 
all cases the proper treatment should have been 
pursued before strabismus, blindness or coma
takes place, because very little is to be done afterwards.
A constant rolling of the head & moving one
arm and one leg are among the most important 
early symptoms which indicate a dangerous affection
of the brain)
The disease sometimes puts on the form
of an intermittent. When the disease has terminated
in effusion the case is probably always fatal.


much dissatisfaction after
existed When an ordinary fever terminated in hydrocephalus 
thinking that the phys. was mistaken at first
“I think this disease is rarely an idiopathic
affection. It supervenes upon other diseases & generally 
depends on disease of the stomach & bowels”
The disease when from ext. violence may 
exist without any [pathognomic] symptom


168
Causes external violence teething worms
Other fevers forming a crisis by effusion into the ventricles 
of the brain. Typh. fev. & dysent. in children terminate in [illegible]
I have known more than one instance in which it followed [illegible] of hip joiont
This is very rarely an idiopathic affection 
unless it may be considered so when it arises from external
violence Vide L. J Pringle on dis. of [illegible] When it does arise from external violence
it rarely puts on the same symptoms or the same appearances 
after death
All the diseases of children from infancy are
liable to terminate by hydrocephalus & hence it is important
to examine all the symptoms which may indicate
a determination to the brain & check the tendency
if possible
Case A girl 14 years of age, had symptoms
of affection of the brain from a fall upon the occiput she complained
of pain in her head for two or three months before she died 
& occasionally had regular epileptic fits [illegible] [mouth] The pain 
the head was relieved by cupping and epispastics to 
the head, but she finally died in an epileptic fit
On dissection the dura mater under the cranium, where 
the injury had been received was thickened and the vessels
were injected with blood. The ventricles contained half a
pint of water. Dropsy in the brain Yet the
pat. had no dilatation of pupils etc. The dis. put
on the appearance of epilepsy occurring once a month.


More common in some families than 
in others 


169
Causes. Hydrocephalus is a disease nearly allied to with scrofula
& like that seems to run in families. Delicate children
in whom the mental faculties are more early developed
are more subject to it. Hence the common observation 
that the child is [illegible] forward that it will not live
long I think persons of a scrofulous habit 
are more subject to this disease & that of the hip joint
When there has been no local injury to the brain, the
disease commences with affection of the bowels, or it is a 
sympathetic affection from disease of the bowels
In the progress of bowel complaints in children, the
[illegible] and the small veins become turgid. This enlargement
of the vessels seems to invite the blood to that 
part. In consequence of this child may die
with symptoms of hydrocephalus, from the turgescence
of the vessels, without any effusion into the ventricles
In typhus fever, in dysentery and in
other bowel complaints of children it is not uncommon 
for children to die with symptoms of hydrocephalus


It is a good symptom in hydro. to have a 
discharge from the [sch??der???] membrane


170
Diagnosis “In its early stage, this disease is scarcely 
to be distinguished from remitting fever When 
from the anxiety of relatives & of the physician, a
diagnosis is eagerly desired, the following circumstances
may perhaps assist in forming a judgment
If there is occasional vomiting, with febricula
the tongue at the same time remaining [illegible], there is
reason to apprehend that the primary irritation has
its seat in the brain and that it will prove a fatal
case of hydrocephalus. But if along with the fever 
and vomiting the tongue is covered with a thick
yellow fur, we may hope that the complaint is confined
to the digestive organs and that the disease is
nothing more than coler or remittent fever.”
Ed.reviewer
Diagnostic symptoms between idiopathic
arachnitis or cerebral fever, and infantile remittent
or fever from intestinal irritation choler
In cerebral fever the abdomen is
flattened, not tumefied but in intestinal fever it 
is tumefied. In idiopathic cerebral fever 
the secretions of saliva and that form the schneideran membrane are diminished. Unless complicated with aff. of muc. m. which is rare. In cerebral
fever the tip and edges of the tongue are red 
In intestinal covered with a thick fur. In cerebral
fever the pain in the head is severe and excruciating; 
in fever from intestinal irritation it is obtuse.


# the sides of the head, back of the head on 
the forehead
Perhaps a constant rolling of the head & 
movement of an arm & leg are among the most important
symptoms
Different opinion ben entertained
about the nature of the disease Some 
have been so anxious about determining the exact
nosological nature of it disease as to refrain
from prescribing until the first stage has gone
by. Prescribe for the symptoms at all events
and make up your mind about the nature of the
affection as fast as you can. Too much discrimination 
cannot be exercised & cultivated yet where 
we cannot determine the exact nature of the disease
we had better treat the existing symptoms & the obvious 
indications
# It varies in scrofulous constit. there is 
no such state It may approximate in some cases
And I might cite the opinion of 20 others
The [illegible] it is sometimes entonic & sometimes 
tonic. It more frequently [illegible] determined 
Why shd not fevers terminate in the brain as well as [illegible]


171
In intestinal fever the patient more frequently directs 
his hand to the nose & about the face in cerebral puts his hand to his head # 
In cerebral affections the head is hotter than the abdomen;
but if the disease originates from the bowels
the abdomen is the hottest. “There in a very few cases seen
picking at the nose in cerebral fever but in general the rule
holds good” “The state of the bowels is not pathognomic”
Dr Beddoes thinks the disease belongs to 
inflammations & that at an early period he should be
inclined to bleed as largely as in pneumonia #
Dr Withering observes “in a great many 
cases if not in all, congestion or slight inflammation are
the precursors of aqueous accumulation
Dr Rush thinks that instead of being 
considered an idiopathic dropsy, it should be regarded 
only as an affect of primary inflammation or congestion
of the brain
“Dr Rush says” It appears that the disease in its first
stage is the effect of causes which produce a less degree of 
that inflammation which constitutes phrenitis & that its
second stage is a less degree of that effusion which produces
serous apoplexy of the brain
Dr Darwin supposes torpor or inactivity
of the absorbent vessels of the brain to be the cause of 
H. internus
Dr Whytt in his treatise on the disease
observes that this and every kind of dropsy depends
upon the fact that more fluids are thrown out by the exhalants
than [illegible] the absorbents take up



I chiefly depend upon calomel for a cure if it cause
too much evacuation check it with opium
There is no evacuation from the brain therefore
the disease must be overcome by altering the secretions
counterirritation etc.
Bleeding with leeches from the temples
seems to translate to the surface and give relief vide
John Hunter.
Case young man apparently as
desperate a cure as ever I saw not scrofulous we
concluded to try tart. emet. gave it without
much weight in about 8 or 16 hours he complained
of violent pain ion the bowels and all the
symptoms of the head were relieved
[illegible] “Irritant to the schneiderian
membrane in the last stages are recommended
by Dr Malachi Foote of N. Y. in the Med. Rep. 
for about 1810. Turpenth min. 1 gr. with liquorice 20 grs 
[apreynum] [myrici] ipecac etc. are the best [stermentatories]” 



172
Treatment Evacuants Bleeding general & local
cathartics calomel and jalap gamboge
Counterirritation local bleeding cupping epispastics
behind the ears and to the whole surface of the head
Salivation should be induced but cal. often
relieves without altering the secretions
There has been a difference of opinion as to 
the application of epispastics to the head. If venesection 
be indicated they should not be applied until after 
bleeding. I prefer cupping and blisters to the back
of the neck and behind the ears
I think some advantage may be derived from applying
to the spine ol. orig. ol. capsc. etc.
Where considerable entonic action has existed 
I have cured this disease by giving tartar emetic until 
colic was produced. give perhaps a grain 
& continue its exhibition until the symptoms abate #
“gr doses every 2 or 3 hours”
Sneiderian membrane dry snuff
malachi root Irritants applied to the schneiderian
membrane have cured the disease in its last stages
Rx 1 part turpenth mineral & 10 parts powdered liquorice 
for a [ster??tatory]
Green tea is sometimes given



In the progress of the bowel complaints of
children the sinuses may become enlarged & a determination 
of blood [illegible] to the brain and 
produce symptoms of hydr. I have known
pat. apparently die of hyd. & yet upon dissection
no water be found in the [ventricles] in this
case some say that the water was absorbed in death 
this is entirely improbably. Certainly many of
the symptoms of hydr may be prod. by other
causes e.g. excessive doses of narcotics is stramonium
belladonna
It shd be remarked that many 
cases supposed to terminate in hydr. in cases
of [termination] in volvulus
“All the diseases of children are peculiarly 
liable to terminate in hydrocephalus. Hence
the importance of caution on the part of the 
physician. He should examine all the symptoms to check
the first beginning of determination of diseases
action to the head V.S. keep the bowels open 
blisters behind the ears cupping leeches”


173
Hydrocephalus from bowel complaints
If in the progress of any of the bowel complaints of children
morbid action should be determined to the brain, Epispastics
should be applied behind the ears and irritants to the feet
Cathartics are useful to obviate this determination. #
In some cases perhaps the determination 
[marise] from nervous irritation. In such cases the 
tepid bath gives relief “Strong green tea” Some
physicians of respectability have in formed one that they have used digitalis
in hydrocephalus with very good success. I have not used
it myself but should consider more adapted for that
form of the disease which arises from irritation, than 
any other
Hydrocephalus from disease of hip joint.
Child of Ezra Hotchkiss child of Horace Edwards.
“I have known hyd. alternate with disease of hip 
joint Case Narcotics etc. till suppuration”
Afterwards died of hydrocephalus
# I have cured a patient by giving him calomel and lemon 
juice in sufficient quantity to move the bowels. It increases the
secretions and improves the tone of the bowels


“I have seen a case in which the child
fell 8 or 10 feet upon a pavement & broke his skull
like a squash shell yet he recovered in 2 weeks and
did well. When the fracture is so extensive there is 
less danger of compression of the brain” The same case?
Hyd. from injury by a fall is not common 
in young children the sutures are not firmly 
closed (the bones are softer & more yielding)(
# He had other severe wounds as a compd
fract. of the radius yet he never suffered 
his head


174
When the disease is produced by violence
Depressions of the cranium in children
from blows or falls are not of course fatal though dangerous. A child
four months old fell head foremost upon the hearth striking
upon the vertex. The head was much flattened & the
parietal bones bulged out on each side. The child did 
not suffer much from the injury. The bowels were kept open 
by mild mercurial purgatives. In these the head assumed
very nearly its natural shape. A boy of eight years fell 
six or eight feet and struck his head against a stone
A depression of the cranium was made larger than the bowl
of a spoon. He suffered very little inconvenience from 
the injury #
There is less danger when the skull is so 
much fractured as not to cause pressure upon the brain 
If a child has received a fall we may apprehend
danger from the following circumstances. If the
fall has been upon the occiput the brain is more commonly 
injured than if the face is upon the os frontis. If the child
vomits after the fall and is very sleepy there is danger that
the brain will suffer.
Treatment If the child vomits or is
comatose after the fall upon the head and there is no
wound that bleeds the patient should lose blood and
take a dose of calomel, one or both according to the urgency
of the symptoms & the death of the patient. All the exciting causes of fever should
be avoided and the patient kept as quiet as maybe.
The symptoms should be carefully watched and if at
anytime there should appear to be a tendency to an affectation 


# for local bleeding is as important a general
bleeding
“[illegible] all causes of irritation, as light noise
heat, food. Keep the pat. perfectly quiet”
“Apply an epispastic behind the ear, or
better upon the injured part.” “Blisters are very 
useful” “Use counterirritation & the tepid bath”
# In torpor of the br. [illegible] al. can excite the latter
may excite the former and excessive action in 
the former may be translated by it act on the 
latter “Give strong cath. cal. gamboge jalap etc.”
“Afterwards give cal. in small doses as an
alterative If it causes too much evacuation check
it with opium”
“In N. Haven we have followed 
Abernethy’s plan of treating infl. of brain for 
40 years”



175
of the brain the patient ought to be bled & leeches or cupped. #
The bowels should be opened with calomel and small doses
of the same remedy frequently given as an alterative
After depletion epispastics may be applied behind the
ears and upon the part of the head where the injury 
was received. 
There is no outlet to the brain & 
consequently more evacuants are needed than in most diseases 
Frequent cathartics are useful as evacuants and 
also to translate action from the brain # 
When effusion has taken place the 
case is probably always fatal Yet I have had 
a pat. with dil. of pupils, who cont. so & paralytic
for months & finally recover
Vide p. 200


The treatment consists of local applications
A variety are used One of the best is [illegible] zii alc. zi
An equally good or a better application is seneka oil but the
smell is disagreeable. Cold water is applied but
though it relieves the pain and the insupportable itching
it is doubtful whether it is of any permanent benefit
Basilicon [illegible] [illegible]
absorbents to ulcers


176
Chilblains Pernio
This is a local affection to which children and old people
are most subject. Some are much more liable than
others. [illegible] [illegible] more liable. The parts affected are the toes heels fingers, hands
face, ears and with ladies who wear short sleeves
in winter. It is caused by exposure to extreme cold & to cold & damp air
& on the feet, more especially by walking through 
melting snow. It is most common in the early part of winter
This affection should be prevented by avoiding
an exposure of the parts to the air, by keeping the hands
warm with soft leather gloves & by keeping the feet warm 
with stockings and shoes
The skin of the part affected becomes tumefied
and hard & of a deep purple colour, there is a 
pungent pain in the part accompanied with an insupportable
itching; & these are often so great as to prevent the patient from 
sleeping. If the disease advances, the cuticle breaks and
discharges a thin fluid. Sometimes a deep ulcer is formed
The treatment for the first stage should consist
of stimulating application as if for a burn. I prefer oil of origanum
alcohol & seneca oil are good applications. Spirits of 
turpentine will ordinarily do well, though in some idiosyncrasies
it acts as a poison. Cologne water may be 
applied or alcohol two parts with one of ol. orig. #
For the ulcers you may use the oxygenated
ointment ointment of red precip. citrine oint.
# or apply a plaister Dyachylon or Noel’s 


Not being able to have any fire on board
for some days
[illegible] to pain of a neuralgic kind as [illegible] were a toothache
One of the best applications is a cataplasm of stramonium
seeds give internally opium narcotics & 
stimulants
Apply [illegible] & narcotics
Followed by no infl. to supp. etc.



177
Painful affection from cold
We sometimes meet with a painful affection of the feet 
without discoloration, or any other visible mark, which 
has been brought on by long exposure to cold without
freezing. Sailors coming upon our coast from the I. in winter, from 
a warmer climate are liable to it.  The affection may 
be a very painful one and give great uneasiness both
night and day
It is relieved by the external application 
of stramonium & epispastics or rubefacients, and fomentations
Cathartics and opium may also be given internally.
Singular effect of cold in Wm Daggett 


Burns are dangerous in proportion to their extent
[illegible] young physicians are called to prescribe for
burns it is important for them to treat them in the best manner
About 30 years ago a great controversy existed in England
between those who advocated [stimulating]
In recent cases stimulating or exciting applications are 
the best provided the burn is not very deep. About 30 years since 
spts turp. were much used. It in some case and these are 
not very rare
Case myself [water] boiled over into my shoe
I immediately poured spts tupr upon the stocking then 
took off the stocking applied a cloth dipped in spts turp. put
on a dry stock. & boot rode out of town and suffered My father
was a man of florid complex. & thin skin He was burned in n
a similar manner
Ol. orig.
Linseed oil is smooth mixed with limewater
alcohol or proof spts good when the skin is [illegible] off
Others use camphor Others stramonium in ointment contain
what [illegible] when the article s off
Carrot poultices etc. exclude the air
Cotton does well except when the cuticle is off if it is
used then you had better smear it with oil


178
Burns
This subject belongs more particularly to surgery, yet as
burns occur most frequently among children, and you may 
be suddenly called in on such an occasion, when it is important
that a remedy be speedily applied. I have thought
proper to make some remarks on the subject.
For the treatment of burns very different 
modes have been recommended. A long controversy was
carried on in one of the English journals with respect to the
phlogistic or antiphlogistic treatment, one party being in 
favour of cold applications in cold water and the other of
stimulating ones as spirits of turpentine The truth seems
to be that in adults where the injury is not extensive and
the powers of life are strong cold applications do well, but 
they are dangerous for children especially if the injury is extensive.
Burns upon the abdomen will not admit
of cold application even in adults
It is necessary that reaction take place
If there be no reaction of the system, no pain, no inflammation
the child dies. The cause of its death is the irritation of 
the nervous system, extended to the stomach, & hence
the death is preceded by cold extremities and vomiting
Where cold application are proper such
applications may be made as scraped potatoes, cloths
wrung out in cold water etc. But if it is necessary 
to produce reaction and inflammatory action stimulating
remedies must be used. And we know from 
experience that these remedies do effect a speedier cure 




Cold applications may do well if immediately
e.g. dip a burnt arm immediately into cold
water. But stim. app. are better. I have tried
both. Cold applic. very dang. in extensive burns
of children Case scarped potatoes no infl. livid
appearance of the burn extrem. cold [illegible] death
In such cases apply stim. app. & give ether, elix.
[illegible] etc. etc. In these cases the child dies of irritation
not infl. It seems to be necessary for a regular [course]
of continuity of action in infl. & suppuration
The best and mildest application as has
been proved by experience is petroleum or seneca oil
In one case I tried the experiment of applying seneca
oil upon one hand & ol. orig. upon another (both being known
alike) one hand was easy the whole night the other painful 
(the burn was a very extensive from the clothes taking fire)
In the suppurating stage use 1 part seneca oil
& 3 parts cerate
These cases are very troublesome to treat
In the above case the system was exhausted by the extensive
suppuration the bowels had to be kept open & 
large quantities of opium to be given. I gave columbo
bark and various tonics and aromatics
Turner’s cerate is a good application
chalk may be sprinkled over it
In the progress of the suppuration a pale
flabby fungus almost like a blister and is difficult to 
manage I have applied a sol. nit. sil. also nit.
sil. & laudanum [illegible] cop. sometimes after these
I have succeeded with ac. op. in ointment green basilicon
i.e. verdigris ground fine & mixed with basilicon
But if you apply only applications after these caustics 


179
The reason is that we apply to the part a stimulus
less powerful than that which produced the injury
and thus render the diminution of the excessive excitement
gradual. On this principle holding the injured part near the
fire is beneficial
Another important indication in the treatment
of burns is to exclude the irritation of the external
air Hence the popularity of some applications as cotton.
sweet oil etc.
1st Of stimulating applications. Spirits of turpentine
will answer for a robust and healthy person but not
for a slender & feeble one; and it must be remembered
that from a peculiar idiosyncracy it is a poison to some 
persons. In general spirits of turpentine is liable
to cause irritation and may be suspended by better 
articles. Being burnt myself a complete cure was effected
without the least appearance of inflammation, by this article
but in the case of my father such violent irritation was
produced as to oblige him to desist from applying it
A common remedy in this town is the oil
of the origanum majorarum called burn oil
mix ol. orig. zii with ol. oliv. zi or mix it with
alcohol or cerate. Cloths may be dipped in the diluted oil
and kept constantly applied
Of late years I have used seneca oil
and prefer it to either of the two already mentioned. In 
several cases I have tried both this and the ol orig. & 
found that the seneca oil relieved more speedily & 
with less irritation. I usually apply the seneca oil & 



the fungus [illegible] Apply rather chalk or fine alabaster
or scorched flour
The sooner you apply stim. appl. the
better ol. turp. produces [illegible] etc. seneca oil
does not
Case a woman thief etc. etc.
we rolled immediately in the snow was thrown by it into a state
of syncope life almost extinguished was burnt universally 
except on the legs covered by the stockings was wrapped
in sheets dipped in a mixture of ol. orig. & 
spirits


180
then cover the part with cotton to exclude the air. I let them
remain till suppuration takes place, particularly if the skin
is broken. When suppuration takes place, apply a poultice
to the loose dressings and then apply simple cerate
or a cerate made by melting together beeswax and lard
and stirring in seneca oil while the mixture is cooling 
This last is an admirable application for burns Dr
[Mons??] said he knew none so wild. It protects the raw 
surface from the cold air and keeps in the animal heat
In the latter stages of the cure, the oxygenated ointment will 
be a soothing application
A popular remedy is stramonium, used
in the form of a plaister of the seeds or leaves. It answers 
well and I have known no ill consequences to happen from 
its use though it is said that in extensive burns it is dangerous
Cotton is a popular application, used by itself
For slight burns it will answer but if they are so
extensive that suppuration is to take place, it should
not be applied in this way
Other remedies that are useful upon the
principle of excluding the air, are the oils as sweet oil & 
lamp oil. Linseed oil mixed with one third part lime
water, is especially recommended
When suppuration takes place and 
the cicatrices do not form well, oily application should 
be laid aside and if there is considerable discharge
apply absorbents, as plaister of paris, chalk & chalk & cerate
i.e. apply chalk first & cover with cerate.


Note from Dr Woodward of Wethersfield extracted
from Dr A. Talcotts notes “Apply immediately spts turpentine
to the inflamed parts and cerate of limewater & 
linseed oil equal parts on cotton to the vesications
2nd If pain & irritation ointment of stramonium
3d To prevent fungus Rx white lead a teaspoonful
lard 2 tablespnfl. ft. ung. Orgrate or
chalk and apply simple cerate over it.
I have seen a metastasis at the end of a week to the bowels
with diarrhoea & tumefaction or the bronchia with 
croup Treat with opium & bark Dr S. B. Woodward”
N. B. I extracted this principally on account
of the definite direction about the difficult treatment
required according on the burned part is vesicated or
not a point on which the above notes of DR Ives
do not seem to be sufficiently precise


181
Should there be a fetid discharge from the burn, it may be
remedied by pulverised charcoal. Sometimes the ulcers are 
very difficult to heal and repeatedly break out afresh
A fungus may arise upon the part if so it should be touched
with caustic. The eager of the ulcers may be touched
with sulph. copper or nit. sil. chalk then applied
and the whole covered with cerate.
If the burn is on parts liable to unite in 
healing, as between the fingers and toes, care should be
taken to prevent the union. A bad cicatrix is often
formed which it is difficult to prevent or cure.
Internal Treat When the constitution has received a severe 
shock and the extremities become cold and the powers
of life being to fail, the system must be supported by 
stimulants & cordials & the excessive irritation relieved 
by opiates. Laudanum ammonia, spirits, alcohol
ether are all good. To a child from 5 to 10 years 
old 15 drops of laudanum may be given; warm-applications
may be made & warm aromatics drinks as ginger tea & 
mint water administered. Elixir paregoric is one
of the best preparations of opium in such cases
In a case in which a large quantity of
sulphuric acid had been drunk by a boy who immediately
afterward, ran to a brook
and drank of the water. I merely give mild mucilaginous 
drinks & the patient being of a strong constitution
recovered





182
Croup from p. 138
In what may seem to be the second type of patient
may go off suddenly. If he throw his head back
in order to enlarge the chest it is a bad sign
I have found the treat. by tart. ant. so 
infallible in the first stage & in general so useful that I have not been tempted
to desert it. If I am called rather late and
find ext. ant. acting locally upon the stomach, I seldom
succeed in curing the patient.
Other emetics may be used when the excitability is worm out for [illegible]
Calomel is proper in the latter stages, [illegible]
the disease is partly broke up by antimony
If the first stage is not interrupted
[illegible] the child may be playful between the paroxysms 
and though the pulse is not affected, yet the second will 
surely come on
In the second stage bleeding is to be first 
resorted to in order to prepare for emetics bleed even to fainting
conjoining the warm bath for the same etc.
Exciting and irritability [illegible] in this 
second stage do mischief. I have seen sanguinaria do much
mischief. Even after bleeding purges is not advisable
for as has been remarked there is a constant tendency 
in the system to the return of this inflammatory symptom
Cal. may be given though if it act by 
the bowels it will be useless. I have seen bleeding and the 
vapour bath palliate the symptoms. Scarcely ever
will the patient recover



183
Croup
In the latter part of the last stage the child
throws its head back. This is a dangerous symptom.
Now the patient goes into the last or suffocating
stage. The patient lies on its back struggles
violently for breath countenance livid appears apoplectic and often goes into convulsions
and in these convulsions sometimes dies
Sometimes in this stage you may hear a
flapping of the false membrane. This is sometimes
thrown up and great relief is afforded and 
the friends think that all is over. Soon however 
in most even of those cases a membrane is formed
lower down & the patient ultimately dies
In this stage the metallic emetics
have in a few cases succeeded The sulph. 
cupri & the sulph. zinc have each
cured Cal. is recommended & may be used 
The cold both has been recommended It may be tried
as a dernier resort.
In the second stage after bleeding blisters
shd be applied over the whole neck & chest
Dr Hosack recommends bleeding from 
the back of the hand immersed in warm water
After bleeding has succeeded in 
subduing the symptoms cal. & the warm bath shd be
used


184
Croup
This disease has been divided into acute & 
chronic but without much propriety
Sometimes it continues for some time. I have
known one case which continued 3 or 4 weeks
In some seasons a different mode o f
practice is better. I have known seasons in which 
cath. & diaph. were the best treatment Although
for the first 15 years of my practice I considered nothing
more unfortunate than to find the child under the 
operation of a cathartic. In these cases, it was the
form in which the duodenum is also affected in a similar manner
Case Wallingford [emet.]
failed & cal. & diaph [illegible] Others that season 
occurred which required the same treatment
Bronchotomy has been recommended
I have seen it performed but never with success
It has sometimes succeeded But in the cases 
which I saw the membrane form lower down, and 
the patient die


186
You will see by looking into the throat
the tonsils perhaps red & the epiglottis certainly inflamed



187
Angina Laryngia
Another form of the croup has been called
angina laryngia [illegible] the croup you can see nothing
by looking into the throat In this the epiglottis & 
the [illegible] glottidis are affected From the larynx 
being affected, the actions & more spasmodic
Frequently comes on while eating
Case of my child While apparently well was taken while
eating with the peculiar croup & respiration of croup 
& became alarmed & treated
This is the form which attacks old people 
probably Geo. Wash. died of it
Case The first time I saw this disease the pat. had had pneumonia & may nearly recover when he went into the cold open air
without stockings. I was informed that he was taken
with difficult respir. & without seeing him prescribed seneka injurious ultimately refused
to swallow anything as the act brought on a spasm
I tried bleeding, blisters, vapour
& after awhile persuaded him to swallow when I gave him 4 gr. tart. ant.
in a cable spoonful of water


188
Angina Laryngea
The dis. is brought on by eating
And if you examine the throat you will see a redness
perhaps upon the tonsils, and will certainly see the
epiglottis inflamed
Bronchotomy promises more in this
form of croup
Readily distinguished for the other by 
difficult deglutition paroxysms being brought
on by an attempt to swallow
This firm 
It is not of much consequence to 
distinguish the forms except that laryngea is 
more rapid And you must avoid acrids
in this form as they irritate the fauces & produce
spasmodic action
For the spasmodic symptoms give
in the latter stages of it asafoetida which also acts upon 
the secretion tinct. ant. & opium
It must be remembered that this disease
cannot be cured by bleeding alone. It is too far out
of the circulation. But by reducing the system very 


189
Croup concluded
When croup follows other diseases it is more
rapid and dangerous they are very apt to die
particularly when following ulcerated sore throat
You may treat by emetics blisters metallic
emetics etc. but you have not so much 
strength left in the system to act upon 
In the latter stage where we wish to 
throw up the membrane the stomach may lose
its excitability to a particular emetic then you are 
to change the em. I have succeeded in throwing 
up
Upon dissection a membrane is 
found formed But sometimes it is wanting and in 
A laryngea then probably is not [time] for a 
membrane to form 
Vide p. 211
low and suspending the functions you may change the secretions 
perhaps 


190


191
Scarlet Fever
Withering in his first edition separated ulcerated sore throat
from scarlet fever. In the second he changed his opinion
Where there is much heat and fullness of the
pulse I would much prefer a strong dose of cal.
followed by antimonials [to] commencing with emetics
Or is Dr Rush & the elder DR Barton thought best turpeth
mineral
Epispastics are to be used with caution
& adopted this rule viz to apply them where there
is much tumefaction [illegible] & enlargement approaching the
quinsy. Scarlet fever after resembling quinsy and
is with difficulty distinguished except from the previous
affections of the family and neighborhood
Mineral acids have been considered
specifics Chlorine was much used in this town
in [1801] etc. as a fumigator. You may give it internally 
with advantage
A great variety of gargles are
used generally stimulating ones are better as those
of capsicum (with salt say in cider water)
In some cases capsicum does not do well
If the patient is too weak to gargle use a syringe


192
Scarlet Fever
Chlorate of potash was used with advantage
to quiet the stomach. It allayed irritation etc.
Ammonia and amm. with camphor
& gum arabic
In the progress of the disease mineral emetics, 
as sulphate zinc will be useful to excite the system 
acting speedily they do not exhaust sul. zinc 5 to 20 grs 
mosely’s solution was the form most used
Sulph. copper 2 to 5 gr. also as an emetic
Acetate of copper was formerly kept as a nostrum in 
some families ½ to 1 t. sp. of sat. sol. of common verdigris
2 to 3 gr.
In some cases and seasons cath. are
required. I have treated children without a
single cath & yet in the same family I have given ant.
followed by cal. & worked off by salts and senna
If a diarrhoea occurs early it must
be attended to white decoction



193
Scarlet Fever
Dr With. lays great [illegible] upon diuretics
particularly senega giving it throughout the 
disease. In moderate fevers diuretics eliminate morbid action will
Serpentaria may be given freely throughout 
the disease adding bark alcohol ether 
or wine Diuretics & diaphoretics
Irritable state of the stomach is to be
counteracted by irritants by aromatics white decoction
etc. etc. a little alcohol upon the fauces voiding a great
bulk of liquid
Case of a boy in delirium his father 
was forcing down articles which he was puking up 
I put into his mouth spoon dipped in brandy 20 or 30 drops his eyes opened immediately 
said it was good continued it in tspfl doses through the night
saved his life
Scarlet fever occasionally passed by insensible
gradations into quinsy and is of an inflammatory 
character. No one character will distinguish them
No one mode of practice will answer in all 
cases though if any indiscriminate mode of practice is
to be followed that by emetics and stimulants will be best
In many cases no evacuations at all are to be
used if this you must judge by the symptoms
In the same family I have lately treated one or two patients
with antimonial and nitre and another who had been
worn down by fatigue and watching with feeble pulses vomiting
coldness etc. was treated by external heat, brandy in moderate


194
Scarlet Fever
quantities, counterirritants spiced tea etc. to stop the vomiting #
(One of the best articles in fevers of a low grade
is spiced tea or hot spiced wine or brandy. The strength is apt
to give out first, and an excitement kept up in the mucous
membrane of the stomach will have a beneficial effect)
# The first patients in this family I had evacuated freely
both by vom.  & purging etc. while this patient had no evacuation 
goodness & was supported throughout the whole progress 
of the disease
After I had seen the disease in 3 or 4 epidemics
I thought I had seen the disease in all its forms but I
found oftenwards that I met with different forms still 
Not only different epidemics differ, but different cases during
the same epidemic may require widely different treatment 
In the malignant epidemic of ’94 I was informed by some
physicians that they met with cases in which there was increased 
action though the many cases of the epidemic ran rapidly in the [illegible] gangrenous
state
In 1803 we generally gave emetics
It is said that in the malignant form the eruption 
is a bad symptom. I do not think so. I think it better
for a general eruption to come out the action is less unequal than 
if a scanty or no eruption appears
I hesitated in 1803 much about the application 
of blisters & I finally found that the rule was a safe and
beneficial one to apply them where there was swelling
of the tonsils
In this epidemic I gave bark, the mineral
acids, alcohol, wine, and (for the first time) tinct. canth
Tinct. cant. [illegible] zi to pt. give 20 gtts once in 2 hours ½ as much to a child


195
In many cases [illegible] requires to be qualified & corrected
by serpentaria or carb. amm. If wine injures
the stomach and [illegible] too locally continue carb. amm.
which will render it diffusible with white vinegar
will have somewhat of an effervescing mixture Use also
effervescing mixtures, as soda water, with brandy
or ether, or aromatics tincture. It is no objection that
you thus combine stimulants and refrigerants, for you 
thus get diffusible action and obviate unequal excitement.
The min. acids may be given in form of 
punch The sugar will be grateful & useful
A diarrhoea is apt to take place in the 
commencement of the disease. Use white decoction 
laudanum & injections of starch & laudanum RX
starch 3 bal. sp. SS. 30 gtts to 2 t.sp.
Pay great attention to cleanliness of the 
patient
Where there is fainting apply ammonia and ether 
& spirits at the nostrils keep them applied to the nostrils
to prevent fainting, I have never known any injury 
done by over excitement by these articles thus applied
Capsicum is used in tropical [illegible]
in very strong decoction. Salts and vinegar has been 
much used as an antiseptic gargle?
For the diarrhoea use tonics, bark,
contrayerva has been though valuable. Avoid injuring
the stomach by distention


196
A variety of garbles (or injections by a small syringe) are
used. [illegible] rosemary has been thought a specific & carried
hundreds of miles into the country Use others when pat. is disgusted
with one # 
Sulph. cop. ac. cop. nit. sil. ([touched])
apply these with a swab
What is called the leathery inflammation 
is sometimes met with. in which the skin dies at first and
afterwards comes off & then a discharge follows. This affection
sometimes extends down the throat. In such cases
apply blisters to the sternum Touch the part with
nit. sil. in such cases. IN one of these the blister on the
sternum produced an ulcer which was 3 mo. in healing
and in another though the affection with throat was relieved
the ulcer for the blister destroyed the little patient
# [illegible] oak bark etc. pomegranate combine brandy 
aromatics etc.
It might to be remembered that in the
latter stages of ulcerated sore throat where there is an
accumulation of [many] a phagedenic ulcer, 
emetics of sulph. zinc give tone
and excite action also when
Acetate copper in the latter stages
used in an emetic as a tonic or locally
applied as a caustic
When the stomach fails in the latter
stages we give capsicum in pill or strong 
infusion (2 tab. sp. to the pt makes a strong infusion give 
to an adult a tablespoonful also acrid oils
There seems to be an erythematic infl. of the mucous


197
membrane of the stomach hence acrids are indicated to excite action
Bark jacket also it seems to 
have some effect
In the latter stages also a cath. will
frequently be beneficial an accumulation
of feces may exist given mild cath. as castor
oil or perhaps a dose of cal. an
emetic also may be needed
One thing to be guarded against
in young children is the supervention of dropsy
In 1803 I had 3 cases all the writers
considered the disease as one of weak [illegible]
action and requiring tonics bark etc. Not
successful Bark does not generally do well when there
is unequal action
I have known in such cases the brain
& nervous system apparently much affected I have
given in such cases digitalis and cantharides to
produce as new excitement and ally this irritation in 
the nervous system
Case related patient very low from a disease digitalis
was given and elaterium being advised was given
when the patient died upon the second evacuation
In general treat these cases with diuretics 
a moderate use of cath. narcotics & remedies
etc. Digitalis is the best narcotic but be cautious 
giving it to children
In ordinary cases of such dropsy 
a cath. will remove it and frictions & exercise 
in the open air. Various articles are popular as ol. [mor]


[199]
[illegible] ol. gaultheria various irritants etc. and to 
encourage the attendants to persevere in rubbing
you may suffer friction to be made with these mere
dry friction though probably just as good does
not seem to them like giving medicine
Various astringents may be 


200
Hydrocephalus
The management of the pat. is equally important with
the medication avoiding in proper diet alternatives
of temperature, and all debilitating irritating and exciting
agents all the exciting causes of disaster. Sometimes
a patient may (after a fall perhaps) continue one
two or 3 years not entirely [illegible] and yet not quite sick
and finally die of eff. of the brain
Sometimes in strumous habits canth. internally 
may be advantageous
Blisters translate action 
The applications of remedies to the 
Schneiderian has been thoroughly treated by Dr Malachi
[Foot] in the N.Y. Rep. about 20 years ago.
The subject has not bee sufficiently attended to Give in 
the way turpenth wine (mixed with liquorice) verat.
vir. apreyn. [illegible] myrica cerifera etc.
If a discharge can be excited relief is afforded
Salivation can rarely be produced in children
In some cases where there is paralysis
the acrids and some of the narcotics as strychnos
Blisters are applied by some to extreme
parts of the body I sometimes change the place of
the blister to the back of the neck etc. But the back of 



201
ears is more efficacious. It seems to have a grater
affect upon the constitution to excite a discharge from 
this part
If the symptoms indicate bleeding
bleed leech also. If there is much infl. about the
mouth scarify the gums as a depleting measure
“In grade of action the fever of hydroceph
may vary from high entonic inflammation or phrenitis
to low strumous fever. If the action is too high or too
low counterirritation will fall in with the morbid
action We must first bring it to the “blistering point” 
(Rush)
“Blisters to the head are thought by some to be 
dangerous and the ears or neck preferred”
“In irritable cases and scrofulous habits, strong
cathartics are hurtful. Give blue pill especially when 
the bowels are primarily affected. But in entonic
phrenetic fever, use the drastic cath. & tart. ant.
ut supra after depletion”
“Scrophulous predisposed mesenteria
glands generally affected the fever analogous to hectic
never entonic pulse soft, frequent, quick I have
tinct. cantharides with advantage in this variety”




[204]
Volvulus continued from p. 89:a:1/2
“Cases I was called to a child 2 years old which 
had symptoms of irritation and was obstinately constipated
It had been carried on the belly upon the shoulders
of another person Gave a cathartic Ordered an
injection but the attendant said it would not [illegible]
The cathartic was thrown up patient died
Upon examination after death no color could be
found. In the upper [illegible] rectum there was a tumor
which seemed of solid flesh as large as the doubled fist
inflamed. The color had been completely removed from 
its place”
“I was called to another family 
where the children had died when 5 or 6 months old as was supposed
of an affection of the brain. This child appeared well when born
but was very costive etc. Upon p.m. [illegible] 2 inches of the
small intestine were found contracted
to the size of a goose quill the coats were thickened & 
the course the cavity must have been extremely small This
contraction undoubtedly existed at birth. This contracted
part was received into the part below it, and no
[illegible] could have availed”
from p. 99 ½ “In another family they 
had lost all their children at about such an age. They 
supposed the disease to be hydrocephalus. The older physicians
called it so. I told them I could not tell what 
the disease was but it was not hydrocephalus I had
then seen no case of volvulus. There were strong 


205
marks of irritation the face was pale and much distress
was depicted with countenance the head was rolled
back and hands tossed violently. There was vomiting and
tenesmus and a discharge of mucus streaked with blood
Cathartics had been given under the impression that the disease 
was an affection of the head The cathartics aggravated the
disease which ran a rapid course and the child
died. The small intestine was found received into itself
and its cavity obliterated. This obliteration of the cavity
would not of itself cause death; for a patient may 
continue several days with perfect torpor of the bowel.
It is the irritation as in cholera morbus which is the
immediate cause of death which [illegible] death usually 
occurs within 24 or 36 hours”
“Called to a child one year old
constant vomiting stool, mucus streaked with blood
Directed mucilaginous injections & fomentations combined with opium
Gave opium freely internally 10-15 minims to allay 
vomiting. The symptoms subsided gradually & in 
3 or 4 days the feces passed off without any cathartic”
“Was called to an Academical student
had given cathartics and they did no good. Called
in older physicians. They were in doubt respecting the
case and advised not to do any thing as we might do
hurt. As I was sitting by his side I heard a motion 
in his bowels. I noticed that it passed down to a certain 
point and then stopped. Upon examination I could 
distinctly feel the involution. I tried injections and 
some [illegible] of them would stay. Ordered a spermacetic
candle with opium upon its extremity to be passed up 
the rectum and allowed to remain. It was s


206
passed in to the length of 10 inches. The opium allayed irritation
and the application by repetition replaced the part & the 
patient recovered another case cured
by a bougie”
“Opium by taking off the spasm and
restoring the natural function of the bowels may be
said to act as a cathartic just as in spasmodic
colic”
From p. 56 “I have given when I 
could obtain it, the [resin] of Mandrake podophyllum peltatum It operates
kindly, and more certainly than any other article. If
the western gentlemen who have so much mandrake
and whiskey, would furnish a supply. I think it [will]
supersede every other article”
“If there is torpor & a stuffing or infarction 
of the bowels we must use injections to assist
cathartics repeating them every 2 or 3 hours. If other
cathartics do not operate give castor oil which will 
promote their operation”
“The particular kind of injection 
is not important and may be left to parents
Thoroughwort, camomile, mayweed 
catnip, dandelion, weak soap suds salt
& water a tablespoonful to ½ pint water


207
Continued from p. 57 “The stools resemble
meconium. In the progress of the disease they exhibit
small pieces of a membrane of a dark green colours,
about the size of the petals of peach blossoms 
floating in a dark green fluid. The membrane of 
coagulable lymph, resembles that formed in angina
trachealis and sometimes as in that disease
it is formed in such quantities as to cause obstructions 
Still in this case it may not destroy life
the action of this part not being so immediately
essential to life. Stools of this kind sometimes
attend the bilious colic of adults. They are an
indication that farther evacuation is needed
Continue the 
calomel or combine it with magnesia or soluble
tartar, or phosphate of soda or other neutral salts


208
Infantile remittent continued from p. 60
“Cases A child had violent fever gave calomel & cathartics
warm bath symptoms abated. In 2 or 3 weeks the
regular symptoms of hydrocephalus appeared; & the patient
seised in the greatest danger. In a short time these
symptoms were relieved by a violent and dangerous
attack of thrush The patient was very much exhausted
lay several days very low gradually emerged and 
after a long course recovered.
“Case of a small little boy
5 or 6 years of age After 5 or 6 days head affected
& became maniacal very irritable and cross swore
profanely would bite and strike all who came 
near him. If any thing was attempted to be administered
he would shut his mouth. If his mouth was pried
open he would close his throat with his tongue Advised 
his parents not to trouble him nor notice him to pass by 
him with drink roasted apples etc. but not to offer
him any thing. The first day to he took nothing second
day took roasted apples etc. readily but ate too 
much mania returned, but soon went off & 
patient recovered” 
“In one case the pat. took 
nothing for a length of time. Recovered by use of 
[even ato] & external applications as aloetic plaisters
to the bowels etc.”



Scrofula continued from p. 163.
“Scrofulous swellings are very difficult to excite
to suppuration I have however then poulticed without
effect for 2 or 4 months Of late I have disused poultices
& have applied blisters as soon as may be to excite invigorate the
absorbents and act as discutients. They do not disturb the
system. If there is suppuration the relaxed state
requires stimulating applications lunar caustic vegetable
astringents etc.”
“Case of a young act 18 with bad cough
swelled neck scrofulous temperament Gave laxatives
blue pill afterwards rub & spec. Then gave decoction 
of [cistus] [canadensis] for several weeks and pat. recovered
“ A physician (Smith) on Long Island (from an
old recipe) has acquired reputation by the use of cistus
canadensis combined with uva ursi at the same time
enjoining a strict & spare diet as in dyspepsia”
“I have given with cist. canat. 1/8 gr. corr.
sub. & also decoct. scroph. maril. which is thought 
by the vulgar to be a specific It has been sold as a nostrum
to facilitate parturition called nerve root.) I
think it useful in scrofula”
“I have known the comptonia [illegible] folia
given internally. It is tonic & has balsamic rpoperties”



“The remedies particularly indicated are tonics & 
deobstruents such as will not produce congestion 
such as uva ursi cistus scrophuloria contrayerva 
agrimonia (entire plant or root angostura etc.”
Sea bathing is recommended, but if the
lungs are affected, it will not be advantageous. A 
sea voyage to the eastward has been of service the constant
motion of the vessel stimulating all the vital organs
to healthy action The change of air is beneficial & at a
distance from the shore there is no danger of taking cold
In chronic complaints attended with a want of vital
energy I direct a voyage to the east rather than to the
south



Croup continued from p. 189
“Vapour bath Inhalation of warm water in 
a [pour] blow a current of air through hot water upon the pate & 
by means of a coffee pot with two spouts”
“Tobacco or snuff applied to the patient”
“Croup is an epidemic disease & of course it will vary 
at the different periods of its appearance We must take
into account the prevailing diathesis I have described the
disease as it has usually occurred in my practice”
“The proxim. cause of the dis. is a
peculiar morbid action translated to the traches for
the disease arises from general causes acting on the system. 
In catarrh diseased action is seated primarily 
with mucous membrane.
The exciting causes of croup act on 
the surface and with different diathesis the same
crises might produce pneumonia, dysentery enteritis
or cephalitis “Disease determines to the weaker part
as the rod attracts lightning” Rush Water & snow
cold damp air a [illegible] & low situation sudden 
changes as when the wind blows from Canada or the
gulf stream are the exciting causes



“In the treatment sanguinaria, if given early in strong
decoction very freely, so that enough of it shall be
given & still it vomits or relieves the symptoms, in very 
efficient practice adopted by Drs Jared Potter & 
Kirtland
“But if inflammation has taken place
& the second stage has arrived seneca and sanguinaria
are both too stimulating and I have seen them do hurt
sanguinaria is less stimulating than seneka
For p. 137 “Some authors state that the 
disease is entirely inflammatory not regarding
the forming stage. If the forming stage is wanting
we must rely solely on the antiphlogistic treatment”
“This disease has a direct tender eye to death 
The physician must take it out of the hands of nature”
“When croup supervenes upon catarrh as it
frequently does of late year the mucous secretion and expectoration
usually cease suddenly
“When croup follows diseases that prostrate
the system powerfully as angina maligna, there 
is little chance for recovery. The sympathies of the
system are broken down and Archimedes can find
no fulcrum for his lever”



“I used tart. ant. at the commencement of 
my practice and succeeded with it as well as I
could wish I therefore contained it, but only in
the early stages & to produce a powerful orgasm. If it
acts upon the stomach only it aggravates the disease
Other practitioners rely upon different
articles & probably with equal success bearing in 
mind however that a powerful impression must be
made Decoct. sang. to prostration & vomiting
seneca or lobelia inflam with the same view”
“Sulph. copper & zinc & acetate
copper useful to assist in the latter stages or when 
other emetics are worn our. So also hives syrup 
which is much used at the south.”
“For six or 8 years past croup has been 
occasionally different from the pure inflammatory.
It affects the lungs and duodenum& calomel and cathartics
are the remedies to overcome this form. The cough is more
frequent and loose the paroxysms less distinct there
is pain in the epigastrium vomiting & a membrane
is formed in the duodenum which passes off.
I have called it angina duodenitis.
The same year ulcerated sore throat came on with it
the slough leathery & like a burn it seems to 
be intermediate between A. tonsillaris & A. maligna


The application of lunar caustic by a pencil or brush would
prevent croup Blisters to the throat & chin were
useful yet a blister would produce the same action as
existed in the throat, forming an ulcer very difficult 
to heal Slough ¼ in. deep 3 mo. in healing. In 
one case the blister cured the croup and the ulcer
killed the patient It is desirable to translate
action to parts less essential to life. Cal. & carth.
would translate it to the duodenum Emetics & 
powerful treatment do hurt here. The vapour
bark is good.
“Croup sometimes recurs several nights in 
succession A. Laryngea is more apt to do so”
“When crop assumes a chronic form
emetics irritate inhalation of vapour blisters
opium diaphoretics & expectorants”
“In chronic croup the inflammation 
in erythematic and not membranific. The 
vapour bark often does wonders Tartrate of 
sanguinaria in ¼ gr. doses Tinct. hyoscyamus
gtts x
N.B. Dr Woodwd treat of subacute ([S?bertonic]) & typhoid croup the latter contraindicating
tart. em. & requiring sanguin. turp. mer. calom. etc. & sometimes
capsicum, ammonia & even perhaps wine & alcohol.




“One of the most extraordinary examples
on record however of the effect of disease in 
developing of perceiving a certain class of relations
is that of [Zerab] Colburn His history 
is well known When quite a child in his sixth
year, without any previous instruction, he
could by mere intuition perceive the relations 
of numbers with so much readiness and
precision, as to solve almost without reflection
questions in arithmetic which would
require a long calculation to enable others 
to answer. How he obtained this result
he could not tell. The answer seemed to 
present itself to his mind with the same
readiness and conviction of its truth, that
the proposition tow and two make four
does to us. These facts I saw are well
known, but it is not so well known, that
this power was the effect of disease. That
such was the case I have very little doubt
This was the opinion of a very distinguished
physician who saw him at the time, and
who ascertained that he was then affected with 
a peculiar nervous disease the same
(chorea) which Jane had a few years 
since. In conversing with Mr Colburn 


about a year ago I asked him if he
retained the power of calculation which 
he possessed in his childhood. He said
no, and attributed the loss to the want
of its exercise. But why should exercise
sustain a faculty in existence which 
was spontaneously developed?”
“Account of Jane C. Rider the
Springfield somnambulist; by S 
W Belden MD. Springfield 1834”
p. 108
“The discovery of Zerah’s power 
of calculation was purely accidental 
Zerah not having yet completed his 
sixth year was overheard by his father, as
he repeated to himself in his play, parts
of the multiplication table. The father
surprised proceeded to examine him & 
[found] etc.


























































1 Diseases of children




[B illegible 31]
Proposed plan
name – history symptoms & causes
[Regar] plan of treatment minutely described
Other modes of treatment
Miscellaneous remedies
N.B. Collect all his remarks on 
art of practising medicine


Contents page
Introduction
Tumour of the head from difficult parturition 5
Cutting the frenum linguae 5
Congenital hydrocele 5
Management of children – as to 
Particular appetites – Preventive medicine 5
General nature of the diseases of children 6
General operation of remedies in children
Diseases within the month
Retention of the meconium 8
Jaundice 11
Acidity, Flatulence, Hiccough etc. 12
mothers milk & cows milk 12
Costiveness & its consequences 12:a
Vomiting 12:d
Diarrhoea 12:f
Prolapsus ani 12:l.
Aphthae 13
Eruptions in general 19
Strophilus interlinctus or Red gum 19
Strophilus candidus 21
Crusta Sactea 22



Eruptions of Dentition 24
Eruption resembling the itch 24
Venereal Eruptions 25
Infantile Erysipelas (Rose rash) 27
Sore ears (Intertrigo) 30
Tinea capitis 
[???phlicus]- [illegible] [illegible] on [illegible] [1821-2] 32
Dentition 34
Cholera Infantum 40
Infantile Remittent 55
Mesenteric Fever 61
Tympanitis 66
Worms 69
Volvulus 86
Nervous Rheumatism Infantile [remedy] 89:a.
Convulsions 90
Epilepsy 96
Catalepsy 99
Chorea 100
Ulcerated mouth 103:a.
Gangrene of the mouth 104
Parotitis or mumps 112
Tonsillitis or Quinsy 115
Rosalia or Scarlet fever 120


Croup or Bronchitis 132
Laryngitis 139
Epidemic catarrh resembling croup 141
Whooping cough or Pertussis 144
Rickets 158
Scrofula 162
Mesenteric fever
Hydrocephalus 164
Chilblains 176
Painful aff. from cold without
discoloration 177
Burns 177
The cause either is to be found in [???uctural] [illegible] for the 
[illegible] This will [illegible] men to trust their lives to 
unknown men, or to fictitious names in the newspapers, where
they would not trust property even to a small amount
# Formerly prescription of an experienced physician
very often set aside for that of the nurse or a 
negro woman


1
Diseases of children
1  In this part of our course I direct your attention 
to the history of man in relation to his habits, diseases, & their
remedies in his infant state
That this subject has occupied the attention of the 
learned less than any other branch of the medical
profession, is universally acknowledged
2 – It is unnecessary for me to enforce
the importance of the subject, by any remarks which 
might be made concerning the evil to society from 
a neglect of a part of the practice in which the community 
is so deeply interested
3 – I need but advert to the evils which must
result from the practice of committing the
management of the diseases of infants to a class in society
which is the lowest in point of intelligence
6* [the opinion of the nurse is sometimes taken 
in opposition to that of the physician – On this subject
the world seems to desert its principles of reasoning
on other subjects. If a point of law is to be decided men 
will not trust to a petty of the court, in 
preference to that of an experienced
If a text of scripture is to be explained, men 
apply to a learned divine in preference to the mere
servant of the church & on the subject of wearing apparel
it prefers the opinion of the master to that of the 
apprentice.]



4 – That this subject has occupied the attention of
the learned less than any other branch of our profession 
is universally acknowledged. (The French & Germans
however, have neglected it less than the English;
and the American physicians have been in the 
habit of paying more attention to diseases of children
than the Europeans)
8 Great attention has been paid to diseases of children
within the last 30 or 40 years
It has been most neglected in Europe, but less by 
the French & Germans than by the English
17 European practice differs from ours – but less so 
at present than formerly because the constitution 
of our countrymen are coming to resemble those
of Europeans
12 It is also the case that European diseases differ from ours on account 
Disease, here is [illegible] more violent owing probably to the greater
of climate etc. Angina [Trachealis] is much 
milder with them & requires much milder treatment
# vicissitudes of the weather



2
5 - The causes which have excluded physicians
from the treatment of [infantile] diseases infants, having ceased to exist
the subject is now receiving the attention which its
importance demands
6 – These causes may be enumerated in few
words – viz. the exclusion of the faculty from the
practice of midwifery – from the difficulty of
obtaining correct ideas upon the subject from its
obscurity – the prejudices of the public on this subject – 
attributing as they do intuitive skill to nurses 
and matrons * vid. page [illegible] & perhaps also the indifference
of the profession
7 – At the present period, however, the enlightened
physician watches the mother during the
whole period of gestation, receives the child upon its 
first introduction to the light, & prescribes for its
diseases from infancy to old age
9 – As knowledge however must on this subject, as
on every other, be progressive, it follows that this
part of the profession having but recently received 
the attention of physicians, has not attained
the perfection of the other branches
10 – American physicians need American treatises on this as on other medical subjectds
13 – European practice, as exhibited in 
their works, is too slow and mild to meet and
overcome the morbid excitement of acute diseases in 
our climate. [Chronic diseases may be treated 



They practice no deceit


3
with mild remedies, but acute diseases are made
worse by remedies if those remedies are not sufficient
to overcome the disease The action 
of the remedy falls in with the diseased action
and aggravates all the symptoms if it is not 
powerful enough to overcome the diseased action
IN such cases disease is to be taken out of the 
hands of nature. The powerful [enemy] is not to
be irritated unless there is a prospect of overcoming 
him]
14 – The difficulty of acquiring a knowledge
of the seat of the diseases of children, on account 
of their being unable to communicate their
sensations by language, has been made an excuse
by some physicians for neglecting the
subject of infantile diseases We may 
remark however that the difficulty of attaining a correct 
knowledge of a subject, cannot be given
as a reason why it should not be committed to 
men of intellect & science
15 – Though children cannot communicate their
sensations by language, yet the other symptoms by 
which we determine the seat of their diseases are more uniform
in their appearance & more certain in their indications than 
those of adults
16 Children are under no restraint from feeling
fear, [delicacy] or from false modesty In the infant, the 


mind does not react upon the stomach & destroy 
its function 
When Dr Harris published his essay on the
acute diseases of children Sydenham said to him
“you are the first man I ever envied and it is
my firm belief that your little book will be more
useful to mankind than 
# Adult patients also will often deny the existence of
dangerous symptoms; for fear they shall be considered as
very sick
The subject has not yet been thoroughly 
investigated. No regular course on it has been [illegible] until 
quite recently in [illegible] of the European schools. I recollect
the embarrassment under which I laboured under
at the commencement of my practice Cases frequently 
occurred which were not described in any of the books [&]
I was obliged to acquire all my knowledge on the subject from 
older physicians or from experience. My students have often
expressed to me the satisfaction they experience from an examination 
of my notes and they have often quieted the anxieties
of parents by reading extracts from them
# In my embarrassment upon being first called to a sick child
though familiar with the treatment of adults & having attended the first schools in the country I found my information 
& in books as to [illegible] nature or treatment and was
obliged to have recourse to the older physicians
29 [Dewers] is popular addressed to mothers, very prolix
& not intended for a text book but perhaps able [work] & is the
30 [illegible]
# Parents think a young physician will do well enough for a young 
children and are much more apt to call one in for such patients


4
mind does not react upon the stomach & destroy
its function We are at no loss how much to attribute to disease & how much to [illegible] #
17 – Still with all these advantages & notwithstanding the importance of the subject
it has been neglected & has received less attention than any other branch
18 – When Dr Harris published his essay on the 
acute diseases of children Sydenham said to him, you 
are the first man I ever envied, and it is my firm belief
that your little book will be more useful to mankind
all I have written” This opinion was not founded
upon the merits of the book but upon the fact that the attention 
of physicians would be drawn to this part of their
profession, not the least useful though the most neglected
25 Authors on this subject & their merits
26 Underwood 
Still the department has received less attention than
any other branches of our profession
27 Dr Rush in his works, has many remarks
28 Periodicals contain more or less upon the subject
21 – No courses in any of the schools
19 – Some physicians of the first respectability have acknowledged
their ignorance & given up to nurses
20 – I recollect the embarrassment I suffered upon 
this subject # It is a common complaint
22 Since I have lectured upon this subject, our students
at parting have expressed their satisfaction.
23 Young physicians are first called to children
because the older ones neglect them # hence its importance to them
24 Parents however seem, as a matter of fact, to prefer
a young physician, for a young patient! #



34 – I shall first remark upon a few surgical cases 
which occur to the young physician soon after the birth 
of the child
[illegible] cutting the frenum. I have never seen a case in which this operation 
was necessary. It is very common for nurses to insist that 
children are tongue tied. Dr [Eneas Munser] was called in such 
circumstances he remonstrated the nurse was instant until 
finally he drew the back of a knife across the frenum & the child
he told [illegible] [illegible] hurting and this with this [result]
was relieved to the great satisfaction of the nurse. If there is
a false frenum it may be divided.” this [illegible] [frenum] is never 
so short as to confine the tongue & cutting it is a dangerous operation
# They will tell you that this particular appetite is indicated
by the natural crying of the child
The mother will set herself to recollect some former
longing of her own
[illegible] 6 Hydrocele
Young physicians are often called on to prescribe for congenital 
hydrocele in young children The complaint is apt to excite alarm but
neither troublesome nor dangerous. It is readily distinguished from [illegible]
by its transparency, insensibility, & not yielding to pressure. In the course 
of my practice I have had to operate in but one case in children. Dr [Dewers] recommends
pouring considerable quantities of cold water on the part. I myself
have frequently cured it by washing the part with cold water in the morning
and applying camphorated spts in the course of the day. You [illegible]
direct the application of spirt & water, camphorated spirits, [muria??]
of ammonia, [opium], spirits of nitre, in short every discutient
Or you may direct astringent lotion, as a strong decoction of
maple bark, spriaea Fomentosa Geranum, Rhei etc.
Case in which I had to operate year old  probably neglected 2 or 3 inches long 
about as large as a small egg. Operate without a cannula  - with a lancet & catheter
& injecting syringe – water 1/6 or 1/8 port wine – children more irritable - vomiting



5
Tumor on the head
35 Children are sometimes born with a tumour
on the head occasioned by difficult labour
This may be distinguished from a tumor caused by 
a deficiency in the bones of the cranium, by a uniform 
hardness. “We may apply mur. amm. or spt & water”
36 – Cutting the Frenum
37. Hydrocele
31 Management
Appetites 32 A prejudice prevails in some classes of society 
with respect to a point in the management of children
Some children are thought to be born with a strong
appetite for some particular kind of food, which 
was possessed by the mother previous to the birth of the
child & inherited from her. It is thought that the child will [pine] & ultimately 
die, if this [illegible] appetite be not gratified #
It is probable that a belief in this doctrine has caused
many children to be killed by the administration 
of improper food A fact of this kind occurred
in Humphreysville, which nearly proved fatal to 
the child. Vide next page
Preventive
medicine 33 As a general rule medicine is not to 
be given to children in health for fear they should be 
sick. Some are nursed to death, while some die for want
of nursing. Some are fed to death while others are starved
Some are physicked to death while others die for
want of medication
injection immediately with [draw] healed [illegible] with swelling


The child cried much # - a council of females was
called who set themselves to make out what the
child needed Finally the 
mince pie was concluded to be
the article the child sucked down the inside & the 
report was that this effected a cure & saved the life of
the infant. Prof. I inquired of the attending physician who 
informed him that the child was indeed alive and well at
present but that it was made very 8ll by the mince pie
& came near losing its life. The crying of the child in 
this case was probably nothing more than a trifling increase
of the ordinary crying of very young infants, which 
is a natural and wholesome exercise # 
The al. can is large in proportion to the [illegible] of the whole 
system
# The above is a good example of the various prejudices
which have prevailed among [nurses] respecting the management
of children. Owing to the influence of enlightened physicians 
these are no disappearing. (examples to be given)


6
38 – Diseases requiring medical treatment
General considerations
39 – In investigating the causes and seat of the
diseases in infants the mucous membranes claim
particular attention
40 The action of this membrane is greater in 
the infant than in the adult constitution
Its secretions are often morbidly increased & are sometimes
diminished. It is subject to spasmodic action 
and to inflammation [illegible] with [illegible] or decomposed with effusion of 
coagulable lymph. “It is subject to turpidity & to
spasmodic action which by sympathy extend to the whole system 
41 The liver is much larger in proportion to the body the infants than in adults “& its secretions are much of [illegible] as to quality & quantity than in adults”
42 The secretions are much concerned in 
their diseases. They are changed as to quantity 
and quality
# Prescott child no ducts lived 3 or 4 
months and was excessively emaciated – there was no bile
in the stools There was no [previous] duct for the gall bladder
into the disorder



# There is greater susceptibility to action & tendency
to conversion
# Just as emetics are given to a stomach [complaint]
from excessive quantity of food


7
42 The nervous system of infants is more easily excited,
and more affected by the various causes of irritation
such as dentition worms acrid substances in the 
first primae via passages etc.
43 – The blood vessels are more rarely the seat o f
disease in infants than in adults – particularly, primarily 
so much as irritative
[acid] if they were affected the action is not [illegible]
44 – Consequently their fevers are fevers of irritation, rarely 
enteric or those of inflammation 
45 Operation of medicines
Children bear evacuation better than adults
witness the long continued diarrhoea without much 
debility following, or the salivation for mouths during 
dentition without a waste of vital energy
In operating upon the abdominal viscera it should be [illegible] it is
not for the purpose of mere evacuation, it is to produce
an excitement for the purpose of overcoming a morbid
excitement also to produce healthy excitement a case of 
torpor # The milder purgatives should be used, the
drastic being irritative.
Emetics
Bleeding
Do not bear narcotics vide p. 11


2 – In general the evacuation of the meconium should be
effected by the [colostrium] or first milk of the mother
which has a laxative property # The child should be
put to the breast within 2 or 3 hours from birth # unless [illegible]
Instead of suffering the nurse to feed the child for the
first 2 or 3 days the breast should soon be presented
for if the child feeds it is in danger of losing the 
instinct to suck If the [colostrium] does not bring
away the meconium we may begin with soda as
mentioned below or with cold sweetened water 
Some give a little cold water at first vide [infra]
5 – In strong children cold bathing may be employed
with advantage, but the bath should be made
tepid for weak ones & gradually used colder as the 
child can bear it
# “If from the exhaustion of parturition the mother be unable
to suckle let the nurse commence feeding at the end of 3 hours” vide infra
Give a grain of carborate of soda in a teaspoonful
of water until iii qts [have] given
# The meconium is frequently evacuated during parturition.
After birth also the al. canal is set in notion by the crying
and mother of the child and the stimulus of the
air upon it vide p. 10 skin. # Colostrium is of a yellowish colour
probably contains bile & is cathartic
# It was formerly supposed that the child
should not suck at first. The consequence often was
that the child lost the interest to suck



8
Retention of Meconium
1 – The first diseases of infants which claim the attention 
of the physician are those which arise from retention of the 
meconium. The meconium is a matter always existing
in the bowels at birth & having a dark green colour
when evacuated. It resembles tea but is more mucilaginous # 
It will ordinarily be sufficient to give a little molasses 
and water to the child until it receives the [illegible] or first
milk from the mother which has a laxative quality 
6 – If it is suffered to remain a train of diseases may 
follow. In the diseases which occur within the 
first moth after birth the retention of the meconium 
is always to be suspected as the cause
7 – The diseases caused by retention of the meconium 
are Severe paroxysms of pain in the bowels
indicated by crying & writhing – Tumefaction of the
bowels. Convulsions. Epileptic fits. Trismus
nascertium or Locked Jaw This last disease is
very common in some of the West Indian islands, but
I have never seen it in this place
8 – Whatever disease may arise from 
retention of the meconium the principal indication 
will be to remove the irritation by evacuating the 
bowels. This is effected by cathartics. A teaspoonful
of castor oil is generally sufficient. If [illegible] necessary


1st indic to remove meconium
2nd obviate effects
# IT will be sufficient to pour on boiling water instead of boiling
the materials in the water The strength however is of little consequence
Sometimes the most powerful remedies are to 
be used beginning with mild. These used
full doses of calomel, scammony 2 to 4 yrs – [illegible]
assisted by injection, & warm bath until the bowels
were moved Wait how long for the operation of each?
# By emollient injection, irritation is allayed, and if the
lower part of the bowels is excited the rest will be
Dose 2 to 6 pills each pill containing 1 gr. of 
(calomel)
# Chalk & calomel is a substitute for blue pill – perhaps
the chalk qualifies the cal & at least it
corrects acidity
Antimony should scarcely ever given to children
within the mouth
# A great part of the calomel has no effect
[illegible] it does not come in contact with the coats 
covered with mucus In cases where there was great
quantities of [mucus] I have given full doses of cal.


9
the dose may be repeated every 4th or 5 hours 
until half an ounce has been given
8 – If the oil is rejected from the stomach Senna & Manna 
may be given – zi of the former to zss of the latter
boiled in gill of water # & administered freely until 
the bowels are moved once in ¼ or ½ hour
“ Rx Sennae zi [illegible] ferv. 1 gill 1 or 2 teaspf every ½ hour”
9 – The operation of the cathartic
should be assisted by emollient injection #
10 – Fomentations to the bowels will assist the 
operation of cathartics & if spasms exist, will always
be needed for their relief
11 Cathartics of various kinds
12 The best cathartic which I have used
for infants within the first month after birth is the blue
pill (or [mellated] pill It rarely offends the stomach
and never produces griping By it the action of the 
liver & the secretions from the mucous membrane
of the intestines are excited more than by any other
cathartic except perhaps calomel. In my 
practice I have never known an infant salivated
by it. # 
13 In severe cases where the blue
pill is insufficient we must have recourse to 
calomel, which may be given in doses of from two 
to 10 grains. It is often necessary to give as large 
doses of calomel to children as to adults owing to the 
great quantity of mucus in the intestines by which 
they are defended from its action. # The meconium 


scammony or jalap as a laxative & had them
operate mildly If the cots were [naked] [illegible]
a dose would prove fatal for irritation
# This is a mild cathartic and supposed to act chemically.
# “Evaporate the [illegible] over the fire stirring it until 
thick then add chalk till it is of a consistence suitable
for pilling Each pill may contain 1 or 2 gr. of
Dose from 2 to 5 gr. Or it may be dissolved in herb
Fish, gall has been recommended [illegible] gall 
Rattlesnake has been thought to have specific
properties especially in fevers. This article
is bitter, tonic [illegible], laxative, & [illegible]
Continued from page 8
“The infant may be put to the
breast in one or tow hours from birth This course will 
produce permanent contraction of the [uterus] & tend to stop [hemorrhage]
& prevent milk fever” When an infant is first
born it is well to wet its mouth with half a teaspoonful
of coldwater and give it nothing else until it is applied
to the breat


10
while retained will likewise prevent the operation 
of the remedy by involving it in its viscid substance
14 Chalk & calomel may be used in doses
of 1 gr. cal. to 4 or 5 chalk repeated once in 2 or 3 
hours
15 Other cathartics which may be used are
or as recommended by Dewers
1 gr. carb. sod. to a teaspoonful of water repeated every 
“it operates”
15 minutes until 10 gr have been given. # Decoction 
of the flowers of the dandelion & the mullein 
Senna 2 dr. to with 4 dr. of aromatic herbs or seeds 
The bile of animals (ox gall) is a good cathartic
Perhaps we may consider it as acting as a substitute
for the childs own bile. It may be given in 
[catnap] tea milk etc. # 16 An injection of bitter or 
16 aromatic herbs will allways assist the operation of 
whatever cathartic you use & in mild cases frequently will be 
sufficient of themselves – superceding the necessity
of giving anything by the mouth
Continued from p. 8 The stimulus of sound upon 
the child, crying, irritation of the air upon the
skin, and especially muscular motion, excites the peristaltic motion 
of the child. The influence of muscular motion upon the
peristaltic action of the bowels, is considerable, as is seen in horses
while travelling, the costiveness of sedentary persons etc.


“The warm bath at the temperature of 98 or 100 assists the 
operation of cathartics renders their action more mild 
equalises the action of the system and nervous irritation
It is especially useful when convulsions are present and may 
be used at any period except in cases of extreme exhaustion”
# It is the most powerful antispasmodic for children
[have] acting upon the extremities of so many nerves
Jaundice
“Jaundice sometimes appears at birth indicated
by the yellow colour of the countenance and arising from obstruction
of the liver etc. Such cases are generally incurable.
The first remedies are the mild deobstructant 
plant, small doses of calomel etc.”



11
When convulsions are present the warm bath should
be used to assist the operation of whatever cathartic
is used, to render the operation mor mild, to equalise 
excitement and to remove irritation. This remedy
may be safely used at any period after birth #
After the cause which excited the convulsions has been
removed, if the morbid irritation of the
nerves continues, the bath will again be serviceable
18 Antispasmodics may likewise be used
such as valerian, aqua ammoniae, elix. asth.
artificial musk infusions of catnip etc.
We may use aqua amm. 3 or 4 drops
or carb. amm 3 or 4 gr.
or asafoetida a teaspoonful of the tinct.
in milk & water, or camphor by enema
Be [cautious] of giving narcotics to children
Some are more susceptible than others. And some children
are accustomed to [them] from birth. Case of 
a mother who had inured a child of 3 m. to bear
30 dr. of SS. I proposed to give paregoric, beginning
with 8 or 10 drops, and found that the child had often
taken with impunity 31 dr. of SS. to produce sleep



4 – “Child bed women are generally to be treated with 
mild diet for the first week after delivery, unless their
strength has been much reduced by parturition, when 
they may take port wine in moderate doses”
# “If light stools indicate a deficiency of bile the administration 
of oxgall will be found very serviceable 
vide [illegible]
If acidity is produced, add limewater, 
If diarrhoea is produced, use arrow root
instead of the water, or any other [fecula]
Children are apt to receive too much food; hence cow’s
milk should be diluted with water. Milk may sometimes coagulate
in the stomach of children, in large quantities and occasion much
uneasiness Meat should not be given under 6 mo. unless in 
particular cases which are exceptions to the general rule, where
milk disagrees or perhaps in the case of some scrofulous children


12
Acidity Flatulence Hiccough
1 – Very young children are often troubled with 
acidity, flatulence & hiccough These affections 
may be removed by a free use of magnesia, lime
water, or aqua ammoniae
2 – It will not always be sufficient safe? to 
administer these articles to the child alone. The 
mother or nurse must often take them likewise
3 – Sometimes the mothers milk disagrees
with the child. This will be known by the constant
disorder of the bowels of the child. by the evacuation 
and pain suffering after nursing both child
and [illegible] mother may seem to suffer without a cause
The stools may be slimy# The child may cry obstinately
5 – If the mother’s milk continues to 
disagree we may use cow’s milk diluted with one
third or one half water & “sweetened” or with arrow root mixed
first with a table spoonful of cold & then with one of hot
water, in order to make a homogeneous mixture 
6 – Children fed on cow’s milk are more apt 
to be costive. To prevent this give a little magnesia, decoct.
of dandelion etc. Peach tree blossoms are much 
used, but are too violent in their operation 


The injection will start the machine again 
The injection may be made of Eupatorium, catnep,
elderflowers mallows etc. etc.
Apply first whatever can be first prepared
counterirritants for instance. Spirit or 
mustard to the fat ammonia etc. ammonia to the mouth
and nostrils etc. endeavouring to rouse the patient
4 – [A young physician should be careful to know what to do in 
sudden cases (much depends on a favorable impression 
at first) Neighbors and friends usually assemble around
a child and the expect the physician will be able to prescribe
at the moment. In such cases set some of the bystanders 
to preparing a warm or tepid bath – no matter if 
eventually if it should not be used. Set others to preparing 
some other thing and so on. Thus while the attendants are
all employed he will be able to devise some course to 
pursue] I recollect an old physician in this situation
who was pressed what to do & replied “stop 
let us think about it”


12:a.
Costiveness & its consequences
1 – Physicians are frequently called upon to prescribe for
infants who are in health except that they are costive
Children fed from a spoon or bottle are mor to be thus affected
than those who are nourished from the breast. If costiveness
is produced by improper quantity or quality of the 
food as is sometimes the case, the diet must be changed
2 – Costiveness if not attended to in time produces
flatulence, watchfulness, startings, hiccough, diarrhoea
vomiting & convulsions
3 – A physician is frequently called to children
I fits, who have been apparently well until the convulsions
come on The safest and most efficacious prescription 
that can be made, is an injection & indeed is 
all the treatment that most cases will require. Let
a warm bath be immediately prepared & the patient put in 
it if the enema does not relieve. While the convulsions
continue the mouth is closed & we can operate on the system
mainly by the rectum & the skin
5 Be careful to make your directions for administering an
enema very definite, unless you know that the family are 
familiar with injections Case of a mason’s man hands & 
knees shooting somewhat off fright rolling over murder
The enema may consist of simple warm water, or milk 
& water, or of tea of thoroughwort or catnep etc. a table 
spoonful of salt may be added finally castor or other
oils may be thrown up in extreme cases the rectum has been filled with lard The water for the tepid 





12:b.
bath should be about blood warm. Be careful 
to bathe the child, & not merely to scatter or sprinkle
water on it. The length of time during which the child
may be kept in the bath may be from 5 to 20 min.
While the patient is in the bath if it is
sufficiently relieved to be capable of swallowing give a 
dose of calomel for a child of 6 months 6, 8 or even
10 gr. If improper food is the cause 20 gr. are not 
dangerous, for infants will bear full doses of cathartics
though very small ones of narcotics
In bad cases of convulsions the means to which 
we have it in our power to resort, are external irritants
such as garlic draughts to the feet, injections of [nervines]
the most powerful of which will be a teaspoonful 
of tinct. camphor thrown up in a gill of milk & water & the
warm bath until we can administer articles by the
mouth
“If the child be feeble & exhausted upon coming 
out of the bath give cordials or tonics”
Any quantity of food in the stomach & bowels
which is not congenial, interrupts the process of digestion 
& the peristaltic motion functions whose importance is 
second on ly to that of respiration. When these functions 
are interrupted the muscles are brought into convulsive 
action to relieve the system



Be particular in your enquiries about food for those who 
have the care of children are very careless and children
will swallow whatever is put into the mouth. I recollect
being called to see a very strange worm which a child 
had voided. The imagination of the attending physician 
& parent were excited. To me whose imagination was
cooler the worm appeared to be a piece of bark I enquired
if the child had had no slippery elm bark & found that it
had been chewing some. Then the supposed worm was accounted for
Rye flour is more apt to become acid than 
oatmeal
# Cal. sometimes by its irritation produces convulsions I have
known a family, all the children of which were thrown into convulsion 
by cal. & I was obliged to be very cautious & use blue pill injections etc.
There are several milk remedies such as dandelion
which is tonic laxative, & deobstrument acting on the 
liver, mullein fl. elder [blo??] tea
“The pollens of most plants has a laxative quality”
I have seen no danger from the prussic acid of the
[illegible] flower & it is much used [illegible] from [illegible]
also among the French they hold a place the French Pharm.
Wild liquorice [gal??] [Circa???] resemble
the dandelion
Moderate friction excites the bowels
Sometimes alkalie or chalk, though generally they are
rather constipating, prove laxative probably on account
of the acid combining


12:c.
II II Where is a tendency to costiveness, the use of oatmeal gruel
or porridge will be beneficial or a porridge made of wheat
flour with the bran, strained through a cloth & mixed with 
the milk with which the child is fed also rye meal gruel or 
rye bran gruel
If the health is not affected by the constipation 
be cautious about giving much medicine. It is always better
to cure this affection by food than by medicine. #
Castor oil from a teaspoonful to a table spoonful
is the best cathartic magnesia given with the milk is a good
remedy but not always sufficient. Elixir salutis is one of the 
most common family medicines. This article with castile soap
dissolved in it has been found very serviceable. The gall of 
animals may be recommended. The blue pill operates gently 
as a cathartic & is useful in changing the habitual disposition 
to costiveness. I have prescribed with advantage decoction 
of the flowers of the dandelion, or mullein. The flowers of the 
peach tree are much used for the same purpose but
“are rather too powerful for ordinary cases” “They are powerful even for adults”
& sometimes gripe unless combined with aromatics
Calomel may be used with safety # “In severe cases
mustard and ginger may be applied to the abdomen”
Mechanical manes in the form of suppositories 
are much used by nurses such as a piece of molasses 
candy or a roll of paper moistened with oil. They are
beneficial.
# If the child has been weaned pay particular 
attention to its food. Nurses are very careless.



# “No serious evil will arise unless young & anxious
mothers should give medicines and thus make the
child sick”
“If vomiting arises from dentition we must
remove the irritation Give laxatives, as magnesia, & 
narcotic
Children should be early accustomed to the reception of 
enemata to prevent subsequent prejudices upon the subject.
I recollect the case of a child about 12 who was suffering
from an obstinate constipation caused by an affection of
the lower spinal nerves which produced a partial paralysis 
of the rectum and bladder so that a catheter had to be introduced
& injections were [illegible] demanded. But all the
efforts of the nurses (women) were unable to administer an 
enema Calomel had been given until the mouth was affected, yet
without producing an evacuation. Finally the patient went
into an insensible state, and injections were given & 
produced free evacuation. I have heard adults say they 
would die before submitting to receive an enema.



12:d.
Vomiting
Spontaneous vomiting in infants arises from over distention of the
stomach. The discharge is made without nausea & almost without
effort, & consists of pure milk or milk coagulated. The mother
should simply be cautioned not to allow the child to nurse
so long at a time. # Children and old people vomit with 
more facility than the middle aged
If vomiting arises from the sympathy of the
stomach with some other part of the system which is in a morbid
state, the primary disease must be first cured & used for the irr. of stom.
For the vomiting itself in palliative we may prescribe lime water & 
milk. a teaspoonful of each; soda water, or any 
liquid affording an abundance of carbonic acid.
Vomiting from irritability of the stomach
or free [illegible] requires particular attention. The attendant symptoms will 
be paleness of the countenance, quick & feeble pulse, & cold
extremities. Irritants must be applied over the region 
of the stomach. They may consist of ginger, mustard, horseradish 
leaves, mint etc. aqu. amm. [illegible] essent oil dissolved in alcohol” The alkalies such as pearl ash, also 
soda water “lime water” may be given internally. Excite a discharge
from the bowels by injection or a calomel cathartic to remedy the irritated action of the stomach “[illegible] counterirritation”
The warm bath will be very serviceable, soothing the nerves
of the skin & by sympathy producing the same effect upon 
those of the stomach nervines also may be given We may try putting a little brandy
into the mouth or a small quantity of capsicum tea. Hot
cloths & fomentations may also be applied externally.
A large bulk of warm water water may be thrown up the rectum
in obstinate cases, use stimulating injections..


One of the most convenient modes of administering a large
injection is by a pipe fastened to a large ox bladder
Press the fingers against the end of the pipe which 
the bladder is fastened so as to make a valve and
prevent the escape of the fluid contained in the bladder,
until after the pipe has been completely introduced
into the rectum
# I used to carry this recipe about me when I practiced in the country
Frequently irr. of stom. is overcome by irr. o f
the rectum by an enema of salt & water or by a large
injection to produce a peristaltic motion downwards


12:e.
Ren “Remove the cause, which is frequently 
indigestion. If it proceeds from the teeth, lance the gums
The following is an excellent recipe # in these cases
Rx Cret. ppt zii sem. card. zi bi carb. potas. zfs grind
aqua bullientis 0 fs Give a tablespoonful every half hour
I am inclined to the opinion that the alkalis, such 
as pearlast act by creating an excitability
Emetics are particularly safe for children
much more so than for adults. Ipecac is generally 
the best unless the disease in which the emetic is indicated
is very threatening, when antimony should be used
Squills are indicated in emetic doses in complaints of the
chest “with [illegible] [illegible] but should not be administered when there 
is much inflammatory action in the system.
“Warwick’s powder a preparation of antimony,
was once popular and often administered without 
the advice of a physician. I have known it endanger
life Nurses should never prescribe antimony”


Some situations are more liable – low situations
[seashore]
Children shut up in low dark apartments suffer
from want of amusement.
If a diarrhoea from teething is suddenly stopped
the brain is apt to be affected. This affection of the brain 
is peculiarly liable to occur in children. There is no 
outlet to the brain


12:f.
Diarrhoea
This complaint sometimes affects children for months & even
years Some families are more subject to it than others & I
have known those in which all the children would be affected 
with diarrhoea from a period soon after birth until they 
were three or foru years old. The children who have this predisposition 
to the disease are born with diseased liver and bowels
& have indeed all the chylopoietic viscera in a disordered 
condition. Hence among the causes of diarrhoea we may 
rank a bad constitution. Other causes are want of 
cleanliness, bad food “want of sufficient clothing” bad air damp rooms, confinement
& want of exercise. Exposure to cold & moisture
A bad air probably causes diarrhoea mainly by 
its depressing influence. The effect of confinement and want
of exercise is very great. Young animals suffer in the same way 
Even vegetables seem to need motion for I think I have observed
a great deficiency of fruit & a sickly appearance of 
fruit trees after a season uncommonly free from wind. Confinement
is injurious in another manner Children need
mental stimulus from a variety of external objects. I have
known surprising cures effected apparently by the operation 
of this very principle.
Teething is a frequent cause & whenever
it is we must palliate & check, but may not stop the diarrhoea
From the sudden stoppage of a diarrhoea during dentition you may 
expect an affection of the brain to follow. The discharge from the 
bowels in this case is similar to that of tears from an irritated 



This will be convenient in many cases as in travelling
Other mints may be used spearmint is most agreeable
I have given this in the latter stages of the diarrhoea of
adults with advantage
Almost any cath. will often check a diarrh. Cal or 
blue pill is generally best
Judgment is to be exercised whether to prescribe an
emetic or a cathartic & as to the choice of a catheter
Ipecac however is almost always safe children bear
emetics well
Put the parents & the nurse upon investigating as
to [diet] Persons are apt to very careless about giving
things to children And they may have wrong notions as 
to particular articles
Prohibit solid oily food, crude
vegetables and esculent roots. Potatoes are very 
bad in diarrhoea so are the analogous roots. They 
contain indeed much fecula, but also much 


12:g.
eye, or of mucus from the lungs
The expressed juice of mentha vulgaris, boiled
skimmed and mixed with white sugar is an agreeable, & useful
article for the cure of a diarrhoea, which has continued but a 
short time & is not severe.
In the early stages of a diarrhoea, which 
is sufficiently severe to demand the attention of a physician
it will generally be best to commence the treatment with a
cathartic; though if fever accompanies it an emetic of ipecacuanha 
should be the first article administered.
Judgement must be exercised in the choice of a cathartic. Calomel
will be best if the child be not particularly feeble or of a very 
delicate constitution & for a feeble child the blue poll. I myself
was for formerly many years unable to take any other cathartic than the 
blue pill without being griped. Generally it will be best to combine
chalk with the calomel, as the latter is indicated for its deobstruent, 
rather than for its purgative effect. The dose may be about
2 gr. cal. with 5 or 6 of chalk
If improper diet is the cause the food must
be changed; & it will generally be necessary to be particular in 
our enquiries with regard to the diet for the parents may 
consider many things a safe which would be strictly forbidden
by the physician. Especially will it be necessary to attend to 
the diet if the child feeds instead of sucking. Every thing 
hard of digestion, such as salted & oil food should be prohibited
The diet should be arrow root and in case of diarrhoea this 
article will be improved if prepared with a little laudanum 
or wine sago taipica, which is probably a hydrate of 



besides They are apt to become acids & acrid in 
the bowels. In the Polyn. islands The inhabitants
living upon taro are very liable to diarrh.
West of the Rocky Mts Lewis & Clark found the 
inhab. subject to diarrhoea for living on a root [illegible] [illegible] men suffered in the
same way after they arrived among them
In the evacuations & the evacuations of children shd always be exam
[may] [illegible] that potatoes remain undigested
Cullen & Rush thought different of potatoes
The evac. of chil. should always be [illegible]
Pies cakes articles containing much sugar
hot bread should be prohibited Bread shd be toasted
The juice of meat will often be beneficial
No gravy (i.e. artificial or carbonized fat with flour etc.)
Potatoe starch, pure, is perhaps not 
inferior to the tapioca etc.
Boiled flour becomes s hard as stone
almost hydrate It is an old practice It is an
excellent preparation make a porrige of it grated
Tapioca I suppose is made by sprinkling
casserva root, powdered, with water & baking it
making a preparation what appears like gum arabic. I have not 
been able to learn how it is made, but have made
it this way a similar substance of arrow root
Arrow root & the tapioca are cooked
by first dissolving them with a small quantity of cold water
& then adding hot water. In this way [illegible] are avoided


12:h.
flour or roasted or baked flour made into a
porridge with equal parts of milk and lime water. The bread
should be toasted and butter should be used very sparingly 
gravy not at all. Casserva sago etc.
An article similar to tapioca, if not the same 
may be made in the following manner. Tie up a quantity of 
wheat flour tightly in a clean cloth & boil it for 5 or 6 hours
The result will be a hard substance which is to be grated &
“[illegible] milk & water or with lime water” 
made into a porridge this will be palatable & good Rice
in gruel, or thoroughly cooked by boiling 
The worst cases of diarrhoea are attended
with feeble pulse, cold extremities, dry skin, & 
generally a rise of fever once or twice in the 24 hours. Soften
the skin by the tepid bath which is [illegible] etc. and keep up an action on it by 
flannel unless there is fever & in such cases use also absorbents freely with 
tonics & aromatics. The chalk julep or white decoction will 
be as good a preparation as any. Rx Chalk [illegible] zfs to zi pul. cinnam. to zii
zii, bum arab zi carb. potas. zi water lb I. boil ½ hour Sometimes
[illegible] a similar recipe shd be used” The Europeans add [illegible] use [illegible]”
a little laudanum may be added. Of this feed freely, giving
say a table spoonful from ½ tab sp. to I once in an hour sometimes. As a tonic the
vitriolic or tonic solution of Moseley is inferior to none in such
cases Rx zinci sulph ziii alum zi water lbi Give from 
four to twenty drops. Tonics must sometimes be combined
with absorbents
Opium is always safe in cases where the 
bowels have been thoroughly evacuated. It is generally 
better to combine it with ipecac, which will determine its
action to the skin and act as a gentle tonic & laxative


The tepid bath is [illegible] as it may be called) 
relieves the irritation of the bowels through the 
skin
Chalk does not act mechanically or chemically it
has a specific action upon the stomach as much as
bark
Make white decoction in various ways if cinnamon
offends use some other spice Sometimes add
astringents or [illegible]
Tonic sol. sulph [illegible] ziii al. zi Mosely sometimes
used al. zii In 3 or 4 gtt it is anti emetic
In larger doses it may be emetic & cathartic
This is a state of the system similar to the collapse
of cholera Asiatica It is a collapse taking place
during diarrhoea. I have found advantage from
stimulating or acrid injections as salt & water, mustard
In chronic diarrhoea opium is often
invaluable. Some families are obliged to give it 2 or
3 times a day for along time to their children until they are so 
old as not to be liable to continual diarrhoea
The stools may be green clayey from deficiency of bile sour curdled [illegible] or very
fetid, so much so as to be very offensive turning the
stomach of the attendants.


12:i.
In cases of chronic diarrhoea where there is attending it
much sensibility and irritability of the bowels opium combined
with diaphoretics cathartics or tonics is an invaluable
remedy
Sometimes violent symptoms supervene vomiting supervenes & the diarrhoea 
stops the patients hands & feet grow cold his pulse
grows small, & if the most active measures are not
take used the patient dies in 24 hours. When this change
of symptoms take place we must resort to the most
powerful means of exciting counterirritation such as application 
to the epigastrium of mustard, horse radish leaves
ol. monardae punctulae, ol. turpent. etc. Such articles 
as pimento will be grateful and stimulating given internally
We may give calomel, opium & the carbon. acid, and use 
stimulating injections. “Effervescing mixture with SS. [illegible] appt”
Particular attention should be paid to the
kind of They may be sour & curdled, or mucousy, [illegible] clay colored, water
stools for much may be learned from their inspection.
Acid is often formed in the whole alimentary canal, producing 
sour and curdled stools which will indicate lime water
or other absorbents, with aromatics. The acid may 
arise from fermentation or more probably from secretion 
Such cases I have often cured by the expressed juice of the
spear mint prepared as above mentioned & given freely.
When the stools are green white, or clayey, give
opium to allay irritation. Ipecac to equalise excitement, & 
the blue pill as a deobstruent, the latter in small doses so as 
to move the bowels, but once or twice in the 24 hours. 
Alkalis are useful as 


# Noel’s plaister was made of white lead red lead castile
soap and olive oil, boiled till the red lead was so far decomposed
by the oil that the mixture was of a cream colour It is a 
smooth plaister and is less stimulating than [illegible]
Use soft charcoal by burning cork, which is
the popular kind or cedar Dose teaspoonful
to a tablespoonful in a convenient liquid
Lime water & other alkalies may always
be given They may be mixed with the food
without [injurious] the taste
When the disease has continued long & 
patient is [illegible] phlegmatic temperament we may 
bandage the bowels, to give mechanical support 
[Opium] also will be useful applied externally in this way
Adults from the Wt. I. with chronic
diarrhoea will look like a mummy
Bog water is a very soft water & contains
carb. hyd.
Astringents [illegible] tinct. vitriol
decoct. of oak bark with milk & sugar & spice
Bandaging & plaisters Take any adhesive
plaster and mix about ½ opium Or soap and opium
Acetate of lead is not a new remedy 1 2 or 3 gr a day
1 gr at a time continued as long as the relaxed state of the bowels
continues as long as they last lead [cholic] cannot take place for 


12:j.
are also enemata formed by dissolving castile soap
in mallows or catnip tea. If there is much griping with 
tumefaction of the bowels injections of camomile tea give
great relief. In diarrhoea of this kind the following is also 
a good stimulating & correcting laxative Rx castile soap zi
elix. sal. zi dissolve & give it 3 or 4 times a day of teaspoonful or ½ teaspoonful doses.
If the stools are fetid give charcoal
internally. It will correct the fetor & it sometimes cures
the disease. For sour stools vie last paragraph of this lecture
During the long continuance of chronic
diarrhoea it will of ten be advisable to apply mechanical
support to the abdomen. We may apply a plaister of
white diachylon [illegible] plaister alone or with opium or of lead and soap & a bandage.
In chronic diarrhoea the skin becomes 
brown, of a dark & dirty appearance, & very dry and husky
If the tepid bath does not relieve this symptom, we may apply 
water from peat swamps, which contains carburetted
hydrogen. Vide Duncan’s commentaries
In the last stages of diarrhoea we must 
resort to tonic solution to astringents, absorbents & aromatics
we may also use opium with cathartics, emetics & absorbents
& If we met with a great craving for salt food it should be 
gratified. The gratification of such an appetite will prove 
a stimulus, especially to the mind & consequently the more
powerful. We meet with similar cases among adults also. Case
of a man who could retain no medicines upon his stomach & 
finally recovered upon bread & cheese, given at his request
In the latter stages also of chronic diarrhoea, acetate of lead 



the [illegible] [become] very lax and there is generally a prolapsus ani
patient being [semiphlegmatic] I saw this article
much used in this way when a young man and though expecting
bad colic no injury resulted.
Prof. Smith was very fond of chocolate [illegible]
It sometimes acts like a charm
Spiraea may be given in decoction or
extract. [illegible][illegible] is not so good being unpleasant
having a fishy taste & offending the stomach Ger. mac. & [illegible]
[arom.] are pure astringents & unobjectionable on 
this score. I have prescribed sometimes one, or another,
according to convenience of locality where I 
happened to be
The root of typh. latif. is used as food by the aborigines
European physicians give [althea] [illegible] which 
is the true marshmallows
Usually when diarrhoea has continued 
long the kidneys become affected. Mucilage will then 
prove diuretic probably by their [illegible] affect. The terebinthinates 
will then be useful. The most common practice in 
this neighborhood is a decoction of white pine bark especially 
with a little milk it is called healing to the bowels. There is
also nutriment in it for the aborigines, sometimes live on it
When mucilages to wear out we may resort to terebinth.
The species of [polygnomic] knot grass are 



12:k.
may be given internally. There will be no danger
of the production of colic, by this remedy, for the bowels are
too much relaxed.
The astringents just mentioned may be various 
We have at least fifty indigenous vegetables, which may be used
given in decoction of milk or water such as the bark of the
currant, the raspberry, the various species of oak, of viburnum
chocolate of acorns etc. white pine bark in milk etc.
the roots of the [illegible] of the [geranium] etc. The viburnum
Especially deserving of recommendation are the spiraea tomentosa
& cornus circinata. The latter of which equalises excitement
Of mucilages we may have occasion to 
use a variety for irritation for any one article may become worn out & another be more grateful
We have typha latifolia, twigs of sassafras, hibiscus, malva
bran, flax seed, slippery elm, gum arabic etc. all the mallows, all the [illegible] marshmallows hibiscus palustris
called rose of [illegible] in the gardens root is [illegible] [illegible] & sub astringent 
Sour stools Be particular in forbidding the use of animal
food. If there be want of bile, give ox gall, lactescent plants
dandelion etc. with mild mercurials; e.g. calomel 2 gr. with 
6 gr. chalk. Aromatics also may be combined. Astringents
elg. [illegible] speraea cornus & geranium do well. Also the following
Rx calc. magn. zfs rhei palm. gr. 8 acaciae zi ol. anisi gtt vi
aquae purae zi Give a teaspoonful at a dose. “once in 2 hours”
In bowel complaints with griping attended with green
or sour stools Rx magn. ust zfs pulv. rhei grs viii pulv. gum ar. zi
ess. menth pip. gtts vi water zi dose, teaspoonful Spiraea & cornus




used – they are mucilaginous sub astringent & diuretic
Articles of a stimulating kind are often needed in 
the latter stages especially erigeron canadande (colt tail) [illegible]
The bitter [illegible] which grows in similar situations (ambrosia [elatio??]
is also used as a bitter apparently nervine in diarrhoea
Roman wormwood) [Cupron] is acrid, sub astringent & diuretic much 
used in the middle states improper when there is entonic action
case of cholerine cured last summer by this garden young
man called etc. chewing the plant etc. The other species
of erigeron have similar properties espec. E. phil.
Various recipes are given for diarrhoea in 
children Ex mag. zfs rhei gr. 8 [illegible] zi ess. pep. gtts 6 gum ar. zi
The popular remedies are generally absorbent [illegible] mucilaginous
astringent etc.
Much benefit may often be derived from 
copious mucilaginous injections mutton broth is the most popular
probably other broth (fat meat) would answer still mutton 
suet is less apt to become rancid. It is thought to be 
useful also as nourishment I have not though much 
of this may of nourishing
Laudanum may be added Also
laudanum & starch injections may be advisable to check the
excess of the discharge It will generally be best to begin with 
about 10 drops of SS. though a teaspoonful may be required
vide p. 2 [illegible] 2



12:l.
Prolapsis Ani
This is a troublesome symptom which sometimes occurs in 
diarrhoea. The protruded intestine should be immediately 
replaced. Most writers recommend to do this with a 
dry cloth, but this will irritate the sphincter ani & make
it contract. The smoothest and least irritating article
within my knowledge, is the crop of a fowl, or the neck
of a bladder, turned inside out & filled with warm water # 
Afterwards we may apply astringent washes & injections
of white oak bark or other similar articles, or
of acetate of lead. The latter article may also be given 
internally in doses of from 1 to 2 grains. It will 
have a tendency to overcome the relaxation.
Astringents are multitudinous
& have had a specific [illegible], which proved to be the
bark of [?strea] virginica At another time I had a specific
sent me which proved to be viburnum sentago all
the vib. are astringent
Prolapsus ani “The part is relaxed
and passes down and is then strangulated by the sphincter. For a
permanent cure we must resort to astringents & tonics, but the
part must be [illegible] by mechanical means If 
the intestine is not replaced, [illegible] or suppuration 
will be the consequence” “Take 1 bladder, cut
off the neck, turn it inside out, fill it half full of 
warm water, and tie up the neck”


“This disease was very common at the commencement
of my practice but is now rare. The change has arisen in a great
degree from the more correct notions respecting the proper management
of the mother and child which now prevail. It is possible
however that it may appear in [epidemics] and that case we
should expect that it would appear for a time and the disappear
# It frequently follows other diseases both in children
and adults
# According to the law of contagious diseases and
that it is of no use to prevent it
# Heat is a stimulus but too much of it produces a 
debility which may be [illegible] perhaps in direct debility
“Since a free ventilation of nurseries has been practical the
disease has been rare. laying aside the use of the preparations 
of alcohol has also been beneficial.” 


13
Aphthae or Thrush
White thrush from [illegible] (to inflame)
This disease often appears within the mouth 
is then generally unaccompanied with fever. In some
cases it is idiopathic but it more generally is a 
consequence of morbid affection of the primae viae #
It is frequently found in adults of robust constitution 
which have been very much debilitated by previous that disease
infancy and old age are most subject to it & in infants,
as was just mentioned it is often an idiopathic affection
In some families every infant is several with this
affection. The vulgar error however, which very generally prevails
that all children have the thrush at some sooner or late period other #
is contradicted by the fact that many children as I have
known never have the least appearance of it 
at any time “and it may probably in all cases, be prevented”
The most feeble and delicate children are affected with the most violence, hence & from the fact of
its being an affection of old age & a frequent sequel of other disease
in adults, it may be inferred that this is a disease of 
debility & this [illegible] will be confirmed by the predisposing
causes which we find to be, confined air, a
very hot room & improper food# It is caused among
the poor by bad air & among the rich by too great warmth 
& confinement. The fever likewise which accompanies it
in many cases is of a typhoid character.
# “Caused by neglect of the nurse by want of cleanliness
& is often the effect of costiveness”


# And have been led to prescribe remedies to prevent 
the thrush
“commences on the inner part of the lower lip & corners of the
mouth & extends over the tongue & inside of the cheeks & gums
sometimes all these parts are affected & sometimes only one of
them”
“It appears in small eruptions or vesicles containing a whitish
fluid resembling a coagulum of milk these vesicles
often coalesce so as to form patches”
“extend down the oesophagus to the cardia & here in all
known cases it has stopped”
Prof. Tully has seen p.m. [illegible] which the thrush the al canal [illegible]
“The feces are sometimes covered with aphthous sloughs”
“in its severest the eruptions are of a dark brown
or deep red colour”
“The alvine discharges are very acrid”


14
Symptoms – The disease is preceded by languor and sleeping
This is so generally the case that it is common for nurses to 
say that the child is sleeping for the sore mouth
In adults I have observed the same fact, & have predicted
the appearance of thrush from the drowsiness of my patient #
The symptoms of thrush are very obvious. It commences
with white specks upon the lips #, angles of the mouth, & 
tongue effervescence. # In severe cases the specks in crease in number
and size until they cover the whole inside of the mouth
the throat & are found indeed upon the 
stomach x & throughout the whole intestinal canal
though this is disputed. One thing is certain, whether these
specks or flocculi extend throughout whole alimentary 
canal or not, viz. that they are found upon the rectum,
agreeably the law that the orifices of tubes are
most affected The white crust will 
fall off and be succeeded by one of a darker colour.
The coats of thrush are often many times renewed
& in this case the formation of a new one is preceded
by unusually protracted sleep. A typhoid fever
may accompany.
It seems to be an eruptive disease
determined [illegible] the al. canal.


“In its milder form it is confined to some particular
part of the mouth or to the mouth itself. The eruption is
white & the mouth appears “as if a stratum of coagulated
milk were spread over it” & but one separation of
the curd like crust will take place. The general health
will be but little disturbed”
“In severer cases two or three successive crop
are formed & the habit being unhealthy, the food innutrient,
& the frame weak and atrophous, the under [surface] ulcerates
and spreads & a low typhoid fever ensues”
# “Your principal object should be to produce an
excitement in the bowels by some mild medicine”
# Because it is an eruptive disease however diaphoretic
seen to be indicated & those which [illegible]
action “The treatment is ordinarily a gentle laxative
but there is a choice in the kind of laxative. Some practitioners 
recommend oily medicines, as butter, goose oil, pigs foot oil
etc. But these articles do mischief As the vital powers of the stomach 
are weak, these oils will become rancid”
# In such circumstances the oils become rancid & 
consequently irritate. I never allow oils to be
given, yet it is a common practice to swab the
mouth with oils, especially goose oil (or [illegible]?)
# Chalk shd generally be preferred the other articles
dissolve more slowly & may act in part
mechanically”


15
It is thought that this disease has often
been prevented, by giving soon after birth a teaspoonful
of cold water & repeating the remedy every
morning, for some time taking care also that the bowels
be kept open There may be some foundation for
this belief inasmuch as the disease is brought on 
by heat and debility. “In families where the children
have uniformly been subject to this disease. I have recommended
cold water as directed that the room should be well ventilated
and the child not covered with too much clothing”
In mild cases & where the constitution 
of the child is robust, a gentle laxative will be sufficient
to remove the complaint # 
Castor oil is very often prescribed for it
& it may be proper to five it to assist the operation 
of other cathartics But there are several objections to 
this article. It does not affect the secretions so much 
as other cathartics. It does not evacuate the contents of
the bowels so thoroughly as others & it tends to 
# relax the coasts of the intestines, already in a state of 
morbid relaxation “It will not remove the mucus of the intestines”
For mild cases magnesia is the best laxative 
where it can be given in sufficient quantities. If the
bowels should not need a cathartic chalk or some one
of the other testacious powders may be given “as [illegible]
oyster shells, crabs eyes, crabs claws etc.” #
Because it is an eruptive disease however, diaphoretics 
and articles which translate action seem to be indicated 



# “Give at first the clear liquor of this infusion and if this does
not operate stir it up and give the substance
(1) “After the stomach and bowels have been evacuated the
ipecac should be given in small doses ¼ to 1/6 of a grain, to 
keep the bowels open, to produce a tonic effect, to determine
to the surface & to prevent convulsion Ipecac has
more claim to be considered as a specific than any thing
else. It obviates the morbid secretions of the bowels it acts as
a tonic never produces unequal excitement or other tonics
& it does not like astrigents produce constrictions Whenever
there is a tendency to unequal excitement it must be
obviated or tonics will do no good”
# I rely upon the ipecac though I use [illegible]
sometimes especially white root asc. tul.
# Indeed “if diarrhoea is present, prepared chalk is a
good remedy as is also charcoal: the best form of which 
is burnt oak for this can do no mechanical injury”
# “I have found this almost a specific” Since I have
used this treatment I have not lost an infant by 
this disease” Ipecac in small doses as an alteration 
approaches as near to a specific in any remedy can
# which is not to be expected
# Astringents must be avoided, though tonics are indicated
because they produce unequal & local excitement & 
stricture they must be given in the latter stages after excitement
has been [equalised]
A little borax may be given
Moseley’s solut. zinc ziii al. zi [illegible] 1 pt


16
In the commencement of the disease if the symptoms do 
not indicate the probability of a severe case an emetic
of ipecac is the best remedy Antimony has been recommended
but it is not a safe emetic for children within
the mouth Infuse [illegible] of ipecac in 6 teaspoonfuls
of warm water & give a teaspoonful every half hour
until the patient vomits or purges. # Ipecac has the advantage
over antimony in its tonic and antispasmodic
properties & in the mildness of its operation, never producing
alarming symptoms # 
If the ipecac empties the stomach and not
the bowels, a blue pill should be given of the size of
from 2 to 8 grains. If this be found insufficient, it may 
be assisted by a dose of calomel, or magnesia or an enema 
(1) After the bowels have been thoroughly cleansed
the ipecac should be given in small quantities a fourth or 
a sixth of a grain to determine to the surface & to prevent
convulsions # If this dose moves the bowels too much, we
may add “[illegible] or 1/6” one sixth of a 1/8 drop of Laudanum to each
dose The absorbent powder or the white decoction may 
be given at the same time#
Astringents should be cautiously avoided
until the stomach and bowels been thoroughly 
evacuated # “& if there is much fever” Where this has been done we may make
use of Moseley’s tonic solution, or cornus [circinata] [illegible] alba, or sericea or saffron safely & with advantage


It is to be remarked that chemical action is prevented by the
vital principle acting upon the food or articles introduced
introduced into the stomach, and putrefactive or [acetous]
fermentation if the vital powers of the stomach are [vigorous]
This principle applies to vegetables Plants taken up in 
full blown in August and packed in live [sphagnum]
will be preserved by the life of the sphagnum
In thrush the powers of life are weakened & not only
substances taken in but the secretions themselves are
subject to fermentation hance the use of obviating the 
effects by alkalies limewater magnesia, chalk [illegible]
absorbent powders
white decoct. Rx.
“To prevent the increase of vesicles of effervescences, syringe
off the acrimonious fluid as well as you are able, by some diluent 
or detergent gargle and expedite the separation of the
sloughs by invigorating astringents” vide Dr Good vol [illegilble] p. 30
“A little borax & ergot may be put into the mouth. But if the mouth
is dry & parched, this and other astringent shd not be used. In such cases
we should give mucilaginous substances as gum ar. slip. elm. or sassaf
X 5 or 6 gr a drachm? of each in a gill of water
# or viola pedata (parsley violet) or comfrey
We must be very cautious about administering it to infants


17
To correct the acidity which often attends this disease
we may administer prepared chalk or lime water
& milk Or Rx magn. usta 10 or 12 fr. elix. pareg.
xx gtts water zi given in teaspoonful doses every hour
If the stools are watery and the child is robust give
coct. ppt # vi gr. cal. 1 gr or the compd powder
of chalk in doses of vi gr. or a small quantity
fo rhubarb instead of the cal.
For watery stools give dal. 1 gr & chalk 6 grs or compd powder of chalk
It is too much the practice to scratch or rub 
off the aphthae in a violent manner with a brush
or swab. As well might the cure of any other
eruptive disease be attempted by violently rubbing
or scraping off the pustules. Rubbing the mouth with
a brush or swab until the bleeds is a cruelty which  
ought to be deprecated
Still something must generally be done
to the mouth in order to satisfy the importunity of 
nurses & prevent their mischievous attempts
A little borax and sugar X is as safe as any thing
If the mouth is dry it may be lubricated with 
muc. gum arab. slippery elm or sassafras twigs
When the mouth is in a very high state of irritation 
probably a small quantity fo sugar of
lead would be serviceable. I have not myself
ventured to administer it to infants within the mouth 
For the proper local treatment of ulcers vide ulceration 
of the mouth


From the sympathy which exists between these parts
and the surface, tonics should be combined with diaphoretics
I have given [illegible] [has] or [illegible] it is [illegible]
observed by tonic and determines to the surface
# It is mucilaginous sub-emetic & diaphoretic. It
may be given freely as a wash or administered
freely internally laxative diaphoretic soothing
antirritant “The other [illegible] may be as good”
The disease of which we have been speaking is 
a local disease


18
Ipecacuanha in this disease is emetic, tonic, diaphoretic
etc. alterative & since I have used it I have not lost
a single infant with thrush
The viola pedata (parsley violet in some 
degree resembles ipecac is its qualities & may be internally 
administered in its stead # “give a teaspoonful of 
of the decoction”
The peculiar kind of thrush of which I have been 
treating is a local eruptive disease of infants
but as it appears in children more advanced it
a critical determination of diseased action. It
is not unfrequently a favorable symptom, particularly
when it succeeds strong morbid action & 
[illegible] early in the disease In the latter stages & 
when the system is exhausted it is unfavorable
For instance in hydrocephalus, when the whole 
mouth will sometimes become sore, and the disease
seen to be translated to the mouth “from the brain to the muc. memb”
In the latter stages of any disease not
so fatal as hydrocephalus it is a very dangerous
symptom of exhaustion “In cholera infantum
it is a dangerous symptom. [illegible] there is not
translation from [illegible] essential part”


18 ½
Eruptions in General
Children of all ages are subject to various eruptions
These are generally occasioned by the quantity or quality
of their food. They are frequently cured by change
of diet alone & the greatest attention should always
paid to the diet is managing them Oily food particularly
nuts, must be strictly prohibited, as they often
cause eruptions. I have known some adults invariably
affected with eruptions about the lips or other
parts of the face after eating freely of walnuts
Fish & poke week may likewise [illegible] the eruption 
We may use the tepid bath for the purpose of 
cleansing the skin. The frequent use of the [illegible]
bath is important especially in chronic eruptive
diseases of children & adults vide p. 21 & p. 20
For infantile [illegible] [illegible] p. 1831-2 of Good
Case of a peculiar eruptive disease
vide [illegible] [illegible] P. 1831 1 [illegible] art.
The eruption was periodical, appearing at a certain hour every day
At first a light coloured opaque elevation of the skin about half an inch
log & a quarter broad like the sting of a bee or wasp. Soon after their appearance blood began to ooze
from them & producing a drop which concreted into a scab, & at the end of 3 days
fall off 8 or ten eruptions came out daily. Treatment was ineffective 
until a change of air & diet, which effected a cure
“Child 8 or 10 yrs of age about 5 p.m. it would complain of a pain
in the face then would appear elevation of the skin to the number of 10 or 12 
the issue was treated as if [illegible]
bark was tried also nit. sil. sulph zinc. arsenic & other minerals
emetics cathartics new diet finally fruit was recom ate freely 
of oranges & was benefitted. Then change of air & travelling were tried
or the first day the eruptions diminished & on the third disappeared
In such cases try changes of mineral waters & dieting”



19
Red Gum
Allied to thrush is that eruption called red gum
The original word was red gown (from a sort of spotted
red calico) which has been corrupted into red gum
It is called by [Willa??] strophilus intertinctus
It is a populous eruption & said to be peculiar to children
but this last is doubtful
The eruption is sometimes confined & sometimes
diffused over the whole body. The papulae rise
above the skin are distinct from each other & of a
rarely contain lymph
bright red colour. The vesicles contain by [illegible] only & 
terminate in scurf. Afterwards subsequent eruptions
makes their appearance. The constitution is rarely 
affected. Physicians are not usually called 
unless the nurse is inexperienced Nurses give saffron
Some physicians suppose this disease 
to be the same with aphthae. Dr [Willan] thinks they 
alternate. Dr Russell remarks “I think that aphthae
of infants is of the same nature with those
eruptions called red gum & differs in this respect
that one disease affects the skin & the other the internal
surface of the alimentary canal. Dr [illegible] thinks 
that this affection, preceded by sickness, arises from 
causes similar to those of aphthae, such as confinement,
heat, irritable state of al. can. indigestion [illegible]
If the disease be suddenly repelled
from the surface, vomiting & spasmodic affections 
take place. Hence the European physicians 


Belonging to the primary [page]
Probably the patient was not dieted so strictly as was
intended & I recommended change of air Oranges
however were beneficial. The was too fond
of good living, fond of oily nuts
There was a slight reappearance after it
but of short continuance
It was called [illegible], but improperly
The eruption was preceded by a warming sensation
of pain in the part.
“Red gum is an eruption of fine pimples of a red
colour affecting infants [illegible] within the mouth. It 
is a disease that rarely requires the advice of a physician
The cure is much better effected by diet and [regimen]
by the exhibition of medicines Still the physician
is frequently called in and he must prescribe something
if for no other object than to satisfy the friends
In order any case give a decoction of saffron & 
snake root to keep the eruption from [striking] in 
& keep the bowels soluble with tinct. rhei compd tinct
sennae magnesia, or other mild cathartics”



20
caution is not to expose infants with this eruption upon
them to a current of cold air, or to plunge them
into a cold bath. It is said that fatal consequences
have resulted from such imprudence
The child should be kept clean & 
be subjected to daily ablution of tepid water.
Particular attention should be paid to the quantity 
& quality of its food. If the eruption should be repelled
from the skin the tepid bath will be the best remedy
This disease often occurs within the mouth
& rarely requires the attention of the physician. [illegible]
tone of the mildest of the eruptive diseases
“We may give a decoction of saffron crocus? & snake
root to prevent the eruption from striking inwards 
& keep the bowels soluble by mild cathartics such as 
magnesia & rhubarb. Still more will depend 
upon diet than upon medicine. Wine & water or
one part milk & three water may be given”
[belonging] to p. 18a
“In managing most eruptive diseases more
attention should be paid to diet than to medicine. In 
most cases it is requisite that the quantity of food should be diminished.
If the food is milk, let it be three parts water, or
substitute whey. Infants should take no animal food & 
no crude vegetables within the year. Oily food and the various
kinds of nuts should be prohibited even for 2 or 3 years. A strong
child in the country, with abundance of air and exercise
might be indulged in such excesses with impunity
when a feeble child in one of our cities would be destroyed by them”


The eruption is so small as not to be observed
It is not my object to treat of eruptions in general
with minuteness but to give the general principles of
treatment food etc.
There are many eruptions met with [illegible]
children which cannot be classed or be found described
There is an affection of children appearing
within the weak, which is not described at all. In three
or 4 days after birth elevations of the true skin not of the cuticle upon the 
hands and arms & various parts of the body containing pus and [illegible] or as large, some of them as ½ dollar 
high [illegible] [fever] I have seen but few
cases they were mortal.  The books in such affections
direct bark & tonics. The practice proved
injurious. The disease as I have seen it has been 
inflammatory and required antiphlogistic treatment
It may however be typhoid sometimes perhaps.
If so it should be treated accordingly. I have seen but 3 or 4 
cases. There were inflammatory. I prescribed in all these cases & from an analogy more fancied
than real, between this & [illegible]
Eruptions are generally caused by 
improper quantity or quality of diet. The remedies
frequently get the credit of curing the disease when 
the amended diet cured the patient
Oily & highly stimulating food should be 
avoided. All the nuts one of the worst is the pea nut


21
Strophilus candidus
In this species of strophilus the papulae are larger then 
in any other of the genus. They are not surrounded with 
an inflamed base. They are very distinct smooth and shining & appear
like little pearls under the skin of about 
the size of half a millet seed. They may continue 
for some time. A close examination is necessary for
their detection. They appear on the bosom & chest
They may accompany other diseases
I have seen them accompany cholera infantum in the 
last stages & considered a fatal symptom
[illegible] dyspeptic consumption a dangerous
symptom The chest appearing to be covered
with an oil surface, looking like particles 
of water I have seen persons attempt to wipe 
them off as if water had been sprinkled on the part
Belonging to p 18 ½
Apples pears and fruits etc.
Cleanliness also shd be strictly practised [enjoined]
robust children, much in the open air, may have eruptions
about the face mouth etc. with impunity
when with the same diet delicate children, much confined, would have
fatal eruptions, diarrhoea cholera infantum etc. 


The appearance of the [former] [have] [illegible]
and the parents are often much alarmed. The disease is not
dangerous however, & leaves no scar behind
A scab is formed & the margin continues to suppurate
and matter forms underneath
“There is a thin [illegible] discharge from the part & the scab
comes off leaving a thing pellucid [illegible]” The disease continues
& this film is thrown off & the process is repeated 2 or 3 times 
It is sometimes occasioned by dentition
sometimes it is an effort of the system caused by 
disturbance in the al. can. “A prejudice sometimes prevails
with respect to this disease that it is an effort of nature 
& ought not to be checked It is a loathsome disease extremely 
unpleasant to both to the patient and the nurse & if allowed to continue
some time it would not be safe to stop the evacuation, at 
least without keeping the bowels open” 
Some [Phys.] recommend partic [illegible]
as specifics. Cal. or blue pill occasionally 
may be advantageous
Buckthorn has been much celebrated in 
this and other eruptions It is drastic& hydragogue
It is perhaps milder in form of syrup. Many families
keep it. Half a dozen berries will operate
If there is much plethora, the
neutral salts may be given Magnesia also both
for the indication & as a corrector
I have known the muriatic ether
much prescribed, but have not used it much
myself, substituting for it mur. ac. as below 


22
Crusta Lactea
This is the [illegible] larvata of Bateman
It appears on the lips, forehead & scalp in small pustules
yielding pus, which eventually coalesce & form large loose
scabs & perhaps extend over the whole face, down the neck
and over the whole body. This eruption never leaves a scar
behind it however long it may have continued. The skin is left smooth It is
more unpleasant than dangerous, as the children affected 
with it are fleshy and otherwise health. When it has
continued a considerable period of time, we must be 
cautious of checking it, as it is like a habitual discharge
from an ulcer
Treatment It is very common to give
laxatives, such as syrup of buckthorn, neutral salts, magnesia etc.
The sweet spirits of sea salt (diluted muriatic 
ether) is a very popular remedy. IT is given in doses of
from 5 to 10 drops, diluted with water & repeated 2 or 3 
times a day. I have seen this medicine given in 
hundreds of cases & am inclined to think it sometimes 
of service. It, at least give satisfaction to the parents 
& does no injury. If there is great irritability give 2 or 3 gr.
of cal. with chalk. In cases where I have thought proper 
to remove the eruption. I have given the muriatic
acid instead of ether, prepared in the following manner
Rx mur. ac. zi alcohol zi Give [3] drops night & morning
diluted with water


make [oxyg.] oint. by adding the nit. ac. to
lard until decomposition ceases, and the resulting
ointment is tasteless. It has about the consistence
of wax. Some add sulphuric acid but this is 
not decomposed & is acrid
Sometimes the ointments seem to irritate & 
then we use [illegible] The best is the sulph. pot.
zi to a porter bottle of water. Sulph. of soda
does not materially differ, but it is unpleasant smelling 
like bilge water.
In different cases apparently similar I have tried ointment
& succeeded in one, but failed in another, & succeeded 
by waste
I was led to adopt the use of sulphuret of
potash from the analogy between its solution & the water [of]
sulphur springs
“We may with advantage make application
of dry powders arrow root roasted flower hair
powder taking care to give a cathartic when we check
the discharge. We should pay particular attention to the diet
both of the child and mother making the food weak & [simple]
Laxatives will commonly be removed; a little magnesia
& sulphur so as to move the bowels once or twice a day
“A discharge like this may be checked with 
safety at the commencement, but when it has become habitual
it should not be stopped unless a drain is made
& kept open in another part.”


23
For this eruption I have found the oxygenated 
ointment, very efficacious in removing the scabs & healing
the sores It is always safe if well prepared. ‘It is made
by decomposing nitric acid with
lard’ Perhaps the [citric] ointment (nitrate of mercury
with lard) may be equally efficacious, but it is less
safe. A good ointment may be made by mixing
calomel zii with simple cerate zi or mutton suet zi
The sulphuret of potash is one of the best remedies 
for this & other similar affections Dissolve zii in a
pint of water & give a table spoonful night and morning
also let the part affected be washed with a solution of 
twice the strength “It sometimes [illegible] two or three days and [illegible] [illegible]” Some prefer sulphuret of soda
sulphuret of lime would also be equally efficacious
Such solutions small like bilge water & are analogous to the water of sulphur 
springs I have sometimes used the sulphuret of pot.
as an unguent. Sometimes liquid applications & 
sometimes unguents will succeed best, & if one fails we
may try the other “Calomel ointment may be applied
about the edges”
If the eruption should suddenly dry up 
& fever ensue, a dose of calomel should be given & be followed
by a few drops of antimonial wine 3 or 4 times a day 
or a small quantity of ipecac. White hellebore may be
given
Sometimes the eruption degenerates to a phagedenic
ulcer. In such cases I have used charcoal 
eternally also a variety of poultices. I have seen much 



The const. irr. may expend itself upon the skin
or upon the gland. syst. or upon the al. can. etc.
We must be cautious about suspending
them suddenly
“It is important in all kinds of eruptions
to keep the skin clean and soft & to effect this
we should prescribe the warm or tepid bath, every day or 
2 or 3 times a week. It removes itching and irritation, is always 
safe and almost always beneficial”
May be caused by teething or by food etc.
Such things often withstand various remedies & 
hence are prescribed for very empirically


24
benefit derived from the application of roasted flour. It 
absorbs moisture & excludes the air
Eruptions attendant upon Teething
Children are very commonly affected with eruptions 
when teething. They generally put on the appearance of a
fine rash, but sometimes consist of distinct pustules containing
matter
As they are symptomatic merely, they require
no particular attention to be paid to them & will 
disappear when the teeth get through. The worst consequences
might result from their sudden suppression; as
if this mode of action by which the system relieves itself
from the irritation of the teeth, be interrupted, there is 
great danger that the system will relieve itself by 
morbid action of the brain, or other parts more essential to life
Eruption resembling the itch
Another kind of eruption appears on children of one or 
two years of age. It sonsists of distinct pustules like
those of chicken pock, which form a scab, continue to 
inflame about the edges & contain a watery fluid
It usually makes its appearance in summer & if not cured
disappears spontaneously at the commencement of 
cold weather
It has often been mistaken for the itch, and 
attempted to be cured by [?dock] root, but without success.
The sulphuret of potash used as above is a good remedy 


The tepid bath is apt to be neglected but shd not
Dock root often fails in this. It is
often very successful in children’s eruptions. It is
a very old remedy (centuries) Sometimes goes
into oblivion & is again revived
Prof. Smith thought most highly of R. patientie 
6 feet high in gardens. Woodville mentions
R [aquaticus] I know not that either is better than 
our [common] [illegible] I prefer the [Robtusifoli??] or [horserock]
It is acrid and acts well when ext. [applied]
and is good int. like rhub.
R. crispus also has about the same properties but is
milder. R. sanguinea is kept by many for it is
as a specific for cutaneous eruptions. called also 
jaundice root & used in jaundice I have
used them all and cultivated than all The leaves
of the R. sanguinea have all red veins.
You will often have such cuticles
exhibited to you in families and be [illegible] of about
them. Hence the importance of a knowledge of their prop.
I have never known them in any but
the children of [foreigners] I am inclined to 
think the taint may be dormant.
The eruption at first resembles what
is called “horn pock” “sometimes resemble a [illegible]” The nurse was changed 
& though the new one was
health yet the ulcer appeared on her nipple


25
I think this kind of eruption might be cured by diet
and the warm both. In all cutaneous affections the 
warm bath is very important to relieve the skin
from every thing that may obstruct perspiration
Eruptions & other irritations of
the skin translate action from the viscera. Where irritated
action exists in the viscera they are symptomatic
Gutta rosea of drunkards is an instance of translation of 
action from the liver “When a cutaneous eruption appears
we may generally apprehend that the al. canal is disordered”
I cannot too strongly enforce attention 
to diet. Nothing will avail without it
Venereal Eruptions
These appear infants born of parents tainted with 
syphilis, though they may have no symptoms of it at the
time of the birth of the child. Some physicians are of opinion 
that this child may inherit the disease from its ancestor 
the parents having been apparently free.
The eruption appears in smooth hard, circumscribed 
elevations of the skin of about half the size of a 
pea 7 resembling a wart before it has seeds. They continue
to increase slowly in size for two or three weeks, & become
soft, containing a watery fluid in [honey] like substance Subsequently the skin
gets rubbed off & leaves an ulcer with ragged edges & sometimes resembling a chancre which
is very difficult to cure. I have known one instance
in which the ulcer was communicated from the child to 
the breast of the nurse. Children affected with this 


Eruptions sometimes depend upon morbid state
of the liver analogous to gutta rosea of drunkards
Prescribe to the liver
“The disease often proves very obstinate”
Mercury does not seem to act as in the
primary disease
Corr. sub. given in this way is as
safe as any other article
The bowels should be kept free
“I think the sublimate acts more on the skin & is therefore
preferable to other mercurials”
The plantain was once celebrated for the cure
of cut. aff.
I have known the plaintain in this
way apparently cure after mercurials had failed
Still the mercury might have prepared the system
The plantain is an old English remedy for bites of spiders etc.
It is treated of by Woodville & [Willan] It has as little acrimony 
I have some confidence in its efficacy. There is an old story about a snake & [spider]
I have known nondiscript eruption
which had resisted the prescription of several phys.
cured finally by diet & change of air



26
complaint have a pale & bloated appearance & the powers of
life are feeble
Treatment. Change the nurse if derived from her
Give corr. sub. in doses of 1/30 or 1/40 of a gr. Give the blue
pill in moderate quantities but it subl. is better Give the tepid bath. Try
the preparations of iron, such as the mur. ferri, or 
tartr. ferr. or the alkaline solution of iron. This complaint
is not so easily cured as the primary [illegible]. Sometimes
it will resist the operation of mercurials & all 
the treatment for scrofula. In this case send the patient
into the country & try simple vegetable articles especially 
the expressed juice of the plantain (plantago major) externally
and internally. It is a popular remedy for poison & is apparently 
valuable. I have known patients cured by the use 
of this, and of the air of the country. Still I think its 
main virtue to consist in its bland & mucilaginous quality
[In these cases the whole lymphatic system is
disordered & deobstruents are indicated. Now the expressed
juice of most green vegetables id deobstruent. For instance 
the farmers make use of green rye in the spring
for this purpose] Perhaps the expressed juice of the green
plantain is deobstruent


Infantile Erysipelas is an improper name
vide Gray [illegible] of Erysipelas
Good’s is an entirely different disease and his account 
will completely [illegible] Corresponds perhaps to the 
rose of the W.F. Goods account of the rash may do pretty well
The infantile erysipelas of Europe described in 
the books is a different thing # 
Resembles shingles this is accompanied with fever 
The primary affection is of the al. can. therefore
the attention is not to be directed exclusively to the skin
I commences with [illegible] [illegible] you are to prescribe
to the fever [illegible]
This disease is distinguished by the eruption 
resembling a rose in the shading off of the colour from 
a dark rose to a light colour & in the concentric circles As I have seen the disease
the rash has appeared in patches about the [illegible] thighs 
principally & the local affection gave no [illegible] and was
trifling while the constitutional fever was severe and dangerous.
The fever if not broken up in the commencement will
resemble a severe case of [autumnal] remittent
I have found no satisfactory account
of the disease in the books, not even in the W. P. writers. I have
however been informed a conversation with W. Indians that the 
rose is one of their most severe and dangerous infantile diseases
fatal in a week
and is treated by a vigorous administration of calomel
# I have never seen the infantile erysipelas described as occurring
in the European lying in hospitals contagious & terminating 
in gangrene I have seen common erysipelas upon infants 
however


27
Infantile Erysipelas
The classification of this disease id doubtful. It answers tolerably 
well to the exanthesis roseola of Good “but [illegible] febrile” there is no species in 
Bateman & Willan which corresponds to it
Efflorescence in blushing patches, gradually deepening
to a “dark” rose colour, mostly circular or oval, alternately
fading & growing brighter chiefly on the legs with irregular
appearance somewhat like concentric circles if the patch is not circular the general circumference
This is a disease of rare occurrence with us
I have met with three or four cases.
It is a severe and dangerous disease, apparently 
the same with the dangerous rose of the W.F.
As it appears with us it is very different from 
the erys. that described by European writers & which is sometimes 
epidemic in their hospitals. In children in this country
it is generally a disease sympathetic with a morbid state
of the bowel
The elevation of the skin is less than in erys. of 
adults the discoloration less deep in colour & the skin though
a little tumefied is as smooth to the touch as if not
diseased In the cases to which I just alluded, the erysipelas
began upon the thighs & extended all over the legs. It was accompanied
with considerable fever & a hot dry skin The colour of the 
efflorescence was purplish rather than red ‘We rarely see
watery or bloody vesicles, as in other erysipelas’ I evacuated 
the bowels thoroughly with calomel (for the sake of the excitement
rather than the evacuation) & rubbed the part affected 


The fever will much resemble that of infantile
remittent
“The spots are in patches from the size of a
dollar to 5 or 6 times as large They are shaded in concentric
circles from purple in the center to a lighter colour”
“If the disease is not checked there will be 
increase of fever, constipation and tumefaction of the
bowels irritation of the stomach affection of the brain, [illegible]
death”
Administer a full dose of calomel in the first place
and repeat it once or twice. Work off the cal. with other 
cathartics. The secretion excited by the calomel is
what we want. The cathar. subsequently given bring away 
Antimony in small quant. & nitre may be given
until the liver is subdued
“When the febrile symptoms run high
pulse tense, tongue furred skin hot it is a very dangerous
practice to apply discutients applications to the eternal
affection Acetate of lead applied externally will probably 
translate the disease to the bowels”
“Treatment I first give colored in full
doses to alter the secretions to change
excitement and promote evacuation, but do not depend
upon it as a cathartic I then give [illegible] or [illegible] & [illegible]
etc. to move the bowels I afterwards use the absorbants
or alkalies, or ant. or iped. in small doses, as the case
may require


28
It is attended with constipation & tumefaction
& [illegible] of the bowels; with hiccup & severe fever, & may 
terminate fatally with severe coma
“Pulse small & frequent child dies usually 
on the 5th or 6th day”
“Dr Dewers says that in the cases he has
seen the disease was not local but would spread rapidly 
over the body disappearing in one spot without leaving a trace
behind it & breaking out in an other & perhaps a remote
part thus changing from one end of the body to the other”
Treatment. “Evacuate the stomach with an emetic, as
ipecac” Clear the bowels thoroughly with cathartics, for the
sake of the impression on the system. Give calomel in a 
dose of from 5 to 10 grs. If it do not operate within three
or four hours repeat the dose. If necessary , work off the
calomel with senna (or scammony?) adding aromatics
if the stomach is irritable or with castor oil if the senna
fails using also some laxative injection & the warm bath
to assist. Then keep the bowels open with blue pill & 
“use some mild diaphoretic as aqua amm.” or  give antimony
from from 1/20 to 1/16 of a grain
Pay little regard to the eruption and direct
your attention to the bowels I have letters from physicians
who have followed my directions & treated the disease not as a 
local one but with cathartics which testify the complete success
of this plan of treatment. In the W.F. also where the


“As palliatives after a strong impression has
been made on the bowels by calomel, we may give sweet 
spirits of nitre, aqua ammoniae etc.”
I have tried various either applic. without benefit
I have
“In those cases when the treatment wa local only 
the patients have uniformly died. I have not lost a single
case to which I was called with commencement. I have
conversed upon this subject with medical [illegible] out from
the W.F. and find that the practice there coincide with
mine”
“When called to cases of some standing I have endeavoured 
to arrest the progress of the disease by a blister
as [illegible] in gangrene & in the erysipelas of adults. The 
disease would extend beyond the blister just as if none
had been applied”
There is an erysip. affection which occurs about the
head of children which resembles that of adults which 
I have treated with lead water


29
disease is frequent it is treated by the physician with 
calomel & cathartics. They give calomel 10 gr. & repeat
it in 5 gr. doses until 20 gr. have been given
I once saw a child with a swelling on one
ankle supposed to have been produced by the sting of a bee or bite 
of a spider, which had resisted the operation of poultices & lead
water. I gave cathartics but they did not operate, & the child
finally died
External applications of any activity
should not be used, Still it may be necessary to apply something
in order to satisfy the parents. The best will be roasted
four “dried [illegible] [illegible]. Warm bathing will be very useful. If treated
with lead water & cathartics not used, probably every case 
would be fatal. I have blistered in imitation of Dr
Physick, but never with any advantage
‘If the disease be followed by diarrhoea
give absorbents & aromatics such as compd powd chalk or white
decoction. If followed by weak pulse etc. give tonics’
I have not lost a case when called early 
‘This disease is supposed by some to be hereditary 
I have seen it affect infants on the scalp when it appeared to 
be a local affection merely In cases of this kind I have used
lead water with [illegible] continualy advantage & without any evil consequences’
Cathartics however should be more or less employed
in conjunction “afterward aromatics or tonics as the case may require”
‘It sometimes affects the brain’


[illegible] a more [illegible] or [illegible] intertrigo an attenuation
& sometimes abrasion of the cuticle. The vessels forming
the cuticle are diseased and the skin is formed
in an imperfect manner It occurs also about the
nates, [illegible] etc. where the skin folds upon itself & the
air is excluded sometimes an acrid discharge Cullen
thought it a very thematic affection. The skin looks
like a new skin upon these parts. it arises from 
want of cleanliness & from confinement. The stomach
may in a state of indigestion secrete an acid and the
skin may secrete an acid. Exercise cleanliness
treatment in general of eruptive disease 
When [illegible] flax they would
burn a rag and put it in an axe & rub their finger
on to harden the skin when chafed. A scorched rag is
beneficial & use absorbent powders first nit. [illegible]
might be used keep dry the parts
Nurses apply “powder post” which is made by [worms]
Sometimes it is a vesicular eruption
which upon the head is called [farrigo] & in some situations
is called ring worm
To the [illegible] or intertrigo occurring in 
various parts the nurses sometimes apply the membrane
from suet which is smooth keep off the air, prevents farther
chafing and does well. The absorbent powders as starch
alabaster etc. do well


30
Sore Ears
This forms a very important subject in treating of the
diseases of children. Nature has chosen the part behind the
ear for eliminating irritation from the system. Under this
head I shall speak of purulent discharges from the cavities 
of the ears & nose
Slight blisters and ulcerations behind
the ears of infants are very common & are in most cases, so mild 
as merely to require washing with cold water weak soap
suds & with cold water, & being covered with a scorched rag
or with roasted flour, to prevent irritation from the cap
Frequently the discharge is acrid & excoriates
the adjacent skin. Often a miliary eruption at the part
commences the disease & is followed by excoriation 
Affections of the brain are sometimes relieved
by a discharge from this part. The discharge is very important 
to children in time of teething & when affected
with bowel complaints.
If suddenly stopped fever may follow
with full pulse, tense constipated bowels & fulness of the fontanelles &
“often nearly all the symptoms of hydrocephalus”
cold extremities Blisters behind the ears will generally 
restore the child to health
When an infant is suddenly attacked with 
symptoms of hydrocephalus [illegible] disease, enquire whether it has had sore ears which have 
suddenly dried up, & if so, apply blisters behind 
the ears, for without them nothing perhaps will cure
the new complaint. The same is true of old sore legs stopping of the [illegible] & other charges
The theory of this, in all such cases, is the necessity, not 



The quantity of evacuation will not amount perhaps 
to more than a teaspoonful & the fullness of the fontanelles
[rain] in the head & plethora is not owing to the quantity of
fluid. The same plethora, pain in the head etc. will 
result from cessation of catamena which discharges will 
not amount to more than a table spoonful
So you may bleed to the amount of pounds 
in cessation of a slight discharge for an old sore leg
with out relief. while if you start the ulcer again 
by [illegible] or [mustard] the symptoms will be relieved
Case of a man with ulcers on the legs of 10 to [20] years standing
discharge stopped [illegible] pleurisy & aff. of liver the
discharge restored by [illegible] blisters caustic etc. cure affected
Sulphate zinc 10 gr. to oz or 2 oz
may be applied Solution [illegible] sil. is one of the mildest application for irritated surfaces vide infra
Oxygenated [illegible] is mildest & 
less apt to become acrid Sometimes when the aff
is of an erysipelatous kind [illegible] relax the parts & 
are injurious
Change the nurse also if necessary
If the child is fed upon milk by hand, add perhaps
a little magnesia or lime water 
Similar affections may affect the 
cavity of the ear & the cavity of the nose. If the 
cavity of the ear is affected in this way & neglected ulceration 
is apt to take place & the small bones affected
causing deafness. First reject milk & water or
carb. soda etc. [illegible] Finally if these means fail use
stimulating injections myrrh finally [vit.] sil.
In the use of [illegible] sil. external began with 5 grs to the oz & increase if necessary 
to xv or xx to the oz


31
of the evacuation, as is generally said, but of the habitual
action of the system.
This affection sometimes degenerates into a very 
troublesome ulcer, extending down the neck, accompanied with 
much pain & yielding a discharge so acrid as to excoriate the 
skin wherever it touches it Deep sores will be formed
& the affection may terminate in gangrene & death
In such cases it may be proper to apply 
emollient poultices of bread & milk; to which may be added
poppy leaves, or pulverized stramonium seeds or ac. plum.
Powdered gypsum is one of the best applications Alabaster gypsum
is the finest kind Some apply red precipitate but gypsum is far better. Case in which this alone cured;
Another physician advised red precipitate The oxygenated ointment if well made is a smooth
dressing for them & is the best kind of ointment, where 
ointments do not disagree, as it sometimes the case. The 
bowels should be kept open with cal. or blue pill.
It will sometimes be necessary to correct
the milk of the nurse by administering magnesia & confining
her to a simple diet
Troublesome & sometimes fetid discharges 
on the internal surface
from the ear arising from a kind of eruption may follow this eruption & may cause deafness if neglected I have known also the 
cavity of the nostrils & the frontal sinuses affected in the 
same manner. A cure may 
be affected in either case by exciting the discharge behind
the ear though it may be necessary to keep it open for some time 
If this fails use (in addition?) milk & water Milk 2 part water 2 part lime water 1 part Tinct. of 
myrrh if the discharge is fetid & troublesome a teaspoonful to a gill, as an injection for the ear
Sol. nit. sil. 1 or 2 gr to oz. water? externally


Be very careful in watching the symptom Case of a 
young man who had had such a discharge for years 
checked by astringents [delirius] inflammatory fever
ertc. bled cathartics etc.
Porrigo galeata ([helvetea])
Cuticles below the scales dotted, shining
Said to be contagious. I have never happened to see it so
though I do not doubt the fact. I have never seen more
than one in a family have it
A very troublesome complaint The 
hair becomes pale, perhaps the roots are affected in which 
case mercury is indicated.
Salivation seems to do no good I have 
seen it practised without any benefit
Recent cases I have cured very speedily 
with oxyg. ointment. Any smooth substance applied
to the part & excluding the air, will often cure as for in stance
a bladder, or the membrane of suet what is useful
also for [fret] Poultices do well, whether upon this principle
or moisture changing secretion
When a student I recollect there appeared 
a strong recommendation of poultices A physician of my 
acquaintance prescribed a poultice & left his patient. It adhered
the hair grew into it and the hard
crust formed a helmet indeed. It [was] a long time a
period of week, before it was removed When it came off
however, the disease was removed!



32
Tinea Capitis. Scald Head porrigo
This is a local affection & yet much influenced by diet. Sometimes
however it affects the system, or is sympathetic of a general affection 
of the system.
The disease consists of scaly eruptions, eventually 
covering the head with a hard & generally brownish
coloured crust. The hair often comes off.
Cleanliness holds of course the first place
in the list of remedies; the head should be carefully shaved 
and washed repeatedly with soap and water. Perhaps as
successful a mode of treatment as any will be to shave the
head closely and apply a bladder or affect skin in close contact with the
skin. It excludes the air. Sulphuret of potash zfs or ai to a porter bottle used as a 
wash & given internally tablespoonful 3 times a day has cured the complaint in a 
few days mercurials or corrosive sublimate will be useful, but do not always cure.
Sulph. prt. internally zii to lb i [illegible] ext zii to lb is [illegible]
The ueast poultice is good, but care should
be taken that it do not become dry on the head, which should be 
first shaved. The oxygenated and the citrine ointments
have been found useful, as had also the tar ointment which 
is made as follows Rx tar ziv wax zfs sulphur zi or is
Mercurial cathartics should be given from 
the first and particular attention paid to the diet. # vide last par.
The practice in this complaint has been 
quite empirical & a great variety of remedies, have been 
popular. Veratrum viride & v. albus & [apocynum] [androsaem??] 
olium have used for external washes. Syrup of 
buckthorn is recommended as a cathartic. Muriatic acid


Lunar caustic about 6 grs. to zi of water (rain water)
well water may decompose it
Decoction of cocculus indica, is given
internally & externally.
Cal. zii al burnt zfs red lead zfs z6 zifs spermaceti cerate head shaved & washed with soap sude every
night and afterwards apply this ointment. It is given by 
[illegible] & Bates [illegible] & called
Diet must be attended to 
Terebinthinate ointment as tar ointment
Tar ointment is made of tar and lard or tar & 
simple cerate
There is no difficulty in the diagnosis of the
disease. You will be called to prescribe for scalled head
and you will find that the nurses have not mistaken the
disease. It begins with small pustules the matter
[illegible] which is acrid and soon forms a scab over the whole
head.
The treatment must be principally local. But
mercury may be given occasionally. I have not derived much 
benefit from the common mercurial ointment. Citrine ointment
is good however. Also cal zif lard zi


33
has been used 3 or 4 drops in a wine glass of water
Finally the sorts of the various species of dock (rumex patientia, crispa
obtusifolia, sanguinea, aquatica etc.) have been much used
All the species have about the same properties, being acrid
purgative etc. They are given internally as cathartics, & 
externally applied, made for instance into an ointment, by 
pounding up the fresh root with lard. The following
is a recipe Rx yellow resin zii
best ale lb i finest flour ziii mix the all & flour thoroughly 
together & add them gradually to the melted resin.
# The tepid bath may be used when this is used always
take care to have a supply both of hot and cold water
in order to keep up the proper temperature. Ipecac may be 
administered to equalize excitement in some cases, & as a 
valuable substitute for this article we can use the
root of asclepia, tuberosa, which is expectorant, diaphoretic 
and laxative.
“Vary the remedies according to their affect
soften use decoct. rumex particularly r. obtusifol. 
called horse dock. It at firs increase, the 
irritation & secretion. Use it externally & internally”


The excitement of the al. can. is affected also of
the nervous system
Various cutaneous aff. different kinds also of
local inflammation, or erysipelatous phlegmous gangrenous 
scrofulous the inflammation varying according to the 
constitution scrofulous gangrenous
I have frequently heard Pres. Dwight
speak of the pain he experienced in cutting his wisdom teeth
suffered extreme pain for a whole summer
She did not appear to me to look like a person in the consumption I was puzzled [illegible] [illegible] I looked into her throat and mouth
and found she was cutting r wisdom teeth
# The irritation may continue for mouths, from 
the pressure upon the gum
Those who commence cutting teeth at 10 mo.
to a year or even later do not necessarily suffer more
Delicate & scrofulous children suffer more


34
Dentition
Among the causes of infantile diseases no one more
claims the attention of the physician than dentition. The bowels
and the nervous system are always more or less affected by it
& to this cause we are frequently to refer affections of the lungs
of the brain, of the ear, of the skin, of the glands, & of the cellular
tissue in general. On this subject there is however a difference
of opinion, for it is said by many medical men that children which are
healthy # well teeth with as much ease as adults. Allowing
for the peculiar irritability of [illegible], no doubt they do,
but in granting this we concede nothing, for adults often
suffer extremely from dentition. I well recollect the case
of a Mrs Waters perhaps about 20 or 21 a married woman and the mother of 
said to have a [illegible]
several children, who was supposed to be in the last stage 
a good deal of cough etc. had raised a little blood
on consumption & upon examination & found was cutting
the four wisdom teeth. The gums were divided & 
antispasmodics administered, when she recovered perfectly.
# Case of Mrs Purcell’s child had been sick
with diarrhoea and fever for some time a flush of fever 
coming on every day. I had previously extracted defective teeth
from the [illegible] mouth. I now looked into the mouth lanced
the gum over a double tooth gave no remedies
The period of dentition commences at different
ages times in different children, varying from the fourth to the sixteenth
mouth, but most commonly in 
the sixth. The two central incisors of the lower jaw appear
about the sixth month and are followed in about a month
or six weeks by the corresponding teeth of the upper jaw.


very [illegible] [illegible]
[illegible] cases I have known a double tooth cut
first in others an eye tooth in others all the teeth at once
You must always examine to see what teeth are
cutting You will perceive the gum swollen and harder 
Some children are born with teeth but
such teeth re merely attached to the gum and are useless
and should be removed
Sometimes there is too much anxiety about
dentition generally however not enough Case of a 
child mother called me insisted upon
# irregular distributions of temperature are [illegible]
[illegible] hot 5 [illegible] cold


35
Next come the inferior lateral incisors & after these the corresponding
teeth above About the twelfth or fifteenth or 20th month
appear the anterior molares & are soon succeeded by the 
cuspidati those of each kind in the lower jaw cutting
through before those in the upper. Next we have the posterior
molares. The last molar teeth are not found in the child & hence
their name, dentis sapientiae. They appear from the 18th to the
25th year.
The above is the order in which the teeth 
commonly appear, but they often come irregularly, sometimes
the lateral incisores, sometimes the molares, & in
a few rare instances the cuspidati appearing [illegible]
Some persons never have more than two incisores in each jaw
Occasionally we meet with families who are said to 
be destitute of teeth. I have known a family from Charleston,
who had this peculiarity. The fact however is in such 
cases that the teeth exist but not rise above the level
of the gums, so that they are not ordinarily seen 
Such teeth have this advantage, that they are not subject
to decay & are also very serviceable.
Whenever between the fourth and the eighth
2nd year? month symptoms of irritation exist, the cause of which is
not obvious, the state of the teeth must be examined. The 
symptoms of difficult dentition are fretfulness 
inclination to bit hard substances, putting the fingers into
the mouth, slavering, starting in sleep eruptions about
the face & on the scalp, flushings in the cheeks. # hot head


pupils contracted sometimes dilated sometimes
losing their brilliancy
In delicate children the eff. will be more
chronic & in vigorous more acute
The system relieves itself often by evacuation 
and this is considered often a good symptom as [illegible]
there is a great flow of saliva. The system relieves itself
by diarrh. by salivation by sweating [illegible]
by every mode of equalizing excitement which 
is the great principles on fevers & indeed in most diseases


36
and cold feet, irregular paroxysms of fever, remitting
fever vomiting diarrhoea irregular & green stools wine
small in quantity & voided with pain or in large quantities 
and of a pale colour bloating of the hand feet and 
face contracted pupils. All the symptoms indeed of extreme irritation
may be met with & we likewise find in many 
cases a tendency to phlegmonous inflammation suppuration in various parts of the
body particularly in the ear. Case of a child who was
thought to have an affection of the brain. A tumour was
found under the arm.
Sometimes dentition is accompanied with 
phlegmonous local inflammations in different parts of the 
body & suppuration of the glands about the ar by which 
relief is afforded
Ricketty children cut their teeth more
slowly than others but not in general with greater difficulty.


The child must be held, and the fingers
keep in the mouth to keep it off the tongue
# The guard being made with a spring, so that when 
pressed upon the guard will yield and permit the
lancet to descend (in the slit of the guard)


37
Treatment. The first and most important indication is 
to divide the gums with a gum lancet or other convenient instrument.
The operation is not usually painful the child will 
even press against the edge of the lancet. The relief is often immediate and permanent
Some relief may indeed be afforded by rubbing the gums with 
a hard & polised substance & by giving the child something
of the same kind to bit, but the most effectual relief will be 
afforded by the lancet. The chief difficulty in the performance
of the operation consists in confining the child. It
may be done while the child is asleep & often without
waking it. We must also be cautious not to cut the tongue
To prevent this it would be better to make gum lancets with 
a guard # For the double teeth two incisors
should be made & it may be necessary to make a transverse 
one in order to divide a band of a sort of ligamentory
substance which confines the tooth.
It is sometimes objected to cutting the gums
in particular instances that, if it is done too early, the
cicatrix formed by the healing of the incision will subsequently 
render it more difficult for the teeth to push themselves through
This is not true for the cicatrix though apparently harder [illegible]
less vitality in it than a part which has not been wounded and will be more easily broken through
Solution of continuity is more easily made by disease in a cicatrix
than in a part which has not been wounded vide J. Hunger. It is a 
common maxim that an old scar is apt to break out in to a sore
The gums should be divided as often
as there are any symptoms of irritation, until the teeth 



Some other diseased action may exist in the
system, and the irritation of the teeth be superadded
the lancing will only relieve the latter
# For the gums having been exposed for a long
time to irritation because [illegible], and perhaps
ulcerated and are kept irritated by contact with 
the hard tooth


38
get through I have repeated the operation three or four 
times upon the same teeth. In some cases however cutting
the gums relieves the symptoms only in part. Indeed the irritation
sometimes continues after the teeth get through # “use astringents”
If any disease from the causes attacks the child
during the period of dentition it will be very important to 
remove all irritation from the latter source, for otherwise
all the symptoms may be aggravated & a disease be rendered
mortal which would otherwise have been mild.
In children of a vigorous constitution dentition
is often accompanied with inflammatory symptoms which require 
an antiphlogistic plan of treatment. Lancing the gums
will then be useful as local bleeding & it may even be advisable
to bleed from the arm though a few leeches behind the ear
are preferable.
It must not be forgotten that in 
infants, the bowels afford a great outlet to diseased action
and to irritation: hence the frequent occurrence of a spontaneous
diarrhoea. If the patient is costive or if it has a 
diarrhoea, a dose of calomel should be administered & if
the bowels are soluble a milder mercurial, as blue pill
may be given. During the whole period of dentition the
bowels should be kept open by such cathartics as the state of 
the system may indicate, such as magnesia, rhubarb etc. adding
aromatics if the system is relaxed and debilitated & chalk
if there is acidity
If a diarrhoea suddenly stops and
vomiting supervenes, externally irritant to the [illegible] [surface] generally, injections, calomel


The skin shd be kept moist for diaphoresis
is one of the most powerful means of equalising excitement etc.
If there is much perspiration you may 
depend upon op. alone but whenever there is much 
[unequal] excitement opium alone will not do well and
ipecac shd be combined with it in small doses
# Also by drafts to the [illegible], by local irritants 
to the skin generally also keep the bowels from 
remembering that there is no outlet to the brain 



39
and the warm bath are to be used, as has already
been mentioned under the head of diarrhoea
Another & a powerful mode of equalizing excitement & relieving 
irritation is by diaphoresis. For this use the warm bath & 
small doses of ipecac & opium or of antimony and opium.
Opium will always be useful to allay irritation & particularly 
if combined with ipecac or antimony, & always safe when 
there is no determination to the head
Small blisters behind the ears relieve the 
symptoms of dentition & prevent the disease from terminating 
in hydrocephalus. # If these cannot be kept behind the ears
mercurial ointment or cantharides may be applied to the 
same part. Nervines may be employed either with our 
without ipecac
During dentition exposure to dampness & 
to currents of air should be carefully avoided & the patient
should be kept warm


X summer & autumnal epidemic
Indeed the effects of it sometimes continue through 
the winter
The desire often resembles spasmodic
cholera in the premonitory diarrhoea & the sudden
collapse 


40
Cholera Infantum
This disease appears in New Haven in the month of July 
August September & October. It rarely commences until 
the latter part of July & in October there are few cases except
those which have commenced in one [illegible] other mouths & continued
until this. Indeed cases are sometimes prolonged till 
the middle of November
Symptoms. It begins in various ways; most commonly 
with diarrhoea, which may continue for days & 
even weeks without any very alarming symptoms; At other 
times times with violent vomiting & purging accompanied with high
fever.
The discharges from the bowels very much in their
usually [illegible] from natural colour [illegible] [irritated] [secretion]
appearance. Sometimes they are yellow, brown or green, sometimes 
in small quantities & slimy and bloody & at others in 
large quantities & watery, smelling like water in which 
putrid meat has been washed. Worms likewise may be
found in all these various sorts of discharges “dead in the advanced stages”
The disease is usually accompanied with great
restlessness & often with severe pain, which increases
by paroxysms at intervals of from 
fifteen minutes to two hours
The pulse is usually quick and weak, the
head hot and the extremities cold. The fever is ordinarily remittent
but the exacerbations are frequently quite irregular
The disease is attended with thirst often [illegible]
and after drinking the child vomits.
The eyes often appear languid and hollow  


During the whole progress of the disease [volvulus] may 
occur Be on the look out for it
“The termination of this disease in hydrocephalus 
I have reason to think is more rare than is commonly 
supposed. Many cases of this kind occurring in my 
practice, I have reason to believe were cases of volvulus
Or varying from cholera morbus of [illegible] [remittent]
bilious fever sometimes putting in the form of cholera of [illegible]
at others that of remittent bilious fever


41
while in other cases they may have an unnatural
brightness as in pulmonary consumption indication a high
degree of mental [illegible] excitement “of bad symptoms” Sometimes the eyes are half
open during sleep, as is indeed the case in various bowel complaints 
of children when severe we often find the diseased action 
translated from the bowels to the head and terminating in 
hydrocephalus. Volvulus also may be another termination.
Sometimes the vomiting ceases
for several days and then returns, while the diarrhoea
continues the whole time
Duration As to the duration of the disease, it may 
be very rapid in its progress & terminate fatally in forty eight hours, or continue for
months, & the symptoms may vary very much during the 
progress of the complaint. A damp hot atmosphere will aggravate 
all the symptoms, while cool weather with the wind 
from the northwest will mitigate them. In different
seasons also cholera infantum will have symptoms peculiar
to the year, varying in this respect like other epidemics
Finally when it proves mortal, the child is
carried off in convulsions, or is worm out with emaciation 
& dies with aphthae while in some cases death is ushered in by hydrocephalus,
volvulus & other diseases
Causes. We may consider the cholera infantum 
as an epidemic sometimes an endemic confined to a particular season of the year
analogous (in its grade of action) to the cholera morbus o f
adult “This disease is perhaps most analogous to a remittent
bilious fever varied by the peculiarities of the 


[illegible] [illegible] will see in [Jackson] all that can be said in 
[favour] of the opinion. The very fact that it is often [illlegible]
disproves the opinion besides the fact that the disease does
not occur at all seasons during the period of dentition 
The disease is affected by the state of the atmosphere
being much aggravated by a damp state of the air 
always minded by a cool bracing northeast wind
The kind and gentle excitement produced by 
nursing is important in chronic disease
“Children should not be weaned till dentition is complete or till
1 ½ years & in the fall”


42
infantile constitution”
Dentition has been considered by some as the 
cause of cholera infantum but to this opinion I cannot assent thought it is held by Dr Jackson & many of our most respectable physicians
Dentition may indeed be an exciting cause; it often aggravates
all the symptoms & accelerates the fatal termination 
yet in the winter spring & months it does not produce the disease of
not unfrequently children are affected with cholera infantum
without any appearance of dentition
Worms sometimes make their appearance during 
the progress of the disease but they cannot be considered as
a [illegible] or cause of it. When they exist during the complaint
the irritation which they produce must be obviated by 
such anthelmintics as are not contraindicated by the state
of the system. “I think I have seen the [illegible] productive 
of unfavorable effects.”
The cholera infantum probably arises
from the same remote causes as the (cholera morbus) & the
bilious remitting fever of adults such as damp hot confined
air (which can be counteracted only by exercise in 
the open air) want of cleanliness & bad diet. Improper 
food may be both a remote & an exciting cause & the same
is true of a bad state of the atmosphere muggy or [illegible] of inequality of temperature & exposure to cold. The predisposing
cause produced by these remote ones is debility
Children weaned in the spring are mor apt
to have this complaint, & do not bear the disease 
so well as those at the breast. I would therefore advise
that in places where cholera infantum prevalent.
children should be weaned in the fall




43
Some consider malaria the cause
Like dysentery this is a disease translated from 
the surface to the first passages. The fever is of that kind which 
Sydenham calls febris introversa the action being of an 
irritated kind in general & rarely of an inflammatory 
Commencing at the skin & breaking up the balance of the
system by obstructing the perspiration the morbid action is
transferred to the mucous membrane of the intestines & involves
the liver, pancreas & all the glands immediately sympathizing 
with them.
Indications. The indications are
1st To evacuate the first passages; if this has not been already 
done by the disease itself
2ndly To translate action to the surface & in general to equalize 
excitement
3dly To excite healthy secretory action and regular peristaltic
motion of the bowels
4thly To avoid the causes of irritation and to remove irritation 
when it exists
5thly To restore the tone of the system & particularly of the
stomach and bowels
1st When the disease comes on like the
cholera morbus of adults, the stomach and bowels are sufficiently 
evaluated by the disease generally when the phys. is called and no evacuation s
are to be used. It is to be treated like cholera morbus
with aromatics as essence of peppermint, with Laudanum 


We must be careful not to prescribe for the [name]
of the disease nor necessarily pursue the plan of treatment
generally proper. Often you will find the patient so
much debilitated at first as to require stimulants & acrids
When we have the collapse stage and
a collapse may recur in any disease then the practice
of the nurses is correct in acting on the skin
Some recommend large doses of cal. [illegible] much 
smaller the [common] Dr Jackson recommends large doses
common in the commencement. Dr [illegible], 1 gr. doses
and salt & water I recommend cal. from 
1 to 10 gr Though sometimes small doses repeated may change
the secretion better than large, yet often a large dose 
will operate more kindly, then a small one [which] merely
irritates
“Dr Dewers recommends injections of salt & 
water 2 or 3 teaspoonfuls to a gill, instead of cathartics. Repeat
the injections till full catharsis is produced the morbid
action is changed, by translation of excitement from the stomach & 
small intestines [illegible] [illegible] with cal. ¼ gr. every [illegible] to alter secretion


44
with counterirritants, as mustard, horseradish & brandy on 
the epigastrium & abdomen with the tepid bath & with injections 
of starch and laudanum. But when it attacks
with a diarrhoea, accompanied with occasional vomiting
unless the constitution is very feeble constitution [illegible] extremely delicate the stomach should be evacuated
by ipecac and the bowels by calomel or blue pill
To vigorous patients & often give in the commencement 
six grains & would not hesitate to give 10 grs of calomel & an hour after give from one 
to ten grains of ipecac according to the age and vigour
of the patient for in this way the stomach and bowels are
more thoroughly evacuated than by giving the calomel
after the ipecac has ceased to operate In some cases
a single dose of calomel will thoroughly evacuate the
bowels, but in others it will only remove the contents 
of the stomach and small intestines into the colon & 
a dose of castor oil must be given or one of senna with 
aromatic seeds
The southern physicians, make less use 
of cathartics and depend much upon stimulating injection,
as of salt & water 3 teaspoonfuls to a gill. This 
practice does not succeed well with us. They also give
smaller doses of calomel. This also I cannot approve for
a large dose of calomel, ten grains for instance, will 
evacuate the bowels copiously and kindly, when small
ones produce scanty stools, with irritation of the stomach
and tenesmus. I may mention also that the French expectant 
plan of treatment adopted in Philadelphia will 
frequently be utterly inefficient.


Where excited has not been equalized, calomel
or any other cathartic may act upon the duodenum only 
and not produce
Such facts as there have been given rise to the
opinion that the disease arises from stricture but then 
the al. can. may be subject to unequal action as much 
as the skin
# a castor oil with elix. sal. aa zi every 2 hours
# Yet this practice shd not be adopted indiscriminately
where there is weak morbid action accompanied 
with coldness of [surface] etc. the exhaustion of cathartics
will be injurious 
This is the most important principle in the cure 
of diseases
Sometimes cath. cure the diarrhoea, where
the action is unequal. For instance the lower intestines
may be torpid and the feces accumulate, the bowels above
may be irritated and a diarrhoea of [small] liquid 
stools may pass by the feces



45
If calomel or any other cathartic produces watery stools
in which are small pieces of feces of an ordinary appearance,
and there have not previously been copious evacuations,
we may conclude that a thorough evacuation of the
bowels has been prevented by a spasmodic action of the
intestines which has constricted them in places, & confined, perhaps
a large quantity of fecal matter. Indeed this may be
proved by the success of the treatment, which should be 
the administration of a dose of opium with a little calomel to change action followed at an interval
of one or two hours by a dose of z ¼ and z ½ castor oil or elixir
salutis teaspoonful #. It is of the first importance in all typhoid 
diseases, particularly in those affecting the bowels, that 
thorough evacuations should be made #
2ndly so translate action to the surface and equalize 
excitement This indication will be answered by an emetic
at the commencement, as already directed & by small 
doses of ipecac, repeated throughout the disease, & also
by small doses of mercurial medicines opium being conjoined
in many cases, as will hereafter be mentioned. In 
some calls where there is much arterial action antimony is 
preferable to ipecac & the lancet or leeches may be indicated
but such cases are rare This indication is also answered
by applications to the abdomen of fomentations,
with decoctions of aromatic herbs sinapisms, blisters, burdock 
leaves, horse radish leaves, ginger in spirits aq; amm or the 


Ulceration of the bowels is generally preceded
by aphthae both are effects not causes of the disease
“An [epispastic] should not be applied after 
aphthae have made their appearance. If the pat. is languid
& sleepy we may suspect aphthae.”
Diluents may be used
Obviating irritation by opium is often necessary to have
the proper effect of cal. for instance Give opium first & follow
with cal. & often you will succeed in obtaining the effect of
the cal. when you had failed before
“Ipecac when it acts as a cathartic
is more apt to produce fecal stools than any other article


46
terebinthinate oils An epispastic upon the epigastrium 
is very useful to relieve irritation of the stomach & to prevent
ulceration of the bowels and aphthae. The warm bath 
will tend powerfully to equalize excitement will relieve
vomiting, quiet restlessness, produce a uniform perspiration 
& if used at evening, procure a quiet nights’
rest. It may always be used and at any time, unless 
the patient is in a state of exhaustion.
As a substitute for ipecac, the root of the 
asclepias tuberosa may be used. It is much used in 
infantile diseases as diluent, to determine to the surface
& to promote expectoration.
3dly For changing the secretion of the stomach and 
bowels and keeping up a gentle peristaltic motion I have found
small doses of mercurial cathartics with ipecac of opium
superior to all other remedies. If any article deserves the
name of a specific in any disease, it is ipecac judiciously 
administered in cholera infantum. It relieves this disease
with more certainty as certainly as than cinchona does intermittents. It
may be observed however that a man successful with one
remedy only m ay be compared to a mechanic, very skillful
with a pen knife! My method of administering the articles
is the following. For a child four months old, mix 4 gr.
of ipecac & 5 drops of laudanum in twelve teaspoonfuls 
of water & give a teaspoonful every fourth or fifth hour
& at the same time give so much of the blue pill as to 


You will know when the blue pill begins to have
its appropriate effect by the change in the color of the stools
Pills of blue pill may be given without much difficulty to children there is little
taste except of the saccharine matter. They may be given in food
[illegible] dried huckleberries which I have often called for in the
country where there was difficulty in administering remedies. There
is often great difficulty with respect to this. A child will
often scream at the sight of the doctor
Opium to allay the irritation of the stomach
and prevent the ipecac from being thrown of Ipecac
to equalize excitement & determine to the surface Ipecac
also, to qualify the opium
# Or if this cannot be done, introduce a paste of opium just within
the sphincter
# Case of a child in a family where 3 or 4 children 
had previously died of chil. inf. [Lax] & [illegible] habit
etc. I commenced the treatment
with the pill and ipecac 
I treated it mildly giving blue 
pill instead of calomel N.B. For such cases [illegible]



47
procure an evacuation from the bowels two or three
times in [never twice] in the twenty four hours. For a child a year old
take twice as much ipecac & laudanum with the same
quantity of water and give it in the same way. Sometimes
three times the quantity of laud. will be necessary; for instance
if the child has been in the habit of taking it or if the diarrhoea is very urgent
If the diarrhoea is urgent, it may be necessary 
to administer injections of starch and laudanum & 
to apply to the abdomen ginger & grandy volatile liniment poultices or other irritants
The enema may be made with three table spoonfuls of flour
& about 3 or 4 times as much laudanum as you give by the
mouth say 10, 15, or 20 drops. # I prefer flour to starch 
because the foreign starch often contains acid. The chalk 
mixture or white decoction may also be used.
# “Children of a bucophlegmatic temperament 
and lax habit are very apt to have this disease & with 
them I have sometimes commenced the treatment by administering
blue pill & ipecac.”
The success of this plan of treatment will be strikingly shown
by the following case. A child 10 months old was taken sick in this town
last summer, with cholera infantum, grew worse and was
directed by the physicians to be carried into the country
Unfortunately the child was carried to a situation not more
elevated than N. Haven & while there its strength decayed
and all its symptoms were aggravated. The parents despairing 
of it recovery returned with it to N. Haven & sent for me with 
a request that I would do something to alleviate its sufferings 


On recovery from the disease they usually crave [salt]
food and salt is a grateful stimulus


48
I found it in a state of emaciation, with hippocratic countenance
frequent vomiting, urgent diarrhoea, with stools fetid, watery 
and containing some slime and mucus, & leaving streaks of
blood upon the cloths. The countenance and gestures, expression 
of great anxiety, and there were frequent paroxysms of extreme
distress. I directed ipecac 5 gr. & laud. 10 drops to be put 
in 10 teaspoonfuls of water and a teaspoonful to be given once in 
four hours flannel wet with ginger and brandy to be applied
to the bowels & gave 5 oz. blue pill, & ordered the diet to be of
arrow root flavored with a little brandy. After the second dose the vomiting stopped, the
stools became less frequent & within 24 hours the complexion of
the stools was much improved. The next day the same medicines
were continued and four drops of the tonic solution with 
a little brandy and water. On the fourth day from my 
first visit, the child began to relish salt fish, which was allowed 
Capt. Dennison’s children
To correct fetor in the stools we should give
charcoal. Carbonic acid, by injection, is given for the same
purpose. The mode of injecting carbonic acid, is to place chalk
& vinegar in a bladder, and 
force the gas into the rectum, as it evolved. “This is 
recommended. I have tried it but not very thoroughly”




But if vegetable food undergoes the acetous fermentation
it shd not be used. The putrefactive fermentation 
however is more injurious than the acetous


49
4thly The most common cause of irritation is dentition 
The gums should be often examined, & be divided if they appear
at all swollen. All kinds of food that is hard of digestion 
should be carefully avoided though for children
somewhat advanced perhaps a small quantity of ripe fruit
may not be injurious If the child has not been weaned
the milk of the mother will be the best food; for those children’
who nurse are more apt to recover than those that 
have been just weaned. The act of sucking is highly soothing
and gratifying & operates like a nervine medicine.
The best food for children that have been weaned, will be arrow 
root, with a little brandy or wine as a condiment & as a substitute
for this & similar articles from the shots, we can
direct a porridge made of roasted flour. If in the latter 
stages of the disease the child craves any particular of food, as
salt fish, or salt meat, or wine or brandy, it should be given, & 
all kinds of medicine laid aside if the stomach leathe3s them; for 
strong disgust will debilitate by exciting nausea. Frequently 
however we can succeed in preventing this effect, by a different
mode of administering the medecine the sight of the spoon for 
instance may may give rise to the loathing & nausea.
With respect to food we may lay it down as a general
rule in such cases that when the powers of the stomach are
so weak that food must undergo fermentation in it, vegetable
diet should be preferred to animal.
For local irritations, various applications should be made
& various articles administered, especially in the latter stages 



“Tea juice? boiled beef a teaspoonful with pepper & salt
is grateful frequently & checks vomiting but at
first vegetable preparations are better”
vide supra
The chalk mixture made with a little opium 
in some cases or with astringents etc. a valuable [illegible]


50
of the disease or when we are compelled to try a variety
of remedies. When there is unequal excitement & unequal temperature
blisters may be used. Blisters sometimes produce perspiration.
To relieve irritation of the stomach effervescing mixtures
may be drunk, they are often more grateful. [illegible] we may 
fill the stomach where there is vomiting and dilute its contents with a tumbler of wine whey 
I have often succeeded with it
with a teaspoonful of aqua ammoniae in it as being thrown up will be no objection. If the disease commences
with much irritation in the stomach, it may be useful
to overcome it by counterirritation in the rectum produced by an
injection of soap suds or of salt and water 3 teaspoonfuls of 
salt to a gill of water, for a child a year old. Dr Dewers
relies must upon this latter article in the commencement of cholera 
infantum and repeats the injections until the bowels are
fully evacuated. He likewise recommends small doses 
of calomel, a quarter of a grain for instance repeated once in 
an hour until the bowels are evacuated. In cases of irritation 
of the stomach & torpor of the liver & portal system, this 
practice of salt & water & small dose of calomel does well. In chronic cases he gives magnesia
rhubarb & opium. With respect to small doses of calomel
it may be further observed that they will not answer when 
the intestines are much coated with mucus & that in some
localities they do not answer so well as in other places. On 
the shores of lake Erie for instance the physicians are obliged
to give large doses of calomel than we give
There are cases in which small doses seem
to irritate & large doses operate kindly 


“In the latter stages Rx magnesia grs 4 SS gtts
Rhei gr i.”
C. Florida not so pleasant but loses its mawkish & 
herbaceous taste by keeping (like peruvian bark)
The spiraea is though less inclined to act unequally 
in this state than most other astringents
If one astringent wears out try another
Oak barks
Rose [illegible] (salix [illegible} “A valuable popular remedy” 
has mucilage combined
seeming to resemble ([illegible]) [illegible] was formerly 
much used but is now superseded by native articles
It is well known that because These astringents are often prompt up is specific
[illegible] virginica was specified good [illegible] & [illegible] it
e.g. viburn. lentigo, raspberry, blackberry, [illegible] [illegible] root decoction
recommended by Dr Rush thought to deter to [illegible] used by many) [illegible]
bark has [mucilage]
There is apt to be a paucity of [urine] in this disease
as well as in Diarrhoea & dysentery and then diuretics
are indicated and are highly valuable


51
5th When in the latter stages of the disease the principal 
indication is to restore the tone of the system & particularly of the stomach
and bowels we must make free use of tonic and astringents.
Moseley’s tonic solution will be one of the safest and best articles
in this stage. If the bowels, by a habitual action keep up the 
diarrhoea, astringent will be more specially indicated such
as the compound tincture of vitriol. I prefer however, the 
cornus circinata to all other articles
C. servicea (red [illegible]) C. [illegible] C. alba nearly allied
Of astringent vegetables we can make choice
from a great variety which are indigenous & common. All
the various species of viburnum all the [potentillas] & the 
roots of the strawberry to say nothing of the bark of the oak & 
indeed most of our forest trees, are astringent & may be used
The spiraea tomentosa is much used in decoction or extract 
All the species of [illegible] are astringent & the C. [rivale] is a most
valuable article; as is also the geranium maculatum, which 
may be be given in wine & then we shall have red wine.
The sttici limonium (marsh rosemary) is not so agreeable but
is frequently more efficacious specially if the mouth is sore. Its taste resembles that of salt
mud. When given internally, it is boiled sweetened & has a 
little wine or brandy added. It is also used as a wash in 
case of the supervention of aphthae.
The erigeron canadense, called colt’s tail
& strangury weed has been found a valuable article in the 
latter stage of this complaint and of dysentery given in decoction.
It is acrid pungent like [illegible] bitter & stimulating & acts also
upon the kidneys as a diuretic. It seems likely to prove a 


Give it in decoction or in milk which will cover 
the taste of it
Balsam of copaiba or turpentine cannot be combined
with mucilage so thoroughly as in the white pine 
bark in milk & water diuretic & [sheathing] to the bowels
I have often used the expressed juice of spearmint
as in diarrhoea q.v. It is important in long continued bowel
complaints of children that the medicine shd be grateful
The diuretics are useful both in children and adults
(dysentery diarrhoea & cholera infant) because there is a
paucity of urine and acrid irritating secretions
In some cases of exhaustion we give opium constantly
in small quantities to keep up the [illegible]
Mucilages marshmallows or substitutes for
which hibiscus palustris hib. syrica hib. [illegible] hib.
(rose of [shora])
Mucilages by stopping irritation are
diuretic


52
a valuable article in the latter stages of bowel complaints 
provided there is not too much vascular action. It has been 
long used, vide Barton, the N.Y. Medicophys. Transactions etc.
In 1790 an itinerant came through N. Haven offering to 
cure the dysentery; and attracted a good deal of notice.
It was found that his [illegible] consisted of this article. The 
other species of erigeron have similar properties.
In the latter stages of the diarrhoea mucilages
should be given. They made of any of the various in articles in 
use, but perhaps the most valuable mucilage, will be that made
from the inner bark of the white pine, which will furnish a terebinthinate 
principle in addition to its mucilage
Often in the latter stages of the disease, great
benefit will result from supporting the abdomen by a bandage
and a plaister of white [diachylon] and opium or
a soap plaister (of [illegible] & soap) 2 parts sp. 4 pts plaister
In extreme exhaustion & debility from the 
long continuance of the complaint with cold extremities, aromatics
and stimulants may be required & we may give spiced tea
spiced wine or brandy in small quantities, or the white decoction 
and apply cloths dipped in brandy to the abdomen & to the extremities


Nothing has more affect upon complaints of the 
stomach liver & bowels than the state of the mind as
we see in dyspeptics
The
We are apt to suppose children not subject to 
notice of [illegible] children [illegible]
mental impressions. When the matter has been dissolved
in grief & abandoned to despair
I told them to tray as a last resort carrying
the child in a hack out of town the excitability was entirely 
gone the child might as well die in the back
as any where strange advice On the top of the [illegible]
about two miles out lifted up the child [sound] trees
grass birds, etc. opened its eyes before this had lain
with eyes half closed noticing nothing 


53
Finally when every form of medication seems to fail, our
only remaining resource will be change of air. This is a
most powerful remedy. The physicians of N. York and Philadelphia
are continually recommending it. We are apt to suppose 
that in children it can be only the purer air 
& the exercise of travelling that produces a good effect, when they 
are carried from home for their health, but on the contrary 
the change of scene seems often to have a more powerful effect
upon them than it would upon adults. Children that
have lain sick for weeks, instead of pursuing their accustomed 
amusement even though mere infants seem of ten to settle into
a state of utter despondency from long confinement & the
constant sight of the same unvarying objects around them, & 
appear to loath every thing offered to be done for them. This morbid
condition  of mind seems to be one directly opposite to that of
nostalgia or homesickness & is to be relieved in a corresponding
manner. I well recollect a child apparently 
in articulo mortis cold & vomiting nothing wd [illegible] the vomiting
entirely beyond the influence of medicine
or food. It was carried in a hack to the top of a hill
without the town N.Y. [illegible] where it had a view of the sound, & the
scenery of the country around. While there is brightened up
vomiting ceased and took food staid an hour or more & then was carried back to town, where it
finally recoverd.




54
The symptoms attending cholera infantum very very 
much and give rise to considerable variety of practice
It is probably owing principally to this circumstance more
than to any other that physicians differ from each other
in their mode of treating it.
Post mortem examination show that this disease
affects principally the mucous membrane of the stomach & the
small intestines; rarely the large ones. Sometimes coagulable
lymph is found in the intestines but less frequently than in 
other diseases. Sometimes the mucous membrane of the intestines
is thickening & according to Dr Jackson ulcers are occasionally 
found both in the small & also in the large intestines. The 
liver is usually enlarged without derangement of structure
Ordinarily the brain exhibits no morbid appearances, unless
the disease has made a determination to that part constituting
hydrocephalus 
N.B. The remarks upon asclepias tuberosa
introduced under the Head of [illegible] capitis probably 
belonged here


Fever of the bowels Acute [illegible] of [illegible]
Different writers give different names and do not always give
the same symptoms. The European disease differs somewhat
from ours. It is our infantile winter epidemic.
Typhus infantum of Prof. [Tully] “Disease of the bowels
bowel complaint, plague of the bowels, winter epidemic 
& [illegible] epidemic. Remittent bilious fever
(at south) Musgrave’s spurious [illegible] fever Duncan III or IV”
There is some [illegible] action but more of the
character of irritation like other infantile fevers
Rarely vomiting never diarrhoea in commencement
The morbid excitement often extends to the lungs
putting on the for [illegible] what is called in adults bilious pleurisy
The disease is not common at this time
though it was very much so formerly Probably it will 
return It is almost the only winter infantile disease
& so common has it been also that the nurses call almost
every disease in winter, of childr, by this name 
of choler.
The dis. is to be broken up in its [illegible]
by means various in various patients by a strong impression 
upon the stomach in a strong constitution but by 
an impression upon the whole system in the delicate
constitution Comparison to a weight upon a [illegible] If applied upon one part only it will break it not if applied to [illegible]
It is desirable that vomiting or at least
nausea should talk place from the cal. In enteric 


55
Constipation with Fever
or
Remittent bilious fever of children Musgrave’s spurious worm fever
marasmus acutis
This complaint has been known in N. Haven for more than 50
years by the name of choler. It is called in some places at the 
“It is unfortunate that we have no better [illegible]”
eastward, the plague in the bowels. It is a common bilious 
“It affects however the duodenum & small intestines rather than the liver”
fever produced by causes which operate upon the bowels a 
part of the system which in children more particularly invites
Children are attacked by it from the age of 3 mo. to 2 or 3 yrs.
febrile action. It is often inflammatory in its commencement
Sometimes it [illegible] in the form of typhus
Symptoms The pulse in the commencement of the disease is 
full, frequent & sometimes tense, the skin is hot and dry 
face flushed, respiration, short and laborious, tongue covered
with a white fur, the abdomen fuller and harder, than in health, & the bowels costive; the urine small in quantity
and high coloured & sometimes the fever is attended 
with cough & expectoration. This disease is a fever
which often affects the lungs and always the alimentary 
canal & liver, the secretions being suspended and the 
bowels constipated.
Treatment. This will be antiphlogistic in the commencement
of the fever & the first indication will be to evacuate thoroughly 
the stomach and bowels. This will best be answered by a  
single dose of calomel of from 5 to 10 or 15 or even 20 grains for a child 
from four to twelve months old We shall thus produce a strong
impression upon the whole alimentary canal & upon the
system at large. In entonic cases and vigorous habits a
little tartar emetic may be added to the calomel
Usually the calomel excites both vomiting and purging, but 
sometimes it is retained on the stomach and has no immediate 



cases it may be beat to conjoin tartar emetic for this
purpose.
Sometimes the cal acts upon the stomach & 
duodenum & excites the action of the liver, and spends
itself there, without producing catharsis
Sometimes it is necessary to repeat 10 gr
doses of calomel once in 2 hours until 40 or 50 gr have
been given and cause them to follow with liquid cath.
a [illegible] or jalap or scammony
N.B. If there is great difficulty in giving medicine
repeatedly, we may give powder of jalap in 
coffee or fermented liquor or we may give a teaspoonful
of the tincture of (not briony root but pure jalap
in milk & water which will not be tasted
Feeble constitution must have the warm’
bath. # Rx senna zjs man zi senega zii anise seed zis
liquorice zfs [illegible] ½ [illegible] This I have held the child with. remember large doses are needed
Rx scamm. grs 2 or 3 chalk & diaphoretic antim. this
was called Earl of Warwick’s powder & was kept in the shop
here. Tart. emet. would be a more certain prop. of art. It 
produced violent vomiting. Scammony is better united
with cal. however. # 
# Cautiokn about covering the [illegible] with a blanket
vide
# Cal. was finally substituted for the [diaph.]
ant. This Warwick’s powder used to be a shot preparation
in this town and parent would send for it. From the uncertainty 
of the strength of the diaph. ant. however, [dangerous]
vomiting sometimes occurred from the use of it 


56
effect. In the latter case a second dose may be
given two or three hours after adding from an eighth to a quarter of a grain of
tartar emetic for a vigorous patient Fifteen or twenty 
grains of calomel will often empty the stomach and
bowels freely & remove all the symptoms. The calomel
may however evacuate the bowels but partially & in some 
instances not at all merely moving the contents of the 
small intestines into the large ones. In such cases another
cathartic is needed for completing the purgative operation 
If the calomel appears to have no effect, it should be repeated
in 5 gr. doses every three or four hours, the patient
put immediately into the warm bath & we should
commence feeding the child as freely as the stomach
will bear with the following R fol. sennae zfs, mannae zi
steep in ½ pint of boiling water & if there is a cough, add
senedae zii & rad glycyrrizhe zfs. If the stomach
will not retain the mixture of senna the powder
of jalap or scammony mixed with tea coffee or milk must be substituted, giving 4 
or 5 grains in the intervals between the doses of calomel
Injections vide p. should be given to assist the operations of the
cathartics and repeated every 2 or 3 hours until the 
bowels have been thoroughly evacuated taking care
however not to commence with injection until the cathartics
have had time to operate
When we have succeeded in procuring stools
we shall find them to consist of viscid green mucus mixed
with half digested food. Sometimes in the progress of the disease they exhibit the 
appearance of small pieces of membrane, of 


There is a membrane [illegible] inflammation of the duodenum
similar to that of croup. This indicated by pieces of 
membrane preceded however by pain in the part
obstinate constipation etc. This is a strong indication for
calomel which however will not operate as a cathartic
until the violence of the disease is broken Warm bath
& injections will also be more particularly
In some violent cases of the fever where
calomel seemed to have no effect. I have known acid
as lemon juice advantageously combined with calomel
Among the cathartics and laxatives used in 
the second stage we have the wild liquorice or [illegible] [circa???]
which was formerly a popular article and kept in families. It is 
diaphoretic and laxative and possesses and also deobstruent properties
It is said that with this the Indians formerly [died] their porcupine quills
# The acids are sometimes used in combination with 
mercurials I should not use them unless when
mercury fails
Sometimes it affects the ear & produces suppuration 
& discharge. It may terminate in effusion into the ventricle
of brain. It may terminate by exhaustion Or may 
terminate in thrush “in which case there is a double translation 
1st from the bowels to the head & thence to the mouth oesophagus & bowels



57
& of about the size of petals of peach blossoms, 
floating in a liquid of the same colour. Such stools
as these latter are a sure indication that a farther evacuation 
from the bowels is needed vide p. 207 They are frequently 
evacuated by adults in bilious (or common cholic.
If such continue it is well to vary the cathartic and give
magnesia, or soluble tartar (peerlash & cremer tart.)
or phosphate of soda, or any other neutral salt.
generally the violence of [illegible] [illegible] & The blue pill may be substituted for the calomel & given
three or four times a day, until the stools change their
appearance or the mouth is affected, though this rarely 
happens to children under four years of age. These
stools rarely have any smell & as they indicate a want 
of secretion I the liver & glands of the abdomen, mercurials
are peculiarly appropriate. In some states of 
fever attended with stools of this kind I have known
the free use of acids with mercury very useful # 
After 48 hours the fever generally 
remits, and sometimes it continues in the form of a remittent
for six or eight weeks or more. Very frequently 
however it changes its seat in the course of 15 or 20 days
& terminate in a phlegmous swelling of some of the glands or in phlegmon
or is determined to the head
& puts on symptoms of hydrocephalus, which are best 
relieved by blisters behind the ear, a place which is the natural 
outlet of diseased action in children. They may terminate
naturally by a discharge of purulent matter from the 
cavity of the ear or fatally by effusion into the ventricles of 


I recollect two cases early in my practice, which 
continued 6 or 8 months. They were very violently attacked
They continued 6 or 8 months coma 
Hence we should never despair
In the latter stages it may be proper to 
give tonics or those articles which are called tonic
very unlike the vegetable tonics however. They produce a
[illegible] excitement
Giving arsenic is no new practice 
It is a safe and efficatious remedy, when the dis. continues 
as a remittent It comes after cal. & tart emet. producing 
liquid secretions. If long continued it must be followed 
by bark to restore tone and obviate the debility caused 
by the arsenic Arsenic can only be called a tonic
as it removes disease. It would never be given as a 
[illegible] is pure debility #
# I have used digitalis, in the latter stages to allay irritation
# In many cases the fever continues from habit
& medicines have little affect. There will be an accession 
of fever every afternoon. Here give sol arsen 2 drops
twice a day which is a full dose for a child ½ years old
If this has no effect give it [illegible] times a day”



58
the brain; in two cases I have known them relieved
by a thrush.
If the disease continue a regular remittent
without symptoms of hydrocephalus, it will be proper to give
tonics, such Moseley’s tonic solution or if the fever intermits or remits Fowlers solution of arsenic
the latter in doses of two or three drops the former
from 4 to 20 drops, 3 or 4 times a day. I have known a child
18 months of age cured in this stage of the fever, in the course o f
two or three days by taking 2 drops of Fowler’s solution 3 times
a day. This article however is liable to produce edema or dropsical
effusion & if it does we must substitute the tonic solut.
(beginning with about four drops) or some preparation of
bark. The dose of the tonic solution will depend upon the
irritability of the stomach If irritable from 3 to 6 drops will 
be as much as can be borne
After the inflammatory action has subsided
narcotics anodynes are necessary to remove irritation and
to procure rest We may use opium, either alone or 
better combined with ipecac or antimony # Indeed as the
skin is usually dry antimony is indicated in almost every 
stage. The warm bath also is indicated in every stage except
in the low typhus state of the fever when it would be too debilitating.
Epispastics & irritants are useful in the progress of the
disease, to translate action from parts essential to life & in 
the last stage also perhaps to keep up the action of the system. They 
may be applied to the abdomen if it is much swollen to the
head behind the ears where there is danger of hydrocephalus & 



Avoid too much heat to prevent tumefaction of the
bowels.
Terebinthinates a [illegible] oil may be needed proper 
If pneumonic symptoms blister etc.
“If the lungs are much affected, apply a blister to the
chest, give expectorants, and pursue the treatment required
in pneumonia. Senega & squills are good, but
are too stimulating for the earlier stages liquorice anise”
By this disease it is sometimes proper to do nothing 
and omit all medicines in mania etc. In those cases
as I have had difficulty to persuade parent to do nothing.
I have applied aloetic plasters 
to the bowels I think they have produced evacuations
injections also can sometimes be given
Case of a very [illegible] child
[furious] parents passed in review before him with 
roasted apples pears etc. after 26 hours he snatched
an apple relapsed in 26 hours they probably had over 
loaded his stomach however the same management 
finally succeeded afterwards of the patient recovered. vide p. [20?]
The same season I had 3 or 4 more such 
cases of mania which required to be cured by fasting


59
a large one to the chest if the lungs are affected.
“This disease is sometimes followed by thrush
when an emetic of ipecac will have a good effect. If the stools
are fetid charcoal should be given. If in the latter stages
there should be tumefaction and pain in the bowels, the
abdomen should be supported by a bandage. In the latter
stages also a decoction of the inner bark of the white
pine be useful. It possesses some tonic properties”
Sometimes in diseases of children the mind is 
affected, the patient will take neither solids nor liquids & struggle
till it is exhausted whenever an attempt is made to administer
any thing. If that is the case in this disease we must use
the tepid bath & we may a apply for purpose of moving
the bowels, a large plaister of aloes and ginger to the 
abdomen Frequently this derangement & morbid revengeful
disposition (according to Dr Rush an affection of the moral
faculty is so great that we must wait even for 24 
hours or more without administering any thing. It may 
require great prudence and judgment in such cases, to 
satisfy the parents.
Before leaving the subject I may observe,
with respect to the propriety of the course I have directed
in the commencement of the disease, that if the cathartic which 
we administer first produces emesis we may be sure that
the alimentary will be operated on, & also that we often 
require a remedy more powerful than the disease, just
as in croup.
“As to diet meat must be forbidden but sometimes salt food is craved. The weak chicken broth is good.



The dis. is something very rapid & violent
Fever as violent as the constitution could bear
Collapse from the violence of action
Parents considered the patient & dead
After the mustard was applied as soon as the
skin was reddened a blister was applied, which 
produced a sore 2 or 3 months in healing
“In one hour pat. revived”
Nervous system affected
Irregular action such as after collapse of
cholera Strong clonic spasms once in 15 min.
“Pat. kept under a constant [narcosis]”
Antispasmodics & tonics finally In two or three weeks [illegible] recovered some strength
It was called the child that died & returned to life again
The above is account of the disease as it
most commonly appears. It is different however in 
different years sometimes effecting one part of the system
sometimes another A practitioner keeps this [illegible] [illegible]


60
Case of a female child 2 yrs of age. The disease ran
the most rapid course I ever witnessed. 
The whole system became
affected; the pulse was full & frequent, the skin hot & the
tongue furred. In 24 hours the disease came to a crisis
and exhausted the excitability of the system; the pulse
grew faint, the skin cold and the respiration languid
the patient became insensible & was apparently dying
sinapisms were applied to the abdomen, ankles & wrists & 
heated bodies put into the bed, to restore warmth. After
the sinapisms had been on an hour and excited some
redness, epispastics were applied in their stead.
Ammonia & ether were put into the mouth & caustic ammonia
was applied to the nostrils to excite 
Inflammation so as to blister. Ether was also put into the mouth
In about two hours the system was resuscitated. Immediately a train of most violent nervous
symptoms followed the chill became convulsed
almost instantly. After trying antispasmodics in vain 
the convulsions were checked by laudanum, 6 drops,
every two hours. The laudanum lost its effect in 
two hours & needed to be repeated. The blister on the 
chest produced a deep ulcer which was difficult to cure
Finally tonic solution was administered. The child recovered
Child of Mrs “Moulth???]
Child of N. Beers’s vide p. 208
diseases and consequently meets with no new disease
For they do not make sudden transition as in botany plants
he is guided by symptoms & by the operation of remedies



Appendix to Mes. fever acute marasmus
This disease sometimes appears in an acute form
with great irritation Sometimes terminates in hectic Patient will run down
very rapidly [illegible] appearances enlargement
& [illegible] of mesenteric glands “Called” consumption 
of the bowels” or Marasmus”
Mesenteric fever is thought to terminate
in hectic Probably it does especially in scrofulous
patient and in those bad cases where the tubercles with a mesentery ulcerate
“The pain in the bowels is no usually very severe 
but of a continued aching kind generally better
removed by [camomile] injections than by anodynes”



61
Mesenteric Fever
Marasmus tabes [illegible] [illegible]
This disease arises from obstructed glands in the mesentery 
& is accompanied with morbid secretions of the stomach & 
liver bowels. It is sometimes the consequence of some other
fever. It is often connected with scrofula, & it is apt 
to be attributed to worms. The disease attacks children
of from two to ten years of age.
Symptoms. The fever is of the intermitting remitting kind, with 
irregular paroxysms attended with tumefaction of the abdomen, 
costiveness, indigestion, loss of appetite & very irregular
appetite & with paroxysms of pain in the bowels. The patient
complains much of its bowels, but the affection seems to be rather 
distress then sharp pain & is neither constant nor regular. The 
countenance is very pale except when the cheeks are flushed with 
fever & the limbs are emaciated
This is generally a chronic disease, but 
sometimes it is acute, & exhibits strong marks of irritation in 
the system. It may terminate in hectic. Dissections exhibit
an enlargement of the mesenteric glands.
Causes. It is sometimes as has been said above, the effect of
another fever. Among the poor, with whom it is most frequent,
it is caused by coarse and unwholesome diet. Children 
born of scrofulous or gouty parents are more subject to it
& hard labor by the mother during the period of gestation 
may have some influence in predisposing to causing this disease in the 
child.



Patients in this disease are subject to paroxysms
of pain


62
The indications are 1st to empty the bowels and to keep 
up a gentle peristaltic motion in them 2nd to change the
secretion of the chylopoeitic viscera.
3d to remove paroxysms of pain
4th to remove the obstruction in the lymphatics.
5th to impose the digestion & to invigorate the system generally 
1at To move the bowels and keep up a gentle
peristaltic motion mild mercurials as blue pill or calomel & chalk should be given & at
the [illegible] time friction as in almost all chronic [illegible] complaint should be employed, upon the
abdomen, and persevered in by the attendants. A very good
mercurial preparation, will be a pill of four parts gr. blue
mass and one 1 or ½ gr of ipecac adding a little opium ½ or 1/8 gr of the bowels
are very irritable. If this preparation 
is not sufficient calomel may be substituted in 
a dose of 4 to 6 grains. The tincture of rhubarb has 
in some cases answered well as a laxative & corrector
combined with neutral salts and aromatics
2nd For changing the secretions, we must rely 
upon the articles just mentioned, and also upon those
to be mentioned under the 4th head
3d For alleviating sudden paroxysms of pain injections
of a gill or a half pint of camomile tea have been found serviceable.
If these fail give a camphor injection
The pain is relieved by opium plaister



There is but a small quantity of iodine and [illegible]
effect appears to be produced than shd result from 
the small quantity of iodine
Neutral salts in connexion with tonics have
undoubtedly [illegible] deobstruent powers


63
4th For removing obstructions of the mesenteric fluids
burnt sponge has been thought very efficacious. I formerly 
questioned whether it had any superiority over soda.
Now it is supposed that all the virtues of the article are
owing to the iodine continued in it. It would probably be [illegible] better
better to give tincture of iodine in doses of 2 or 3 drops.
Still the burnt sponge containing carbon & alkaline matters
may have peculiar properties The neutral salts given
with tonics have some influence in removing these obstruction 
It has been proposed to use mercury by injection for this purpose.
I know not that it has ever been tried
For the indication I have been in the habit of
employing the muriate of lime & here given it in connexion 
with the mercurial pills mentioned under the first head 
It may be made by adding muriatic acid to chalk 
or marble & the dose for a child of 3 or 4 years, should 
be from 5 to 50 drops, given in tea coffee or milk.
It is best to begin with a small quantity, say 3 drops & increase 
by one drop at every dose until the stomach
is offended remembering that the stomach bears the article
best if much diluted. The muriate of barytes might be 
used; also the carbonate of barytes is used in dose of but
2 or 3 grains, it being a powerful article. But iodine is
probably the best article that we know of
Other articles containing iodine, have been 
used besides burnt sponge, as [fucus] [nodasus] & vesiculosus
[reckoned] vide scrofula



mur. [illegible] dose 4 or 5 drops in milk & water for a child of
3 or 4 years increasing to 50 even 100 perhaps
This [illegible] is not to [illegible] [illegible] it iodine as to be substituted
by the latter We are apt to neglect an old remedy as 
a new one comes on
The tepid bath shd not be used when the system
is too much debilitated
It excites the action of the mucous membrane
and of the skin not affecting particularly the blood vessel 
add a little spirit to make the opium 
[illegible] if necessary 


64
Muriate of lime has the important advantage of exciting
the action of the skin which is generally torpid.
Hence also the tepid bath has been used with 
success in this disease The flesh brush too if thoroughly 
applied several times a day will have a powerful effect.
5. To improve the digestion and invigorate the general system
Carbonic acid is a most grateful stimulant to the stomachs 
of patients in this disease. Hence soda water and other effervescing
mixtures, may be recommended spruce bar also & 
similar articles, if they agree well with the stomach. Aromatics 
as ginger & spice may often be added to them with advantage 
Among the tonics which are used to invigorate
the system. Iron is very often employed & frequently with good
success. The mildest preparations least irritating are the best, such as 
the tincture of the muriate, the martial flowers & the
alkaline solution. Still iron is apt to cause irritation
Cold bathing is a good remedy for invigorating
the system but if the patient is much debilitated, a cordial
should be administered previous to using it
When the patient is much debilitated I have found
anodyne plaisters upon the abdomen
give great relief (where opium did not agree) I have 
used Noel’s plaister (similar to dyachylon) with soap mix
opium zii with zfs of this plaister & spread it sufficiently
large to dover the whole abdomen


Children are very fond of potatoes but they should 
not be allowed, unless cooked so as to be dry and [illegible]
and then thoroughly mashed
Some vegetables as spinach, [illegible] & asparagus
may be allowed but only in moderate qualities
Preparations of meal of [illegible], especially fried, are bad
Rx dough roll it in flour and then cut
into thin slips, twist & bake them for [some] hours An excellent preparation
for dyspeptic batter than crackers called twisted bread
In making broth avoid adding rice, flour, etc. which 
will make the compound approach the nature of pastry 
and be more indigestible. Make broths as simple as possible
& season with pepper & salt


65
Under this head may be ranked the use of the terebinthinates
which have a valuable effect upon the mucous membrane of the alimentary canal
The best article is a decoction of white pine bark, which is
milder than any preparation of the turpentine of the shops
Regimen. Flannel should be constantly worn next the skin
to keep up an action in it. The patient should take exercise in 
the open air whenever the weather is good & damp
easterly winds should be carefully voided as they have great
influence in all chronic affections particularly glandular of the bowels. Friction & 
cold bathing have been already mentioned.
Diet. This should be carefully attended to Raw fruits, 
potatoes and other garden vegetables, corned beef & in short all 
articles which are not of the easiest digestion or which have any 
tendency to ferment & become acescent in the stomach should be 
forbidden & caution should be enjoined that the stomach
be not distended with liquids, so as to interrupt digestion.
The diet should be dry consisting of toasted bread & farinaceous
vegetable substance, as arrow root etc. well boiled & seasoned
with a little wine & spice. If meat be given it should 
be broiled & eaten, with condiments. In some cases a piece of 
lean beef that has been partly broiled & then boiled, makes
a broth that is grateful & sits well on the stomach. But if
there is much dyspepsia, broth of any kind a not good
If this fever terminates in hectic the mineral acid shd be used 



Undoubtedly however the affection may be produced 
by excessive purging vide next page
low states of fever in adults also for the 
state of the bowels occurs much oftener than some phys. are
aware of
“The gases may arise from the ingestion, from a 
fermentation of the natural secretions, or, as I think from a
direct secretion of gas by the intestines. this alone would see
to account for the rapidity of its production”
sometimes small watery stools


66
Tympanitis
In diarrhoea dysentery & constipation with fever & typhus fever
after these diseases have passed the first stage, the bowels of 
children affected with them, are liable to be affected with 
tympanitis. a troublesome symptom This state of the bowels may occur of itself about
the time the febrile action begins to subside, or it may be brought
on at an early period by the use of astringents, or by heat
produced, either by too many bed clothes or by hot articles
applied to the body for the purpose of exciting perspiration
it is important to examine daily the state of the abdomen in 
children affected with bowel complaints, that a tympanitic
state may be obviated, as soon as it begins to appear
The abdomen is [swollen] and elastic to the touch
feeling tense like a drum head under the fingers
We can tell as soon as the hand is applied whether the
swelling proceeds from inflammation, or from imprisoned
air, for in the former case the pressure will cause pain
The proximate cause of this state of the bowels 
I believe always to be a relaxation of the villous coat of the
intestines & a deficiency of peristaltic motion in consequence
of both which the villous coat falls down & forms a 
valve which confines the gas, while at the same time there
is a morbid secretion of all the chylopoeitic viscera 
which [illegible] the evolution of the gas
In the first stages of tympanitis, the alvine
discharge usually cease even if there had been diarrhea
& dysentery before & the little patients exhibit signs
constant [illegible] not acute pain
of great uneasiness from the unusual distention of the 



“It is thought by some that tympanitis is always 
occasioned by bad treatment in not giving cathartics enough at
the common [illegible] Such persons probably do not examine
the abdomen of their patients with sequels of severe bowel
complaints. Tympanitis comes on whether cathartics have
been used or not and nothing is more likely to bring it on 
than an excessive of cathartics at the commencement of the
disease”
The temperature had been raised above it
secreting [illegible] & the child might have died
“I am very partial to diaphoretic measures in general
but must confess it is often abused If carried to excess 
it rapidly exhausts the patient also if excessive heat as aplied
and the pat. does not sweat.” 


67
bowels. In the progress of the disease tympanitis the child frequently 
comatose. The tympany is not always to be regarded as 
a dangerous symptom it sometimes indicates a favorable
crisis, yet if it is accompanied with coma, there is danger
that the brain may become seriously affected. If symptoms 
of congestion in the thorax exist, the disease of the thorax
should claim our first attention, and the tympanitic
state of the bowels be treated as a [illegible] complaint
Treatment. The indications are to evacuate the flatus 
and excite healthy action of the viscera of the abdomen
If the disease has been produced or aggravated by heating
applications too many bed clothes or too 
confined an atmosphere, the heated substances should 
be removed, the bed clothes thrown off & air admitted
freely to the patient. In the summer of 1814 I was
called to a child sick with dysentery whose bowels became
extremely inflated in consequence of filling with 
the steam of boiled potatoes in [illegible] the bed in which he lay
The child because if much [illegible] & [illegible] was so difficult that it 
was thought to be dying; but upon removing
the potatoes throwing off the bed clothes & opening the
doors, the symptoms were at once amended & in the
end the disease was completely removed by the use of a little [cajeput] 
oil in water and laxatives
For removing the flatus of the bowels 
we may use enemata of the decoctions of aromatic plants or 
suds, such as catnip, camomile; the seed of fennel caraway 
or masterwort seeds or the essential oil of such suds may 


I prefer camphor to any other articles 3 or 4 [illegible]
IN colicky complaints etc. I have known more benefit [illegible]
injections of camphor in milk & water than from any [illegible]
articles and that too after the most violent purgatives
had vailed. I know of no article which operates
so well in relieving irritation of the pelvic viscera
[Anodyne] balsam Rx vol. [lin] zi [illegible] camph
“Sometimes blister the abdomen”


68
be injected in milk and water. But I think I have experienced 
the greatest benefit in the case of children from the 
injection of a teaspoonful 2 or 3 of the tincture of asafoetida in a 
gill of warm water. It unites more readily with the water
of a little milk is added
A pipe of ivory or the pipe of a common 
injecting syringe may be introduced into the rectum as is
recommended in hysteria, for the purpose of evacuating the
flatus. I have sometimes used an elastic catheter with success
The peristaltic motion of the intestines is
to be excited and healthy secretions induced For this purpose
we are to apply friction with dry flannel to the abdomen
and mild cathartics are to be given. The latter may be jalap
aloes rhubarb etc. with castor oil to work them off
If frictions do not succeed, we may apply volatile liniment
camphor, oil of origanum & finally epispastics
We may likewise give internally cajeput oil in 3 or 4 in sugar oil 
of mint, oil of caraway, asafetida zfs to si etc. which is [illegible]
to offer [illegible] its stomach & is not offensive to the taste
and magnesia with [illegible] & cubebs [illegible] [illegible]
or guaiacum 


Dr Good classifies [worms] according to their locality
yet he makes mistakes as to their locality
Much has been under the subject, and the
remedies are almost innumerable. It is rather difficult to select 
the most important parts of the subject


69
Worms
This subject naturally follows that of bowel complaints
From testimony which cannot be invalidated it appears that worms
of various sizes and forms have been found in almost every 
part of the human body. It is only in the alimentary canal
however, that they occur with any frequency and give rise
to symptoms, from which we are led to infer their presence
Those worms which are of anomalous kinds, or
are found in anomalous situations (oftenest perhaps in the lungs
& frontal sinuses) as they are of rare occurrence & as the indications
of their presence were either very obscure or altogether unknown wanting 
are interesting only as curiosities and will be passed over,
without any notice, except an occasional reference to 
the fact known with regard to them
“Worms in the alimentary canal are so 
common, as to have given rise to a class of diseases called
verminous & a class of therapeutic agents called anthelmintics.
The kinds of likewise of worms which occur in 
this part of the body have been thoroughly investigated & we
are in possession of a large mass of information upon the 
subject
I shall consider this subject under the following
heads 1st The kinds of worms found in the al. canal
2nd their origin & that of worms in general, found in the body
3d the general effect they produce on the system & the general symp
5th the morbid effects produced by each species, with their treatment
4th the general treatment of verminous diseases




70
II. The genera of the common intestinal worms are three; toenia ascaris & tricephalus
Of the tania there are two species. Tania solum or cucurbitana
& t. lata or vulgaris. Of the ascaris there are also 
two specis of a. vermicularis & a. lumbricoides.
1st Tania This a long flat worm varying much in breadth
and thickness which is formed by a chain of flat articulations,
united by a border or edge. The accounts of the length 
of this worm are almost incredible from thirty to a hundred
feet. Taenia solum (called also cucurbitina
or gourd seed worm & the armed taenia) is distinguished
by having the head forked and surrounded
with papillae or long fangs (holders) by which it fastens
itself to the mucous membrane. The broken off joints have
when discharged the appearance of gourd seeds. hence 
its name of gourd seed worm.
Taenia bata (or vulgaris the unarmed taenia) has an 
external form like a ribbon joints scarcely perceptible
& is white and seen transparent. The head is
narrower & smaller & the papillae not elongated
2nd Ascaris vermicularis & a lumbricoides
The first, a. vermicularis (thread worm, pin worm & when
existing in number called ascarides) is filiform, slender at
both ends & from half an inch to an inch in length & of the diameter of a small thread found
generally in the rectum & though not confined to that part of
the intestines. It feeds on the mucus of the intestines & produce
its young in immense quantities. It is found in the stomach 
& called maw worm





71
Ascaris lumbricoides (or [illegible] long round worm) is perfectly 
round & from four to ten inches in length bearing a striking 
resemblance to the common earth worm It is said sometimes to perforate 
the intestine with its mouth 
3 The trichocephalus now called [tric???] is a small capillary worm from 
an inch to an inch & a half or two inches in length. The body 
is about half an inch in length & Is terminated a tail which 
is twice as long & end in a fine hair-like point
In addition to these worms have been reckoned
two others the vesicularis & the gordius. The former is a 
small vesicle found in the brain (sometimes in great numbers)
& containing many small worms. It is now considered a 
hydatid & is excluded from the subject of worms & verminous diseases The gordius (horse hair worm) is found in soft
stagnant waters from four to six inches long & twisted into 
various knots & contortions” Good. They are sometimes found
in the earth in great numbers they turn black on exposure
to the air & resemble horsehair, hence their name
of horsehair worm They are very common in our vicinity They are rarely found in the human
stomach. I have known them coughed up in abundance from the 
lungs; when they had probably come from an abscess in the
liver. It gives rise to a severe disease among the [lapladens]. Vide Good. 
The maggots of the common house fly & the’
larvae of many other insects, have occasionally been met
with in the alimentary canal of the human body vide Good
What were formerly called vesicular worms
are now considered as hydatids. [Brera] or worms recommended 



An attempt has lately been made to revive the doctrine
of [equivocan] generation. The learned advocate has
attempted to fortify his opinion by the analogy of 
vegetables. But where the experiment has been made the 
seeds of the forest trees that come up as [illegible] may 
be found at the roots of the young trees
Hyoscyamus formerly was common here
but is not now However when the gourd is broken in the 
college yard Hyoscyamus springs up. It has also in the
soil brought from a cellar in Chapel St.
Leeches & a variety of insect are undoubtedly taken in in water etc.
In Duncans [illegible] we shall find an account of
a number of caterpillars [illegible] by a child produced by eating cabbage leaves
I think I have never known an instance of worms
in children while nursing


72
II II. The origin of worms in the human body
Worms arise from eggs. Some multiply by depositing
their eggs to be afterwards fecundated by the 
male. Others are propagated by copulation between the 
two sexes While a third kind of the taenia fecundate themselves.
I have spent much time in investigating
the origin of worms in the human body but must confess
that I cannot satisfy myself upon the subject.
It has been supposed that worms found in the human 
body are produced from eggs deposited by flies about 
the rectum, at the time of going to stool. Were this the
fact, they ought to be more abundant in summer 
than in winter, while the reverse is the fact. I am 
inclined to think that the rudiments of worms are 
contained in certain kinds of food as apples pears, cider
water & unboiled fruits and vegetables. In infer this
from the fact that worms make their appearance, oftenest
when such articles have been taken & disappear
when they are avoided. If confirmation of this view 
of their origin we find that children are rarely if ever affected
by then when under three months of age & seldom
while they are nourished from the breast. For though
some have asserted that they have seen worms in the
bowels of children within the mouth & even before birth 
yet the fact is not well ascertained.


Breras opinions, also adopted by Good speaking of the
fluke worm
There is no doubt of the fact of worms within [fetus in uteri]


73
Brera thinks that the minute eggs of worms are absorbed 
into the circulation He says “when we consider that the
eggs of worms are so small that they are not perceptible by 
the microscope of Hoffman and these eggs themselves are masses
of small eggs, nothing is more probable than that the eggs of worms
are absorbed by the lymphatic vessels, pass in to the circulation
pervade the system with the blood & are deposited in the various
parts of the body, where they enlarge and unfold themselves when 
circumstances favour their development.”
If worms are found in the foetus, the fact
will favour this idea that the eggs of worms are carried 
into the circulation. It may be remarked also that
the parts of the body which favour the development of their eggs
are those abounding with mucous
The hypothesis of equivocal generation 
is neither specious nor probable. It derives no support
from analogy aid from reason, nor countenance from fact
In its operation it is worse than useless as it tends to obscure
truth by substituting conjecture while it disregards with 
the most vague and licentious imagination the boundaries
between the animal and numeral kingdom & ascribes 
to chemistry what pertains only to animal life
When the creator first gave being to 
the natural world, every part of the vegetable and animal
system was brought into existence by 
an extraordinary exertion of productive power. They  were
not moulded by the slow operation of time & the cooperation 





74
of mechanical and physical forces, but he spake and it 
was done. But since that first act of creative power, we
find are that these creatures are propagated and perfected by processes
more gradual successive and [operose], many of
which may be traced by human wisdom and admit
of being regulated and controlled by human culture & ability
Rosenstein says “from the eggs of a fly proceeds 
a fly, from the egg of a hen a pullet and not a 
serpent, from the egg of a goose, a goose and not a fish
So from one worm is produced a worm and nothing else”
II II II. The effects of the presence of worms in the body
When the seed of worms are once developed in the human 
body, the health is more or less affected, and the morbid
symptoms which then appear are in proportion to 
the number of size of the worms the sensibility of the part
they occupy and the general morbid diathese which
takes place at the time, whether the cause or the effect of
the worms
Worms in the alimentary canal are less
frequently the original cause of diseases than is generally 
supposed, inasmuch as in many cases of disease where 
they exist, the disease was merely aggravated & not originated
by the worms & all the symptoms of worms from which it is 
common to infer their presence, may be occasioned by 





75
undigestible substances for a diseased state of the bowels
Worms are often also found to have existed & that too in 
great numbers, where the general health has been apparently 
good. I well recollect the case of a child in 
North Milford who fell from a height & was taken up in 
a state of coma from the concussion. A dose of calomel was
given him which brought away twenty or thirty large
worms. The child had been healthy to all appearance previous
to the accident.
Some physicians go so far as to say that worms
are necessary for the health of vigorous children that they 
are nature’s scavengers a natural provision to destroy the
superabundance of food taken into the stomach. Dr Rush
was of this opinion. The opinion supported by Dr [Parr] It is a fact beyond controversy that
very healthy children have worms with out manifesting
any symptoms of their presence until the supervention
of some other disease causes them to make disturbance 
in the system. It is but seldom that they are the excit. cause of dis.
The following are some of the ways in which 
worms are injurious to the system. They may be injurious
from their number obstructing the bowels and consuming
too much food. They are particularly hurtful by 
the irritation which they produce when the irritability
of the bowels is excited by fever. They sometimes threaten
suffocation by rising in the oesophagus & in one instance 
a single worm I have known to lie in the fold of a volvulus 
of the intestines so as completely to obstruct the passage 





76
Linneus attributed the dysentery to a worm or insect [illegible] dysenterical
[languis] the measles to a similar origin. Various
authors the itch, sigler, petechiae lusitanus the syphilis
martin the elephantiasis nyander, eruptive
& contagious diseases in general lancissi, plague, remitting & 
intermitting fever considering miasm [it] being a collection of insects # some authors, toothache Dr [Adam]
observes cancer itself is nothing more than an animalcule 
a worm or an insect. It would seem from 
such speculations, that a great part of the diseases
which flesh is [illegible] to result from a superabundance
of vitality and that as Good remarks in his [illegible] corruption is no longer the triumph 
of death over life, but of life in one form 
over life in another. Such fancies lead into the 
wildest speculations of equivocal generation & relinquish 
all principles & all limits in natural 
history.
# Vide N.Y. Rep. about the year 1815




77
Symptoms of worms. Those children are most frequently 
troubled with worms whose powers of digestion are weak.
The symptoms of the presence of worms in the alimentary canal
are very equivocal, for they may all proceed from other
causes. They are countenance pale or flushed sad and dejected 
livid around the eyes, eyes sunken
eyelids swelled pupils dilated itchings in the nostrils, head
ache after taking food, mouth water [illegible] filled with saliva, breath
fetid, great thirst, grinding of the teeth in sleep, starting
in sleep fainting vertigo, palpitation of the heart, irregular
pulse & cold abdomen bowels flatulent
costive or loose colic throbbing in the bowels severe from [illegible] the small [intestines & umbilicus] appetite irregular
& craving loss of appetite pain in the stomach when empty, which is relieved
by food urine increased or diminished turbid and milky, stools irregular,
containing much mucus nausea & vomiting Sleepiness particularly
after eating, bloated countenance swelled nose & upper
lip, paleness of the lips, irritation about the mouth, rubbing
the nose, itching at the anus irritation about the neck of the bladder dry & convulsive cough
difficult respiration sense of suffocation paroxysms 
of suffocation body emaciated frequent flushings of fever with irregular pulse convulsions, epilepsy
and partial palsy. Of course these are not all present
at any one time
Chorea catalepsy & epilepsy are produced
sometimes, by worms
Dry convulsive cough Diff respiration
In addition to the other symptoms there may be these of irritation
of the lungs producing cough also irritation of the brain




[772]



It will be impossible to class all the articles inasmuch
as we do not certainly know the modus operandi of many 
articles which yet have sustained their reputation for [illegible]
Much stress has been laid upon the operation of cathartics
in evacuating the [illegible] which the worms generate by their irritation, 
just as irritation in the lungs produces [illegible]. But then
the [mucus] although it forms [illegible] for them, an effect more 
than a cause, and the worms will make [mucus] enough for themselves
Probably many caths act by their acrimony upon the worms
themselves. Others by the violence of their operation dislodges 
them. “Aloes are beneficial in mild cases as a tonic
when there is no excessive irritation. If there is excessive sensibility
& irritability they are improper as they irritate the
rectum they may be given by injection When there are
symptoms of worms though no worms exist aloes are serviceable
in the form of elxiir prop.”


77:a.
IV.
[general
treatment]
In the treatment of patients afflicted with worms two 
general objects seem to have been pursued both in popular
practice & in that of physicians 1st to destroy & 
expel the worms themselves & 2d to obviate their effects
upon the system & at the same time by the improvement
of the general health of the patient, prevent their recurrence
and increase This second indication will often coincide 
with the first, inasmuch as a diseased state of 
the body is the most favorable for the multiplation of
worms
Of those remedies which destroy or expel 
the worms themselves we have three kinds
1st those that expel them by strong cathartic operation
2nd those that act mechanically upon them
3d those that are prisoners to them.
1st Although strong & even violent
purges may be used to drive out an accumulation of 
worms in the bowels yet they should not be often repeated
as they would increase the weakness & irritability of the 
stomach & bowels to such a degree as to favour this increase.
In general calomel will be the best cathartic 
inasmuch as it will tend to promote a flow of healthy bile 
& to restore healthy secretions. In Europe the gall of 
animals has been administered. One of the best forms 
for the administration of cathartics is that of alkoholic
tincture, for the sake of the joint effect of the alcohol
hence elixir proprietalis in teaspoonful doses & the tinct.


“The bark of the button wood taken from the north
side of the tree has been recommended. It is a nauseous bitter
& a cathartic good” #
“It is a question whether cowhage acts mechanically 
or whether it contains an acrid principle like that which 
exists in the nettle”
# One of the remedies that I have most 
reliance on for ascaride in tinct [illegible]. Fill a
bottle with the young inner bark fill the interstices
with [prosp] spirit & give I to zfs night & morning
It is an old remedy and better than tinct aloes
It is tonic & deobstruent”
Some of the acids to be narcotic, are more probably active
merely by their pungency, odour etc.



77:b.
of hickory bark or buds have been found very serviceable
Podophyllum peltatum is much used but is probably not better
than other cathartics. The best form would be that of a tincture
2 Mechanical remedies are not now used. Cut hair
has been given cowhage though some doubt whether the operation 
of this is wholly mechanical. I have thought that the root of
osmunda given in pieces acted mechanically The filings of
tin, formerly were much employed as was also an amalgam
of tin & mercury. There is a curious account in one of our
journals of a man in Kentucky who took a pound of the 
amalgam & was unable to expel it from the bowels The 
mass lodged in a part of the intestines & could be felt externally
It was very troublesome to him when riding.
Oil has been given with the intent that it should fill the 
respiratory pores of the tape worms & thereby destroy its
life. In Madame Nouffeurs recipe The supper of
panada is intended to act mechanically by its bulk.
3d The remedies which destroy the worms seem generally 
to be narcotics All articles of this class however do not
have this effect opium for instance. Particular animals
are sensible only to particular narcotics as for instance
swine are poisoned by stromonium while sheep eat it with
impunity. The most valuable article of this class
are the two species of spigelia s. [ma??ndica] & s. anthelmia



A strange notion has existed about a little innocent [illegible]
was considered as the narcotic agent
Similar reasoning has been used with respect
to denarcotising the opium Opium denarcotised would
be not better than bread
Spigelia zii in ¼ pt water to a child may be given in divided
doses. It is better to give a cath. e.g. cal. or ruhb
Spegelia from zfs to zf for an adult
Sometimes but rarely it operates itself as a cathartic
Sometimes convulsions are produced
Our pink is bad because it is gathered by [illegible]
packed in hogsheads & the rotten saved & the rest [illegible]
The emigrants from St. [Illegible] brought what they 
called worm syrup which they said shd be given in the
night because it affected the eyes
S. [anth.] is [illegible] S. [illegible]
about zi if S. anth.
“Pink is given more especially for the [round worm] & sometimes
for the tape worm”
[illegible] [illegible] & [areca] [oleacea] zii to zfs
“The French use the syrup of peach flowers & seeds 
They first give sulph either zi in [illegible] decoction male
form & an injection of the same. They probably act by 
their prussic acid”


77:c.
The former is the one commonly used in this country
and in England It is called Carolina Pink. This is a most
valuable article and is useful not only for its operation 
upon the worms but for its effects upon the system, in allaying
the irritation which they occasion. I have prescribed it for 
a cough & other symptoms of irritation where I had no reason 
to suspect the existence of worms Then given for its effect
upon the worm from half an ounce to two ounces should be 
given in decoction in the course of the night, accompanied with rhubarb
or some other cathartic to drive the worm off while in a state
of intoxication. It may be given in powder in a dose of from 
10 to 20 grs The French W. Indies s. anthelmia is used
& called wormgrass. It is a stronger article than ours
The French use the article in form of a syrup & give a 
teaspoonful at a dose.
Veratrum subadilla & helleborus [fetidis]
belong to this class and have been given in doses of 2 to 6 grs for
children In Europe the most famous article
of this description has been the Felix mas
Other articles of this class are camphor, prussic acid & tobacco
The bark of the cabbage tree (of which there are two species
vide Good) is found highly valuable in this way by the
West India physicians
Other articles which have been said
to be successful in cases of worms owe their success apparently 
to their acrimony in whole or in part, such as
the terebinthinate oils Oil of turpentine is the one commonly 


Various aromatics have been used, as chenopodium 
[illegible], rue tansy
“The leaves of cedar juniper & [illegible] powdered
20 grs They are acrid stimulating and tonic & may have
a mechanical action. It might be used to add to the
powdered leaves some aromatic as rue ol. tansy [worm]
wood etc.”
“Melia [azidurach] bark of root or plant
zfi to zi act as emetic cathartic & narcotic. Acts
more effectually at the south where the recent article is
used”



77:d.
employed should be given in large doses, when it will
prove cathartic. A concentrated solution of salt has been
strongly recommended given by the mouth or by injection 
Ether is much used by the French & perhaps has an effect
upon the worms. Some of the other antispasmodics 
which have been popular may also have some effect upon 
them such as asafoetida, petroleum the essential oil of
the chenopodium etc. Perhaps arsenic poison intestinal
worms I have known it cure. Ammonia may perhaps act on them
2 Of the remedies which are designed to have an effect
upon the system. In severe affections from worms our first
attention must often be directed toward quieting the excessive
irritation of the system, by antispasmodics. Various popular
remedies for worms seem to have little other virtue
The chenopodium anthelminticus & c. ambrosioides called 
worm seed & the c. botrys. or [juris]
oak ar probably valuable, mainly if not entirely a
nervine. They may be given in decoction or the essential
oil may be used. The garlics are used in syrup or decoction they are nervine
7 have considerable effect as condiments upon the intestinal canal. The 
ictodes fetidus is of this class & so are the empyreumatic
oils, petroleum given in a dose of 10 to 40 drops barbadoes tar etc.
For giving tone to the digestive organs
and exciting their sluggish action the tonics
the bitters & the aromatics are indicated while mercurial


[Artemesia] ][santonica] is no better probably than the
other bitter tonics Some confusion results from the appellation 
worm seed being applied both to this and to [illegible] botrys
c. anthel. & “Indeed anything which tends to [procure]
healthy secretions of the viscera. Of this kind are the
mercurial which produce healthy bile which is especially [illegible] 
to [illegible]”
# “Indian corn or maize has been supposed to 
favour the generation of worms in the body. The aborigines
of this country have been peculiarly subject to them perhaps
from this cause”
Worms are far less common now as are also colic dysentery et. than formerly when cold
water & cider were drunk instead of tea and coffee AT the
south likewise the negroes who feed more upon crude and raw
articles are more subject [illegible] of the plantations it is a 
rule to give a decoction of melia to the black children once
in 3 months #
Though you can cure worms generally by calomel
yet sometimes they will resist all treatment
Eupatrium perfoliatum is used for worms
Flowers of [zinc] are antispasmodic so also sulph zinc 
Dr Rush thought well of [sugar] especially when given in the
morning
Petroleum seems to be a valuable article a substitute
for turpentine It may be supposed dangerous, but I have
used it for many years without inconvenience I began with 
small quantities from fear of danger, but now I give 10 30 or 60 grs
It very often to produce no violent effects. Yet we must not conclude
hence that it is useless. Asafoetidae for instance produces 
nothing but a little [illegible] in healthy persons


77:e.
preparations & other deobstruents will be valuable 
adjuvants. The metallic tonics as the preparations of iron
& of zinc, the mineral acids, myrrh, bark, the various bitters 
& the astringents have been found useful I have used alum whey with advantage. Among us the geraniums
& all the indigenous aromatics & bitters have been given
in popular practice. Alcohol from its stimulating effect
upon the digestive organs will be a useful vehicle, for the
exhibition of medicines. Condiments used freely with the
food, will answer to the same indication
The diet of patient troubled with worms
should be dry & stimulating, rather than liquid & cold
raw fruit, acids cold water & all indigestible articles
should be avoided & in extreme cases I would advise that
neither food nor drink be taken but which has not been
subjected to heat. I have apparently cured patients by this
means. “[illegible] toasted bread [illegible] [illegible] vegetable
[illegible] though they occasion [illegible] dyspepsia”
A multitude of heterogeneous articles have been 
used as anthelmentics, besides those already mentioned; some of 
them are sugar; worm-wood; rue; peach flowers; bark’
of prunus virg; valeriana selequa used by the French; muriate of
barytes; injections of mur. of tin (Alibert); oxide of tin grs iii with
etr. of juniper (Alibert) mur. of amm. of linseed; mur. of amm.
[illegible]I with jal. or rhub 10 gr.; all the forms of ammonia; crude
mercury; merc. boiled in water; aethiops mineral; artemisia
[illegible] [illegible] ([illegible] [illegible]) & a. [illegible] [illegible]
[s?tonica] worm seed bitter & of some value; melia azedarach much
used at the south; butternut bark intensely bitter dose a tablesp. full of decoct cathartic & said to be narcotic;
allows asclepiadis I think I have seen the a. [illegible] then beneficial; etc. etc. 


Garlics seem to do well how it is difficult to 
say perhaps operate upon the worms. Garlic also 
will relieve the eruptions of worms. It is though also
that garlic prevents worms
I have a very good opinion of sulph ether
introduced into the rectum used by the Germans, Italians
nervine & antirritant. It is valuable both in cases for worms 
& in those of irritation & affections of liver severe pain in bowels etc.”
½ oz or 1 oz. iron filings taste by [illegible]
remedy worse than disease
Wherever leaves of [illegible] are recommended
you may give our common juniper For the imported [illegible]
loses its strength by keeping & drying
Rosenstein recommends cold water during the
operation of a cathartic He recommends effervescing mixtures
to destroy the worms by carb. acid
An old remedy of the tonic kind is alum whey
Rx milk & water equal quantities & put in [illegible] [alum] to [illegible]
give the whey [illegible] children takes it pretty freely; It is a 
given in cases of relaxation of bowels and for ascarides & round worm
It is of consequence often to have a remedy [illegible] and not require
to be forced down


77:f.
Various external applications have been prescribed
Oxgall & venice soap aa zi made into a liniment with 
oil of tansy or wormwood;
Aloetic plaisters; ether oz vi, bruised garlic zi, camphor 
zi (used by the German Brera) for a liniment; petroleum mixed with gall;
Most of the patent medicines for worms [illegible] or both contain calomel,
Storr’s lozenges are calomel with sugar & gum. These
are his white lozenges. His brown are resin of jalap,
gum tragacanth & calomel.
Good on the authority of the Germans recommends 
[illegible] milk
Electricity 
A popular article (cath.?) is decoction of [plantanus]
occidentalis strong bitter
For ascarides I rely as much as any thing upon a saturated
tincture of the juglans [illegible] & [illegible]
All the indigenous bitters as cherry bark [illegible]
melia [azedarach] zii of recent root is divided
doses ½ pt water. When dried & long kept it is apt to 
disappoint here.
It is acrid [as the] narcotic & cathartic
a powerful article The berries are also narcotic causing
lard to fall down not from [choking] as has been thought
The [planters] think it too powerful for [white] children!


Tape worms frequently produce headache 
[illegible] about the umbilicus
yet generally produce a sense of weight. Yet I have known 
persons evacuate them when they had not been suspected
Case of a man who had kept taking remedies for a catarrh
Finally a medicine ? brought away to his own surprise 
and that of his physician a tapeworm
Perhaps vomiting occurs oftener from tape worm
than from any other species
# “When the worms are very numerous, there is a sensation 
of something falling from side to side on a change 
of posture”


78
V. Symptoms of each of the kinds of worms with the treatment.
1st taenia solum. This worm generally inhabits the upper
part of the intestines & adheres so firmly as to be removed
with difficulty It is sometimes solitary but commonly in 
considerable numbers. When brought away from the bowels
many of the joints are separate & have the appearance of gourd
seeds hence the name. 2 T. lata or vulgaris This likewise
inhabits the upper part of the intestines and is usually in families
of three or four
Both are called by the common name of tapeworm
They may exist without any apparent symptoms of worms
or they may give rise to the severest affections In general 
they are attended by severer pain in the bowels & more violent
symptoms in general than the other worms. The diagnostic 
marks of their presence in great quantities, are
sense of weight in the abdomen, # irritation of the stomach
nausea & vomiting loss of appetite, irregular appetite
weakness of the chylopoietic viscera, bloated countenance
emaciation of the body etc. All these symptoms however 
may arise from mere irritation of the stomach of a child
Adults are more generally affected with
tape worms but children sometimes have them.
For the taeina solum t. lata or vulgaris or cucurbitina the
gourd seed worm the spirits of turpentine has been 
very successful. Though not prescribed by the physicians
it has been used as a popular remedy here for more than
T. lata
fifty years. I have known a man of intemperate habits 


No cautions are given about the use of the article (so far as I know)
But if it does not act as a cathartic immediately, it will produce
great irritation especially of the urinary organs
I recollect the case of a lady who had been treated
with aph turp. in N.Y. taking 2 or 3 ounces Violent vomiting
& catharsis had been produced and the tone of the 
stomach and bowels seemed to have been permanently destroyed
Worry had indeed been brough away, but then they would 
come away themselves & the relieve was fallacious
In delicate cases it had better be combined
with castor or sweet oil
In the case of the lady cath seemed to do no 
good, they would indeed bring away large quantities but
they would return in a few days. I put her upon arsenic 
but she left town and I have not heard from her
It is difficult to tell how arsenic operates whether 
upon the worms or producing healthy bile
For the t. lata the spts turp. seems to do 
better


79
take a wine glass full of spirits of turpentine to expell a
tape worm Though an habitual inebriate, he said he never
had been so drunk in his life & large tape worm of this kind? came
away # It is said sometimes to intoxicate & sometimes to produce irritation
T. solum
2d The t. lata is the most difficult of all 
worms to manage. Spts of turpentine do no good at
least in those cases in which I have tried the article In
T. solum
one case I gave zfs. In another I gave it in teaspoonful
doses. In the latter it operates freely as a cathartic
a single teaspoonful procuring as many as ten stools 
Worms were evacuated but they would make their appearance
again in as large quantities as before. Indeed
any medicine may bring them away for the bowels
are sometimes so filled with them that they come away 
T. solum
when the patient is walking, or is asleep. I have known
two quarts to be brought away in a day, & then a fresh
supply in a few days after!
T. solum
# Arsenic has succeeded better for this kind? with me than any other
remedy, which I have used. In the case of a child
5 or 6 years of age who had both the round & the gourd
seed worm the common cathartics were given with some
advantage, as some worms were brought away; but the
symptoms still continued and the worms passed occasionally
with the stools. Fowler’s solution of arsenic was 
administered in doses of four drops three times a day. In a 
few days worms ceased to be evacuated the symptoms 
disappeared & the child has once had no recurrence of the worms



[Osmunda] cinnamonea is bitter, subastringent
and perhaps deobstruent. So is polypodium vulgare
and perhaps more decidedly so
The polypodium vulgare & felix mas They 
are used in chronic affections of the stomach & bowels & thought 
they have not obtained much reputation for worry in 
this country yet they have sustained their reputation for
2000 years. It was used by Galen
“The [form] is tonic”


80
I recollect case of one patient, a woman, who kept 
passing tapeworms, in great quantities, for months. After failing
with medicines I threw them all aside & tried diet
All the food taken was roasted or boiled even the water
used for drink was boiled. She was cured. It must be 
remembered the healthy bile & gastric fluid will destroy 
those worms & from this fact results an important indication,
which I shall presently dwell upon.
Felix mas the male form has been considered
in Europe, as a specific for this worm. With us the
osmunda cinnamonea [illegible] ([hog brake]) has been used as a substitute for 
it. It is bitter, astringent & sweet. The polypodium vulgare,
which is tonic & deobstruent, & other forms may 
probably be used also
The famous fern remedy bought by the king of France of Madame [Nouffleur]
is as follows. Take a super of the following panada
Rx water lbi [illegible] fresh butter z 2 or 3 bread cut into small pieces
zii add salt zi & boil thoroughly. If the patient is costive
give an injection of water lb is in the evening olive oil zii salt gr. s.
The next morning eight or nine hours after the supper the
specific is to be given viz. Felix mas ziii in powder, mixed 
with 4 to 6 z of the distilled water of the fern or the
flowers of the linden tree the whole to be swallowed at a
dose. In children the dose is reduced to zi of the fern
Two hours after the fern is taken the patient is to swallow 
the following bolus R. cal. & scamm. aa grs xii
Gamboge grs V powdered fine & made into a bolus to be 
given at one dose to a person of vigorous constitutiokn


Ether acts especially upon the nervous system
on which account it has been used as an anthelmintic 
Alibert for taenia gives about zi in a glass of the
decoction of the male form in the [illegible] an hour
after his doze zi of the ol. ricini are to be given
in syrup or in composition the dose to be 
repeated twice & sometime three times a day
The worm is usually evacuated after the first doses 
Mr [Bonadier] directs an injection of the decoction 
of the male form to which zii of ether are 
to be added Mat. Med. art. ether


81
Mathieu adds to Mad. Nouffleur’s remedy the filings
of tine & the sulphate of potash
The French & German add ether to the same
remedy
Rothier’s method is Rx powdered savin grs xx
seeds of rue 15 cab. grs x oil of tansy gtts xii syrup 
of peach gr. s. make a bolus Take half in the morning 
& half after dinner, drinking with each dose a glass of 
vin. tincture of peach kernels
Dr Baurdier gives the following 
Rx sulph. ether zi decoct felix mas 1 gill taken fasting
4 or 5 an injection of the same decoction with 
zfs of ether an hour after zii ol ricini or zi of
the syrup of peach blossom the worm is discharged 
half organiz
Oil is used in order to kill the tape worms
by filling their respiratory foramina. Ol ricini has
been given for taenia & other worms in doses of 3 or 4 z
Liquid carb. amm. might be given for taenia
The German physicians are fond of giving 3 or 4 
ounces of castor oil They are fond likewise of peach flowers
Within 5 or 6 years the bark of pomegranate has
been recommended. Paris says bark of the root [illegible] probable
however the office preparation is meant viz rind of 
the fruit which is the most astringent substance to 
the [illegible] which we have [illegible] also cathartic! I have
not [illegible]
N.B. The male form is astringent, and is given
to enable the bowels by the tone it gives, to bear the [strong]
cathartic afterwards. Hence the union of these give in [illegible] [illegible] may be useful



I have seen the worm occasionally in rain water
I recollection one man of 60 who informed me he had been
troubled with then nearly all his life until he removed his [illegible] Change of place
may effect a cure by change of water
Probably [illegible] of our cholera are
troubled with this worm delicate children only suffering much
children troubled with them will be faint, have
turns of colic etc. you will be called [illegible] Give an injection, and no worms will 
come [illegible] yet give afterwards a strong cath. & or repeat
the injection and worms will come away proof that they 
were not in the rectum They probably breed in the duodenum
I have known but one case in which they were vomited
up. The subsequent cath. will bring away 
smaller worms 
More is done by diet int his worm than by 
any thing else
Alcohol in this morning especially its bitter
tinctures. Condiments are useful. Worms are less common 
now because condiments are more used. It is said that
the aborigines when they cannot get salt used potash ashes
by a condiment The aborigines are said to be very subject 
to worms
# Ascarides sometimes produce severe pain at the 
umbilicus and colic
# “Ascarides though often found in the rectum
are generated in the stomach & small intestines. Hence they 
are sometimes no discharged till the second or third operation
Hence they are sometimes thrown up by vomiting. I have examined this point carefully 


82
3d Ascaris vermicularis. This worm is always troublesome
when it exists in considerable numbers though it is but seldom
that they exist in healthy persons in such numbers as to 
give rise to morbid symptoms. They are very common in 
children, and not rare in adults & are called by the
generic name ascarides
These worms are commonly found in 
the rectum & hence are often said to inhabit that part 
This is a mistake they multiply abundantly & lodge in 
the rectum as they daily pass void by sphincter. Sometimes
they exist in the stomach in vast numbers (hence called
maw worms) so as ever to threaten suffocation by rising
in a ball into the esophagus & sometimes they 
cause severe griping pains by their presence in the 
small intestines #
They pass in the stools & sometimes come
away spontaneously at night, they are said even to 
make their way to the vagina & urethra of females producing
troublesome symptoms X Ascarides are most troublesome
in the latter part of the day & the first of the 
night, when they excite an intolerable itching 
at night [illegible] probably than feeding They give rise to symptoms of general irritation
& sometimes to a cough # Ascarides are particularly 
injurious to dyspeptic patients & they themselves may give 
rise to the symptoms of severe dyspepsia such as craving
appetite, indigestion, faintings. Flatulence, cold
extremities pale & sallow countenance, cough etc. The irri


“They are attended with violent itching
about the rectum general irritation convulsions
irregular appetite pale urine flatulence want
of vigorous action of chylopoietic viscera increase of mucous
secretion darting pains in the abdomen stomach 
& chest faintness cold extremities the symptoms of
dyspepsia sporadic cough”
Tobacco injections & tobacco smoke injected are
very useful and will often cure. It is not safe for children
I have seen great prostration produced in children & I have
known an adult killed by a tobacco injection #
A physician who had been much troubled
with ascarides told me he had tried merc. oint. externally 
with advantage. “I have used it but was rather disappointed
# When the ascarides are in the small intestines, tobacco
smoke will do not good & by its debilitating effect will
favour their existence
“Injections of camphor and milk 
have done more to remove ascarides
than all other remedies I have used. The injection 
immediately removes the irritation produced 
by the ascarides & the ascarides themselves. It
may be made of milk ziv to spts camph. zi
This is the form in which I have used it, probably 
an emulsion is as good, perhaps a
better form” M. M. 


83
which they cause sometimes, in children brings on convulsions
Whenever, finally, they exist, in the alimentary canal
they are accompanied with great quantities of mucus in 
this part. They feed on the mucus of the intestines, the flow
of which they excite by punctuating the mucus membrane
Treatment It is very difficult to cure a patient
troubled with ascarides. The most immediate relief is
given by injection. If the worms are in great quantities & too much 
“Tobacco smoke is one of the most powerful means we possess for the
involved in mucus, they may be completely removed by 
cure of these troublesome worms”
injecting tobacco smoke. Injections of warm water or milk & water will
relieve for the time being by washing out the rectum & if
a quantity of aloes zis to ½ pt is added a still better effect may 
be expected though camphor being a nervine & a poison to the 
worms would be a still better addition. Injections of milk 	
and water, with camphor zii tinct camph to ½ pint, 
will if preserved [illegible] destroy them 15 grs of [illegible] [saladilla] have been injected. Still the frequent injection,
required in bad cases may debilitate the bowels
& consequently invite the return of the worms.
For internal administration. I have found
a tincture of the buds or bark of the hickory given in doses
from a tea to a tablespoonful one of the best articles both
for removing the worms & for preventing their return
Drastic cathartics should not be depended upon 
for they weaken the bowels & increase their irritability & 
hence favour the production of the worms. On the contrary 
calomel & tonics should be given to restore healthy secretion
Aloes if given should not be in large doses, for that will
irritate the rectum still further, but in smaller ones as a tonic


Oily articles shd be avoided as butter, because
they relax the [illegible] of the intestines Potatoes, vegetables 
All kinds of pastry avoided
All the metallic tonics are useful as tonics
They are thought also to be unfriendly to the worms
It is said that forth ascarides a pint or a quart
of sea water has been drunk with advantage, producing
vomiting & purging. Salt is a good remedy. Dr Rush proscribed
a teaspoonful of salt in the morning to a gentler one
much troubled with ascarides. He told him after trial than 
the remedy would not do. Dr Rush gave him, then, for worm
powders # 
For the worm the [illegible] the pink shd be the remedy vide [illegible]
“Rhub & cal. are the best cath. but all are useful For children Rx
tinct. [illegible] Fowlers solut. cold water” 
“Common salt ground up with cochineal to colour & disguise
the article. The gentleman reported that the last prescription 
had answered well. Dr Rush also believed
in sugar. This more doubtful
The asclepiasis have been much used especially 
for this worm especially A. incarnata called wild hemp It is 
dried pounded to a fine powder mixed with molasses & given in doses of a teaspoonful
Or [illegible] down and make a strong decoction [illegible] the [illegible] with it
molasses and give freely until it moves the bowels
This much used by the practitioners of the state more than any 
other article after calomel. it is an article which may always
be obtained growing in clayey situation and is safe
The other asclepians are similar & may be used S syriaca
is the most laxative


84
To prevent the return of ascarides, condiments should be freely used
such as pepper, ginger etc. in short all warming and bitter things
In extreme cases let the diet be so regulated that nothing shall be 
received into the stomach which as not been subjected
to heat. Mercurial ointment has fasted in my 
hands.
4. Ascaris lumbricoides the long round worm is perhaps
more commonly found in the alimentary canal than any other
This worm more than any other is found to have existed in 
the stomach or intestines while the general health has been good
is the presence of worms not suspected.
Strong purges may be used to remove
them & alcoholic tonic tinctures given to prevent their increasing.
For this latter object the carbonic acid has been recommended 
in the London Med. & Phys. Journ. & in confirmation 
of the idea I have used soda water with advantage
Melia azedorach or pride of India a decoction of the bark
is much depended on at the south for their young negroes
who are much subject to worms. It loses much of its virtue when dried. The spigelia is also
sued but of this I shall speak under the head of general 
treatment.
I recollect with an aff. of the liver
wh often vomited up dark [gravous] blood, which had evidently been 
long in collecting. Finally he was said to have thrown at 
a snake. Many eyewitness testified to the snake & to its eyes 
& teeth. I saw it. It was a very large round worm of the kind


To be distinguished only by the violence of the
symptoms. The same itching at the arms will exist as of the
ascarides, but non violent etc.
“Treatment similar to that for ascarides. It
is more common than is generally supposed. Many 
of disease & death by irritation from an unknown cause, are probably 
owing to this worm. In examination the contents of 
the bowels should be placed upon linen cloth and then
this worm can be seen.”
For the gordius Linnaeus recommended the angelica
Archangelica (not our viz the [atropur????])



85
5. The tricocephalus is but seldom met with 
The irritation produced it may be so great as even to bring
on delirium & will be manifested by screaming
throwing of the hands & [fat] etc. I have found this worm in a 
fold of the volvulus of the intestines vide Volvulus.
I should try narcotics for this worm, but 
cannot speak from my own experience. I should recommend
also an injection of a table spoonful of ether in a gill of
water or mucilage. Ether given in this way will undoubtedly 
pass the valves of the intestines in a state of vapour 
Vesicular worms, according to the old division of verminous
diseases, are met with commonly in the brains of adults & 
are attended with the symptoms of vertigo, convulsions
apoplexy & hydrocephalus.
Cases of worms & of colic are much less frequent with 
us than formerly; owing to the change in our mode o f
living. They are said to be very common among the 
aborigines of this country



One volvulus may be received within another
a second, a third and fourth time & [illegible]. The whole may 
then become inflamed, the vessels may run
from one to another, and the whole become one complete mass 
of organised matter or sometimes [illegible]
“It may occur in any part of the intestines except the rectum
though the colon is often received into the rectum”
The symptoms of the two kinds [illegible] [illegible]
owing to the different susceptibility of these two portions of the 
al. canal, and the diff. ages of the subjects of each
Nor located in books vide Ed. med. & surg. J
where the best account of it is given. Good merely mentions it
as an accident that is found sometimes to have occurred in ileac
passion
“Predisposing of exciting causes”
The cavity of the natural stricture may not be large than a goose quill, & such 
children will be very liable to an occurrence of volvulus
This is not a primary disease. It occurs more
in some families of [illegible] fibre & [illegible] phlegmatic
temperament
It may occur from debility of constitutional
or that of the bowels [illegible] by bowel complaints etc.
Local violence One instance, in here the child 
was apparently thrown into it by being carried over the shoulders


86
Volvulus or Introsusception
This is a disease with which I was at first very much perplexed
especially as I derived little satisfaction from the books
Volvulus or introsusception is the reception of one portion of
intestine within another. It doubtless exists often in a 
slight degree, when there is a strong action of the bowels
& are inverted peristaltic motion & the bowels disengage
themselves. Sometimes there is a double involution, or one
involution within another. In some cases likewise the 
cavity of that portion of the intestine is entirely obliterated by 
the tumefaction of the coats. I have always found in post 
mortem examinations, that the upper portion of intestine was
received into the lower & not vice versa the involution having been caused apparently 
by inverted peristaltic action
This affection of the intestines occurs oftenest
in children though adults are liable to it. It would seem also 
that some families of a leucophlegmatic temperament & 
delicate constitution are particularly liable.
It may be caused by a natural stricture
of a portion of the intestinal tube when it will be incurable
It may arise from extreme irritability; local violence
& injury may occasion it, & the irritation of worms may 
bring it on. Drastic cathartics may bring on volvulus
& hence should be cautiously avoided where there is a liability
to it. Bowel complaints, as colic, cholera, dysentery
etc. sometimes terminate in one or more volvuli of the
small intestines. The disease is more frequent in the 
summer, when debility is greater & bowel complaints prevail 


“Symptoms incessant irritation one or two copious evacuations
but usually these have ceased entirely before the physician 
arrives constant efforts to vomit, resembling hicup constant
efforts to pass stools & nothing passes but mucus streaked with blood
Generally mistaken for hydrocephalus
In bowels complaint of delicate children look out
for volvulus It is much more common in some seasons than 
in others. About 10 years ago they were quite common. I had
many letters from our students, who met with the disease
& disagreed with the phys & gained [reputation]. They 
frequently sent me such accounts.
Sometimes there will be a partial involution of the
large intestines [illegible] to relaxation of inner membrane what descends
like a funnel & may be felt by the finger #
In the large intestines there is not very much irritation
than is torpor of al. can. not much vomiting except upon 
the administration. There is no purging
You may sometimes determine that of the
large intestine by heaving the peristaltic action discard
& stop at the [illegible]
This is most common in adults. The symptoms
are more mile
# It occurs in females who have had long continued effetion
of uterus, occurring in females about cessation of [catamen]
and from long continued bowel complaints. The [inner] membrane
will descend like a funnel An injection will perhaps 



87
Symptoms These will be different according as the 
affection is of the small or of the large intestines
1st Where the small intestines have one
or more volvuli the symptoms [illegible] vomiting or
Symptoms like those of violent injury to abdomen vide case 1st 6.89
a constant endeavour to vomit as often as once in ten 
or fifteen minutes the matter thrown up being a greenish 
fluid or simply mucus. In severe cases the vomiting is 
attended with a discharge from the rectum at the same 
time. The stools are fecal at first & copious but afterward 
they are small in quantity & consist principally of white mucus streaked with blood
the blood not being diffused throughout the mucus as
“no fecal smell generally”
in dysentery, but in streaks or specks. These symptoms 
are attended by others which indicate great inquietude or irritation
such as throwing the h ands & feet, rolling the 
head paleness of coutenance This set of symptoms resemble those of hydrocephalus
& hence volvulus is often mistaken 
for this disease. The pulse is small and frequent
“[illegible] usually occurs in 24 or 36 hours”
2 A volvulus of the colon or rectum 
is not usually attended with much vomiting unless this
is excited by cathartics. It is attended with the ordinary 
symptom of constipation. There is no evacuation 
from the bowels unless at times a little blood and
mucus. If the passage be not completely closed, an 
enema thrown-up will remain & not come away if
completely closed. it either cannot be thrown up 
or it returns immediately. Blood often follows the introduction 
of the pipe. Indeed the inflamed part is often 
so low as to be reached by the pipe & admit of being felt
by the finger.



come away immediately. [Schyl?la] of feces may come away 
And large quantities of mucus may come away sometimes 
½ a pint. This is not apt to be fatal. Treat by a strong
inject prescribe for the [illegible] with conium [illegible] etc. mechanical 
means
The more cath. you give the more the unsolution is
increased therefore give more
Give mucilaginous injection, in involution of the 
small intestines, sufficient to fill the intestines. If it is
said that the injection will not pass the valves. I answer 
that whether by sympathy or in whatever manner, I am satisfied
of its utility # 
Give [illegible] enough to allay irritation 
I have treated # patients for 8 or 10 days without 
evacuation & cured them 
Not long since I had a case in what
I suppose there was such a volvulus, for the attendants
could not make the child receive injection. “thought
the bowels were swelled” The child was suffered to 
get 8 or 10 days without evacuation & eventually died
of another disease with which this was connected
# In the incipient stages, filling the intestines
with warm water [illegible] recovered. I was led to it from 
its [illegible] strang. hernia I am satisfied it acts well as a 
local nervine etc.
I would recommend the injection of ether 
in cold water table sp. to a gill warm wat. will make it fly off. The inject of it
is practised by the French & Germans. Other antispas. might be [injec??]
is asaf. petroleum etc.


88
We may often hear a rumbling noise proceed as far as 
the stricture & then stop.
Treatment The indications of cure are principally,
to relieve the excessive irritation both constitutional & 
local & to attempt the restoration of the involved intestine
chiefly by mechanical means
When the small intestines are affected we
must give opium and aromatics & depend mainly upon
these as internal remedies, until the intestine restores 
itself. As an adjuvant the warm-bath will be valuable
& fomentations or irritants, as mustard & horse radish
leaves may be applied to the abdomen. Soothing injections 
also may be copiously given. The quantity of opium 
which will be safe at a dose may vary from half a drop to 30 
None but the mildest cathartics are safe, as blue pill
and aromatic tincture of rhubarb I have succeeded in giving 
only a decoction of senna & the blue pill [Savage]
When volvulus is in the large intestines
all our remedies must be given by injection. The 
warm bath etc. may be used & we may also attempt
the restoration mechanically, by means of copious 
injection repeatedly given & thrown up with force
Two cases are related of young men cured by inserting
into the rectum & keeping these for a considerable time 
as spermacete candle with a quantity of opium at 
its extremity.




The first case which I had I treated for constipation 
with repeated cathartics, which are thrown up etc. The
attendants complained that they could not give the injections when
I ordered I was ignorant of this case Tried warm bath & 
every remedy for colic constipation etc.
Upon examination at first the colon was
apparently wasting at the sigmoid flexure where there
was a large tumour which we thought to be a malformation
It proved to be a repeated & insolution of the intestines Inflammation 
had taken place & the whole was adherent, some
[illegible]
Afterwards I was called too late, to a similar
case which upon an examination showed circular appearance
Afterwards called in consultation to a child
said to have hydrocephalus all the children of which family 
had died in a strange way. I pronounced the disease
not hydroc. but some could not say what was the matter.
No treatment was serviceable. Examin showed volv.
of small intest. Symptom is above. vide p. 204
The children of the family were subject to 
diarrhoea & were leucophlegmatic. I afterwards 
[illegible] the family and was very cautious about cath.
giving nothing stronger than blue pill or tinct. rhub. The
family raised 5 or 6 children afterwards
Case of a student [unaccountable]
Dr Munson & Dr Smith at a loss. [Cath.] retained & yet
not thrown off by vomiting Sitting by him I observed
a rumbling noise Which he said upon my enquiry, he
felt & which stopped. I felt the stricture. Spermacite 
candle, sharpened, opium at [end]. kept up about a [illegible]
[renewed] afterwards injection passed up 
Case of a gentleman on the wharf similar cured


89
Cases. A man over whom a cart had passed without
leaving any external injury, died with all the symptoms 
of volvulus of the small intestines. On dissection the duodenum 
was found cut entirely in two. One remarkable
physiological fact occurred in this case; a cathartic
was given by the mouth & produced a regular 
evacuation from the anus, although the intestine
was completely severed.
An interesting case occurred to me
in which the worm ascaris tricocephalus was found
to be the cause The worm lay in this fold of the intestine. Grace Linsey, a delict schoolgirl
on was taken with slight in disposition for 3 or 
4 days the rejected her food by vomiting then came
on constipation with vomiting attended with great
restlessness & throwing off the bed clothes, cold extremities,
low & small pulse the tongue not much furred,
little or no thirst, no tumefaction of the abdomen
no determination to the head. She was visited on 
Tuesday and died on Saturday. A blue pill was
given & followed by 15 or 20 grs. of calomel in divided
doses No effect was produced though they were 
not rejected. Opium and stimulant were tried but
were not retained. There is no pain but faintness & 
an uneasiness about the alvine & urinary passages.
Both copious and small injection pass up well but
produce no evacuation. On Wednesday injections produce
stools which are clay coloured. Black vomit came
on two days before death. P.m ex. liver very pale
little bile in the gall bladder no marks of inflammation cavity 
containing the intestines very dry as in cholera. Two volvuli were found one in the
ileum which was disengaged with difficulty, & one in the jejunum 


In other cases with similar symptoms I have had supposed 
there was volv. caused by worms, but have had no opportunity 
to examine Vide p. 204
[illegible] Lindsay’s case continued. After the examination 
we accidentally observed some of these worms minute 
& coiled up among the mucus on the cloths. The worms seem
more calculated to irritate the bowel than any other “If it
could have been known that the worm was there, perhaps tobacco should aught have
succeeded
# It is called leg ache in slight affections 
alluded to by DR Rush
Affects the legs, calves of the legs
[illegible] continues extends up to the [illegible]
coats” It is a disease manageable in its commencement
Being a severe disease it calls for 
decisive remedies
The indications are to allay pain 
equalize excitement & promote peristaltic action
by opium by diaphoretics by cath.
Cal. in full doses some would call 5 grs a
full dose some 10 But if 5 gr. should be given
every hour it would amount to a full dose. You 
may give 10 gr. 2 or 3 times repeated. AT the
same time apply warm bath & fomentations
not regarding your giving cath. Put drafts
at the feet. Follow the cal. with senna, salts etc.
But do not be too anxious about the calomel’s operating
immediately It is better that it shd lie sometimes in 
[illegible] vessels
With the cal give opium also guiacum 
& guaicum with dovers powder the latter
to act on the skin and the whole to produce a 
decided [nerve] action affect on the al. can. and on the whole system


89:a.
Nervous Rheumatism
Infantile neuralgia
This is a disease which has never to my knowledge
been described in the books, though it may have existed unnoticed
I first met with it some years ago, but it is [not] some years
since I have seen of a case. It may occur again
It occurs in the winter and spring mouths & 
occurs after exposure to cold especially after the feet have
been in snow water.
Children are the only persons that I have
known attacked # 
This disease is in its symptoms allied to neuralgia
acuta. The affection leg ache is probably allied
The attack is sudden after exposure to cold 
with excruciating pain in the inferior extremities sometimes
rigidity of the whole muscular system more or less disorder
of the digestive passages (apparently the muscular coat of the
intestines is affected) abdomen frequently tense
and full stomach sometimes irritable. If the disease advances
there is nausea, vomiting, tumefaction of abdomen
(appearance of tetanus?_ (coma?) etc. and the patient dies
in 4 or 5 days
The indications of treatment are to equalize
excitement by acting upon the whole surface of the alimentary
canal and skin at the same time introduce new action in the system
commence with a full dose of calomel 5 to 10 grs or 20 & follow
it by senna and manna, or castor oil and enemata
“I do not expect that cal. [illegible] I as above will operate at 8 years therefore follow it.


Immediately after administering the calomel I put the patient
into the warm bath or the feet in to the tepid bath,
wrapping them afterwards in flannel or boil cedar boughs
in water, roll them in cloths and apply them to the body & 
feet. Irritants also may be applied to the extremities and
to the abdomen
Sometimes it will be best to repeat the cal
in the course of 2 hours. The stools will be fetid and
dark but this must not be considered as an indication 
for further evacuations as the appearance may be caused by 
the calomel, and is a sign that secretion is beginning to take
place. After producing free evacuations by your cathartic
you must keep up a regular course of exciting the secretion 
by cal. & guaicum with Dover’s powders, especially if 
pain continues & keep up a diaphoretic action by Dover’s
powders calomel and camphor alternately increasing 
doses if necessary. Calomel and gum arabic, as an emulcent, 
& calomel and decoction of cedar twigs, as a diaphoretic
may be given
Give the calomel first in divided doses
If cold applications are made to the extremities, to 
discuss the inflammation the disease is translated to the
stomach and death is the consequence
I called in the first stages, & am always successful in effecting
a speedy cure



The irritation of the system is so great that secretion 
is prevented hence the production of
secretion
I have been called to patients with [illegible]
where little had been done the abdomen was
swollen the patient went into a comatose state
& died and that too where the disease
was not of the most violent form
After the bowels are thoroughly evacuated
depend upon diaphoretics camphor guaiacum and 
[illegible] etc. giving so as not to offend the stomach 
and beginning gradually 
It is a violent and excessively 
painful disease and it is a great satisfaction to the 
phys. to cure it
Dark stools [illegible], satisfied
“The pain usually begins in the calf of the
leg and extends to the contiguous parts. Sometimes it is attended
with tetanic spasms & a constant rigidity of the abdominal
muscles. The stomach becomes in these cases irritable,
and nausea & vomiting prevail. In the progress
of the disease the abdomen becomes full and tense, with 
constipation.”
“It should be our leading object to make the
muc. men. of al. can. & the cutaneous system active [concert]
After the operation of cathartics, if the pain is severe give diaphoretics 
with opium, as Dover’s powders. Camphor & cal.
in small doses as an alterative. If the stools are watery & fetid
give opium ¼ gr. guaiacum 1 or 2 grs. camph. 1 gr. Ipecac ½ gr.
with cal. repeated till some effect is produced not to salivate, but
to this children are not so liable as adults”


Young physicians are often called in a case of convulsions
as their first case The neighbors & friends (women) have assembled
in great numbers and their sympathies are excited. Hence
an impression is made with respect to a young physician’s talents which 
will be of great service or detriment
Morbid condition to brain so that ordinary stimuli
produce convulsive action
Convulsion fits may continue 5 m or from 1 to 2 hrs


90
Convulsions vide costiveness 12:a
This is a very common disease of infants. The mortality from 
it is truly appalling nearly one seventh part of the whole
number or deaths of patients under the age of puberty
by the bills of mort. in Phil in 20 years
Medical writers commonly make two 
kinds of convulsions idiopathic and symptomatic, the
former arising from some morbid condition of the brain 
and nerves and the latter from some other disease, or from 
irritation. Children are subject to both kinds & most
of the diseases of children may be expected when they prove mortal
to terminate in convulsions
The causes of symptomatic convulsions
are as various as the agent capable of producing irritation
though the causes of convulsions in one child will not 
necessarily produce them in another. The susceptibility to 
them varies with the age of the child and the peculiarity 
and degree of delicacy of the constitution.
Convulsions may arise from the sudden suppression 
of evacuations to which the system has become
habituated. Irritation from teething is a very common 
cause. Worms in the alimentary canal may excite convulsions.
But perhaps the most frequent cause is the 
presence of indigestible substances in the primae viae.
irritating the nerves of the stomach & through them those of
the whole system. Over distention of the stomach, even with 
food of a healthy quality interrupt the progress of digestion
& the food undergoing action [illegible] fermentation 


“Or the excessive quantity of food may produce
convulsions from the mere stimulus of distention”
“Dyspepsia is a cause”
This is an important maxim in the first children of 
young mothers Their anxiety of mind will often affect their
milk


91
in the stomach, becomes noxious matter & excites convulsions
In the season of fruit we may always suspect this as a 
cause in children old enough to eat it. Calomel has been
known to be so irritating to the system as to bring on convulsions
Costiveness also is a cause of convulsions in children
A change in the quality of the milk of the
mother or nurse, produced by improper food or
by strong affections of the mind, in some instances
is the cause of convulsions in young children. Hence 
not only the diet of nurses should be regulated, but their
minds kept tranquil. It may be observed also that the 
countenance of the mother or nurse as also those of the bystanders
has more influence upon children than is commonly 
supposed. Even a child but 3 weeks old, will be strongly affected.
In some families there is said to be an hereditary 
predisposition to convulsion among the children.
For the treatment we have two indications
1st to remove the exciting cause where this is local & 
2nd to relieve the irritation of the system
1st We must enquire into the causes with 
with care. If evacuations are found to have
suddenly ceased they must be restored. The guns should
be lanced. Anthelmintics should be given if there are worms
If improper food is suspected we must be particular 
in our enquiries, or we may be misled by a [vague] & 
general answer. When the convulsions have been brought
on by improper food or by food in large quantities
recently taken the stomach should be evacuated by an
emetic of 5 or 6 grs 4 to 8 of sulph of zinc or of ipecac.


# How long should we wait after giving one cathartic
before we try another? the child being in convulsions 
all the while?
The equilization of temperature will do a great deal
to remove convulsive action Besides the soothing of the [nerves] etrc.
Some rely on one and [illegible] or another
Oil of a amber is not in my opinion better than many others
The oil of amber apparently is the [illegible] the oil of [capal] brought from its E. [illegible]
It is recommended to dissolve the oxyg oil in [illegible]
[but] it is slow of solution It dissolves readily in either


92
If the offending substances have probably passed the stomach
& the irritation is in the bowels, these must be evacuated as
speedily as possible giving and injection to begin with [illegible] it to [illegible] cathartic. Sometime
it will perhaps be best to give a dose of calomel
large enough as to operate both as an emetic & cathartic.
Frequently large & repeated doses of cathartics
will be needed in order to overcome the torpor produced
by an excessive quantity of food. The food also diminishes
the cathartic operation is the case with the French
[dinner] pill. We may give calomel, 5 to 10 grs. or scammony 
3 to 4 gr. jalap 2 to 3 gr. senna & manna, castor
oil, neutral salts etc. If dry cathartics fail to produce
the desired effect, the liquid should be tried. Sometimes
will be acted on by one kind when they will not by the 
other # If one fails after 3 doses try another & assist with injections
Begin with cal. & follow with the others
2. If the convulsions continue after the removal of the cause we must
rely upon antispasmodics or even at the commencement. Of these the warm bath must
be considered the most powerful remedy in convulsions
of children always [illegible] & often efficacious. Its influence is immediate and extensive.
Antispasmodics, as pearl ashes or aromatic herbs, may be
put in to the water of the bath
Of antispasmodic articles a great variety are 
used. Oil of amber Dr Rush called his sheet anchor in 
spasmodic diseases. It is useful internally, and applied
as an external irritant along the spine. The artificial
musk a preparation of amber is in my opinion a better
article than amber itself, for all cases where amber is 


“# Seneca oil is more limpid & pure & approaches nearer to naphtha”
Soot is a [illegible]
Soot is efficient as a nervine tonic & deobstruent
It is sometimes very efficacious in jaundice & dyspepsia It was
very popular in Philadelphia with ashes for stomach complaints
“The British oil is manufactured in this country from 
Barbadoes ter & spts turpentine”
The nostrils may be rubbed & it may be given
internally “also rubbed on the skin”
Though so offensive to the small yet children taking 
the tinct readily
potash [illegible] & [illegible]
All the alkalies & alkaline earths are antispasmodic.
They are not nervine properly. There yet
seems to be abundant testimony to their antispasmodic
properties. They are to a certain degree tonics. i.e. they 
have a specific action on the mucus membranes. I have maintained [illegible]
they operated by generating excitability a view supported by Jobe
vide Hufeland’s Journal in Lond. Med. & Phys.


93
indicated. The mineral oils from whatever source obtained,
such as petroleum, seneca oil, British oil, are
little inferior to the oil of amber I prefer the seneca oil 5 to 30 drops #. The eympreumatic oils
are useful antispasmodic and soot is often given by nurses in 
decoction
Ammoniae in any form is a good antispasmodic 
A solution of ammonia in spirits often contains an empyreumatic
oil of this solution we may give to a child from 2 to 
6 drops in an ounce of water. Either the spirt, the carbonate
or the aqua ammoniae will be useful in alleviating spasms 
in children either applied to the nostrils, rubbed
upon the skin or given internally. Dippel’s animal oil, a
very fetid substance distilled from bones in a state of putrefaction owes to antispasmodic
virtue to the presence of ammonia. It is too disgusting
Castor and valerian are good articles
of this class, but in cases of children they are too bulky & a sufficient quantity
cannot be introduced into the stomach. A more
powerful article than these is the asafoetida fetid gum 10 or 20 40 
drops of the tincture. This is a very valuable remedy to 
give by injection using for this purpose either the tincture zii
or a decoction
all the alkalies are antispasmodic & 
are proper for children. The most powerful is 
pearlash given by injection, zi to zii in lbis of water 
I have seen more sudden and permanent effects in cases
of spasm produced by injection of this kind, than by any 
other remedy. It has been successful in cases both of 



In for [illegible] who have [resumed] in convulsion 2 or 3 days
when a variety of narcotics had been given. I have seen
surprising effects produced by the injection
These applications sometimes fail & we 
cannot tell to what sort of cases they are Yet we must have
a variety of resources if we would be able practitioners
Opium is powerful, but though it
frequently relieves, yet it sometimes aggravates the symptoms
I have given it with great success in paroxysmal convulsions
anticipating the paroxysms yet in these it will sometimes
fail



94
infants and of adults. Sometimes however this remedy 
fails & I am not able to point out in what particular
“We are compelled sometime to practice [illegible]”
instances it is indicated. All the narcotics
are antispasmodic. Opium is a powerful antispasmodic
and may be given to patients of any age when the condition
of the system does not contraindicate it vid. lect on m. m
I have given opium
where the convulsions were violent & returned
at stated periods with fever preceding. When the
convulsions appear at regular intervals, as once in an
hour, or day, opium in repeated doses may be considered
a specific.
Counter irritation may be valuable adjuvant
in the treatment of convulsions. Oil of [origanum]
& similar articles may be rubbed along the spine
 drafts may be applied to the feet and wrists & mustard
horse radish leaves etc. to the abdomen.
When the convulsions are frequently repeated
in children and become in any degree periodical, a
cathartic of calomel given once or twice a week, rarely 
fails to prevent their recurrence. If this fails I give
stramonium or other narcotics
If convulsions arise from organic affections
we can expect to effect more than to palliate
instead of curing the disease.
“Counterirritation by mustard, horseradish etc. may be
useful”


An injection can do no harm can always be administered
and if one cannot administer articles by the mouth
Irritants may be applied immediately e.g. mustard
horseradish garlic N.B. we do not need powerful vesication
for the tender skin of infants. Even garlic sometimes vesicates
Ammoniae to nostrils & in mouth
Be sure that you have [water] enough to [illegible]
the child completely for the nerves are apt to think that it 
is sufficient to half [illegible] child & then sprinkle
or scatter water over producing an equal excitement
Friction may be applied while in the bath & after
coming out [illegible] with dry flannel
If the irritants have been applied before
the bath taken then off when [illegible] about to immerse in the
bath & put them on again if necessary after coming out
If the child seems to be in a state of asphyxia 
the emetic may not take effect; then irritate the fauces
the child being lard on its abdomen supported by the
hand of the nurse



95
When you are called to a child in convulsions, without 
previous sickness, direct an injection to be immediately
administered and the warm bath to be prepared. if the
injection does not relieve, put the child in the warm bath 
previously adding pearl ash in proportion of zfs to a gall.
of water. Let the child remain from 5 to 15 minutes taking
it out when it begins to grow exhausted. When taken out
of the bath let it be wrapped in flannel & put into a 
warm bed. Then apply irritants as mustard, horseradish
garlic, or aqua ammonia to the abdomen feet and wrists
Apply aqua ammonia to the nostrils and temples
As soon as the child can swallow give a dose of calomel;
If the countenance is pale or livid the
cause may be suspected to be some offending matter in the 
stomach & an emetic ipecac not [illegible] generally should be given. We may often
succeed in exciting vomiting by irritating the throat with 
the finger or a feather & this method should be tried
when the patient cannot swallow & is known to have taken
improper food or when it is desirable to hasten the 
operation of an emetic. The child will vomit with much
more ease if it is held lying with its belly upon 
the nurses’ hand, which this supports the abdominal 
muscles
If the child is much agitated at the 
sight of the water which it is to be immersed, let
the tub be covered with a blanket & the patient gradually 
lowered into the water there will then be 
no difficulty




96
Epileptic fits are very frequent among children
Epilepsy is defined by Good A “spasmodic agitation & 
distortion, chiefly of the muscles of the face; without sensation
or consciousness; recurring at periods more or less
regular.” One side is generally more affected than the opposite
The limbs may be fixed and rigid with twitching 
of particular parts. The pupils may be contracted or dilated
& the attack may be followed by coma. The attack may 
be abrupt and without warming or may be preceded by 
hilarity, or a giddiness or other unpleasant sensation.
Sometimes there is what is called the Aura epileptica, a
sort of formication, creeping up the body for which the 
ligature may be applied
The fits may be kept up by the constant 
presence of the cause such as malformation of the brain etc.
or, by habit & while in the former case the disease
will be incurable, in the latter habit will be very 
difficult to break up.
The causes of epilepsy may be, malformation 
of the brain tumours of the brain derangement of the system 
produced before birth by syphilis & rickets or the same
causes as those which produce the rickets & in children oftener than after preventing the disease
may also arise though more rarely from mere excessive irritability of the system, even’
without any exciting cause of irritation such as indigestible substances
in the alimentary canal or suppressed evacuations
Among children however epileptic fits are
most commonly excited by teething, suppressed evacuations
& the irritation of a morbid condition of the bowels or of 


In scrophulous children remedies for scrofula
may be given. [illegible] rickets I have often
found advantage from blisters behind the [ears]
I have found the cath mode of treat successful 
for children within the year especially calomel
In some cases the most powerful cathartics are
required
If there is acidity of the passages so that cal. seems
to gripe much [illegible] chalk any quantity from 5 to 10 
It is immaterial whether the action is chem. or certainly 
the effect is good
The system being very irritable ordinary stimuli
or rather a little more than ordinary brings on [illegible]
Hence improper articles improper exertions of mind & body
etc. Careful management & [illegible]


97
indigestible substances in them.
The treatment of epilepsy must vary
with the causes which produce it but does not differ materially 
in the case of children from that of convulsion fits
In epilepsy from rickets I have used the
cold bath with advantage. In children our attention 
in the treatment of epilepsy must more especially be directed 
to the alimentary canal. Cathartics are far more valuable
with them than for adults. I have almost always succeeded
by means of a course of mild cathartics & 
joined with one of tonics, such as the tonic solution 
& the different preparation of iron
When called to an attack brought on 
by offending matter in the stomach and bowels, we should
commence the treatment with a strong cathartic in 
order to thoroughly clear the alimentary canal
calomel is the best article but if the bowels are loaded with 
mucus so that calomel fails to operate we may conjoin 
1 or 2 gr. of gamboge & of scammony & 5 of jalap & this
though powerful, will yet operate kindly. In 
the subsequent treatment calomel should be given 3 or 4 
times a week; though if there is a deficiency of mucus
in the bowels an abrasion as it were the blue pill will
be preferable or chalk may be conjoined.
Among infants most cases are curable
by careful management, both of the physician of nurse
The diet should be regulated with great care Generally 
however there is a morbid appetite, & a sub-[insanity]


There is often a difficult, particular waywardness
[illegible] like into [illegible] etc.
In children more than a year old I have given stramonium
so far as to dilate the pupils keeping the child under
the operation of it I have not prescribed it to children
under 2 yrs or 18 m. I recollect one case in which 
the convulsion begun to subside as soon as the pupils began to 
dilate
I would not prescribe to [illegible] but to [all]
symptoms e.g. tonics all the nat. ton. tinc irr. cap.
lead
I would give the lead where cathartics, from 
the excessive irritability of the al. can. aggravate all the 
symptoms Lead will produce a torpor or sub paresis
contrary to this Narcotics also will meet this condition
Opium will occasionally, but not generally 
Why it is we know not but the fact is that phys. do 
not depend on [illegible] ep. seems to cause a determination
to the head


98
with regard to food. This subderangement of the mind
manifests itself also in other ways by oddity of appearance
gesture & action. A strange propensity for climbing for
instance is met with & epileptic children will often be so 
active & so artful as to be very difficult to manage
For more particular treatment see my 
lecture on m. medical articles stramonium & nit. silver
[illegible] turpentine from 10 gtts to zi diluted
stramonium, camphor, opium atropa belladonna
& most of the more powerful narcotics Arsenic
zinc is one of the best of the metallic tonics
Actual cautery, [moxa] etc. have been highly extolled
“In epilepsy caused by rickets or by the same
causes as those which produce ricketts. I have used the 
cold bath with advantage”
“Mercurials followed by mild cathartics
[Seontod??] etc.”


The child will be still breathing languidly
The parents think it dead If you look at it carefully 
you will perceive as languid treating & looking at
the eyes you will often perceive a little convulsive motions of 
the balls pulse not much disturbed
The child continues a few [illegible]
with paroxysm & comes out with a scream like
an adult from nightmare
Not dangerous
In a few instances [somerset]
Case adult patient [illegible] a chair stands fixed eyes fixed
come out with a stare irritable & sub derangement
for a few days Afterwards [somersets] “asleep
once a sleep twice”
Case a girl last year gather up [illegible]
[somerset], even 50 times than cataleptic then exhausted
This case changed from chorea to catalepsy Repeated
bleedings did not change the emaciation etc.


99
Catalepsy
This affection when it affects children, is called in 
poular language still convulsions. It is a very rare disease 
among adults, but among children I have met with several
cases of it
In catalepsy the muscles are universally 
or partially affected with a tonic spasm. The patient remains
fixed in the position in which it happened to be
when seized appears asleep, is insensible and scarcely 
breathes. The eyes are commonly fixed, but sometimes have
a little motion. The paroxysm may terminate with common 
convulsions. The length of the paroxysms I have known
vary from a few minutes to three hours & in some cases
they are frequently repeated
The disease arises from the same causes
in general & requires the same treatment
as epilepsy & convulsions. Cataleptic convulsions 
sometimes follow other convulsions & in some instances
have been brought on by drastic cathartics
In adults catalepsy is often followed by irritability 
& a degree of mental derangement.
“Catalepsy arises from the same causes and
requires the same treatment as epilepsy chiefly 
by cath. & antispasm. Sometimes children are
affected with catalepsy without it being observed
When I commenced practice I thought the notion of
still convulsions a mere whim”


Dancing before the [illegible] of St. Vitus
Dance [illegible] 3 or 4 well persons
Comes on gradually parents complain that
their children are getting into bad habits Awkward
motions
The dis. is not benefit. by [illegible]
I recollect a gentlem. 40 or 50 yrs told
me he had chorea when a child & recollects perfectly 
the indignation, horror & disgust when so long as to be 
unable to speak [illegible]
Hand carried not to the mouth
Sometimes the motions finally become regular
“The dancing master” feet blind [illegible] then 
hands then body then stop like a statue then begin 
one foot like a [falling] [illegible]


100
Chorea Sancti Viti
This is a disease not to be mistaken in its ordinary appearance
the voluntary muscles are but partially subject to the well
and their motion is convulsive. It occurs oftenest in 
females of relaxed habit & about the age of puberty
especially if they have grown rapidly or been much 
confined to the needle or to study.
In children this disease is often caused
by irritation in the primae viae Chorea also arises in 
some cases from a peculiar irritability of the system in 
which ordinary stimuli produce convulsive action
This irritability may be accompanied with 
relaxation, or with increased action together with a
determination to the head. Indeed it is said sometimes
to be connected with inflammation of the brain 
 & hydrocephalus. With those who are predisposed
to this disease, particularly if they are females
about the age of puberty affections of the mind may bring it or
epilepsy sometimes runs into chorea, or alternates with 
it. Finally, the disease may come on in a very gradual
manner, so as not to be suspected, causing a strangeness
in the gestures walk etc. which at first is attributed 
by the friends to the formation of bad habits.
This disease is rarely fatal and is not
difficult to cure in patients under the age of puberty after
that period it is seldom cured. When the disease is
of long continuance a great variety of remedies are generally 


“When I give cathartics in chorea it is not for the 
evacuation but to produce a new action. All cath.
will not act favorably. Hamilton’s views in prescribing 
cath. are not generally correct.”
There sometimes irritation of al. can. from accumulation
of feces about the coecum. Hence Hamilton’s
plan of purgatives Purgatives will cure but [general]
by impression on system
It is said to arise from a tonic infl. of 
brain I have read periodicals have not so
I have seen all kinds of treatment tonics, cath
narcot. electric. galvan. cold bath etc. etc.
Perhaps no disease prescribed for more [illegible] periodically
We find one and another article fails and are obliged 
to go the whole [illegible] off [illegible] narcotic etc.
# “In one case of chorea I tried the arnica until the
head became affected. The patient began with a decoction of zii
the flowers & increased to zfs without any abatement of the disease”
Prof T’s [illegible] [illegible]
Nux vomica has been used with success in many 
cases but there are other narcotics which act more powerfully 
& more certainly I have not used it deterred by [Ba??]
[Surrey] who found it injurious for some convulsive cases 
“Stramonium succeeded in a case following
epilepsy”



101
tried and the one last given is apt to be considered
as having effected the cure; but I am inclined to think that 
in many of these cases the disease instead of being cut
short by the treatment and run its course and then ceased 
of itself
The most common indications are [for] narcotics
and tonics with antispasmodics as palliatives & 
permanent counterirritation along the spine in some cases.
In children however cathartics are commonly indicated; though
in general the plan of treating chorea by cathartics, has not
succeeded very well in my practice. Dr Hamilton however
depended upon cathartics and had better success, though it may be remarked that those who act on that treatment are also the metallic [illegible]
When there are symptoms are symptoms of worms, of hydrocephalus, or of
inflammation, of the brain or when the disease follows epilepsy
we must treat as for those diseases; & if it the chorea
is the result exclusively of the peculiar irritability above
alluded to, narcotics must be our chief dependance. 
The principal articles which I have employed
in my practice are conium, conium & iron
sulphate of zinc, sulphate of iron & other metallic
tonics. Various narcotics are used, as the nux
vomica in doses of 1 or 2 grs of the seed in pill or 15 or
20 drops of the alcoholic tincture; and antispasmodics
as valerian musk etc. may be used as palliatives
Cullen’s favorite tonic was the ammoniuret of copper 1 to 4 gr.
I have lately used it with advantage in pill 2-3 hours in creasing
other tonics are mineral acids, nitrate of silver, bark
& the arnica montana #, which is a narcotic & tonic & 
was successfully used by Dr [Monsen] in chorea” Dr. T’s copy [M. ?]




“Sulph zinc 1 gr. may be given 3 or 4 times a day
nit. sil. 1/6 to ¼ gr. succeeds best in relaxation of the blood-vessels”
“Evacuate the first passages and restore the healthy
secretions & irritability of the system by tonics & antispasmodic
“I have rarely effected a cure by cathartics though I generally 
begin with them The cure with antisp. & tonic is slow 2-3 [illegible]
with narcotics more speedy but uncertain”
A good deal may depend upon the careful management
of the patient keeping him quiet & amusing him especially 
avoiding the irritation of the [pressure] and the impertinent
curiosity of strangers
The young man in a debilitated 
“So camphor has sometimes been given in mania to 
such an extend as to produce epilepsy & sub-apoplexy & this 
sometimes cures the mania”


103
double the quantity, when the head began to be affected still
there was no considerable relief The patient was finally cured
by taking the bark in substance zi a day.
One case which came on in the gradual
manner above described & was brought to a high degree
by a dysentery proceeded so far at least as to present
the peculiar symptoms of hydrophobia such as horror of
water etc. convulsives perfectly [like] that frothing of the mouth etc. died in coma exhausted
narcotics tonics etc. no effect excitability exhausted by [illegible]
This disease may affect the mind causing
it to run upon particular subjects especially upon that
of numbers & calculation. I once travelled a short
time with a book pedlar who had the odd gestures of 
chorea & had also this facility in calculation, being
in this respect fully equal to the famous [Serah] [Colbourn]
[Serah] [Colbourn] though furnished in Europe with 
the best advantages for education never improved
and this result I ventured to predict, when I first
heard that he was to be educated. I have seen several
such cases. # They have a peculiar articulation & expression
of countenance; and are deficient in memory and
judgment. Vide [illegible] 12 [illegible] for [Serah] [Colbourn]
Case girl at stool good talents studied
hard [stand] out of schools [illegible] Cal. narc. cath. tonics
operated but
[Elateri.] 1/16 gr. once 4 hr in about 24 
hours deadly sick nausea prostration vom. purg.
disease broken up. It may be diff. to class this
A year after similar causes brought on a second attack #


Connected with acidity gives great pain not
dangerous
“This is a troublesome and not unfrequent 
complaint, arising often from improper food 
and that stab of the stomach which causes acidity. In 
a torpid state of the stomach when the healthy action 
ceases or is feeble, chemical action commences, and
the acetous or putrefactive fermentation, prevails according
to the contents of the stomach”
“If our remedy fails try another for there are no two
exactly alike & the judicious physician will discriminate as
they are indicated”
Among the astringents should be mentioned the rose
willow It is one of the pleasantest astringents & is a popular 
remedy in canker It seems to combine a mucilage
Almost any of our wild willows may be used
Nitrate of silver may be used It is often however
difficult to touch the ulcers and we may then use astringent
washes.
Rhus glabra and R [typhina] are good astringents
vide hosp. [illegible] sub. [illegible]
The poison of R [vernex] I have more than once known
communicated in more than one instances by using the wood as
fuel. I recollect a man’s [illegible] to me on account of an eruption 
on his legs. I told him he was poisoned. He replied that
there could be no cause for it but a pair of the pantaloons
lately dyed black. Upon investigation I found that
the poison species of sumack had been used by the dyer
by mistake for the common one. Young persons are more 



102
Cold bathing is sometimes advantageous tepid is seldom proper
Electricity has been used. I have seen little benefit from it
Setons, issues, tartartar emetic ointment along the spine & 
other modes of counterirritation, are employed & may be advantageous
but where the irritability is great they do injury
If the disease is not translatable it is made worse by counterirritation
In the treatment of patients affected with 
this disease, we should bear in mind, that they are the
subjects of great mental sensitiveness & irritability
The presence of strangers in injurious & the remarks of bystanders
upon the patient may cause an amount of mental
irritation little suspected.
I have succeeded in curing chorea by 
elaterium though this is an article not mentioned by writers
as applicable to this disease. A young man debilitated
by confinement as a clerk in N. York was thrown into
convulsions and derangement of mind, by a sight of distress
while on board the packet for this place Elaterium was
given to prostrate the system & break up the habit. It was
successful & this led to its employment in chorea. I have
completely broken up the latter disease by an eighth of a grain
of elaterium & this is the only case which I have broken up
vide end of this article
Case a female delicate 14 yrs of age had not menstruated had been
treated with cathartics, epispasmodics and narcotics, which 
palliated the symptom. The patient then took arnica for
10 or 12 days beginning with moderate doses (zii to a pint
of boiling water being given in 24 hours) & increasing to 


I have found [illegible] which however was Dr [Rush’s]
favorite remedy in females about the cessation of the [illegible]
useful
Friction antispas. electricity etc. had merely palliated
The case then [illegible] to indicate tonics
[illegible] the other remedies had [illegible] effect or not recovery
rapidly upon bark
Sometimes connected with pneumonic affected
or with [organic] eff. of the heart In some of these cases 
[illegible] of copper 1 to 3 gr. rarely more than 2 gr. nauseating article [illegible] in such cases more
especially
As the [disease] advances sometimes [illegilble]
difficult [illegible] swallowing dark [tongue]
# [illegible] of them the book pedlar and [Minot]
[Sheri] [illegible] [illegible] Both these had this facility in [calculating]
# At this time there was not excitability enough left to enable
the elat. treat. El. shd not be cont. more than 


103:a
Ulceration of the mouth in children
This is sometimes a troublesome complaint and one that
does not readily yield to remedies. It is commonly called
canker. The complaint consists of one or more ulcers, which 
commence with an inflamed point or with a white slough
situated commonly near the frenum but sometimes extending
over the whole inside of the mouth. The edges of the ulcers are
inflamed & elevated & their surfaces excavated, as if they had
been eaten out with caustic. The child drools much
and nursing is evidently very painful to it. A febricula
attends the first stage. The bowels are slow and digestion
not vigorous indeed the complaint often arises from improper
food and is connected with that state of the stomach
which causes acidity
Treatment. First excite action of the bowels by magnesia, 
if there is acidity, blue pill, if there is torpor, or calomel grii & chalk grvi. After this give
tonics & astringents as Moseley’s tonic solution 3 to 12 2 to 10 gtts 4 to 6 brak compound
tinct. vitriol 4 to 5 gtts & the vegetable astringents as geranium in a [ter] spoonful of water
statici spriaea cornus etc. a little laudanum may be added
For topical applications we may use the
vegetable astringents just mentioned, catechu, kino etc. or
the following which has been recommended as very efficacious RX sulph. cupri grs x, cort. peruv. zii acad. gum zi
mellis et aquae aa zii make a soft paste to be applied to the ulcers with a 
pencil. A weak wash of corrosive sublimate may be used
Sometimes a mild caustic is serviceable, as nitrate of silver
A wash of opium or of opium & corr. sub. is sometimes the best
viola pedata makes a valuable wash. Asclepias tuberosa is
escharotic. [Post] [illegible] case


affected by this poison than old. When young I have often
been poisoned myself by boing near the plant
merely. Now I can brush past it with impunity provided
it does not touch my hands or face. Some
persons are not affected at all. The uncertainty of its
operation is the only reason why it is not used in 
medicine. Corrosive sublimate is a good application
for the affection of the skin. Yet the disease is
a specific one and must generate run through its
regular course. A similar disease is produced by 
the oil of the shell? of the cashew nut
Ulceration of the mouth continued “The disease
sometimes attended with severe pains, as severe as in tooth ach
in which case opium is serviceable. Case of an adult use
veg. astring. copper, zinc, opium, nit. silv. & at last corros.
sublimate. This last would not be safe in the case of children.
Intense pain was produced, which was remedied by holding
it in the mouth There was a profuse salivation but it soon 
ceased and the disease was entirely removed. The surface of the
ulcer was destroyed by the sub. & the dis. being local this effected a cure
# I have turned my attention particularly to the question whether
cal. produces it. I have known the dis. to allow dysentery
It was an old notion that cal. broke down the crasus of the
blood and it produced a tendency to gangrene. But 
in the venereal wards of hospitals you will see patients 
with sloughs all over the mouths and yet no gangrene 



104
Gangrene of the mouth
This is not a primary disease but a termination of other
diseases making its appearance soon after their abatement
I have known it follow dysentery and other affections of the
bowels, but not any disease in which the blood vessels
have exhibited an inflammatory action. It seems to follow
diseases of the nerves rather than of the vascular system
Children are generally subject of it.
This disease is sometimes accompanied 
with much pain & at others with none ordinarily with little or more. One of the first
symptoms is a constant inclination in the child to pick
some part of the mouth with the fingers where the gangrene
first commences either the teeth gums, less or cheek 
That part becomes spongy & has a fungous appearance in 
the course of a few days discharges a [illegible] matter, has
 a livid appearance & finally becomes black and dry 
the adjoining parts of the face become tumefied and indurated
and the disease continues until a considerable part
of the face becomes completely [sphacelated] when the 
patient dies It may continue sphacelatal in [illegible] etc.
the sphacelus being hard dry & black like a piece of leather
This disease has been attributed to the 
use of calomel, but it is entirely unlike that produced 
by this article, and occurs also in cases where no 
calomel has been given. # In those cases where calomel has been freely 
given the disease is not so apt to occur vide case 4th
I have known a similar affection occur
in the leg of a child, & an irritative fever preceded by rheumatism.
Commencing with a spongy and orange coloured spot
which afterwards become hard & black, the gangrene 


livid purpled as though the blood had settled
pulse small not much disturbance of the circ. syst. except that it was large
# & Prof. Smith & myself could not get down much medicine 
and were obliged to [illegible] [illegible] with external applications
We [illegible] injections and a great variety of external application 
blisters
“When the disease appears with tumefaction I think
leeches might be of service. This was called by Dr Smith congestive
inflammation. In other cases of gangrene, leeches would not be of service
It is not easy to [class] the operation of charcoal It
has been called a tonic, but it does not much resemble peruv.
bark and we do not gain much by classing it with it
It seems to act by generating an excitability
Charcoal shd be made of soft wood or of lamp black 
burned over again in crucible, as is sometimes done by the
apothecaries


105
extended up the leg and the child above the knees on both sides died [illegible] No applications 
seemed to have any effect. The child was irritable &
The disease under consideration is nearly allied to 
that called swelled tongue, but the latter oftener attacks
quadrupeds 
The treatment should be stimulant & antiseptic.
Acrids as capsicum may be used & the arum 
triphyllum accidentally has been known to cure.
In one case which I shall relate charcoal appears to have
effected the cure.
Case 1st The first patient that I saw affected
with gangrene of the mouth was an adult female who had the typhus 
fever. The gangrene commenced on the inside of the 
cheek & when I first visited the patient a portion of the
cheek as large as a dollar had sloughed off out? Great
part of the food taken into the mouth passed out at the
hole in the cheek. The patient continued in this state
for eight or ten days & then died The attending physicians
informed me that she has received the ordinary
treatment for typhus fever.
Case 2nd The next patient affected in a similar
manner was a girl seven years of age. Previous to the
gangrenous affection she had had a most excruciating
disease, which affected the knees legs and bowels I have
called it nervous rheumatism & shall notice it in another 
place. For this she had taken large doses of purgatives




106
calomel & opium, with diaphoretics & tonics. In three
or four days the pain ceased and the fever almost
entirely disappeared. The guns presented no symptoms
of salivation & there was no increase of saliva.
In five or six days after the fever subsided 
the patient complained of severe pain situated in the right temple
& extending down to the shoulder like that which had been in the extremities. This was removed by opium
to complain of the teeth
Soon after she began to work at the molar teeth of the upper
jaw, on the right side, at the same time she had a cough
which was accompanied with an expectoration of white
viscid mucus, and the breath became very offensive, resembling
the effluvia of an anatomical room where 
subjects have been kept a long time. The appetite
was tolerable, however the patient took animal food, with 
relish, and the bowels were easily moved with a little
rhubarb
the patient world at the teeth until she had removed two 
of the molar teeth with her fingers, she still continued
to pick at the gums. The cheek of the side affected
became hard, swollen & red. In forty eight hours a 
black spot appeared in the centre of the swelling. This 
spot the patient immediately began to rub with her fingers & 
soon made a hole through her cheek. The gangrene 
continued to extend, for a week & at the end of that period
had proceeded as far back as the angle of the jaw
affected the throat & perhaps the aesophagus The patient then died, having taken
food and medicine will until within forty eight hours
of her death.




107
Peruvian and oak bark, opium & camphor were
very freely given the affected side of the mouth between the 
teeth & the cheek was filled with superfine bark & poultices
of bark were applied to the face In the last stage affected
perhaps the lungs
Case 3rd Another case occurred in [illegible] subject a child etc.
A female child, about 5 years of age was attacked,
in the winter of 1813 with “constipation with fever”
the complaint being principally confined to the bowels The 
attending physician gave a dose of calomel and worked
it off with senna and manna. A considerable quantity 
of matter was discharged from the bowels, but from its appearance
further evacuations were deemed necessary, and several
doses of castor oil were given. On the fourth day I was
invited to see the patient. I found her with considerable fever 
of the typhoid grade, attended with pain in the bowels and
head. There was also some swelling of one cheek & the child
complained of one or two of the double teeth of the upper jaw
on that side. These she frequently attempted to pull out
with her fingers & finally succeeded in extracting one of them
The cheek afterwards became swollen, inflamed, and hard to the touch
& in a short time an orange coloured spot, appeared, upon
the outside near the centre, which soon became livid,
and the gangrene spreading rapidly, the child died, in 
eight days from my first visit. She became delirious previously 
to the cheek becoming livid & afterwards, was comatose.
In this case the disease seemed to affect the brain 
as it does in some cases
Bark, opium and camphor were truly given & antiseptic





108
poultice applied to the face as bark [illegible] [fermenting] [poultice]
Prof. Smith saw this patient
soon after my first visit & agreed with me in the opinion 
that the case would terminate fatally. He informed
me that he had seen but one case of the kind before & 
that he had attributed that case to an injudicious
use of calomel After seeing this patient however, he considered 
his former opinion as incorrect since in this case
there were no marks of the effects of calomel & there was no 
probability that the single dose of calomel, given in the
commencement of the illness, could have produced such 
an effect, especially when repeated doses of other
cathartics, had subsequently been given & 
had operated freely 
4th Case. The next case which I met with was that
of a female 12 or 13 years of age, who had the dysentery,
in the summer of 1815, accompanied with much typhoid
fever & rather a larger discharge of blood by stool than 
is common in dysentery.
The child had been sick for some days
before a physician was called. I did not succeed in 
my attempts to determine the diseased action from the
bowels to the surface by diaphoretics & the warm bath, & 
the disease ran its course and nearly exhausted the patient
When it began to decline, the stools to present a fecal appearance
& the appetite to return, the friends were 


There had been some aphthae and I was on a 
careful watch


109
much encouraged I, however, began to expect a fatal
result for I observed, between the anterior incisors of the
lower jaw, a fungous enlargement of the gum, the apex of merely a slight discoloration [illegible] & swollen between two teeth 
which had a purplish appearance somewhat as appears in salivation sometimes. I apprehended gangrene
in the case (perhaps from the countenance) and on the first
symptoms of it informed the parents, who however, could see 
nothing alarming in the small swelling between two of
the front teeth. I began early with oak & peruvian 
bark, and at the same time gave freely of brandy and
porter. As this course had no effect I applied 
bark and diluted sulphuric acid to the part affected
& also covered with the lunar caustic. Still the treatment
had no good effect the gangrene extended under lip and chin became
black and the child died
Case 5th A child about 3 yrs of age cousin of the previous one [illegible] had a dysentery,
in the summer of 1815 [illegible] as there was another
member of the family sick in oil uncommon & interesting
manner viz the case of chorea resembling hydrophobia was much neglected Her fever was typhoid
& the stools sometimes bloody and sometimes of a 
green mucus. After a course of 15 days and amendment
in the symptoms took place the stools
became less bloody, the green stools more rare & though
the patient was extremely weak but no reduced low as the previous one, the appetite returne
After convalescing gradually for six or eight days, there
came on a samous discharge from the nose, small in quantity
but very fetid which reminded me of gangrene


# In this case I examined the gums to see if there
was any appearance of salivation and found the gums etc.
Two teeth and a piece of the alveolar process came out
The disease did not spread so rapidly as the other ones
In addition to bark, tonic solution etc.
I gave charcoal


110
of the mouth which I had not been on the look out for AT this period the patient inclined to 
keep her fingers I her mouth. # The gums were very clear
and bright & adhered firmly to the teeth, except on the 
left side of the upper jaw, where the gums of the biscupides
appeared discolored and discharged a samous
matter. I declared the parents that in my opinion 
the case would terminate fatally. The child complained
of pain in the face and teeth. The cheek opposite the teeth 
became swelled and hard and of an orange colour. I declared to the friends
that mortification had taken place 7 pointed to a black
spot on that cheek which happened however to be accidental. I was mistaken for the next day
it was found that the black spot was produced by a piece
of burnt apple skin, which was washed off This encouraged
the friends; yet within 24 hours sphacelus took place 
the apple skin was
in the very spot where I had supposed that I had seen
it. This gangrene ceased to spread after 
the spot became as large as the end of the little finger
 A circular piece sloughed out and left a hole in through
the cheek of about a quarter of an inch diameter
The disease abated, the affected teeth and a piece of the alveolar
process came away the lips of the wound produced by the sphacelus
healed up & the child recovered
I recommended the same treatment in this case as in 
the preceding, but having no confidence in it, & abandoned
it and gave charcoal to the amount of perhaps a pound
or a pound & a half a day I h ad pudding made of 
half charcoal & half flour, sweetened with molasses & sugar
& fed to the child for the appetite was good. Tonic solution 



When the disease commences of itself
# At the time when the disease called the scalled
tongue was very prevalent affecting cattle principally with 
swelling of the tongue & salivation but to some extent human 
beings with swelling of tongue cheeks etc. It was found that
acrids as [arum] were the best remedies
pulse 120 tongue then [brown] fur, considerable pain



111
and compd tinct. vitr. were also given & I commenced
the treatment with white oak & peruvian barks & yeast
poultice. I attribute the cure, however, to charcoal.
Case 6th This was an idiopathic affection. Martha Denison
a delicate constitution about 12 yrs of age was attacked in 1819 with symptoms of gangrene
of the mouth. There was severe pain in the teeth and jaws
oppression at the stomach and symptoms of fever. I discovered
the purplish spot in the cheek & “the gums soon put
on a spongy appearance” In this case I commenced
the treatment with an emetic, which operated favorably 
I gave it to [illegible] the excitability of the system
& gave relief. I then gave stimulants, bark, brandy & 
opium & kept in the mouth between the gums and cheek a paste made of powdered
bark wet with brandy and laudanum. The patient
recovered, but the two front teeth of the lower jaw became
very loose and there was occasional pain & 
suppuration for nearly a year. It was about a year before
the teeth became firm. [Superfine] bark was occasionally 
used.
Case 7th In 1820 I visited a black child in the last
stages of this complaint. At the time when I saw it, it
could not swallow. It lived however in this situation for several days
I have seen several children in the latter stages 
Even if there is no chance for a cure it si desirable to be able
to give a correct prognosis Trouble has sometimes arisen
from the opinion that such cases were produced by calomel
A student of this school in [Litch.] cty from notes of 
my lectures



It is known by an [illegible] swelling in the throat
some fever etc. etc. 
In some seasons it prevails extensively & 
affects persons of all ages. In some seasons these diseases
which are called contagious affects one description 
of persons in another another owing to mode
of life etc. “It rarely affects a person the second time. It is said
that if it affects the parotid of one side only it may occur again”
I have treated cases of this disease with 
great anxiety. I have never known cases of greater 
irritation than from this disease
“It is milder in children than in adults & is
seldom translated to the mammae or testicles till after puberty”
“Sometimes the swelling of the testicle is simultaneous
with that of the parotid gland or [previous] I have seen
several such cases”
“The first symptom observed is sometimes
a soreness of the testicles. They at length become 4 or 6 times
their natural size a suspensory bandage will be 
necessary”
“In some cases there arises suddenly, [illegible]
pain in the head pulse full and tense eyes red & all 
symptoms of phrenitis”


112
Cynanche parotidea Mumps
This disease is an inflammation of the parotid glands & is generally 
moderate in its symptoms Sometimes however it is translated
to other parts & is then a severe disease endangering life. It is milder
in youth than in adults & in general it is only after the age of puberty 
that it is translated. The parts to which it is translated 
occasionally, are the testicles & the prostate gland in males
the mammae of females more rarely & sometimes the brain or stomach
I have never myself seen a case in which the inflammation was
transferred to the mammae but do not doubt the fact
Sometimes it appears first in the testicle or at least simultaneously in that
& the gland This disease has been considered contagious
In my opinion it is not, but on the contrary is liable to be
epidemic. When its prevailed in college, the students who 
left in order to avoid the contagion were attacked as early 
and is certainly as those who remained. I have noticed 
that it made its appearance pretty regularly once 
in seven or fourteen years
The fever which accompanies the severer
forms is either of the inflammatory or the typhus grade or may be merely irritative & 
should be treated accordingly When the testicles are affected
they are painful swollen sometimes to an excessive degree & 
sometimes so highly inflamed as to indicate venesection 
When the stomach is affected “it puts on crythomatic inflammation”
and there is hiccough, subsultus tendinum, irritability
of stomach and frequent vomiting. # When the brain is affected
there is pain of the head & eyes, with hard and tense pulse
When the parotid glands only are affected the
# These symptoms may come on after the affect of test. [illegible] continued, some
[illegible] begin to subside.


Dr Rush observes that applying a blister
directly on the infl. prevents the system from being
affected. I do think blisters keep the aff.
in one part “In some seasons an emetic at the commencement
or a blister will prevent a translation”
Having [learned] the importance of attempting 
the breaking up of diseases I cast about
one year for means to interrupt it & found emetics
quite efficacious
Stramonium
After the testicles have been affected some time 
and the affection begins to subside the symptoms sometimes change 
There is subsultus tendinum the stomach become affected 
vomiting is frequent with hiccough etc. In this case apply 
mustard to the stomach & feet etc.


113
a generally mild and more inconvenient than painful
A translation makes it worse; more so when the translation is
to the stomach than to the testicles & most of all when to the
brain. Sometimes the complaint is very severe, the fever lasts
three or four weeks and the patients are many years in recovering
from the disease
Treatment. The disease is often broken up by an emetic
in the commencement It is best to stop it in the first stages
if possible. Mild applications to the inflamed parotids
we generally sufficient, such as ammonia or volatile
liniment. Dr Rush however recommends blisters to the parts
affected, in order to prevent a translation.
When the disease effects the testicles & give emetics
and apply discutients to the local affection. I also 
apply blisters to the inside of the thighs. They relieve the 
testicles when they are swollen & prevent translation to the 
stomach For a discutient was we may take the following
Rx mur. amm. ziii; camph zi; brandy or vinegar 1 gill;
water 3 gills. When the inflammatory action is high, bleeding
may be practised. It will be well also to use a suspensory 
bandage.
If the stomach is affected in the manner above
described
we have a difficult case to manage. Epispastics must be
applied to the scrotum, counterirritants to the epigastrium
to ally vomiting, with effervescing mixtures internally for the 


Ether is best given in effervescing mixture (carb amm. & 
lemon juice) Carbon ac. makes stimulants more diffusible
& hence causes them to be [used] gratefully and often to be well borne when 
otherwise the would not be
Case 18 grs plethoric parot. gland & testicles swollen
head affected Relieved by bleeding decidedly entonic
the only entonic case which occurred In the 
progress of his case stom. became very irritable abdomen
sore & tender excessive irritability Did not 
recover his health completely for years was left dyspeptic
& with nervous irritability.
To correct irritability of stom. lem. juice
[illegible] is most grateful add [doses] of aromatics
lime water also external blistering etc.
Tonics or metallic tonics myrrh 
asafoetida (nervine also) hops lettuce
These cases are so obstinate and will 
give you an opportunity to try a great variety of
remedies cajeput oil on sugar ol. valerian
Though the cases may be apparently alike
yet you may find one article best for one & another for [another]
A very distressing hiccup, accompanied
with spasms might have been mentioned in connection 
with the vomiting give ether lavender cajeput
oil also & valerian which are called terebinthinates 


114
same purpose diffusible stimuli as ether given
to rouse the system opium ipecac, as tonic stimulant, diaphoretic
& nervine 7 finally to allay irritation of the system 
in general antispasmodics as castor & counterirritants to the
extremities effervescing mixtures absorbents, also, as chalk & magnesia, cathartics
cantheride & occasionally emetics may be indicated.
When the brain becomes affected, the lancet
should be freely used, cupping, leeches & blisters, applied
to the head of the neutral salt given as cathartics
Antimonials nit. [illegible] cal. & neutral salts # 
Some cases will require a vigorous antiphlogistic 
course of treatment, others with typhoid fever
will require in the [illegible] a stimulating & supporting one, while others
again will have symptoms of irritation chiefly & require 
a corresponding treatment
In the progress of the disease uniform
perspiration will be valuable
Angostura serpentaria, qualified
with cardamom or cubebs The old writers
recommend also [contrayerva] I have much used it
atonics of a peculiar character resembles much 
agrimonia eupatoria which I have used for it
in the country where it is easily obtained the latter is non 
astringent
# “Cold to the head and warmth to the feet avoid mental
irritation recovery is usually speedy adults most
liable to this translation”



I consider [quinsy] an affection of the mucus membranes
and [tonsils] nearly allied to catarrhal aff. There
is a catarrh aff. nearly allied in which there is a
thickening of the membrane. This diathesis may also 
run into croup
Good classes angina maligna with 
quinsy Here is the evil of nosology For scarlet
fever gradually runs into quinsy. We must have
science and nosology but still we ought to 
know the errors which nosology is apt to lend [illegible] & 
the imperfection of science
I have the advantage of not [illegible]
having seen the disease but of having had it myself
often
[illegible] with an unpleasant sensation
a relaxation a disposition to hawk and throw off
[illegible] In this stage it may certainly be cured
After the symptoms comes on swelling, or moderately 
succeeding to this a chill then swelling with 
pain perhaps extending to the [illegible] The tonsils enlarge
The fever is considered enteric or a common but
unless among the labouring men in the country it is 
more usually subacute
One tonsil is perhaps more enlarged
than the other perhaps one goes on to suppurate & 
the other becomes of the natural size and appearance 
The uvula and fauces swell and respiration and deglutition 
are prevented. Sometimes ulcers from at first
upon the tonsils. Examine each case and do not be
too positive in calling it quinsy for this & scarlet
fever do blend
These symptoms continue 2 to 36 or 48 hours
I do not know that I have ever seen a fatal case of 


115
Cynanche Tonsillaris Quinsy
This diseases has been called
“I include also under the term quinsy all effections of the upper
part of the aesophagus and pharynx which resemble quinsy in 
their grade of action”
Quinsy is an inflammation seated in the larynx glottis & fauces
The characteristic symptoms is swelling of the tonsils
Sometimes it is seated lower down in the pharynx than the tonsils, but this 
does not alter the nature of the disease
In some cases it is complicated with catarrh. Those who have once had this disease are very liable to a return of it
“The disease common at the age of puberty that before or after”
Quinsy may be divided into two stages
1st Predisposing debility indicated by relaxation of the uvula
and tonsil, irritation about the fauces, weak deglutition,
general languor, with cold chills and uncommon sensibility
to cold. This usually continues from 3 or 4 to 12 hours
the progress of the disease being sometime rapid and sometimes
slow
2nd As the disease advances we find, soreness, pain, redness
and swelling of one or both of the tonsils & an inflammation 
of the mucous membrane of the pharynx; deglutition
in exceedingly difficult; there is a severe cough & especially 
a spasmodic one upon taking food or drink, there is
much heat about the throat and about the head & sometimes
pain in the head, with a pulse so full and tense as to 
indicate bleeding. Sometimes there is an excruciating
pain in the ear. “rarely cough unless complicated with catarrh”
This stage may continue three or four
3 to 7 days days. It terminates either in resolution, or suppuration.


of quinsy though I have seen many that I thought 
would prove fatal. I have known a patient
continue unable to swallow for 3 days and yet recover
When however it is in the form of swelled tongue it may 
prove fatal. “An entonic fever may attend, with fullness
of pulse much headache excruciating pain extending to the 
ear; but for more commonly at least in my practice, the pulse
is little affected, and the disease is almost not entirely local”
# riding on horseback and having the snow melt on 
his throat & [conduct] off the [caloric] rapidly
# and shd carry a piece of alum in the pocket
“It is important to distinguish this disease from 
roseola (scarlet fever) There is an erythema of the fauces
distinct from both which yet may terminate in either
[illegible] The diagnosis is generally easy but there are cases
where it is extremely difficult & indeed there is no definite
line believed the two especially in the first stages
We must bear in mind that quinsy is commonly 
more inflammatory that it is not apt to ulcerate
& we must be guided somewhat by the prescribing epidemic


116
The suppuration is generally in the tonsils, but in some cases
where the disease is seated lower down, a part of the aesophagus
suppurates. “The tonsils often remain permanently enlarged”
Causes. Quinsy occurs must often in the latter part of autumn
& in winter. It is caused like catarrh by alternations of heat
and cold by exposure to cold & especially by exposure
to cold storms of rain or snow. # Sometimes it is connected
with dyspepsia & it may be brought on by irritating 
substances, as acids, acting upon the mucous membrane
of the stomach. I recollect a case of a young man who 
was attacked with a severe quinsy in consequence of drinking
freely of cider made cold with ice
Persons who are subject to quinsy should be very cautious 
about exposing themselves to the alternative of heat and cold # 
Diagnosis. This disease has sometimes been mistaken for 
scarlet fever. It is not difficult however to discriminate
between them by attending to their prominent symptoms the
quinsy being as inflammation of the mucous membrane etc.
The first stages however of scarlet fever, resemble those of
quinsy, and the difficulty of discriminating between them 
is at that period much greater. In deciding upon any 
particular case we must be governed by somewhat by the nature
of the prevailing epidemics


Chewing camphor will also but not so well break up quinsy
in the forming stage but chewing this article
is apt to produce pleasant symptoms in the stomach 
and head Other stimulating applications 
would probably answer as [guaiacum] & any 
alcoholic tincture “The prophylactic plan of carrying
alum in the pocket etc. has succeeded in hundreds of cases. Indeed
when called in the latter stages I often tall them I can do 
little except to prevent it in future”
When the dis is fully formed and when 
there is much pain in 
the neck running up into the [illegible] fomentations
and the vapour of warm water, the steam bath 
by throwing over the patients head a blanket and
having a teapot of warm water
A blister also in the above circumstances
will relieve the pain and give great relief 
An emetic also will be often very 
beneficial in the commencement of the second stage
There is often an excessive quantity of acid in the stomach 
Case A young man in very hot weather [illegible]
a large quantity of cider made very cold with ice was taken at night
with great pain and difficulty of swallowing
The patient was very anxious to be cured that night
A large quantity of tartar emetic was given in excessive
doses until a severe orgasm was produced then seeing
to [illegible] stricture of the upper orifice of the stomach the 
[illegible] & secreted from every pore from the violence of
the action of the system finally he [illegible] away, and
continue in syncope for 10 or 15 mins came out of his 
fainting fit, the tart. ant. acted as a cath. and the patient
was entirely relieved of the difficulty of swallowing [illegible]
was merely feeble and exhausted from the prostration of the [tart]




117
Treatment In the first or forming stage. Quinsy may 
be easily broken up by keeping a small piece of alum say 
of the size of half a pea in the mouth, and swallowing the 
saliva until the symptoms have left. Various other astringents
may be useful in the first stage. I have given the astringent
barks and bitter roots, catechu etc. & have also combined
with them the mineral acids chlorine etc. “But all these things will be injurious in the 2nd stage”
When the disease if farther advanced a more
energetic treatment is necessary. If the tonsils are largely swelled astringents will merely aggravate. IN this stage it may often
be broken up by a strong impression made by nausea
and vomiting. A strong emetic 3 grs tartar emetic with 8 grs of ipecac # may be given & when the 
disease arises from a chronic affection of the mucous membrane
& acidity of the stomach, an emetic will remove it. In one
case I gave half a grain of tartar emetic once in 15 min. 
until the system was affected, I succeeded in conquering
the disease. The patient was in extreme pain & exhausted 
he fainted previous to fainting he was unable
to swallow after coming to, he could swallow & the
disease was removed. “But if the case has advanced a 
little farther, emetic will do no good”s
Gargles will in general do harm 
rather than good, where there is much inflammation.
If the irritability is extreme mucilages may be given, and 
when there is great difficulty in swallowing a cloth wet with 
spirit and water ay be applied over the mouth and 
nostrils. Cold water applied externally & internally has
been recommended but is dangerous. It may be used however
as a preventive.
# Eupatorium etc.


I have known some phys. generally successful [illegible] breaking
up quinsy with cold water but as I predicted
there was danger of the translation to the brain he lost
one patient in this way “It may be used as a preventive”
When the trails are much enlarged it is
customary to bleed I would bleed it there was
much fullness and strength of the pulse I have often bled
and seen it done without the beast benefit still however 
without any injury as I could perceive “V. S. is important
when there is danger of affection of the brain”
Scarifying is generally practised. It is
sometimes beneficial but often it increases the disease
as is the case when a boil is scarifyed I do no t
know that I can point out the circumstances
which it is beneficial but if there is much irritation 
I think I would not scarify I have often
had my own throat scarifyed without benefit
Perhaps it is as often as once in 20 cases
that the disease proceeds to suppuration. But if 
you puncture the swelling be careful 
to see where you introduce your lancet Case of [young]
an opening was made which subsequently caused a troublesome sore the
swelling burst of itself
In various cases astringents was useful 
Lister’s [scoriae] (devils bit button snake root) it acts 
a little like seneka stimulating the fauces it operates considerably 
in a decoction It has been much used not of
much consequence
I have not much confidence in gargles
The patient cannot gargle
But you will give great relief
by washing out the mouth with warm water or with 
mucilages or with a little old spirits and water which 
is very grateful to the patient Wash off the [illegible]
which [illegible] Great advantage is derived from 
injecting with considerable force with a syringe & washing on 
the parts Spirits & water will be grateful & reviving


118
When there is redness and swelling but not extreme
irritability, scarification is beneficial. If there is irritating
soreness or inflammation scarifying will aggravate it
After the inflammatory stage is past, blisters
may be used I have not been successful in scarifying
Bleeding may be necessary, if so it will 
be indicated by pain in the head and a full & tense
pulse.
When suppuration is about to take place
poultice may be applied externally & vapor inhaled The 
latter remedy may be administered, very well in 
the following manner. Put a vessel of hot water in the
bed, by the side of the patient & cover him with a sheet. # 
Touching the tonsils with nitrate of silver, is 
highly useful
If the ear is affected, wet a piece of cotton 
with strong ammonia and apply it to the dear. it produces
a pungent sensation and often gives relief
The [liatris] scariosa is used in quinsy
in the form of a decoction of the root. It is expectorant, diaphoretic
& diuretic. It is called “devils bit”
“After the inflammatory stage is established
apply blisters”
“If the irritability is extreme apply mucilages”
“[illegible] & diaphoretics have been used 
in the early stages and are undoubtedly serviceable”
# If you cannot well distinguish where suppuration has
taken place, you had better not attempt to open the tonsils 


When the swelling is great poultices are very beneficial
Dove’s [Dury] poultice Devils dung asafoetica
Album graicum blown through a quill!! much used
by my predecessors in this place
Cathartics are proper early in the disease
neutral salts if the fever if phlogistic
Diet & regimen
Give while the patient can drink, nitrous
ether & water or a acidulated drink etc. Feed
with arrow root etc. for the diet
When the inability to swallow has 
continued sometimes the action is not enteric & the
patient shd not be bled nor exhausted by cath.
The disease is at this time principally local & 
from want of food etc. the pulse becomes feeble spirit
and water injected into the throat will bring grateful and 
reviving [illegible] exhausted patient “Apply poultices keep the bowels
open with enemata” “Inhale vapour of ether”
Various gargles are recommended
such as chlorine muriatic acid & water etc.
but when there is much action they are apt to irritate
Camphorated gargle vapour of camphor
etc. There are a variety of these things which are
mere palliatives
The difficulty of swallowing is not caused 
so much by the swelling as by the soreness and pain 
for I have seen patients declare themselves much relieved
and able to swallow when upon looking into the throat
I could perceive no change in its appearance



119
“Scarification is recommended but I could never succeed
with it. If the disease were pure inf. scarif. would be of service 
but it is an irritation infl. & scarific. increases the pain & 
infl.” In [illegible] case a free scarific. made the case worse in 
every respect” There is a stage when scarifying is beneficial
when there is redness & swelling but not extreme irritability”
“Leeches have been applied in the inflammatory
stage externally and to the tonsils. It is difficult to make
them take hold on the mucous membrane, but they would
be more effectual there”
“Suppuration does not take place in one 
tenth part of the cases. There is free secretion but no solution 
of continuity upon extermination” “When suppuration
is likely to take place use poultices and inhalations of vapour 
poultices of bread and milk with stramonium are serviceable
Gargle or syringe the mouth with spirits & water or
camphor”
“When the disease is seated farther down 
in the larynx it is essentially the same”
“White dry pigeon’s dung in a poultice with 
bread and milk was used by Dr [Monson] He thought the
phosphate of lime of service” I prescribed it in one
case and they mistook for it devils dung (asafoetida) 
& it did wonders. I did not tell them of their mistake”



[illegible] state of fever is a better
classification than Good’s. Good separates the disease
under different classes making one part are [illegible]
disease another an aff. of the blood vessels
“Scarlatina & angina are sometimes considered 
as separate diseases, but they seem to be only different forms
of the same disease”


120
Scarlet Fever
This disease has been called by various names, among
medical writers, though the popular English appellation
has been scarlet fever with little or no change. Canker
rash however has been its common popular appellation in 
New England, until of late. Under the name scarlet fever 
I include both scarlatina mitis & S. maligna & likewise the
paristhmitis maligna or ulcerated sore throat called also malignant
sore throat & malignant quins. Other names that
have been given are Scarlatina mitis & maligna 
cynanche maligna paristhmitis maligna 
scarlatina anginosa 
Enanthesis rosalia is defined by Good
Rush a scarlet flush appearing about the second day 
on the face neck or fauces; spreading progressively over
the body; and terminating about the seventh day; fever
a typhus. This author divides rosalia into two varieties
simples or mild scarlet fever which he considers as
being slightly contagious & paristhmitica with an ulcerated
throat & a rash not so regular
as that of the other variety. This he calls highly contagious
Under the name scarlet fever I included
both the common mild scarlet fever with a rash & nothing more and the most malignant forms
of ulcerated sore throat with the intermediate varieties
considering them all as being but different degrees of the same
disease
This disease with its varieties a naturally associated 
with pneumonia quinsy influenza etc.



Quinsy is an exception persons who have had
it are more liable to another attack
So too in tropical climates even have what
is called a seasoning
As a matter of fact this disease is theoretically 
considered contagious practically not so no precautions being
taken the patient not being separated nor the friends and
neighbors refraining from coming “The notion of contagion
may sometimes be useful in keeping away idle visitors
case in Guilford”


121
Scarlet fever often appears as a sporadic and
sometimes as an epidemic disease. In general it affects children
and women more than men. Dr. Rush’s opinion Some say that the disease never 
persons over 40 years of age. When epidemic however it attacks 
persons of all ages, though even then the majority of cases
are among children and persons of delicate constitution.
In general persons who have once had the 
scarlet fever are not attacked with it again, still this
rule is liable to many exceptions for I have known repeated 
instances of a second appearance of the disease in the
same person. This partial security from a second attack
is met with in various epidemics & we may say in general 
that a person who has had any one of several different
diseases the same general diathesis is less liable to have another
Scarlet fever is said to be contagious especially 
in its severer forms The fact is disputed but this is 
the general opinion. Some fevers are perhaps contagion & among
them some forms of this may be so. It certainly, however
appears to follow the laws of epidemics and I am inclined
to think that the facts which have led to the opinion 
that it is contagion are better explained by reference
to those laws. It is said sometimes to go through the country 
like the influenza.
Like other epidemics, those of scarlet
fever exhibit appearances
in different seasons, being sometimes milk and
harmless & at others highly malignant & dangerous
It has occasionally been as 



# And because blisters applied produced
mortification
It swept off whole families
The fever considered a typhus It is not always
so It is sometimes [sub-entonic] always however
of a typhous grade



122
as the plague. About a century ago this disease prevailed
in this state in its most malignant form, sweeping off whole
families. It was called the black canker because the sloughs
in the throat turned black & this name, though the influence
of tradition, inspires terror in this town even to the present day
Since that period the disease has probably been growing 
milder up to the present time. In 1794 however it
was very severe in this town in Litchfield county & over the state more malignant than it has
been since. Subsequently to that period adult males have
been less affected. The last severe epidemic in this town was in 1803.
Though sometimes attended with inflammatory 
symptom. Scarlet fever as a general rule, is of the typhoid
or typhus grade & when malignant puts on the form of typhus 
gravior or gangrenous state of fever
Symptoms. This disorder, when not malignant, nor
irregular, commences with ordinary febrile symptoms general
disturbance of the functions of the system, chills alternated
with flashes of heat & pulse in most cases frequent and soft
In severe attacks there is much nausea, sometimes
vomiting, pain in the head back and limbs & great prostration 
The tongue
of strength. In 1803 the disease frequently commenced
with pain in the teeth or in the ear is the first symptoms
In the progress of the disease there is more
or less tendency in proportion to the violence of the
disorder. In severe cases there is often great heat and dryness
of the skin & perhaps the color mordax. In such cases also 
we frequently with an acrid discharge from the eyes & 


“When delirium is present it arises rather from inanition 
than repletion IT is accompanied with subsultus”
Swelling of the tonsils is rather a favorable
symptom Swelling and suppuration of the
glands in the neck
haemorrhage for the [illegible] & petechiae
may occur


123
nose which excoriates the skin wherever it touches.
Irritability of the stomach & vomiting are common & sometimes there
is a troublesome diarrhoea. Petechiae may make their appearance.
Case at [Hotchk??] town Haemorrhages sometimes take place; & in case of 
heat on the surface and what Armstrong calls congestive state
of the system, a slight haemorrhage from the nose will be
beneficial. Finally in the ordinary malignant forms of the disease 
the breath is very fetid.
The epidemic of 1803 was characterised by 
great irritability of the stomach vomiting & diarrhoea pulse
very low and feeble. In this epidemic after obviating the
inverted action (of the stomach) stimulants were indicated.
The throat is more or less affected from a 
slight redness to a deep slough. Sometimes there is a high degree 
of inflammation of the uvula & tonsils at others a relaxation 
indicating astringents both conditions accompanied
with a high degree of tumefaction.
A common appearance, in the commencement of the severe form
of the disease is that of a white coat upon a part of the tonsils
In the progress of scarlet fever, the affection of the throat 
may be more or less troublesome. It often terminates in ulceration
& sometimes in gangrene
In three or four days from the first appearance
of febrile symptoms or rather on the second day of 
the fever the eruption appears in the form of a fine rash
as described in the definition. In about as many days from 
its appearance about the seventh day of the disease it disappears 


Peculiar dulness of the eyes hollow sound
of the voice patient appearing much like a night walker
The first case of the kind which I saw I had no doubt 
about The friends had doubted whether he was sick enough
to send for a phys. I declared at once that he probably 
would die. This was a case of pneumonia notha
Most resembles measles Ordinarily distinguished 
readily sometimes with difficulty
If scarlet fever is accompanied with 
a running of the discharges from nose with catarrhal symptoms, and is somewhat 
distinct in its eruption (hard under the touch under
the skin) and such cases occur it cannot be distinguished 
from measles except by the general character of the epidemic
I used to notice in the first commencement of my practice
that on the first breaking out of the epidemic the older phys. used to 
wait and observe several cases before they decided upon the name 


124
with branny scales & in ordinary cases the patient is then
out of danger. The eruptions, however may vary much & even
be altogether wanting the local morbid action being determined 
wholly to the throat. Ataxic cases will have no eruption.
The worst cases of scarlet fever are those
which transcend ordinary febrile action. In these the patient 
is scarcely sensible of being ill, appears dull and languid, his
countenance indicates torpor of mind, he has little irritability of 
mind and is indifferent to surrounding object, his extremities
are cold & his pulse small frequent and feeble & 
perhaps intermitting. Upon examining the throat ash coloured
sloughs are found upon the tonsils and uvula. In these
cases life is extinguished without any reaction 
of the system in the course of 24 or 48 hours, unless the tendency 
to death is obviated by the most powerful treatment.
These ataxic cases resemble the ataxic cases of yellow fever
pneumonia typhodes etc. which have sometimes been called 
walking cases
The scarlet fever is liable to be confounded with 
measles, the disease which it most resembles. The marks of 
discrimination are these. In measles the eruption is less diffused
is in pimples or circular dots more pointed & partly distinct & partly in clusters & the pimples produce a palpable
roughness of the skin. In scarlet fever the eruption is diffused
like erysipelas & consists of innumerable points or specks under 
the cuticle, intermixed with minute pupulae In some
cases the eruption is in irregular patches & in others are uniform flush 


“Symptoms of pneumonia rarely attend scarlatina”
This is one of a series of epidemics. It is usually followed
or succeeded by measles & is followed by hooping cough
For only it probably existed only as an epidemic now
we meet with sporadic cases continually 


125
while no roughness is felt, except in a slight degree upon 
the arm. The two diseases differ also in the time at which 
the eruption appears. In scarlet fever it shows itself
upon the face and arms on the second day, but in measles
it is not seen upon the arms till the fourth day.
The scarlet fever is distinguished also by the absence of the
catarrh, cough & determination to the lungs, suffusion
of the eyes & the red and swollen state of the eyelids, which generally 
attend upon the measles. The latter disease also
is generally accompanied by an inflammatory fever instead
of the typhus which characterises the former.
Still these two diseases of ten blend together
so as to make the discrimination very difficult. It is barely 
 possible that they are the same disease, though it may 
be objected to this view, that scarlet fever likewise is occasionally 
seen to blend with influenza # 
Epidemics of influenza are followed by [measles & scarlet]
The prognosis in this disease will be obvious
upon attending to the malignancy or the severity of the 
symptoms. In its severer forms it is always a dangerous
disease & in its highest malignancy one of the most fatal
while in its milder forms there is but little danger.
# It is sometimes difficult to determine whether a particular 
case should be considered as one of scarlet fever, or of quinsy
A case of scarlet fever in which there is no eruption & the
tonsils are inflamed &swollen can be distinguished from one
of quinsy only by attending to the state of the pulse, the prevailing epidemic etc.


I have known it appear as an epidemic
when it required nothing more than nursing
One idea which I wish to impress particularly 
upon your mind, is that you must investigate the particular
epidemic which you have to treat for no previous one
will probably have been similar


126
The treatment of this disease must vary according
to the diathesis. Epidemics of scarlet fever will differ
widely in different seasons & different places & require very different treatment
In a country where intermittent prevail the treatment will 
be different
This has been some dispute about using the
lancet in this disease. This will depend the degree of inflammatory 
diathesis. As a general rule emetics are indicated, 
but not always. Cathartics are generally improper 
but sometimes are required. In short indiscriminate treatment
is as improper in this diseases as in any other.
In this milder forms of scarlet fever, we
may employ the usual treatment for typhoid fever, & administer 
those remedies which translate & keep up action 
and equalise excitement, as diaphoretics, the warm
bath etc. For the mildest form it will be sufficient to 
give mild diaphoretics such as wine whey & elder flower
tea, with perhaps a little antimony, acidulated drinks
& gentle laxatives
As the fever is generally of a typhoid or
typhus grade, emetics are of especial importance in its 
treatment. They affect particularly the mucous membranes
and may be repeated in the course of the disease, for the
purpose of throwing off the accumulated mucus. The violence
of the disease may often be completely broken by an emetic 


“In some epidemics when there is considerable action cath. of cal. are
important especially in intermittent districts Rx cal. & 
jal. as for remittent bilious fever”
“When there is tremor paleness, cold sweats, vomiting
diarrhoea, cathartics might destroy the patient We must
rouse the patient by counterirritants etc. and then we may go on 
with the treatment by emetics of ipecac etc.
“Dr Rush bled but f.s. is very rarely indicated 
and in such cases as approach to A.  tonsillaris” “Still it
[illegible] all forms entonic atonic etc.
“If malignant give bark & the min. 
acids. If the system does not respond give cantharides 
& capsicum oil of cinnamon cloves or cajeput”



127
at the commencement. All writers agree in recommending
them. [Witherin] advises ipecac grs vi & tart. ant. gri for
an adult followed by a strong decoction of senna
Dr Rush recommends the turpenth mineral 2 to 6 grs with the view
of strangling the disease in its birth. Sulphate of zinc is a
good emetic & is preferable in the latter stage. It is local
in its action & tonic in its effect. It operates speedily and
produces less exhaustion. Vomiting by snake root has
been practised
In the irregular forms of scarlet fever, this
practice is more questionable & if emetics are given they must
be preceded by stimulants to rouse the powers of the system
Cathartics are sometimes needed & calomel
is to be preferred The judgment of the physician however 
must be exercised & the character of the epidemic studied, 
for great caution must be exercised that the system be not weakened 
by them & in extreme debility they should be preceded
by stimulants. In some epidemics they will destroy the pat.”
In some epidemics bleeding may be 
proper, but the apparent indications for it will generally 
be better answered by leeches about the throats and [temples]
In malignant cases where the powers of life
are very feeble no evacuations are to be used. External 
irritants are to be applied to rouse the system such as ginger
mustard brandy a paste of mustard spts. turpentine & 
aqua ammoniae etc. Internal stimulants must be given 


Ammonia with bark opium etc.”
“Tinct. canth 20 drops once in 2 hours till
there is some effect.”
“Serpentaria with ammonia acts as a tonic
and diaphoretic”
Where there is a prejudice against cold affusion
with water alone spirits or [illegible] or camphor
may be added


128
[illegible] to 4 [illegible] 3 or 4
such as capsicum Capsicum especially when the stomach is debilitated 4 to 5 grs [illegible] Cantharides in 20 drop doses. Ammonia
camphor quinine, mineral acids etc. Carb. amm. & cantharides 
may be given to excite the system & be followed by 
bark and brandy to keep up the excitement.
Diffusible stimulants also may be required, such as chloric
or sulphuric ether 20 gtts to a teaspoonful of water
for a child. In small children if there is difficulty in getting down
medicines the bark may be given by injection, or the body covered 
with it, by means of a bark jacket.
In severe cases, not of the most malignant
form, the heat and dryness of the skin are often very 
great & calor mordax may exist. Cold applications to the 
skin, especially those of stimulating kind will then be beneficial. The cold bath
cold affusion, or sponging with vinegar & water or spirits
& water may be used according to circumstances. The cold 
bath or affusion of cold water may be superseded in case of 
prejudices on the part of the [illegible] or objections from other
causes, may be superseded by sponging the body with vinegar
& water If the case is attended with extreme debility 
and relaxation of the system or if
any chills are present sponging must be used
& [illegible] with caution. If the cold applications produce a chill or
if the eruption comes out irregularly. I should advise 
the tepid bath to determine to the surface. In the advanced
stages of the disease when debility & relaxation are
great the vinegar & water should be made tepid & spirits
may be added. The rules with respect to these applications 
are the same as in typhus. In the atonic form of 


“In children with disturbance of the stomach
and pain in the bowels at the same time the eruption not
coming out well use the tepid bath It obviates the tendency
to convulsions and makes the disease regular In the most
malignant forms it is inadmissible”
“If there is irritability of the stomach give chloride [illegible]
4 grs 2-3 hours absorbents counterirritants”
“In the latter stage of protracted cases emetics of 
sulphur zinc or copper are very useful”
“Withering advises in the typhoid state, after evacuating
the stomach & bowels to give senega freely This 
would be injurious in a malignant case”


129
scarlet fever, the cold bath or cold affusion must not be used
IN 1803 I used sponging with vinegar and gave internal
stimulants at the same time as min. ac. alc. brandy
For children the tepid bath is invaluable in scarlitina 
particularly in the early stages of the disease and 
when the eruption is not fully out, or where the eruption is 
irregular. It is questionable however, how it would succeed
in the most malignant form of the disease
If there is great irritability of the stomach
with vomiting, absorbents and counterirritants are to be used
& in malignant cases capsicum, tinct. canth. & care to be given
In cases of vomiting saffron & snakeroot
If there is much diarrhoea we may 
give # white decoction with opium, injections of laudanum
etc. astringents etc.
In ordinary cases, when the eruption has been 
regular & ends with branny scales, about the seventh day
the case is out of danger But when the disease is protracted
sulphate of zinc or Moseleys tonic solution is
to be given as a tonic. The latter article in a dose from 
a teaspoonful to a tablespoonful is an emetic in cases 
of great morbid action. Emetics of sulph. zinc & sulph.
of copper have been recommended also of acetate of copper 
The latter article is also escharotic tonic & caustic. The chlorides chlorates are adapted 
to this stage of the disease
[illegible] [chlorate of potassa]
grii to vii


“In those cases that require stimulants blisters
may occasion gangrenes”
“When there is tumefaction of the tonsils use
blisters paediluvium & gargle with the mur. ac.
especially the [oxymorestic] diluted with 6 parts water”


130
The treatment of the local affection of the throat is of two
kinds, external & internal When there is much inflammation 
about the throat, with the uvula elongated, the
tonsils enlarged an inflamed & the pulse full I apply 
epispastics externally. Blisters, mustard, oil of origanum 
ol. monard punct. etc. may be applied to the throat
Gargles are injurious in bad cases & perhaps
of little use in most. Still in ordinary forms of the disease
from four to six ounces of any mild astringent acidulated
perhaps with muriatic acid may be thrown in by 
a syringe. The marsh rosemary is considered better than 
any other astringent. The alum root (henchera amer.) is
useful both as a gargle & given internally. For the latter
purpose sweeten it & add a little brandy
When there is not much tumefaction & 
considerable relaxation of the parts stimulating garbles
are good, as capsicum & brandy astringents may be 
added. In gangrenous cases quinine is good if it can
be got down. In the latter stages of the disease it may 
be useful to touch the ulcers in the throat with nit. silv.
“Vinegar & lemon juice may be 
used as a gargle”
“If the ulcers are thick and leathery
apply nit. sil.”



“I have seen the brain affected and much spasmodic
action subderangement pain in the head 
and all the symptoms of hydrocephalus with a bloating
of the whole cellular membrane pulse frequent & extremely 
quick and all the marks of irritative actions
For 3 or 4 years I have used tinct. dose in 4-5 & sat. tinct.
canth. in 10 3 or 4 times a day giving also the tonic
solution and keeping the bowels open”
“It produces eruptions on the skin, heat dryness & 
soreness of the fauces febrile action & if continued 8 or 10 
days I think it would be useful. I would try it were the
disease severe and epidemic, whether I thought it contagious 
or not”


131
The sequel of scarlet fever is dropsy. In children
especially an anasarca and sometimes an universal
dropsy comes on after the disease has subsided. The 
first two cases which I met with were in the severe epidemic
of 1803. I treated them according to the direction 
of the books, with bark & brandy opium & lost my patients 
Considering this as an affection of the absorbent and nervous
system I treated the subsequent cases which fell
upon my hands with tinct. cantharides & tinct. digitalis
The digitalis allayed the morbid action of the exhalents 
& absorbents & the cantharides acted as a diuretic.
“Give of each 
2 or 6 drops every 3 or 4 hours It [opens] [illegible] in these cases the
effect of irritative action hence the propriety of digitalis
Hanneman proposes to prevent the recurrence
of scarlet fever by the administration of moderate
quantities of atropia belladonna an article which produces an
eruption upon the skin, similar to the rash of scarlet
fever. The influence of belladonna, upon this hypothesis
is similar to that of vaccination in preventing small 
pox.



The termination of the chain of actions in health
in some diseases & if we say nature cures the disease
then we may say when the tendency is [inevitably] to death
that nature commits suicide. The latter is true
of this disease Yet if this chain of morbid actions is 
broken up by a powerful impression the constitution
will take on its ordinary action
Scarce any disease is more curable
when taken in season yet it would not be proper
for a physician to say he could cure all cases
then pretending infallibility
I shd doubt whether Good had ever
seen the progress of a single case. He says nothing 
about the first stage.
The tendency of the disease is to destroy 
the patient not by infl. or irritation but by 
suffocation from a foreign body in the trachea
The stages run into one another, and 
yet a phys. watching the progress would naturally 
divide it into three stages
Always curable in the first stage unless complicated with some other disease
rarely in the second almost never in the last yet
I have known cases cured in the last stage
The peculiar sound of the cough is 
alarming (in the first stage) even to those who have never
before heard it
Dr [Hesark] I have been told divides the
disease as I have done into 3 stages and directs to give
2 grs. tart. ant. combined with ipecac. I shd give
for the effect not according to the quantity. I put out 3 or 4 gr
and give till the effect is produced
rarely over 10 grs


132
Croup
This disease has been called in America by the popular name
of hives which is probably a corruption of heaves called rattles
The name given it by Good is empresmia bronchitis. The 
most common scientific appellation has been cynanche
trachealis or angina trachealis
The persons attacked by croup are
I have never [illegible] 3 and [illegible]
almost exclusively children from 3 months to 12 years 
old # in one instance I have known it attack
a person 60 years of age When it occurs in adults it
succeeds other diseases I have known 2 or 3 cups of [illegible]
“Croup sometimes though less frequently than most diseases, blends with
other diseases as catarrh” Some have considered the disease as
contagious, but though a few facts appear to favour the
supposition, they are not numerous enough to establish a 
general law.
Croup usually occurs in the winter
and spring, when it is brough on by exposure to a cold
and damp atmosphere. Children upon the sea coast are
more subject than in the interior of the country, because
exposed to more variable weather and more frequent [thaws]
& notwithstanding the greater warmth of the climate on 
the seacoast For when the air is filled with 
vapour, the caloric of the body is conducted off with 
more rapidity than in a dry atmosphere, even if the
temperature of the latter is colder.
# It is principally confined to persons under 5 years of age
though it sometimes attacks persons of all ages, and 


It is not precisely entonic or atonic & hence
might be called specific in peculiar
It is said that in croup the exhalent
arteries are affected & in catarrh this [illegible]
vessels Whether the different vessels are affected or not there 
is certainly a different action
“I have thought croup might destroy life by 
coating the entire surface of the lungs with a mucous
or membranous coat thus preventing the decarbonization 
of the blood”
“I have never seen croup without more
or less spasm; & probably in fatal cases it is always a 
spasmodic contraction that closes the passage to the lungs 
which is only diminished by the membrane. I never
saw a case on the other hand of what is called
spasmodic croup which did not if neglected put on the
membranous & inflammatory form”
A similar [membranific] inflammation
exists in the duodenum


133
Croup is a specific disease of a peculiar kind and
is never malignant. It comes on with all the symptoms
of pyrexia and consist in an inflammatory affection of
the mucous membrane of the larynx and trachea, which
causes a remarkable shrill sound in breathing & a ringing
cough by which those who have seen the complaint
cannot fail to recognise it. The proximate cause is a 
peculiar inflammatory action of the system, 
determined to the exhalent vessels arteries of the trachea
and bronchial vessels, where there is produced an exudation 
of coagulable lymph similar to that which forms
on the membranes of closed cavities from inflammation & 
entirely different from secretion of the mucous glands
whether healthy or unhealthy. This coagulable lymph 
which is thus exuded, always forms a membrane which 
lines the larynx and trachea, if the disease proceeds
to a fatal termination, and causes death by suffocation. 
This appearance is always found in the
tracheae of those who have died of the disease.
The membranific inflammation distinguishes 
croup in its nature, from catarrh which is in all its
varieties, an affection of the mucous glands



Most diseases attack in the night
“Diseases are cowards, they mostly attack in the
night” Rush.
“The peculiar ringing sound of croup is made in 
[expiration] that of hooping cough is inspiration”
# As is the case when respiration is impeded
by any foreign body there is a great deal of
irritation
# when the nose discharges [illegible] [illegible] it
bronchial vessels secrete mucus and a new
action takes place the patient will be apt
to recover
# The patient was subject to asthma
and the croup was neglected until the latter 
stages finally died
+ “I have known this to happen only once
In this case the friends were not alarmed because the
child had been subject to catarrhal affections & the symptoms 
received no attention till the last stage”
# Frequently appears to be [illegible] in the
very commencement of the disease


134
This disease sometimes come on like a
catarrh and continues two or three days without any 
alarming symptoms, until suddenly, & often in the night
the peculiar symptoms of croup appear. At other times 
the first symptom of the disease is a severe paroxysm of 
suffocation attended with the hoarse & shrill ringing noise made
during expiration like air through a broken tube & the peculiar ringing cough. The cough
in its progress is attended with more or less of spasmodic
action. # It is always dry; and when it becomes loose
or when mucus is expectorated the disease is broken up 
and there is no further danger # It rarely continues so long as five
days and is sometimes fatal in twenty four hours. Sometimes,
though rarely the membrane of coagulated lymph is
coughed up. I have met with but one case + In this the 
membrane was thrown up three times, at each subsequent
time forming lower down than before # 
No disease resembles croup so much as
suffocating catarrh yet there are obvious marks of discrimination
The latter disease as I have seen it is not attended
with much cough and the difficulty of respiration is
not in paroxysms but constant & commence with the disease. The pulse is often quickened
and when the system is prostrated may be low. #  In suffocating 
catarrh the powers of life are to be raised by external
irritants & excitement equalized by the inhalation of the vapor
of [illegible] of warm water etc. “Mustard” “If pulse tense
bleed”



From the earliest of my practice I 
have been in the habit of dividing it into 3 stages
[illegible] that they are perfectly distinct, but [illegible]
person would naturally take this view
Quiet between the [per.] apparently 
not much affected during the paroxysms Between the paroxysms pulse natural & eyes bright. You will 
know this disease in this stage only during the par.
Parents in this place know the disease in this stage
and send forth phys. 
In this first stage, the disease 
must be broken up by a powerful impression 
upon the system This may be done many ways
Some are partial to a [illegible] & some to another 
“That which is best administered is best” A local
effect upon the stomach will not answer
I have relied more upon tart. ant.
than any other & found it answer all reasonable
expectations. I have preferred it to any other
I have occasionally used other [illegible]
I have found seneka better as an auxiliary
than as a commanding [remedy]



135
Croup may be divided into three stages each 
of them requiring different treatment. 1st The forming stage
2nd The inflammatory stage & 3d The last or suffocating
stage
1st In the forming stage, the cough
is severe & hoarse & occurs in paroxysms of from five minutes 
to have an hour in interval. “There is little or no fever” The
pulse is regular and small, & sometimes trembling. The patient
is often chilly. In this stage the disease may with
certainty be cured
“I have not lost a patient & have not saved one
in [illegible] when not called till the second paroxysm 
had commenced”
In the treatment of this stage we must depend
upon emetics. Large doses must be given moderate
ones do no good. A dose should be administered sufficiently 
powerful to affect the whole system and call into action 
every muscle. We must be regulated not by the quantity 
but the effect for we must calculate to overcome the diseased
action completely by the operator of our remedy.
I have given three grains of tartar emetic to a child three
months old, & kept up the action by the large doses of seneka
repeated every half hour for six or eight hours
Tartrate of antimony is the best emetic to 
commence with and may be given in a dose of from 3 to
six grains of strong tart em. After its operation a constant nausea must
be kept up by seneka or some similar article, for some
time in order to prevent a return of the disease. The seneka
excites a new action in the system. It may be given
in decoction. Take zfs or zi of bruised seneka to half a pint of
water, & boil away a quarter. Give a table spoonful for a 



It has so happened that with us the [serpentaria]
has not answered so well as tart ant. It acts 
on the fauces perhaps more [illegible] than tart. ant. 
but does not affect the system act upon the skin 
& determines to the surface so well as tart. ant. We have 
not used it however except in the latter stages & perhaps have
not given it a thorough trial
Sanguinaria vide p. 212 has been used 50 perhaps
a hundred years. Three generations of physicians
in one locality have used it and relied on it
in croup with as much success as upon other articles
These mode of using it was in strong decoction 
without weight & give a table spoonful until 
the desired effect is produced till vomiting is excited
or the disease is broken up There are however
forms of the disease where it fails even in [illegible]
“Much has been said of the good effects of calomel
Give in large doses 20 – 30 [illegible] acting as an emetic it is
serviceable but when catharsis is produced, the emetics 
would fall in with the catharsis. I never could in such a 
case make the strong impression on the system what I 
[illegible]”


136
does once in half an hour or as much as the stomach
will bear. Seneka has been relied upon by some as
a specific in croup, but it is inefficacious when inflammation 
is present, being a stimulant, and it is too slow in its operation
for the first remedy. After giving it as the first
article, other emetics seem to lose their influence; acting
as cathartics; but after the violence of the disease has
been broken up by other emetics, you may avail yourself
of the nauseating & deobstruent effects of the seneka & effect
a cure. Dr Rush preferred the turpeth mineral 2 to 6 grs
as the first emetic. The physicians in Wallingford for 5 years
make a strong decoction of sanguinaria, and give it
until emesis or a cure is effected. This article may be
used instead of seneka in the way above directed
In connexion with these means the warm
bath and fomentations may be used as adjuvants. Much 
has been said of the good effects of calomel in this disease
You cannot rely upon calomel for the cure of the disease
It is too slow in its operation. Never give calomel until 
you have broken the violence of the disease 
After emetics have operated and you have availed your 
self of the operation of seneca & sanguinaria and the disease
still exists, give from 5 to 10 grs of calomel
By this producing an orgasm in the 
system more powerful than the disease & continuing it until 
the latter be overcome, croup may be cured with more certainty
than most other diseases. All diseases should be attended



I know that there are some very respectable physicians who rely
upon calomel For this purpose they 
give very large doses and produce [illegible] & [illegible]
I should prefer it as an auxiliar. I have often 
used it but after the emetic or with the
emetic or before the emetic
A variety of other men [illegible]
India tobacco which though not allied in 
botany are so in their operations The common 
tobacco is generally applied eternally to the pit of the 
stomach. Lobelia acrid & emetic loses some of its virtues by drying
In its recent state 1 gr will often excite full vom.
Indeed I have known vom. prod. by merely 
chewing the capsules & [illegible] without swallowing
by the impression upon the mouth	
Dose of tinct. 20 drops to a t. sp. according to age
Other acrid narcotics as veratrum & colchicum
may be used
In this forming stage bleeding is not
indicative by the pulse, nor by state of the
system and you will obstruct your efforts to excite
a powerful effort of the system if you bleed
2nd stage
In this acrid emetics are injurious
seneka is too stimulating Sanguinaria had I have
seen all the symptoms aggravated by bloodroot in [illegible]
the high entonic stage
# “If the disease is complicated with a similar
affection of the stomach & duodenum give calomel & other
cathartics”



137
to in the beginning & it is owing to the imperfection of 
or our art that every disease is not broken up in 
its first stages. When however croup supervenes upon other
diseases, it is more dangerous. “Those who practice in the
country rarely see the disease in the forming stage. I had one
winter 20 cases of croup all in town recovered most of the in the country died”
2nd Country practitioners however seldom see
this first stage which I have just been treating of when the 
tongue is not discoloured, the fauces have a natural appearance
the pulse is unaffected respiration natural & ordinarily 
no inflammation about the tonsils. On the contrary 
they too generally arrive when the disease is in the
second or inflammatory stage the disease has effected in which the bloodvessels the skin is hot and 
dry, the face flushed, the pulse tense & sometimes full the
tongue furred, respiration between the paroxysms difficult
tongue furred, respiration between the paroxysms difficult
and the cough so severe as to threaten immediate death vide p. 213. In this stage 
we should immediately bleed from freely from a large orifice the arm or jugular vein
freely, even until syncope is produced put the patient
in the warm bath & let him also inhale the steam of warm
water, and give calomel and other cathartics. # Never
give emetics in this stage until after depletion by V.S. 
when we may give 4 grs. of tart. ant. in a table spoonful
of warm water & apply epispastics to the throat” in the commencement 
apply a blister” I dread to be called in this stage of 
the disease, for it is the almost always fatal venesection 
sometimes succeeds but very seldom. I would not apply 
leeches cupping would be better & perhaps friction might be serviceable.
Digitalis has been recommended, but 



In this stage inhale the vapour cover
the child & nurse in a chair with a blanket
In this stage cal. & cath. may be given
In the first stages I have conserved it very unfortunate
to find my patient under the operation of a
cathartic It feels as if my hands were tied
The excitement is of a different kind from what is wanted
And emetics are apt to produce hyper cathartics
Where the dis tends to the [illegible] the
[illegible] a specific. This is known by the
cough being less hoarse, by fever, by constipation 
fever more intestinal membrane
will pass off from the duodenum I was formerly 
disposed to cure this form of the disease [illegible]
& described it as such
In the second stage epispastics
over the whole chest also diaphoretics
and tepid bath When the cough is milder
and beginning to be loos after being principally 
broken up in the first stage give cal. in 2 or 3 gr
doses once in 2 or 3 hours
In the 2nd stage remedies have been
given to obviate the fever & digitalis has been used
with good effect It was used as a depressing agent
It operates by its narcotic power however. here refrigerants
are of little efficacy
In what may be seen to be the last


138
I have not used it. It is at best but a doubtful remedy
in inflammatory effections though calculate to remove more irritations. Sanguinaria diminished arterial
action like digitalis and operates powerfully as an
emetic. I have not succeeded with it in the last stages of
croup & have not used it in the first. [?ronchotomy] has
been proposed, but does not promise much benefit, as the
disease is seated below the place for operating. “Dr Smith did not recommend it”
After depletion and especially after the disease assumes
a bilious form you may give powerful cathartics
The pt. begins to thrown his head back death may happen any moment
3d IN the last or suffocating stage* you may give emetics
of turpeth mineral sulphate of zinc or even
corrosive sublimate to throw off the membrane. Something may depend upon changing
the emetics & sulphate of zinc may be tried. The cold bath
is said to have been successful in this stage, but the fact is
not well authenticated. I have used calomel and the
warm bath with advantage.
Child of Mr Culver
[last] in chronic stage
“I regret that I have not tried 
affusion of cold water in the last stage. It is 
said to cause the membrane to be thrown off & to procure
relief even in the very article of death”
vide p. 182
*”In the last stage respiration is constantly laborious
head thrown back pulse often irregular
& intermittent sometimes strong”
Chronic form “Sometimes though rarely the disease is only partially 
subdued I [illegible] on in a chronic form. Calomel
vapour best tepid bath are the appropriate remedies”




139
Angina Laryngea
Empresma Laryngitis of Good, q.v. for a definition & 
an account of the disease
In this disease the symptoms differ somewhat
from those of croup, though the cough is similar
The disease is seated in the larynx glottis and fauces & the
characteristic symptoms is swelling of the tonsils. The cough
is spasmodic and is excited by taking food with drink in this respect also indistinguished from croup. The
disease is more violent and rapid than croup, as the inflammation 
being seated in the narrow part about the glottis
produce suffocation sooner. The respiration is more difficult
than it croup particularly between the paroxysms
This disease more commonly affect adults
The first case that I saw was that of an old man in whom
the disease was brought on by exposure to cold after a pneumonia
From a relation of his symptoms I prescribed
seneca which only exasperated the disease, so that when 
I saw the patient he was unable to speak or swallow. A 
small red spot appeared on the tonsils. venesection, epispastics,
pediluvium, inhalation of vapor etc. were resorted to with 
no abatement of the symptoms. Venesection was performed a second
time & as soon as the patient was able to swallow, 4 grs. of 
tartar emetic were administered. Some nausea and vomiting
with considerable catharsis followed. The vesication 


“Angina laryngea is mor apt than croup
to recur several nights in succession”
“The slough were thick and leathery. Sloughing
even under blisters. In one instance blisters did not
heal in 4 mo. Lunar caustic applied to the tonsils & 
uvula & inflamed parts proved serviceable
# “In one case of A. laryngea I gave sanguinaria 
It was too acrid and increased the cough etc. It might 
do good if we could avoid the local effect of its
acrimony”



140
was extensively returned & the patient recovered.
Much the same treatment is required
as in croup but it should be more prompt and with earlier
venesection. For the inflammatory stage comes on earlier
and the disease runs a more rapid course
Last year this diseases differed in its appearance
from the former years
It has often followed certain affections
of the tonsils called black canker. The tonsils are inflamed
in black canker and sometime covered with a leathery
crust. This comes off and leaves an ulcer. If the inflammation 
extends to the larynx, symptoms of croup 
supervene
Case of black canker. Two called in the
last stage gave blood root with disadvantage # Still at 
this late period calomel and other cathartics in large
doses produced free evacuations and the child recovered 
Cathartics appear to do better than emetics. In one case after 
giving cathartics I used the vapour bath and applied 
a large epispastic over the whole sternum. Though at
so late a period the disease abated. A large slough however
was produced by the blister which required three 
months to heal. The morbid action on the skin being
similar to that of the tonsils
Vie p. 187


Sometimes comes on with a sudden paroxysm of
suffocation sometimes gradually 
“Distinguished in its commencement
from croup by the quantity of mucus in the bronchial
vessels”
“in the case which I have attended, 
not much febrile action attended the disease”
Proximate cause a morbid action of the lining
membrane of the lungs accompanied with a viscid secretion 
of [mucus]
By vomiting the disease may be relieved & apparently 
cured but may appear again in the course of 
an hour
The quantity of mucus is greater than in 
any other catarrhal affection”


141
Catarrhal epidemic resembling croup
Peculiar catarrhal affection resembling croup suffocating
catarrh
This disease is characterised by a severe hoarse 
cough, much resembling that of croup. The disease is distinguished 
in its commencement from croup by the excessive quantity of
mucus in the bronchial vessels which causes the suffocation 
The disease resembles croup likewise in the mode of its attack
which is sometimes sudden with symptoms of suffocation, and at
other times gradual with paroxysms of coughing and intervals
of perfect ease The turns of coughing are so violent in this
disease as to produce a livid colour of the face. The extremities
evident determination to the head
are cold and the head is hot from the quantity of blood
thrown into the vessel of the head by coughing. The evacuation 
from the bowels are healthy and among children with no disease which I am acquainted
affect the bowels so little ass this.
The proximate cause of the disease is a morbid
secretion of mucus on the lining membrane of the lungs & 
trachaea with obstructed perspiration. The quantity of
mucus thrown out by this membrane in this disease is astonishing After
the disease is fully formed, great quantities of viscid mucus
may be brought away by vomiting, to the great relief of the
patient for a short time, and yet within an hour the patient
will appear to be suffocating from the the quantity again 
collected in the bronchial vessels
In the commencement of this disease, the indication
is to break it up at once by a powerful emetic, of
tart. ant. unless the system 


The principal indication is to break up the disease
by a powerful action on the skin on the stomach
the duodenum and the fauces It is best affected by 
tart. ant. which is more difficult in its action than
[ipecac] though is very delicate constitutions ipecac 
may be practicable
# prevent accumulation of [mucus]
The bowels shd be evacuated not for the purpose
of curing the disease but for the prevention of an
accumulation of feces which would be irritating
In all diseases of the lungs examine
the state of the skin and particularly that of the lower
extremities for perspiration upon the upper extremities 
[only] may be a part of the disease
I have known the lives of several patients saved
by the use of the vapour bath
I formerly [illegible] and used [illegible]
for transmitting vapour by transmitting air through
boiling water
It was old practice to apply cat-skins
fowls split open (to the feet) etc. with the intention of
communicating vitality


142
is too much weakened to bear this treatment. This is a 
general principle viz, if possible to break a disease in its
commencement by means of a strong orgasm. Often the
emetic is to be repeated, and it may ever be necessary to give
four or five emetics 1 gr [illegible] tart. emet. each in the course of a day. After the disease 
is somewhat broken up, and epispastic applied upon the 
breast will assist much in allaying its violence #
If the disease still continues or if when first
called we find it fully formed and powerful emetics inadmissible
the primary indication will be to open the pores of the skin and
keep up a gentle perspiration, by small doses of antimonial wine
to which may be added in all quantities of camphor by elix. [illegible] & in 
some cases tinct opii by fomentations and especially by 
the warm bath and the inhalation of vapour. To affect the 
latter object the child may be placed in the warm bath & 
a blanket thrown both over it and the nurse, so as to keep
the child in an atmosphere of vapour. Long continued 
perspiration invariably relieves the symptoms. I have known
an instance in which the skin of a sheep warm from the animals
body was wrapped round the naked body
of the child with beneficial effect.
In small children when the stomach ceases
to be excited by emetics the throat should be irritated 
by a feather or the finger, when we wish to produce vomiting 
For we must never rest satisfied with merely endeavoring
to palliate the symptoms. In small children also the
mucus should be wiped out of the mouth by the finger or a cloth 
This disease prevails most in the winter and spring months & does not
occur every year. The first patient that I treated for the disease suffered
from it a year. I gave mercurials & finally the silver pill (nit sil)





143
I was puzzled with the first cases of this disease
which I met with. Some of them continued for weeks
and months I was obliged to use perspiration,
by warm bath to vapour bath emetics etc. I determined
to break up the next cases in the commencement
with tartar emetic repeated until full vomiting
was produced walking my patients. This 
plan was more successful
A s a general rule break up 
all diseases if you can
“The complaint is epidemic or rather
endemic. It has been mistaken for croup, but it
differs As croup formerly occurred no mucus was raised
in the earlier stages, and when there was an excretion
of mucus we considered the disease cured
But of late years the two complaints are somewhat blended.
Mucus is thrown off sometimes without permanent
relief”
“There is often in this disease a disturbance of 
the brain and nervous system resembling epilepsy or chorea
produced by the cough”


A distinction was formerly made by some
writers and some practitioners, between hooping cough
and [chin] cough the latter being a spasmodic cough
without the hoop. Such a distinction will not hold
good there is no difference
“Linneas and Rosenstein attributed it to an insect
others to malaria”
There had been a very severe winter & no one
had left the island for months


144
Hooping Cough Pertussis
Called also chincough
This is a disease which generally attacks children
yet occasionally, adults are the subjects. I have known persons
of 60 years of age affected with it. As a general rule also it
does not affect persons a second time. I have known about 
20 or 30 exceptions & among them was the late president Dwight at 60 years
Hooping cough generally appears as an epidemic.
With respect to its origin there is considerable difficulty 
in making up an opinion. It is said to be contagious 
to arise from a specific
contagion which affects a person but once. Dr [Dewers], however,
says “We confess that we are inclined to believe that it depends upon 
causes of a more general and pervading influence that 
contagion.” Dr Cullen asserts that he has said a disease which 
though evidently arising from chincough contagion never put on 
any other form than that of common catarrh. In the tenth
volume of the medical commentaries DR Willey gives an account of
the breaking out of the disease on Block Island under such 
circumstances that it would seem that it could not have originated
from contagion. When the disease prevails many become effected
where every precaution is taken” When the disease has been extensively 
prevalent I have not been particular about keeping patients
apart, perhaps however it is best for prudence’ sake to consider the disease
as contagious and to treat it as such. One fact I have noticed
that in particular seasons may have the disease who have had it
before.” Some suppose that it is contagious only in the first stage 
others in the second “Some think it caused by malaria or
animalcular”


“The stricture may be overcome by not
attempting to inspire, but to expire till the lungs are
emptied the pat. can then inspire without difficulty
I have known persons subject to this kind of hooping
without cough Adults are sometimes attacked in the night
with paroxysms of suffocation they start from bed when 
the recover their breath there is hooping but no cough, at
least at first The more they struggle to catch breath 
the greater the difficulty there seems to be a spasm of the
glottis Let them make no effort to inspire but expire 
the little air remaining in the lungs & they will bye relieved at
once. The disease is liable to recur bathe the feet at night 
give paregoric wine whey diluents The disease is not described


145
Some suppose this disease a peculiar inflammation of the
mucous membrane of the trachea and lungs, others that it arises
in the bowels
This disease often commences with the 
symptoms of ordinary catarrh & continues without alteration for
some days.  Sometimes the peculiar mark which gives this
cough the appellation of hooping & distinguishes this disease
from every other does not appear until the 3d or 4th week
It is impossible however to distinguish the disease until this
peculiar hooping makes its appearance. When the disease
is prevalent it will be safe to treat every severe case of catarrh
among children as one of this disease
The phenomena peculiar to this disease may 
be the described. Several frequent expirations are made in 
succession by spasmodic coughing, and a full inspiration is
then necessary to restore air to the lungs. The air as it passes
rapidly into the lungs produces a loud sound called whooping
The sound however is made more by the structure of the passage 
than by the rapidity with which the air is drawn into the lungs
I have known persons subject to this kind of whooping, without
having a cough caused by a spasm of the muscles of the trachea 
larynx? to which adults are sometimes subject. (Goods laryngismus?) 
A similar sound is also made in croup, when 
the air is expired after the passage becomes constricted
The patient is aware of the coming on of a 
paroxysm of coughing by an unpleasant sensation in the throat, & 



The cough is violent in proportion to the shortness of 
the paroxysm


146
it is common for children support themselves during its continuance
by changing to a chair or other support near them. During the
paroxysm the blood is returned with such violence to the head as to 
produce a livid colour of the face & often in 
bleeding at the nose. Very violent paroxysm sometimes
in young children terminate in convulsions or death The paroxysms continue
until a quantity of mucus is thrown up from the
lungs or the contents of the stomach are evacuated by vomiting
They are short in proportion to the facility with which the mucus
is brought up or rather in proportion to the rapidity with which it is secreted
It is the secretion of mucus, not its removal
which gives relief to the irritation of the lungs 
Many suppose that this mucus which is generally in considerable
quantity is the cause of the paroxysm of coughing instead 
of the effect of it. The peculiar irritation of membrane in 
a paroxysm of coughing produces a secretion of [illegible], and 
when a sufficient quantity has been secreted it is coughed up 
like the secretion of tears from an irritated eye
and the paroxysm is relieved “The mucus sheaths the part & the ceases”
The disease continues from one to six
months It is often kept up by habit. The cough is usually more violent by night than
by day. Violent cases are often attended with considerable fever
and in the worst cases respiration is laborious between the fits of
coughing. The disease may terminate by apoplexy or suffocation
or by ulceration of the lungs and hectic & sometimes by 
permanent visceral obstruction “or apoplexy or suffocation”
Whooping cough is not dangerous to adults
and I have never known a child over two years of age die
with it. It is most dangerous to infants and the younger the 


It is usually dangerous to children within the mouth
It is apt to wear out very young children especially 
if they are of a scrofulous tendency
It is frequently accompanied with a morbid sensibility
and irritability of mind and hence in the latter
stages a change of air and of place is salutary as in 
cholera infantum The same despondency of mind takes place
as in chol. inf. q.v.
The disease is a fever spending itself upon the
lungs and trachea, and affecting also the glandular
system
Some phys. think this dis. like common
catarrh, is always inflammatory in its commencement, and 
requires antiphlogistic treatment. But we know that
pneumonia may be highly typhoid & require treatment
opposite to [enteric] pneumonia. If infl. of the lungs exists
the antiphlogistic treatment shd be adopted in its fullest
extent I have seen antimony as efficacious in this dis
as in pneumonia. In general perhaps mild
antiphlogistic diet & treatment will be proper.
In some cases I have thought the
veins lost their power, and in such cases the
blood [illegible] has been prescribed & with advantage
It is a catarrhal fever at first and to be
treated as such


147
child the greater danger in children under the age two years
The anger, to be apprehended from the disease will also depend
upon the debility of the child when attacked. The cough may be
violent and attended with frequent vomiting yet of the patient’s
appetite be good there will not be much danger
to be apprehended. A moderate hemorrhage from the nose
is often salutary
Treatment. If the disease is mild and the constitution
good little need be done with the way of treatment. But if inflammatory 
symptoms supervene with a tendency to pneumonia
the antiphlogistic treatment must be adopted. Bleeding
will often be advisable. A small quantity of blood
taken from the arm proves serviceable. In general greater 
effects may be expected from the application of a few 
leeches to the breast or neck than from bleeding at the arm
but when decided symptoms of pneumonia appear, & the blood 
seems to be transmitted with difficulty through the lungs.
I would recommend venesection. In this case also the 
bloodroot will be the best article for internal administration
In most cases the disease comes on like
a catarrh, and should be treated as such, with mild 
antiphlogistic regiment [illegible] important part of the
antiphlogistic treatment of this disease is the keeping 
the bowels open. Costiveness frequently attends the disease & should
be carefully avoided. In general it is better to obviate 
this symptom by diet as far as it can be done 



Begin with antimony in small doses 1l or 2 drops ant wine & 
in [illegible]
For very delicate children however it may be better
to give ipecac
Almost all the writers recommend vomiting [Best]


148
rather than by medicine. The best cathartics for the
indication are those which excite the secretions of the stomach
and liver. Sometimes the disease has a tendency to produce
congestion of the liver and obstruction of the mesenteric glands
and in that case also mild mercurials should be given 
and their use continued as long as any symptoms of congestion 
exist.
All the medical writers on this disease recommended
vomiting in the first stage
Tart. ant. is in ordinary cases the best emetic. Sometimes
for a child from two to six months old two drops of antimonial
wine will be an emetic dose while for another
of the same age 20 or 3o drops may be required. In 
affections of the lungs children will bear antimony better
than in those of the stomach and duodenum. In some
constitutions antimonial emetics produce (in this disease)
a sort of spasmodic stricture other emetics also may produce
this effect a symptom which must be relieved by diluents 
and opium
In general antimony in small doses
may be given to children of any age, either by itself or combined
with a small quantity of paregoric or any other mild preparations
of opium. Given in this way it removes febrile action and 
congestion of the lungs, and determines to the surface
When the disease has proceeded with 


You may see the fontanelles swell in such 
cases. I recollect a child in the whooping cough going
into the country I told the parents not to suffer the child
to be vomited. A physician in the country said the child 
must be vomited of course all the books directed it
in whooping cough He vomited the child. It went into
convulsions and died
# Here insert the recipe for hire syrup or 
compd sys. of squills p. 150
I have known the lives of some patients saved 
by 
this antimony internally had lost its power produced no effect


149
violence for some time and there is much determination of
blood to the head, threatening convulsions or apoplexy from 
distention of the blood vessels, or when the patient has become
debilitated vomiting by emetics should not be practises
or but cautiously.
When the system and particularly the
stomach has become debilitated. Ipecac is preferable to 
antimony, given in emetic doses, or in small quantities 
as an alterative diaphoretic and antispasmodic. And in the
latter stages likewise on account of the debility, sulph. tinc. is a good
emetic using 5 or 6 grs. with as much of ipecac
If there is not much febrile heat, and there is much 
viscid mucus in the stomach and lungs, and emetic of
squills is often serviceable # particularly I [illegible] phlegmatic temperaments syrup of squills vinegar of [illegible]
In this disease if there is danger of convulsions 
from vomiting, blood root and similar articles should
be given. The hive syrup or compd tinct. of squills may be used
In children under three 6 months, whooping
cough may be much relieved (respiration being promoted)
by vesication on the breast. A blistering plaster may be applied but
I have more generally used the following. Rx common or mild
tinct. canth zi targ. ant zi Dissolve the ant. in the 
tinct. & apply a linen cloth with the mixture till [illegible] or partial vesication 
is produce & then dress with simple cerate In this way we have the vesicating & irritating
qualities combined. This external use of tart. em. was
recommended 20 years ago, in the Lon. med. & ph. Journ.


This disease may be cured in its first stage but it
ordinarily runs a regular course & the treatment is generally palliative 
brown mixture
You will perceive that this is a strong decoction
of seneka and squills, with a large proportion 
of tart ant. shd be given cautiously 4 to 30 drops 
Narcotics have been strongly recommended
e.g. atropa belladonna & hydrogen of the former
for 2 gr of the leaves in powder Alibert recommends
the fresh bruised root


150
A popular remedy in whooping cough in Godfrey’s cordial, made
of molasses and water with a little laudanum and oil of [illegible]
“Hive syrup” (or compd syr [illegible]) is made as follows Rx bruised seneka root & 
squills zz z8 water lb 8 boil and evaporate one half
strain and add honey 4 pts boil to lb 6 Add tart.
ant. gr.i to every ounce Give for an emetic 8 or 10 20 drops
to a child 4 mo. old & repeat the dose every 15 or 20 minutes
until vomiting is produced
The “brown mixture” is as follows elix. pareg. zi; ant. wine zfs;
ext. glyc ziii pul. gum ar. zii wat. zvi trit. & boil 
dose from ½ teaspoonful to tablespoonful
This has been very extensively used
This disease has been prescribed for more 
empirically than most others; a fact which proves the
difficulty of curing it It is a popular notion that it must
“run its course” & under the influence of this many parents
object to its being prescribed for. Undoubtedly this
like every other disease must “run its course,” if it is not
cured; but this is no reason why the cure should not be 
attempted.
Ammoniae asafoetida (especially if
the cough is kept up from habit)


1st antispasmodics 2nd tonics
# An emetic is occasionally administered with advantage 
“I have prepared this from seneca oil also
from gun copal”



151
2nd In the second or chronic stage tonics & 
antispasmodics are indicated. Sulph. of copper or of zinc
tinct canth. cinchona, arsenical solution etc. may be required 
to rouse and support the system & as antispasmodic
tinct. asafoet. petroleum Artificial musk etc. and also
the narcotics, as hyoscyamus, conium, stramonium, belladona arnica, opium etc.
When the cough is kept up by habit, # asafoet.
is often administered to children with advantage. It may 
be given in tinct. or decoct. & if it cannot be given by 
the mouth it may be thrown up in an enema, using 10, 20, or 
30 drops of the tinct. It is a valuable [illegible] the taste is less
unpleasant than the [illegible]
Artificial musk or oxygenated oil of 
amber was first introduced by Prof Hufeland of Jena
as a specific for whooping cough and has since been found 
very useful in other spasmodic diseases vid. Lon. M of ph. J.
vol. 1: p.181 van Swieten’s comm. etc. Rx nit. ac ziiifs
cl. succini zi. And the acid gradually, ina temperature 
of 100 [degrees] or in the sun. Prof. Hufeland triturated
x or xii grs. in a mortar with a few almonds & diluted with 
z 5 or 6 of water & gave a teaspoonful every 2 hours to 
a child a year old. This preparation was very celebrated 
and very effectual, for a time, but afterwards fail 
was thought to be ill prepared. The truth was the diathesis had 
changed. Probably it will be as affectual at [illegible] time
I have given the above article in tinct. Rx zii 
of the oxyg. [illegible] [illegible] lbfs alcohol dose 10 to 12 20 gtts
It is much more soluble in ether. I frequently dissolve zi 
of oxygenated amb. in zi of ether dose 1 to 2 drops on sugar 





152
It may be prepared indeed of any strength, to suit the
convenience of the physician. Probably gum copal oxygenated would
answer the same purpose as amber as there is every reason 
to suppose that the two are essentially the same
amber being gum copal mineralised Case of a vein of 
olibanum or Frankincense found in S. America.
Opium is not indicated in this disease
except when it is qualified and its action determined to the
skin by antimony ipecac or camphor. Hyoscyamus
is better than opium for in the cough it produces no constipation
and the tincture is very pleasant. I have not
however used it in this disease. Conium has been recommended
by writers of the first respectability, but later authors do not 
speak of it with much confidence. It deserves a trial
when other things fail. Alibert recommends atropa belladonna 
1/6 gr. of the root or leaves powdered & given in milk
I have used I have more confidence however stramonium in the [illegible] & think it preferable
most of the narcotics
to any other narcotic It is peculiarly calculated
to remove spasmodic action depending upon irritability 
of the system or kept up by habit From the relief obtained
by its use in asthma I was led to employ it in this disease
and from those cases in which I have tried it I am of opinion 
that it is a very valuable remedy in it 
The ripe seeds of the stramonium are best the full dose of 
these for adults is gr. ii for a child  1/10 gr. or more according 
to the age



Mercurials occasionally blue pill rhub & 
ipecac enough to keep up a gentle excitement in the 
bowels
Not unpleasant to the taste
An old [illegible] Chalmers ([illegible] of silver) recommends sulph. cop. & 
tinct canth in wh. cough
# [ago] more used than any other Lately the ox. bis.
has taken its place dose the same used  for irritating
cough & irrit. of stomach


153
Carb. potash is a good antispasmodic used externally 
and internally. It is not only antacid & antispasmodic but it appears to 
me to produce a peculiar excitement upon the stomach
and aesophagus, which makes the more susceptible to 
the impression of other articles. Pearlash zfs & water z8 with 
cochineal enough to colour the solution has been considered
relied on by some physicians
a specific. The cochineal merely colours the solution.
is an article from which I never could perceive
any medicinal effects when used alone. I have tried the
experiment & could perceive no medicinal effect from it
Tonics. I have given the sulphate of zinc
more than any other tonic in this disease, and have experienced 
the greatest benefit. Sulph. tinc given by itself,
sometimes produces spasmodic action, the effect I attribute
to its being used in substance & hence I always
give it in the form of Moseley’s tonic solution. This 
preparation is both conic and antispasmodic is easily 
taken and retained on the stomach of very small children
Sulph. copper possesses properties similar 
to those of sulphate of zinc. It is administered in the 
low stage of whooping cough. In this place the preparation
of it called compd tinct vitr has been used
according to the recipe in the 10th vol. Duncan’s Commentaries
in doses of 3 to 30 drops according to the age of the patient
The oxide (or flowers) of zinc & also bismuth 
formerly much used in spasmodic cough 30 grs
have been occasionally used 1 to 3 grs 1 to 10 to an adult
The Peruvian bark is a good remedy in 
the last stages. The only objection to it lies on the difficulty 


It sometimes happens that the physician is 
not called in until the latter stages. As one resort we
may have recourse to irritate along the spine
It is an opinion very extensively prevalent to that
it is of no consequence what kind of food a child takes
when he has the whooping cough But great attention 
shd be given
Removal from sea side to country 
and [illegible] country to sea side either is beneficial


154
of administering to small children, a quantity sufficient
to produce any considerable effect. This difficulty may 
now more be overcome by using sulph. quinine ¼ gr to 1 gr Dr Chalmers of 
South Carolina recommends a combustion of bark, sulphate
of copper and cantharides
Tinct. cantharides has been long since
recommended for whooping cough. It is useful when the system
requires an inflammatory diathesis to be produced. Its action on the stomach 
is probably similar to that which it has in cases 
of gleet and leucorrhoea the stomach being in a relaxed
state & requiring to be excited to a healthy inflammatory 
action
Irritants, as oil of capsicum canth. [illegible] or ol. orig.
or vol. lin. rubbed along the spine have been used in 
the latter stages. They should be tried when you have reason 
to suspect that the spinal marrow or the nerves proceeding 
from it are affected.
Attention should be paid to the diet of children
in the whooping cough avoiding potatoes, oily foods etc.
Change of scene & change of air especially by 
riding should be resorted to in bad cases, to tranquillise 
the patient & furnish mental excitement. Sometimes the little
sufferers will be excessively irritable constantly worrying and teasing until 
this is done requesting first one thing & the other to be done. It is the worst of such cases, medicine does
little good, even the irritation produced by administering 
it may counteract its beneficial effects.


violent palpitation throbbing of the heart
a soft flowing pulse and a jarring feel of the pulse under
the finger ([illegible]) (The French call an enlarged heart
hypertrophy I object to the [name])
For this I have given nit. sil. 1 or 2? gr.
(in the chronic stage of [illegible]) Digitalis & also
[languinaria] (tinct. 2 or 3 gtts.) This article is dangerous for
children because it accumulates in the system
Lead has been recommended 
I have been doubtful with respect to its propriety in affection 
of the lungs etc.
# Pneumonia typhoides 1815 the system seeming to lose the
power of [illegible] the blood and the bloodroot was
given to promote venous absorption The digitalis
might probably be given in such cases but is not as
well adapted. I used the blood root and found
as much benefit as could or [expected] from any article


155
If the patient having the whooping cough happen to be teething
the treatment recommended for dentition should be employed
The patients are very liable to have an 
inflammation of the lungs from taking cold in any stage
of the disease & in such cases the remedies for pneumonia
should be administered, such as antimony bleeding
epispastics, bath etc.
The disease I think sometimes determines to the
head & produce a relaxation of the sinuses & 
[illegible] likewise produces a relaxation of the ventricles of the 
heart the immediate cause being the violence of the cough
In such cases I have used lead, but not in sufficient
quantities to enable me to recommend it Iodine has been
recommended 2 or 3 doses 3 times a day Nit. sil. languinaria & digitalis
When in the progress of the disease
the circulation becomes much affected the pulse frequent,
soft, flowing with occasional intermission
respiration high frequent and laborious, with a bloated
and sometimes analogous to # a livid countenance, the blood root has
done more than any other remedy not failing in any 
instance to give relief & palliate sympt & in some cases the relief has been
permanent. I gave the bloodroot repeatedly, the last
spring, 1815 to my patients in the whooping cough. To a
child a year old 5 to 10 or 20 grs of the dried root, according
to the urgency of the case, infused in 6 or 8 teaspoonful of
boiling water. Give a teaspoonful every hour, until 
vomiting is produced or the patient relieved. Children 


Sometimes the dis. will be very mild and yet leave 
the system in such a state that a slight subsequent disease
will carry off the patient e.g. in 1815 the dysentery
attacking children would often be very slight and yet
would carry off every one who had had the whoop. c.
in the spring. The attack would be mild and insignificant
of dysentery and yet the pat. would go into 
a [illegible] very speedily like cholera
Elaterium has been recommended I shd
be cautious in trying it except in very vigorous children
I can speak with confidence of arsenic. Excepting
occasionally prussic ac. I know of no remedy which 
so completely cures the wh. cough except prussic acid in 
some cases.
Case child 2 gtts night & a [illegible] in a
weak countenance pale, eyes dull face bloated muscular
strength weak muscles soft & flabby Parents
much [illegible] cough gone recovered colour & 
strength upon bark I have known several such 
cases and have known no ultimate injury result from this practice
Yet parents are afraid


156
who had the whooping cough that spring were very liable
to be carried off by the dysentery of the following summer
none died in 1815 of the disease but many in consequence
of it, with hydrocephalus and dysentery
Prussic acid dose 1/3 of a drop to begin with and arsenic
occasionally cut this disease entirely short; and these are 
the only articles which I have known do so, without leaving
a vestige of the disease behind. The former is a dangerous
article to use, from its want of uniformity and strength
Fowler’s solution of arsenic gtt more [illegible] is safe but does not answer
so well in the first stages. If it makes the patient feeble
livid bloated & with swollen lips etc. it must be stopped & perhaps
bark administered. It has cured the cough in the 
second stage. Dose 1 drop 1 or 2 drops twice a day. Sometimes is only palliates
Case. June 1815. A child of Capt. Totten’s a boy 
of 5 yrs of age rather full habit had been affected
with the cough for a fortnight before I saw him 
I found his pulse very frequent soft convulsive & with intermissions
face swollen and livid, circulation much increased on 
slight palpitative [illegible] motion of the body in the symptoms aggravated to an
alarming degree by a paroxysm of coughing. Previous t the
disease a remarkably even tempered and pleasant child he
was not on the contrary very irritable. Trifles irritated his
mind, and when irritated, all the symptoms of his disease
were aggravated. He took an emetic of ipecac, with 


The sequels of this disease are numerous
Sometimes the heart is affected as above and continues
so for years. Sometimes the glandular system
is affection. Sometimes the lungs. There is a lady in 
Philadelphia who had (under my care) suppuration of
the lungs whoop. cough now healthy hence never despair
The stomach and abd. visc. are
sometimes affected in a chronic way requiring 
dandelion mercurials hop [illegible] etc.
It is very tedious to attend children in the 
chronic stage an account of the excessive irritability
When bath recommended
Cold bath doubtful. I have known patients killed
by being brought from the country and plunged in the
sea bath
“Good speaks highly of rhus [illegible]. It is
given to produce a distinct action on the system which shall
overcome the diseased action. It determines powerfully to 
the surface and has a powerful exciting effect on the
blood vessels while it does not produce a determination
to the brain. I should not recommend this article and 
it is so uncertain in its effect. On one person it will
have no effect at all, when in another it will cause
swelling of the eyes, blindness, fever, & great irritation


157
but inconsiderable & temporary relief. He was directed
to take the bloodroot every hour, as much as the stomach
In relieved the violent symptoms
would bear. It was continued for two or three days, and the
palpitation of the heart was much abated, the circulation
was less irritated, & the livid colour of the face was gone still did not cure
When costive he was benefitted by full doses of cathartics.
because the system was [illegible] deranged heart lungs etc.
I considered the case a fatal one and expressed that opinion 
to the parents. The cough and other symptoms continued
though in a less violent degree disease chronic an epispastic was applied
to the chest very irritating (changed clothes often in the day [child] run upon various subjects)
Patients strength began to fail and tonics were given
white vitriol bark cantharides Finally the patient refused
to take any medicine and was left to his own appetite
called obstinately for it took cake for food for several days then baked pears then [illegible]
Afterwards recovered but was unable to run “for some years”
without a palpitation
If this disease should again prevail
I think I should atropa belladonna as a prophylactic.
As the disease continues the stomach
may become very much debilitation and require 
compd powd of [contragerva] cat carilla etc. etc.
“Ledus palustra are narcotic”


It is not certain that the dis. did not exist before
It may have existed before but no general account
given of it. It may have been known in diff. places by 
diff. varies and it [illegible] have been known than the 
diff names meant the same disease Diseases are not
apt to appear suddenly. Still at this period, there
[illegible] cause operating for the increase of the dis.
Belly usually large and limbs small
Joints unusually large
Often morbid cravings of appetite
Yet the same causes operating in a higher degree
produce cretinism
There is no difficulty in recognizing the disease
You will be struck at first sight with the large size of the
head the blue [veins] of the forehead paleness of countenance as you cast your eyes
down you will notice the large joints


158
Ricketts
This disease according to Underwood was first noticed
in England in the year 1628. It is said to have immediately 
succeeded the increase of manufactures, when people left the villages
to settle in large towns, where they wanted exercise and a
pure atmosphere
Children are rarely attacked with this disease
earlier than the sixth month and not usually until after
that period. The symptoms are soft flesh muscles & cell. sub. relaxed general relaxation 
of the system paleness of the countenance unless the face
is flushed with fever, which when it exists is of the hectic kind a fever of irritation
pulse, usually quick and feeble,
tumefaction of the abdomen appetite and digestion bad tendency to acidity
veins of the head [illegible] and blue the sutures of the head not firmly closed head large fontanells unusually 
open joints large in bad cases all the bones of the system enlarged & softened
One effect of the disease is that the teeth are cut later than 
usual. Ricketty children are usually precocious in 
intellect. Their mental faculties are developped more early 
but are not capable however of so much improvement, as
those of others. Evolution of the mental faculties does not
proceed with the tardy progress of the assimilating function 
The child learns to [illegible] very early and exhibits an acuteness
of intellect beyond his years with the exception however of those
cases so severe as to have a tendency to cretinism It is a common 
saying that very forward children are not likely to live long
and the precocity of scrofulous & rickety children may have contributed
much to the production of this impression.


Too much heat may produce an indirect
debility
Undoubtedly aff. the brain & nervous system
Give mercurials occasionally Do not produce salivation
and do debilitate by mercury
Frictions are very efficacious exciting the skin
The reasons why friction are not more successful is that they are not perservered 
[illegible] the al. can. etc.
The cold bath is the only strengthening remedy which 
acts suddenly
No effect can be produced by any medicine
equal to the astonishing effect of exercise & amusement in many 
cases of chronic aff. of stomach & bowel.


159
The causes of this disease as in some instances a predisposition
transmitted from debilitated parents sometimes
a syphilitic taint of the parents In others bad nursing
the children being kept wet and dirty and confined in 
close & damp apartments or if the child has been carefully 
fed and kept clean debility produced by confined air
too great warmth, too great variety of food and as some think
too much saccharine matter in its diet. Inanition may be
a cause. The disease prevails among the Alps
and is perhaps there caused by the combined influence of 
cold and moisture
This is a disease of debility nearly allied to 
scrofula & cretinism affecting the viscera of the abdomen generally, the
lymphatics and the [isseous] system. The chylopoietic viscera
are probably first and afterwards the mesenteric & lymphatic glands generally 
the indications are to give tone to the system 
and excite healthy secretions
The diet should be dry and nutritious
and such as is not only easy of digestion but rather stimulating
and the bowels kept open by cathartics which act on the
secretions. A dose of calomel with a little ipecac will 
be useful. The cold bath should be used every day Take the child out of bed in themorning bathe & return. If the
Cold bath of salt water is [illegible] tonic
patient be very feeble it should be begun with at of a temperature 
of about 80 [degrees] and gradually used colder
The child bath is equal to all other remedies It is more tonic if made of salt water 
As a substitute for exercise, frictions will be very useful
But exercise in the open air should be like whenever the
weather is good in a carriage or on horseback and exercise
should be so managed as to afford amusement and mental 



The [guephalin] [polyapt] & also the gr. marg.
(which is less odorous) are also used Their agreeable odor
if there is no other advantage will prove grateful
stimulus & promote healthy secretions
Take the child out of bed and plunge him
in water (about 70 at first) and replace him in bed
Yet in exhaustion of fever the cold bath
gives a shock from which the system will not react but
yet in the debility the cold bath is highly beneficial whether
we can explain it or not.
It may be necessary to vary the tonic And 
it is desirable to have a variety of tonics to [chorea] from 
also carb iron & tinct. carb. iron ac. fer. alkaline solut
The sulph. zinc is not inferior to iron and is not subject
to the inconveniences of iron not producing inconveniences Mosely’s sol.
The compd tinct vitr. although apparently [illegible] is yet
certain in operation and has been long used in this vicinity
A tinct. of potash is thought very useful to 
rub the body with. It is a popular remedy & has sustained
its reputation in this neighborhood for many years
Lime water made of caustic lime is more tonic
than the carbonate That made of shells is thought better being
pleasanter than that made for stores probably not as pure
but containing muriate of lime. Be careful to see that the
shells are thoroughly burnt so as to fall in powder when 


160
stimulus by the sight of scenery vegetations, flowers etrc. The patient
may even be benefitted by being carried in the arms into the garden
and amused in this manner. It must not be forgotten
that this cheerful excitement has a powerful effect on the secretions.
Feather beds should be prohibited. They are too 
enervating, and hard ones should be used in their stead.
Beds made of the sweet fern (comptonia [asph??folia]) are
popular & do very well. They not only from their hardness
check the profuse perspiration of the hectic diathesis, but correct
the acid smell of the sweat which is very common. IN general 
heat should be avoided as too relaxing
I have rarely failed of curing the disease by 
the cold bath as the principal remedy, using tonics however as
occasion may require. The tonics which we may use are sulphates 
Phosp. & mur [illegible] 3-10 grs
of zinc & of iron muriate of iron martial flowers of iron
etc. and the plan has been tried of applying finely powdered bark eternally in a 
quilted jacket of flannel. It is difficult to give bark in substance to small children. Astringents may be indicated & 
there is often a degree of acidity so great as to indicate a free use
of absorbents
The alkalies as pearlash may be beneficial internally
& frictions with pearlash & water zfs to a pint may be recommended.
Of late iodine has been given in doses of from 
2 to 4 drops of the alcoholic tincture 3 or 4 times a day, given
mucilage or other convenient vehicle. This article when persevered
in has cured a great many cases. It should be [given] at first
in small doses & the quantity be gradually increased or 
a disgust towards it may be created


Phosphate of [illegible] was popular
Forgetting that the deficiency of [osseous]
matter may be defect in the action of the secretions
Though the theory was wrong yet the practice
was found beneficial absorbents
Give a solution of the acid of about the strength
of lemonade The phosporus is preferred to the phosphoric
quenches in the water you will then have, not as is
too commonly the case merely smoky water but lime 
water of full strength These preparations are called
tonics by Good called stimulants (too loose as use of the
word) Long before I had any explanation in [illegible]
I thought I observed that these articles created a susceptibility
to the operation of tonics apparently as generating excitability


161
It has been supposed that the proximate cause of this disease
is a deficiency of phosphate of lime with bones but 
this is an effect, caused by want of action as those vessels which 
secrete this substance. The proximate cause, as it is called, is in 
this case the disease itself. In consequence of this notion 
burnt bones have been much prescribed. They are probably 
useful not as supplying the matter of bone but as an 
absorbent & perhaps as a tonic
Acids especially the phosphoric have
been given. Phosphate of lime has been used with benefit
muriate of [illegible] and barytes were
formerly much prescribed.
The worst cases are those of children
born of syphilitic parents for these tonics mercurials and 
the cold bath will also be the treatment.
I give them corr. subl. 1/30 gr with
no injurious effect


Nearly allied to ricketts and often as sequel
of it ricketts often running into it Sometimes appears
with ricketts sometimes afterward Ricketts occur with 
the year. Scrofula occurs later. Ricketts children
are more generally of a scrofulous temperament
The tendency may exist in the parents and yet
be developed only in the children from the causes of 
bad food [illegible] pain etc.
These swellings may continue
in children of 5 or 6 [illegible] or within the year with little or
no change but increasing of size in spite of poultices filling the whole neck
I have found poultices apparently injurious promoting the
relaxation but blisters would stimulate and bring on 
a suppuration. The pus will not be healthy but curdy 
and whey like The edges will be ragged, not unite
readily, and will leave a bad scar. Scrofula,
ulcers are said to be distinguished by a smooth overlapping
margin. the disease may continue for months
and years with little or no change of it does not attack
a part essential to life as the lungs, producing tubercular
consumption attacking the liver producing a peculiar
atonic infl.
I have seen cases of scrofula that were [entonic]
They were injured by tonics and benefitted by cal. and ant. They 
would have borne bleeding



162
Scrofula
This is a disease of the lymphatics and affects persons of a peculiar
temperament this temperament is characterized by a fair, thin, translucent
skin, light hair, blue eyes, sometimes black hair and eyes delicate 
fullness of lips & nostrils usually texture of skin and cellular substance general laxity of
muscular fibre usually delicate organization mental faculties 
developed early on in ricketts. Person who have been affected with ricketts
in infancy are after affected with scrofula in after life.
This peculiarity of constitution, when a morbid action 
is superadded, gives rise to the following symptoms
First small swellings appear about the neck, slow in their 
progress & with an imperfect suppuration. Small holes
form in the swelling and discharge a subpurulent,
watery and flocculent fluid. These scrofulus 
ulcers when fully formed are distinguished by smooth spongy 
and overlapping margins & by very lax granulations. The disease forms tubercles upon the lungs, liver
kidnies & ovaria & causes a great enlargement of the mesenteric
glands
This morbid condition and action may 
be transmitted from parents to children. It prevails especially in cold and variable climates exists most in 
large manufacturing towns where it is caused by bad food
and air, want of cleanliness all of them debilitating causes
It is sometimes also in persons predisposed, a sequel of other
diseases particularly of small pox, hooping cough & measles
Treatment. more may be accomplished in 
the treatment of scrofula by diet, exercise, sea air etc. than
by remedies. Scrofulous swellings should be treated by 



Avoid cold vegetables & watery diet give animal 
food articles containing nitrogen as infants are said to 
abound more in albumen and adults to be [illegible]
“Iron zinc copper silver tonics & antispas. are useful”
“Conium 2, 3, 4 grs with carb. fer. 10-20 grs”
# “I have used with advantage mur. lime 3-4 drops increased 
to a tablespoonful & also mur. [illegible] 3-30 drops given
in milk & water or in coffee. They are tonic & act on the lymph. & gland. syst.”
Articles containing [illegible]
In [anthelmint???] vesicular [illegible]
F. idealis ([illegible]) (sea cabbage) has been given for worms and
some families learn their children to cut it
A mucilage may be made F [vesiculosis]
[illegible] which with bran has constituted a popular poultice
for scrofulous tumours
When there is loss of tone & an ill conditioned discharge 
cantharides with opium is a valuable excitant
Never continue any remedy after it debilitates
by exciting disgust and nausea
Mercurial plaister of the shops (gum ammoniac 
& blue ointment equal parts) has been much used 
especially for scrof. [swell.] of the joints In these [illegible]
become extensively effective and become spongy
A man at the westward was very celebrated for 
curing scrofula. He used wild violets but was not particular
as to which species he used



163
blistering van Heuvel’s child a round of remedies had been tried [illegible]
Occasional purging with calomel and rhubarb
and ipecac in a pill will be useful
Preparation of iron, carbonate of iron with conium etc.
muriate of [illegible] 3 drops or 6 and barytes in [illegible] you give a teaspoonful iodine
scrophularia mar. [Cistus] Canadensis uva ursi
Mr Daggett Havanna Dublin Eliza Collis
Vide p. 209
Iron no prep. perhaps are better than myrrh
mixture or Jenkins’ pills (carb. per. [illegible] camph.)
“Bark & quinine”
Different preparations of [illegible] & barytes # Now
superseded by iodine. I have seen more powerful
affects produced by 4 dr. tinct. iod. persevered 
in a long “5 to 20 gtts within the year 2-3 gtts ter in die”
Various vegetable articles I think very highly 
Rock rose or Cistus Can. (Helia [illegible] [pity] it is changed)
Some years since a person went to Long Island to be cured
of scrofula to a family famous for curing scrofula returned much benefitted should his remedies
they [illegible] [illegible] & [illegible] always used than 
afterwards, when [illegible]
[illegible] from Havan. neck filled up 
cured by [illegible] had been salivated W. I. without benefit
Eliza Collis scrofulous cough much [illegible]
cured by [cistis] vide p. 209.
Scroph. maril. has been popular has been
much used by empirics I have seen it sold at a great price 
brought from the west a very common plant It has been 
celebrated for accelerating parturition probably with out foundation
The article has probably little or no power. Yet it is advantageous
to know such articles in order to [illegible] [illegible]



Two entirely different diseases but are classed
together and may be treated together
“H. externus is correctly named hydrocephalus”
“No fever ordinarily attends. The disease
consists in loss of town in the absorbents”
Of late iodine has been recommended 
[illegible] two years since I was called to a patient with 
had enormously distended [illegible] [upon] gr. cal. & 
2 drops tinct. iod. [illegible] recovered
Tinct. canth. Face pale and bloated child sleepy and [illegible]
I know one child who recovered, but at at the ages of 5 or 6 years died of H. 
internus. If the patient recovers he is more liable to the acute disease
afterwards. Puncturing the membrane has been tried with success,
and the application of bandages then supporting the 
child. It is said that puncturing of the pressure
has [illegible]



164
Hydrocephalus
Divided into two species externus and internus
In H. externus the water is formed between the membranes
of the brain (between the brain and its membranes?) In H.
internus it is in the ventricles of the brain
H. externus make its appearance at birth
and is usually born with the child. # In its ordinary form
it is fatal (It is almost always fatal when it makes its appearance
immediately after birth and always so if born 
with the child)
Stimulating and discutient applications
to the head have been recommended. Epispastics are 
said to be serviceable. (Blisters have been found serviceable
they should be kept up for a length of time) Mild mercurials
cal. or blue pill & the muriate of lime or sometimes [illegible] pressure by bandaging . If
the disease is accompanied by rickets the cold bath 
is indicated and has been found serviceable
I have known one child recover from 
this disease and other who has been mending under
medical treatment for 2 years past. I do not know whether it recovered
# H. externus appears to be nearly allied
to those watery tumours which affect the spine.
In consequence of a partial opening of the sutures of the
cranium, or the absence of a portion of one of the
bones the dura mater and scalp are protruded by the
pressure of the contained water & form a swelling on the
outside of the head. Puncturing this tumour is suddenly 
fatal (is as fatal as the same operation performed on the tumor
of the spine.


Arachnoid inflammation, arachnitis, apoplexia hydrocephalica 
(Cullen) encephalitis phrenicula of Rush
cephalitis profundu of Good We might multiply 
[illegible] but perhaps this is sufficient
The disease different in different cases
A great deal has been written and great deal
of confusion exists
“In this species of hydrocephalus the effusion 
of serum is into the ventricles of the brain. This
serous effusion is the effect of the disease and not the
disease itself & hence it may follow diseases of
various kinds. I consider the name very improper”
# “The vomiting if it cannot be ascribed to improper 
food in the stomach is an important symptom in 
the diagnosis”



165
Hydrocephalus Internus acutus
Under this unfortunate name I propose to treat of all
those cephalic diseases which are less violent in their action
than phrenitis (or are less inflammatory). I shall 
principally confine myself to the disease as it appears 
in children
“Symptoms different in different cases”
The disease commences with the following
symptoms (one form of the disease is well described by Dr
Quin) vide [illegible] vol 2 p. 315 The patient is languid inactive and drowsy 
more or less feverish at times apparently free from any 
complaint (drowsy & peevish at intervals easy and
apparently free from any complaint) The appetite is
poor and irregular (week) & (Nausea &) in many 
cases vomiting # occurs once or twice a day. The skin
“Exacerbation towards [illegible]” 
is generally hot and dry (towards evening) and if a perspiration 
occurs it is partial. Soon after these symptoms. The 
patient is troubled with a headach. The seat of the pain 
varies in different cases, sometimes it is confined to one
side of the head (Soon after these symptoms commence
the patient is affected with a sharp headach either 
in the fore part or crown) It is a common observation 
that the headache alternates with the affection of the 
stomach, the vomiting being less troublesome when the pain 
in the head is most violent. The pain occasionally 
attacks other parts of the body (& sometimes principally confined
to the back of the neck and the space between the scapulae)
At this period the patient is averse to the light, cries
much & sleeps little While asleep the patient shows 



# “The tongue is commonly clean & in this respect this
aff. differs from remittent bilious fever, in which the vomiting
& febricula are attended with a yellow fur upon the 
tongue”
One side of the face body one arm or one leg more affected or moved often is perhaps
a severe a pathogen sump. as any other. This is an
indication of paralysis I have known [illegible]
patient recover from paralysis 


166
signs of uneasiness grating grinding the teeth. starting
and screaming in sleep as if terrified. The bowels are usually 
constipated though sometimes relaxed. The pulse in this early 
stage does not indicate much danger (These symptoms 
however are subject to great variations). These symptoms
are succeeded by affections of the eyes. One eye is turned
in ward to the nose its pupil is dilated The pupil contracted in this early & dilated in the latter stages. Sometimes both
eyes at the same time are affected in this way both turned
inwards & both pupils dilated. In this stage the 
vomiting becomes more constant and the headache
more excruciating, the pulse is frequent and the breathing
quick. # If these symptoms supervene to typhus fever,
the pulse becomes more slow Exacerbations of fever
take place towards evening. There is often a flush upon 
one cheek (flushing is usually confined to one cheek)
Perspiration if it appears is usually confined to the
head and chest. A discharge of blood from the nose
at this time relieves the symptoms of fever (& removes the
flush from the cheek) for a time & any favorable symptoms. Delirium often takes
place at this time and is violent in proportion to the age 
of the patient All this time the disease is undergoing a change. As the disease advances the pulse becomes
more slow and unequal & the patient becomes 
less sensible to (the pain in the head) his sufferings 
Lethargy succeeds the disturbed sleep and restlessness
of the early part of the disease. The strabismus and
dilatation of the pupils increase & the eye loses its sensibility
Loss of vision (The patient after sleeps with one or both eyes half
closed) The patient in this stage often takes medicine & 


# “Even in this stage patients have been cured
by the strong impression on the system made by tartar em.
pushed so far as to produce colic” vide infra
Sometimes when hemiplegia takes place the 
disease puts on a chronic form
In the


167
sometimes food will sometimes however
he obstinately refuses to take any thing. The bowels for
the most part continue costive. #
To these symptoms succeed a quick small
pulse (almost imperceptible) bad symptoms in 
the last stage sure forerunners of a speedy dissolution 
(a difficulty of breathing in many cases the flushing of the
face is succeeded by extreme paleness sometimes in this 
stage petechial eruptions appear on various parts of the
body & the patient dies in convulsions or sometimes a hemiplegia
takes place two or three days before death
The disease sometimes runs through its stage in 4 or 5 days
at other times it requires as many weeks. The dilatation 
of the pupils in some cases does not take place until 
the last stages & perhaps sometimes not at all. In 
all cases the proper treatment should have been 
pursued before strabismus, blindness or coma
takes place, because very little is to be done afterwards.
A constant rolling of the head & moving one
arm and one leg are among the most important 
early symptoms which indicate a dangerous affection
of the brain)
The disease sometimes puts on the form
of an intermittent. When the disease has terminated
in effusion the case is probably always fatal.


much dissatisfaction after
existed When an ordinary fever terminated in hydrocephalus 
thinking that the phys. was mistaken at first
“I think this disease is rarely an idiopathic
affection. It supervenes upon other diseases & generally 
depends on disease of the stomach & bowels”
The disease when from ext. violence may 
exist without any [pathognomic] symptom


168
Causes external violence teething worms
Other fevers forming a crisis by effusion into the ventricles 
of the brain. Typh. fev. & dysent. in children terminate in [illegible]
I have known more than one instance in which it followed [illegible] of hip joiont
This is very rarely an idiopathic affection 
unless it may be considered so when it arises from external
violence Vide L. J Pringle on dis. of [illegible] When it does arise from external violence
it rarely puts on the same symptoms or the same appearances 
after death
All the diseases of children from infancy are
liable to terminate by hydrocephalus & hence it is important
to examine all the symptoms which may indicate
a determination to the brain & check the tendency
if possible
Case A girl 14 years of age, had symptoms
of affection of the brain from a fall upon the occiput she complained
of pain in her head for two or three months before she died 
& occasionally had regular epileptic fits [illegible] [mouth] The pain 
the head was relieved by cupping and epispastics to 
the head, but she finally died in an epileptic fit
On dissection the dura mater under the cranium, where 
the injury had been received was thickened and the vessels
were injected with blood. The ventricles contained half a
pint of water. Dropsy in the brain Yet the
pat. had no dilatation of pupils etc. The dis. put
on the appearance of epilepsy occurring once a month.


More common in some families than 
in others 


169
Causes. Hydrocephalus is a disease nearly allied to with scrofula
& like that seems to run in families. Delicate children
in whom the mental faculties are more early developed
are more subject to it. Hence the common observation 
that the child is [illegible] forward that it will not live
long I think persons of a scrofulous habit 
are more subject to this disease & that of the hip joint
When there has been no local injury to the brain, the
disease commences with affection of the bowels, or it is a 
sympathetic affection from disease of the bowels
In the progress of bowel complaints in children, the
[illegible] and the small veins become turgid. This enlargement
of the vessels seems to invite the blood to that 
part. In consequence of this child may die
with symptoms of hydrocephalus, from the turgescence
of the vessels, without any effusion into the ventricles
In typhus fever, in dysentery and in
other bowel complaints of children it is not uncommon 
for children to die with symptoms of hydrocephalus


It is a good symptom in hydro. to have a 
discharge from the [sch??der???] membrane


170
Diagnosis “In its early stage, this disease is scarcely 
to be distinguished from remitting fever When 
from the anxiety of relatives & of the physician, a
diagnosis is eagerly desired, the following circumstances
may perhaps assist in forming a judgment
If there is occasional vomiting, with febricula
the tongue at the same time remaining [illegible], there is
reason to apprehend that the primary irritation has
its seat in the brain and that it will prove a fatal
case of hydrocephalus. But if along with the fever 
and vomiting the tongue is covered with a thick
yellow fur, we may hope that the complaint is confined
to the digestive organs and that the disease is
nothing more than coler or remittent fever.”
Ed.reviewer
Diagnostic symptoms between idiopathic
arachnitis or cerebral fever, and infantile remittent
or fever from intestinal irritation choler
In cerebral fever the abdomen is
flattened, not tumefied but in intestinal fever it 
is tumefied. In idiopathic cerebral fever 
the secretions of saliva and that form the schneideran membrane are diminished. Unless complicated with aff. of muc. m. which is rare. In cerebral
fever the tip and edges of the tongue are red 
In intestinal covered with a thick fur. In cerebral
fever the pain in the head is severe and excruciating; 
in fever from intestinal irritation it is obtuse.


# the sides of the head, back of the head on 
the forehead
Perhaps a constant rolling of the head & 
movement of an arm & leg are among the most important
symptoms
Different opinion ben entertained
about the nature of the disease Some 
have been so anxious about determining the exact
nosological nature of it disease as to refrain
from prescribing until the first stage has gone
by. Prescribe for the symptoms at all events
and make up your mind about the nature of the
affection as fast as you can. Too much discrimination 
cannot be exercised & cultivated yet where 
we cannot determine the exact nature of the disease
we had better treat the existing symptoms & the obvious 
indications
# It varies in scrofulous constit. there is 
no such state It may approximate in some cases
And I might cite the opinion of 20 others
The [illegible] it is sometimes entonic & sometimes 
tonic. It more frequently [illegible] determined 
Why shd not fevers terminate in the brain as well as [illegible]


171
In intestinal fever the patient more frequently directs 
his hand to the nose & about the face in cerebral puts his hand to his head # 
In cerebral affections the head is hotter than the abdomen;
but if the disease originates from the bowels
the abdomen is the hottest. “There in a very few cases seen
picking at the nose in cerebral fever but in general the rule
holds good” “The state of the bowels is not pathognomic”
Dr Beddoes thinks the disease belongs to 
inflammations & that at an early period he should be
inclined to bleed as largely as in pneumonia #
Dr Withering observes “in a great many 
cases if not in all, congestion or slight inflammation are
the precursors of aqueous accumulation
Dr Rush thinks that instead of being 
considered an idiopathic dropsy, it should be regarded 
only as an affect of primary inflammation or congestion
of the brain
“Dr Rush says” It appears that the disease in its first
stage is the effect of causes which produce a less degree of 
that inflammation which constitutes phrenitis & that its
second stage is a less degree of that effusion which produces
serous apoplexy of the brain
Dr Darwin supposes torpor or inactivity
of the absorbent vessels of the brain to be the cause of 
H. internus
Dr Whytt in his treatise on the disease
observes that this and every kind of dropsy depends
upon the fact that more fluids are thrown out by the exhalants
than [illegible] the absorbents take up



I chiefly depend upon calomel for a cure if it cause
too much evacuation check it with opium
There is no evacuation from the brain therefore
the disease must be overcome by altering the secretions
counterirritation etc.
Bleeding with leeches from the temples
seems to translate to the surface and give relief vide
John Hunter.
Case young man apparently as
desperate a cure as ever I saw not scrofulous we
concluded to try tart. emet. gave it without
much weight in about 8 or 16 hours he complained
of violent pain ion the bowels and all the
symptoms of the head were relieved
[illegible] “Irritant to the schneiderian
membrane in the last stages are recommended
by Dr Malachi Foote of N. Y. in the Med. Rep. 
for about 1810. Turpenth min. 1 gr. with liquorice 20 grs 
[apreynum] [myrici] ipecac etc. are the best [stermentatories]” 



172
Treatment Evacuants Bleeding general & local
cathartics calomel and jalap gamboge
Counterirritation local bleeding cupping epispastics
behind the ears and to the whole surface of the head
Salivation should be induced but cal. often
relieves without altering the secretions
There has been a difference of opinion as to 
the application of epispastics to the head. If venesection 
be indicated they should not be applied until after 
bleeding. I prefer cupping and blisters to the back
of the neck and behind the ears
I think some advantage may be derived from applying
to the spine ol. orig. ol. capsc. etc.
Where considerable entonic action has existed 
I have cured this disease by giving tartar emetic until 
colic was produced. give perhaps a grain 
& continue its exhibition until the symptoms abate #
“gr doses every 2 or 3 hours”
Sneiderian membrane dry snuff
malachi root Irritants applied to the schneiderian
membrane have cured the disease in its last stages
Rx 1 part turpenth mineral & 10 parts powdered liquorice 
for a [ster??tatory]
Green tea is sometimes given



In the progress of the bowel complaints of
children the sinuses may become enlarged & a determination 
of blood [illegible] to the brain and 
produce symptoms of hydr. I have known
pat. apparently die of hyd. & yet upon dissection
no water be found in the [ventricles] in this
case some say that the water was absorbed in death 
this is entirely improbably. Certainly many of
the symptoms of hydr may be prod. by other
causes e.g. excessive doses of narcotics is stramonium
belladonna
It shd be remarked that many 
cases supposed to terminate in hydr. in cases
of [termination] in volvulus
“All the diseases of children are peculiarly 
liable to terminate in hydrocephalus. Hence
the importance of caution on the part of the 
physician. He should examine all the symptoms to check
the first beginning of determination of diseases
action to the head V.S. keep the bowels open 
blisters behind the ears cupping leeches”


173
Hydrocephalus from bowel complaints
If in the progress of any of the bowel complaints of children
morbid action should be determined to the brain, Epispastics
should be applied behind the ears and irritants to the feet
Cathartics are useful to obviate this determination. #
In some cases perhaps the determination 
[marise] from nervous irritation. In such cases the 
tepid bath gives relief “Strong green tea” Some
physicians of respectability have in formed one that they have used digitalis
in hydrocephalus with very good success. I have not used
it myself but should consider more adapted for that
form of the disease which arises from irritation, than 
any other
Hydrocephalus from disease of hip joint.
Child of Ezra Hotchkiss child of Horace Edwards.
“I have known hyd. alternate with disease of hip 
joint Case Narcotics etc. till suppuration”
Afterwards died of hydrocephalus
# I have cured a patient by giving him calomel and lemon 
juice in sufficient quantity to move the bowels. It increases the
secretions and improves the tone of the bowels


“I have seen a case in which the child
fell 8 or 10 feet upon a pavement & broke his skull
like a squash shell yet he recovered in 2 weeks and
did well. When the fracture is so extensive there is 
less danger of compression of the brain” The same case?
Hyd. from injury by a fall is not common 
in young children the sutures are not firmly 
closed (the bones are softer & more yielding)(
# He had other severe wounds as a compd
fract. of the radius yet he never suffered 
his head


174
When the disease is produced by violence
Depressions of the cranium in children
from blows or falls are not of course fatal though dangerous. A child
four months old fell head foremost upon the hearth striking
upon the vertex. The head was much flattened & the
parietal bones bulged out on each side. The child did 
not suffer much from the injury. The bowels were kept open 
by mild mercurial purgatives. In these the head assumed
very nearly its natural shape. A boy of eight years fell 
six or eight feet and struck his head against a stone
A depression of the cranium was made larger than the bowl
of a spoon. He suffered very little inconvenience from 
the injury #
There is less danger when the skull is so 
much fractured as not to cause pressure upon the brain 
If a child has received a fall we may apprehend
danger from the following circumstances. If the
fall has been upon the occiput the brain is more commonly 
injured than if the face is upon the os frontis. If the child
vomits after the fall and is very sleepy there is danger that
the brain will suffer.
Treatment If the child vomits or is
comatose after the fall upon the head and there is no
wound that bleeds the patient should lose blood and
take a dose of calomel, one or both according to the urgency
of the symptoms & the death of the patient. All the exciting causes of fever should
be avoided and the patient kept as quiet as maybe.
The symptoms should be carefully watched and if at
anytime there should appear to be a tendency to an affectation 


# for local bleeding is as important a general
bleeding
“[illegible] all causes of irritation, as light noise
heat, food. Keep the pat. perfectly quiet”
“Apply an epispastic behind the ear, or
better upon the injured part.” “Blisters are very 
useful” “Use counterirritation & the tepid bath”
# In torpor of the br. [illegible] al. can excite the latter
may excite the former and excessive action in 
the former may be translated by it act on the 
latter “Give strong cath. cal. gamboge jalap etc.”
“Afterwards give cal. in small doses as an
alterative If it causes too much evacuation check
it with opium”
“In N. Haven we have followed 
Abernethy’s plan of treating infl. of brain for 
40 years”



175
of the brain the patient ought to be bled & leeches or cupped. #
The bowels should be opened with calomel and small doses
of the same remedy frequently given as an alterative
After depletion epispastics may be applied behind the
ears and upon the part of the head where the injury 
was received. 
There is no outlet to the brain & 
consequently more evacuants are needed than in most diseases 
Frequent cathartics are useful as evacuants and 
also to translate action from the brain # 
When effusion has taken place the 
case is probably always fatal Yet I have had 
a pat. with dil. of pupils, who cont. so & paralytic
for months & finally recover
Vide p. 200


The treatment consists of local applications
A variety are used One of the best is [illegible] zii alc. zi
An equally good or a better application is seneka oil but the
smell is disagreeable. Cold water is applied but
though it relieves the pain and the insupportable itching
it is doubtful whether it is of any permanent benefit
Basilicon [illegible] [illegible]
absorbents to ulcers


176
Chilblains Pernio
This is a local affection to which children and old people
are most subject. Some are much more liable than
others. [illegible] [illegible] more liable. The parts affected are the toes heels fingers, hands
face, ears and with ladies who wear short sleeves
in winter. It is caused by exposure to extreme cold & to cold & damp air
& on the feet, more especially by walking through 
melting snow. It is most common in the early part of winter
This affection should be prevented by avoiding
an exposure of the parts to the air, by keeping the hands
warm with soft leather gloves & by keeping the feet warm 
with stockings and shoes
The skin of the part affected becomes tumefied
and hard & of a deep purple colour, there is a 
pungent pain in the part accompanied with an insupportable
itching; & these are often so great as to prevent the patient from 
sleeping. If the disease advances, the cuticle breaks and
discharges a thin fluid. Sometimes a deep ulcer is formed
The treatment for the first stage should consist
of stimulating application as if for a burn. I prefer oil of origanum
alcohol & seneca oil are good applications. Spirits of 
turpentine will ordinarily do well, though in some idiosyncrasies
it acts as a poison. Cologne water may be 
applied or alcohol two parts with one of ol. orig. #
For the ulcers you may use the oxygenated
ointment ointment of red precip. citrine oint.
# or apply a plaister Dyachylon or Noel’s 


Not being able to have any fire on board
for some days
[illegible] to pain of a neuralgic kind as [illegible] were a toothache
One of the best applications is a cataplasm of stramonium
seeds give internally opium narcotics & 
stimulants
Apply [illegible] & narcotics
Followed by no infl. to supp. etc.



177
Painful affection from cold
We sometimes meet with a painful affection of the feet 
without discoloration, or any other visible mark, which 
has been brought on by long exposure to cold without
freezing. Sailors coming upon our coast from the I. in winter, from 
a warmer climate are liable to it.  The affection may 
be a very painful one and give great uneasiness both
night and day
It is relieved by the external application 
of stramonium & epispastics or rubefacients, and fomentations
Cathartics and opium may also be given internally.
Singular effect of cold in Wm Daggett 


Burns are dangerous in proportion to their extent
[illegible] young physicians are called to prescribe for
burns it is important for them to treat them in the best manner
About 30 years ago a great controversy existed in England
between those who advocated [stimulating]
In recent cases stimulating or exciting applications are 
the best provided the burn is not very deep. About 30 years since 
spts turp. were much used. It in some case and these are 
not very rare
Case myself [water] boiled over into my shoe
I immediately poured spts tupr upon the stocking then 
took off the stocking applied a cloth dipped in spts turp. put
on a dry stock. & boot rode out of town and suffered My father
was a man of florid complex. & thin skin He was burned in n
a similar manner
Ol. orig.
Linseed oil is smooth mixed with limewater
alcohol or proof spts good when the skin is [illegible] off
Others use camphor Others stramonium in ointment contain
what [illegible] when the article s off
Carrot poultices etc. exclude the air
Cotton does well except when the cuticle is off if it is
used then you had better smear it with oil


178
Burns
This subject belongs more particularly to surgery, yet as
burns occur most frequently among children, and you may 
be suddenly called in on such an occasion, when it is important
that a remedy be speedily applied. I have thought
proper to make some remarks on the subject.
For the treatment of burns very different 
modes have been recommended. A long controversy was
carried on in one of the English journals with respect to the
phlogistic or antiphlogistic treatment, one party being in 
favour of cold applications in cold water and the other of
stimulating ones as spirits of turpentine The truth seems
to be that in adults where the injury is not extensive and
the powers of life are strong cold applications do well, but 
they are dangerous for children especially if the injury is extensive.
Burns upon the abdomen will not admit
of cold application even in adults
It is necessary that reaction take place
If there be no reaction of the system, no pain, no inflammation
the child dies. The cause of its death is the irritation of 
the nervous system, extended to the stomach, & hence
the death is preceded by cold extremities and vomiting
Where cold application are proper such
applications may be made as scraped potatoes, cloths
wrung out in cold water etc. But if it is necessary 
to produce reaction and inflammatory action stimulating
remedies must be used. And we know from 
experience that these remedies do effect a speedier cure 




Cold applications may do well if immediately
e.g. dip a burnt arm immediately into cold
water. But stim. app. are better. I have tried
both. Cold applic. very dang. in extensive burns
of children Case scarped potatoes no infl. livid
appearance of the burn extrem. cold [illegible] death
In such cases apply stim. app. & give ether, elix.
[illegible] etc. etc. In these cases the child dies of irritation
not infl. It seems to be necessary for a regular [course]
of continuity of action in infl. & suppuration
The best and mildest application as has
been proved by experience is petroleum or seneca oil
In one case I tried the experiment of applying seneca
oil upon one hand & ol. orig. upon another (both being known
alike) one hand was easy the whole night the other painful 
(the burn was a very extensive from the clothes taking fire)
In the suppurating stage use 1 part seneca oil
& 3 parts cerate
These cases are very troublesome to treat
In the above case the system was exhausted by the extensive
suppuration the bowels had to be kept open & 
large quantities of opium to be given. I gave columbo
bark and various tonics and aromatics
Turner’s cerate is a good application
chalk may be sprinkled over it
In the progress of the suppuration a pale
flabby fungus almost like a blister and is difficult to 
manage I have applied a sol. nit. sil. also nit.
sil. & laudanum [illegible] cop. sometimes after these
I have succeeded with ac. op. in ointment green basilicon
i.e. verdigris ground fine & mixed with basilicon
But if you apply only applications after these caustics 


179
The reason is that we apply to the part a stimulus
less powerful than that which produced the injury
and thus render the diminution of the excessive excitement
gradual. On this principle holding the injured part near the
fire is beneficial
Another important indication in the treatment
of burns is to exclude the irritation of the external
air Hence the popularity of some applications as cotton.
sweet oil etc.
1st Of stimulating applications. Spirits of turpentine
will answer for a robust and healthy person but not
for a slender & feeble one; and it must be remembered
that from a peculiar idiosyncracy it is a poison to some 
persons. In general spirits of turpentine is liable
to cause irritation and may be suspended by better 
articles. Being burnt myself a complete cure was effected
without the least appearance of inflammation, by this article
but in the case of my father such violent irritation was
produced as to oblige him to desist from applying it
A common remedy in this town is the oil
of the origanum majorarum called burn oil
mix ol. orig. zii with ol. oliv. zi or mix it with
alcohol or cerate. Cloths may be dipped in the diluted oil
and kept constantly applied
Of late years I have used seneca oil
and prefer it to either of the two already mentioned. In 
several cases I have tried both this and the ol orig. & 
found that the seneca oil relieved more speedily & 
with less irritation. I usually apply the seneca oil & 



the fungus [illegible] Apply rather chalk or fine alabaster
or scorched flour
The sooner you apply stim. appl. the
better ol. turp. produces [illegible] etc. seneca oil
does not
Case a woman thief etc. etc.
we rolled immediately in the snow was thrown by it into a state
of syncope life almost extinguished was burnt universally 
except on the legs covered by the stockings was wrapped
in sheets dipped in a mixture of ol. orig. & 
spirits


180
then cover the part with cotton to exclude the air. I let them
remain till suppuration takes place, particularly if the skin
is broken. When suppuration takes place, apply a poultice
to the loose dressings and then apply simple cerate
or a cerate made by melting together beeswax and lard
and stirring in seneca oil while the mixture is cooling 
This last is an admirable application for burns Dr
[Mons??] said he knew none so wild. It protects the raw 
surface from the cold air and keeps in the animal heat
In the latter stages of the cure, the oxygenated ointment will 
be a soothing application
A popular remedy is stramonium, used
in the form of a plaister of the seeds or leaves. It answers 
well and I have known no ill consequences to happen from 
its use though it is said that in extensive burns it is dangerous
Cotton is a popular application, used by itself
For slight burns it will answer but if they are so
extensive that suppuration is to take place, it should
not be applied in this way
Other remedies that are useful upon the
principle of excluding the air, are the oils as sweet oil & 
lamp oil. Linseed oil mixed with one third part lime
water, is especially recommended
When suppuration takes place and 
the cicatrices do not form well, oily application should 
be laid aside and if there is considerable discharge
apply absorbents, as plaister of paris, chalk & chalk & cerate
i.e. apply chalk first & cover with cerate.


Note from Dr Woodward of Wethersfield extracted
from Dr A. Talcotts notes “Apply immediately spts turpentine
to the inflamed parts and cerate of limewater & 
linseed oil equal parts on cotton to the vesications
2nd If pain & irritation ointment of stramonium
3d To prevent fungus Rx white lead a teaspoonful
lard 2 tablespnfl. ft. ung. Orgrate or
chalk and apply simple cerate over it.
I have seen a metastasis at the end of a week to the bowels
with diarrhoea & tumefaction or the bronchia with 
croup Treat with opium & bark Dr S. B. Woodward”
N. B. I extracted this principally on account
of the definite direction about the difficult treatment
required according on the burned part is vesicated or
not a point on which the above notes of DR Ives
do not seem to be sufficiently precise


181
Should there be a fetid discharge from the burn, it may be
remedied by pulverised charcoal. Sometimes the ulcers are 
very difficult to heal and repeatedly break out afresh
A fungus may arise upon the part if so it should be touched
with caustic. The eager of the ulcers may be touched
with sulph. copper or nit. sil. chalk then applied
and the whole covered with cerate.
If the burn is on parts liable to unite in 
healing, as between the fingers and toes, care should be
taken to prevent the union. A bad cicatrix is often
formed which it is difficult to prevent or cure.
Internal Treat When the constitution has received a severe 
shock and the extremities become cold and the powers
of life being to fail, the system must be supported by 
stimulants & cordials & the excessive irritation relieved 
by opiates. Laudanum ammonia, spirits, alcohol
ether are all good. To a child from 5 to 10 years 
old 15 drops of laudanum may be given; warm-applications
may be made & warm aromatics drinks as ginger tea & 
mint water administered. Elixir paregoric is one
of the best preparations of opium in such cases
In a case in which a large quantity of
sulphuric acid had been drunk by a boy who immediately
afterward, ran to a brook
and drank of the water. I merely give mild mucilaginous 
drinks & the patient being of a strong constitution
recovered





182
Croup from p. 138
In what may seem to be the second type of patient
may go off suddenly. If he throw his head back
in order to enlarge the chest it is a bad sign
I have found the treat. by tart. ant. so 
infallible in the first stage & in general so useful that I have not been tempted
to desert it. If I am called rather late and
find ext. ant. acting locally upon the stomach, I seldom
succeed in curing the patient.
Other emetics may be used when the excitability is worm out for [illegible]
Calomel is proper in the latter stages, [illegible]
the disease is partly broke up by antimony
If the first stage is not interrupted
[illegible] the child may be playful between the paroxysms 
and though the pulse is not affected, yet the second will 
surely come on
In the second stage bleeding is to be first 
resorted to in order to prepare for emetics bleed even to fainting
conjoining the warm bath for the same etc.
Exciting and irritability [illegible] in this 
second stage do mischief. I have seen sanguinaria do much
mischief. Even after bleeding purges is not advisable
for as has been remarked there is a constant tendency 
in the system to the return of this inflammatory symptom
Cal. may be given though if it act by 
the bowels it will be useless. I have seen bleeding and the 
vapour bath palliate the symptoms. Scarcely ever
will the patient recover



183
Croup
In the latter part of the last stage the child
throws its head back. This is a dangerous symptom.
Now the patient goes into the last or suffocating
stage. The patient lies on its back struggles
violently for breath countenance livid appears apoplectic and often goes into convulsions
and in these convulsions sometimes dies
Sometimes in this stage you may hear a
flapping of the false membrane. This is sometimes
thrown up and great relief is afforded and 
the friends think that all is over. Soon however 
in most even of those cases a membrane is formed
lower down & the patient ultimately dies
In this stage the metallic emetics
have in a few cases succeeded The sulph. 
cupri & the sulph. zinc have each
cured Cal. is recommended & may be used 
The cold both has been recommended It may be tried
as a dernier resort.
In the second stage after bleeding blisters
shd be applied over the whole neck & chest
Dr Hosack recommends bleeding from 
the back of the hand immersed in warm water
After bleeding has succeeded in 
subduing the symptoms cal. & the warm bath shd be
used


184
Croup
This disease has been divided into acute & 
chronic but without much propriety
Sometimes it continues for some time. I have
known one case which continued 3 or 4 weeks
In some seasons a different mode o f
practice is better. I have known seasons in which 
cath. & diaph. were the best treatment Although
for the first 15 years of my practice I considered nothing
more unfortunate than to find the child under the 
operation of a cathartic. In these cases, it was the
form in which the duodenum is also affected in a similar manner
Case Wallingford [emet.]
failed & cal. & diaph [illegible] Others that season 
occurred which required the same treatment
Bronchotomy has been recommended
I have seen it performed but never with success
It has sometimes succeeded But in the cases 
which I saw the membrane form lower down, and 
the patient die


186
You will see by looking into the throat
the tonsils perhaps red & the epiglottis certainly inflamed



187
Angina Laryngia
Another form of the croup has been called
angina laryngia [illegible] the croup you can see nothing
by looking into the throat In this the epiglottis & 
the [illegible] glottidis are affected From the larynx 
being affected, the actions & more spasmodic
Frequently comes on while eating
Case of my child While apparently well was taken while
eating with the peculiar croup & respiration of croup 
& became alarmed & treated
This is the form which attacks old people 
probably Geo. Wash. died of it
Case The first time I saw this disease the pat. had had pneumonia & may nearly recover when he went into the cold open air
without stockings. I was informed that he was taken
with difficult respir. & without seeing him prescribed seneka injurious ultimately refused
to swallow anything as the act brought on a spasm
I tried bleeding, blisters, vapour
& after awhile persuaded him to swallow when I gave him 4 gr. tart. ant.
in a cable spoonful of water


188
Angina Laryngea
The dis. is brought on by eating
And if you examine the throat you will see a redness
perhaps upon the tonsils, and will certainly see the
epiglottis inflamed
Bronchotomy promises more in this
form of croup
Readily distinguished for the other by 
difficult deglutition paroxysms being brought
on by an attempt to swallow
This firm 
It is not of much consequence to 
distinguish the forms except that laryngea is 
more rapid And you must avoid acrids
in this form as they irritate the fauces & produce
spasmodic action
For the spasmodic symptoms give
in the latter stages of it asafoetida which also acts upon 
the secretion tinct. ant. & opium
It must be remembered that this disease
cannot be cured by bleeding alone. It is too far out
of the circulation. But by reducing the system very 


189
Croup concluded
When croup follows other diseases it is more
rapid and dangerous they are very apt to die
particularly when following ulcerated sore throat
You may treat by emetics blisters metallic
emetics etc. but you have not so much 
strength left in the system to act upon 
In the latter stage where we wish to 
throw up the membrane the stomach may lose
its excitability to a particular emetic then you are 
to change the em. I have succeeded in throwing 
up
Upon dissection a membrane is 
found formed But sometimes it is wanting and in 
A laryngea then probably is not [time] for a 
membrane to form 
Vide p. 211
low and suspending the functions you may change the secretions 
perhaps 


190


191
Scarlet Fever
Withering in his first edition separated ulcerated sore throat
from scarlet fever. In the second he changed his opinion
Where there is much heat and fullness of the
pulse I would much prefer a strong dose of cal.
followed by antimonials [to] commencing with emetics
Or is Dr Rush & the elder DR Barton thought best turpeth
mineral
Epispastics are to be used with caution
& adopted this rule viz to apply them where there
is much tumefaction [illegible] & enlargement approaching the
quinsy. Scarlet fever after resembling quinsy and
is with difficulty distinguished except from the previous
affections of the family and neighborhood
Mineral acids have been considered
specifics Chlorine was much used in this town
in [1801] etc. as a fumigator. You may give it internally 
with advantage
A great variety of gargles are
used generally stimulating ones are better as those
of capsicum (with salt say in cider water)
In some cases capsicum does not do well
If the patient is too weak to gargle use a syringe


192
Scarlet Fever
Chlorate of potash was used with advantage
to quiet the stomach. It allayed irritation etc.
Ammonia and amm. with camphor
& gum arabic
In the progress of the disease mineral emetics, 
as sulphate zinc will be useful to excite the system 
acting speedily they do not exhaust sul. zinc 5 to 20 grs 
mosely’s solution was the form most used
Sulph. copper 2 to 5 gr. also as an emetic
Acetate of copper was formerly kept as a nostrum in 
some families ½ to 1 t. sp. of sat. sol. of common verdigris
2 to 3 gr.
In some cases and seasons cath. are
required. I have treated children without a
single cath & yet in the same family I have given ant.
followed by cal. & worked off by salts and senna
If a diarrhoea occurs early it must
be attended to white decoction



193
Scarlet Fever
Dr With. lays great [illegible] upon diuretics
particularly senega giving it throughout the 
disease. In moderate fevers diuretics eliminate morbid action will
Serpentaria may be given freely throughout 
the disease adding bark alcohol ether 
or wine Diuretics & diaphoretics
Irritable state of the stomach is to be
counteracted by irritants by aromatics white decoction
etc. etc. a little alcohol upon the fauces voiding a great
bulk of liquid
Case of a boy in delirium his father 
was forcing down articles which he was puking up 
I put into his mouth spoon dipped in brandy 20 or 30 drops his eyes opened immediately 
said it was good continued it in tspfl doses through the night
saved his life
Scarlet fever occasionally passed by insensible
gradations into quinsy and is of an inflammatory 
character. No one character will distinguish them
No one mode of practice will answer in all 
cases though if any indiscriminate mode of practice is
to be followed that by emetics and stimulants will be best
In many cases no evacuations at all are to be
used if this you must judge by the symptoms
In the same family I have lately treated one or two patients
with antimonial and nitre and another who had been
worn down by fatigue and watching with feeble pulses vomiting
coldness etc. was treated by external heat, brandy in moderate


194
Scarlet Fever
quantities, counterirritants spiced tea etc. to stop the vomiting #
(One of the best articles in fevers of a low grade
is spiced tea or hot spiced wine or brandy. The strength is apt
to give out first, and an excitement kept up in the mucous
membrane of the stomach will have a beneficial effect)
# The first patients in this family I had evacuated freely
both by vom.  & purging etc. while this patient had no evacuation 
goodness & was supported throughout the whole progress 
of the disease
After I had seen the disease in 3 or 4 epidemics
I thought I had seen the disease in all its forms but I
found oftenwards that I met with different forms still 
Not only different epidemics differ, but different cases during
the same epidemic may require widely different treatment 
In the malignant epidemic of ’94 I was informed by some
physicians that they met with cases in which there was increased 
action though the many cases of the epidemic ran rapidly in the [illegible] gangrenous
state
In 1803 we generally gave emetics
It is said that in the malignant form the eruption 
is a bad symptom. I do not think so. I think it better
for a general eruption to come out the action is less unequal than 
if a scanty or no eruption appears
I hesitated in 1803 much about the application 
of blisters & I finally found that the rule was a safe and
beneficial one to apply them where there was swelling
of the tonsils
In this epidemic I gave bark, the mineral
acids, alcohol, wine, and (for the first time) tinct. canth
Tinct. cant. [illegible] zi to pt. give 20 gtts once in 2 hours ½ as much to a child


195
In many cases [illegible] requires to be qualified & corrected
by serpentaria or carb. amm. If wine injures
the stomach and [illegible] too locally continue carb. amm.
which will render it diffusible with white vinegar
will have somewhat of an effervescing mixture Use also
effervescing mixtures, as soda water, with brandy
or ether, or aromatics tincture. It is no objection that
you thus combine stimulants and refrigerants, for you 
thus get diffusible action and obviate unequal excitement.
The min. acids may be given in form of 
punch The sugar will be grateful & useful
A diarrhoea is apt to take place in the 
commencement of the disease. Use white decoction 
laudanum & injections of starch & laudanum RX
starch 3 bal. sp. SS. 30 gtts to 2 t.sp.
Pay great attention to cleanliness of the 
patient
Where there is fainting apply ammonia and ether 
& spirits at the nostrils keep them applied to the nostrils
to prevent fainting, I have never known any injury 
done by over excitement by these articles thus applied
Capsicum is used in tropical [illegible]
in very strong decoction. Salts and vinegar has been 
much used as an antiseptic gargle?
For the diarrhoea use tonics, bark,
contrayerva has been though valuable. Avoid injuring
the stomach by distention


196
A variety of garbles (or injections by a small syringe) are
used. [illegible] rosemary has been thought a specific & carried
hundreds of miles into the country Use others when pat. is disgusted
with one # 
Sulph. cop. ac. cop. nit. sil. ([touched])
apply these with a swab
What is called the leathery inflammation 
is sometimes met with. in which the skin dies at first and
afterwards comes off & then a discharge follows. This affection
sometimes extends down the throat. In such cases
apply blisters to the sternum Touch the part with
nit. sil. in such cases. IN one of these the blister on the
sternum produced an ulcer which was 3 mo. in healing
and in another though the affection with throat was relieved
the ulcer for the blister destroyed the little patient
# [illegible] oak bark etc. pomegranate combine brandy 
aromatics etc.
It might to be remembered that in the
latter stages of ulcerated sore throat where there is an
accumulation of [many] a phagedenic ulcer, 
emetics of sulph. zinc give tone
and excite action also when
Acetate copper in the latter stages
used in an emetic as a tonic or locally
applied as a caustic
When the stomach fails in the latter
stages we give capsicum in pill or strong 
infusion (2 tab. sp. to the pt makes a strong infusion give 
to an adult a tablespoonful also acrid oils
There seems to be an erythematic infl. of the mucous


197
membrane of the stomach hence acrids are indicated to excite action
Bark jacket also it seems to 
have some effect
In the latter stages also a cath. will
frequently be beneficial an accumulation
of feces may exist given mild cath. as castor
oil or perhaps a dose of cal. an
emetic also may be needed
One thing to be guarded against
in young children is the supervention of dropsy
In 1803 I had 3 cases all the writers
considered the disease as one of weak [illegible]
action and requiring tonics bark etc. Not
successful Bark does not generally do well when there
is unequal action
I have known in such cases the brain
& nervous system apparently much affected I have
given in such cases digitalis and cantharides to
produce as new excitement and ally this irritation in 
the nervous system
Case related patient very low from a disease digitalis
was given and elaterium being advised was given
when the patient died upon the second evacuation
In general treat these cases with diuretics 
a moderate use of cath. narcotics & remedies
etc. Digitalis is the best narcotic but be cautious 
giving it to children
In ordinary cases of such dropsy 
a cath. will remove it and frictions & exercise 
in the open air. Various articles are popular as ol. [mor]


[199]
[illegible] ol. gaultheria various irritants etc. and to 
encourage the attendants to persevere in rubbing
you may suffer friction to be made with these mere
dry friction though probably just as good does
not seem to them like giving medicine
Various astringents may be 


200
Hydrocephalus
The management of the pat. is equally important with
the medication avoiding in proper diet alternatives
of temperature, and all debilitating irritating and exciting
agents all the exciting causes of disaster. Sometimes
a patient may (after a fall perhaps) continue one
two or 3 years not entirely [illegible] and yet not quite sick
and finally die of eff. of the brain
Sometimes in strumous habits canth. internally 
may be advantageous
Blisters translate action 
The applications of remedies to the 
Schneiderian has been thoroughly treated by Dr Malachi
[Foot] in the N.Y. Rep. about 20 years ago.
The subject has not bee sufficiently attended to Give in 
the way turpenth wine (mixed with liquorice) verat.
vir. apreyn. [illegible] myrica cerifera etc.
If a discharge can be excited relief is afforded
Salivation can rarely be produced in children
In some cases where there is paralysis
the acrids and some of the narcotics as strychnos
Blisters are applied by some to extreme
parts of the body I sometimes change the place of
the blister to the back of the neck etc. But the back of 



201
ears is more efficacious. It seems to have a grater
affect upon the constitution to excite a discharge from 
this part
If the symptoms indicate bleeding
bleed leech also. If there is much infl. about the
mouth scarify the gums as a depleting measure
“In grade of action the fever of hydroceph
may vary from high entonic inflammation or phrenitis
to low strumous fever. If the action is too high or too
low counterirritation will fall in with the morbid
action We must first bring it to the “blistering point” 
(Rush)
“Blisters to the head are thought by some to be 
dangerous and the ears or neck preferred”
“In irritable cases and scrofulous habits, strong
cathartics are hurtful. Give blue pill especially when 
the bowels are primarily affected. But in entonic
phrenetic fever, use the drastic cath. & tart. ant.
ut supra after depletion”
“Scrophulous predisposed mesenteria
glands generally affected the fever analogous to hectic
never entonic pulse soft, frequent, quick I have
tinct. cantharides with advantage in this variety”




[204]
Volvulus continued from p. 89:a:1/2
“Cases I was called to a child 2 years old which 
had symptoms of irritation and was obstinately constipated
It had been carried on the belly upon the shoulders
of another person Gave a cathartic Ordered an
injection but the attendant said it would not [illegible]
The cathartic was thrown up patient died
Upon examination after death no color could be
found. In the upper [illegible] rectum there was a tumor
which seemed of solid flesh as large as the doubled fist
inflamed. The color had been completely removed from 
its place”
“I was called to another family 
where the children had died when 5 or 6 months old as was supposed
of an affection of the brain. This child appeared well when born
but was very costive etc. Upon p.m. [illegible] 2 inches of the
small intestine were found contracted
to the size of a goose quill the coats were thickened & 
the course the cavity must have been extremely small This
contraction undoubtedly existed at birth. This contracted
part was received into the part below it, and no
[illegible] could have availed”
from p. 99 ½ “In another family they 
had lost all their children at about such an age. They 
supposed the disease to be hydrocephalus. The older physicians
called it so. I told them I could not tell what 
the disease was but it was not hydrocephalus I had
then seen no case of volvulus. There were strong 


205
marks of irritation the face was pale and much distress
was depicted with countenance the head was rolled
back and hands tossed violently. There was vomiting and
tenesmus and a discharge of mucus streaked with blood
Cathartics had been given under the impression that the disease 
was an affection of the head The cathartics aggravated the
disease which ran a rapid course and the child
died. The small intestine was found received into itself
and its cavity obliterated. This obliteration of the cavity
would not of itself cause death; for a patient may 
continue several days with perfect torpor of the bowel.
It is the irritation as in cholera morbus which is the
immediate cause of death which [illegible] death usually 
occurs within 24 or 36 hours”
“Called to a child one year old
constant vomiting stool, mucus streaked with blood
Directed mucilaginous injections & fomentations combined with opium
Gave opium freely internally 10-15 minims to allay 
vomiting. The symptoms subsided gradually & in 
3 or 4 days the feces passed off without any cathartic”
“Was called to an Academical student
had given cathartics and they did no good. Called
in older physicians. They were in doubt respecting the
case and advised not to do any thing as we might do
hurt. As I was sitting by his side I heard a motion 
in his bowels. I noticed that it passed down to a certain 
point and then stopped. Upon examination I could 
distinctly feel the involution. I tried injections and 
some [illegible] of them would stay. Ordered a spermacetic
candle with opium upon its extremity to be passed up 
the rectum and allowed to remain. It was s


206
passed in to the length of 10 inches. The opium allayed irritation
and the application by repetition replaced the part & the 
patient recovered another case cured
by a bougie”
“Opium by taking off the spasm and
restoring the natural function of the bowels may be
said to act as a cathartic just as in spasmodic
colic”
From p. 56 “I have given when I 
could obtain it, the [resin] of Mandrake podophyllum peltatum It operates
kindly, and more certainly than any other article. If
the western gentlemen who have so much mandrake
and whiskey, would furnish a supply. I think it [will]
supersede every other article”
“If there is torpor & a stuffing or infarction 
of the bowels we must use injections to assist
cathartics repeating them every 2 or 3 hours. If other
cathartics do not operate give castor oil which will 
promote their operation”
“The particular kind of injection 
is not important and may be left to parents
Thoroughwort, camomile, mayweed 
catnip, dandelion, weak soap suds salt
& water a tablespoonful to ½ pint water


207
Continued from p. 57 “The stools resemble
meconium. In the progress of the disease they exhibit
small pieces of a membrane of a dark green colours,
about the size of the petals of peach blossoms 
floating in a dark green fluid. The membrane of 
coagulable lymph, resembles that formed in angina
trachealis and sometimes as in that disease
it is formed in such quantities as to cause obstructions 
Still in this case it may not destroy life
the action of this part not being so immediately
essential to life. Stools of this kind sometimes
attend the bilious colic of adults. They are an
indication that farther evacuation is needed
Continue the 
calomel or combine it with magnesia or soluble
tartar, or phosphate of soda or other neutral salts


208
Infantile remittent continued from p. 60
“Cases A child had violent fever gave calomel & cathartics
warm bath symptoms abated. In 2 or 3 weeks the
regular symptoms of hydrocephalus appeared; & the patient
seised in the greatest danger. In a short time these
symptoms were relieved by a violent and dangerous
attack of thrush The patient was very much exhausted
lay several days very low gradually emerged and 
after a long course recovered.
“Case of a small little boy
5 or 6 years of age After 5 or 6 days head affected
& became maniacal very irritable and cross swore
profanely would bite and strike all who came 
near him. If any thing was attempted to be administered
he would shut his mouth. If his mouth was pried
open he would close his throat with his tongue Advised 
his parents not to trouble him nor notice him to pass by 
him with drink roasted apples etc. but not to offer
him any thing. The first day to he took nothing second
day took roasted apples etc. readily but ate too 
much mania returned, but soon went off & 
patient recovered” 
“In one case the pat. took 
nothing for a length of time. Recovered by use of 
[even ato] & external applications as aloetic plaisters
to the bowels etc.”



Scrofula continued from p. 163.
“Scrofulous swellings are very difficult to excite
to suppuration I have however then poulticed without
effect for 2 or 4 months Of late I have disused poultices
& have applied blisters as soon as may be to excite invigorate the
absorbents and act as discutients. They do not disturb the
system. If there is suppuration the relaxed state
requires stimulating applications lunar caustic vegetable
astringents etc.”
“Case of a young act 18 with bad cough
swelled neck scrofulous temperament Gave laxatives
blue pill afterwards rub & spec. Then gave decoction 
of [cistus] [canadensis] for several weeks and pat. recovered
“ A physician (Smith) on Long Island (from an
old recipe) has acquired reputation by the use of cistus
canadensis combined with uva ursi at the same time
enjoining a strict & spare diet as in dyspepsia”
“I have given with cist. canat. 1/8 gr. corr.
sub. & also decoct. scroph. maril. which is thought 
by the vulgar to be a specific It has been sold as a nostrum
to facilitate parturition called nerve root.) I
think it useful in scrofula”
“I have known the comptonia [illegible] folia
given internally. It is tonic & has balsamic rpoperties”



“The remedies particularly indicated are tonics & 
deobstruents such as will not produce congestion 
such as uva ursi cistus scrophuloria contrayerva 
agrimonia (entire plant or root angostura etc.”
Sea bathing is recommended, but if the
lungs are affected, it will not be advantageous. A 
sea voyage to the eastward has been of service the constant
motion of the vessel stimulating all the vital organs
to healthy action The change of air is beneficial & at a
distance from the shore there is no danger of taking cold
In chronic complaints attended with a want of vital
energy I direct a voyage to the east rather than to the
south



Croup continued from p. 189
“Vapour bath Inhalation of warm water in 
a [pour] blow a current of air through hot water upon the pate & 
by means of a coffee pot with two spouts”
“Tobacco or snuff applied to the patient”
“Croup is an epidemic disease & of course it will vary 
at the different periods of its appearance We must take
into account the prevailing diathesis I have described the
disease as it has usually occurred in my practice”
“The proxim. cause of the dis. is a
peculiar morbid action translated to the traches for
the disease arises from general causes acting on the system. 
In catarrh diseased action is seated primarily 
with mucous membrane.
The exciting causes of croup act on 
the surface and with different diathesis the same
crises might produce pneumonia, dysentery enteritis
or cephalitis “Disease determines to the weaker part
as the rod attracts lightning” Rush Water & snow
cold damp air a [illegible] & low situation sudden 
changes as when the wind blows from Canada or the
gulf stream are the exciting causes



“In the treatment sanguinaria, if given early in strong
decoction very freely, so that enough of it shall be
given & still it vomits or relieves the symptoms, in very 
efficient practice adopted by Drs Jared Potter & 
Kirtland
“But if inflammation has taken place
& the second stage has arrived seneca and sanguinaria
are both too stimulating and I have seen them do hurt
sanguinaria is less stimulating than seneka
For p. 137 “Some authors state that the 
disease is entirely inflammatory not regarding
the forming stage. If the forming stage is wanting
we must rely solely on the antiphlogistic treatment”
“This disease has a direct tender eye to death 
The physician must take it out of the hands of nature”
“When croup supervenes upon catarrh as it
frequently does of late year the mucous secretion and expectoration
usually cease suddenly
“When croup follows diseases that prostrate
the system powerfully as angina maligna, there 
is little chance for recovery. The sympathies of the
system are broken down and Archimedes can find
no fulcrum for his lever”



“I used tart. ant. at the commencement of 
my practice and succeeded with it as well as I
could wish I therefore contained it, but only in
the early stages & to produce a powerful orgasm. If it
acts upon the stomach only it aggravates the disease
Other practitioners rely upon different
articles & probably with equal success bearing in 
mind however that a powerful impression must be
made Decoct. sang. to prostration & vomiting
seneca or lobelia inflam with the same view”
“Sulph. copper & zinc & acetate
copper useful to assist in the latter stages or when 
other emetics are worn our. So also hives syrup 
which is much used at the south.”
“For six or 8 years past croup has been 
occasionally different from the pure inflammatory.
It affects the lungs and duodenum& calomel and cathartics
are the remedies to overcome this form. The cough is more
frequent and loose the paroxysms less distinct there
is pain in the epigastrium vomiting & a membrane
is formed in the duodenum which passes off.
I have called it angina duodenitis.
The same year ulcerated sore throat came on with it
the slough leathery & like a burn it seems to 
be intermediate between A. tonsillaris & A. maligna


The application of lunar caustic by a pencil or brush would
prevent croup Blisters to the throat & chin were
useful yet a blister would produce the same action as
existed in the throat, forming an ulcer very difficult 
to heal Slough ¼ in. deep 3 mo. in healing. In 
one case the blister cured the croup and the ulcer
killed the patient It is desirable to translate
action to parts less essential to life. Cal. & carth.
would translate it to the duodenum Emetics & 
powerful treatment do hurt here. The vapour
bark is good.
“Croup sometimes recurs several nights in 
succession A. Laryngea is more apt to do so”
“When crop assumes a chronic form
emetics irritate inhalation of vapour blisters
opium diaphoretics & expectorants”
“In chronic croup the inflammation 
in erythematic and not membranific. The 
vapour bark often does wonders Tartrate of 
sanguinaria in ¼ gr. doses Tinct. hyoscyamus
gtts x
N.B. Dr Woodwd treat of subacute ([S?bertonic]) & typhoid croup the latter contraindicating
tart. em. & requiring sanguin. turp. mer. calom. etc. & sometimes
capsicum, ammonia & even perhaps wine & alcohol.




“One of the most extraordinary examples
on record however of the effect of disease in 
developing of perceiving a certain class of relations
is that of [Zerab] Colburn His history 
is well known When quite a child in his sixth
year, without any previous instruction, he
could by mere intuition perceive the relations 
of numbers with so much readiness and
precision, as to solve almost without reflection
questions in arithmetic which would
require a long calculation to enable others 
to answer. How he obtained this result
he could not tell. The answer seemed to 
present itself to his mind with the same
readiness and conviction of its truth, that
the proposition tow and two make four
does to us. These facts I saw are well
known, but it is not so well known, that
this power was the effect of disease. That
such was the case I have very little doubt
This was the opinion of a very distinguished
physician who saw him at the time, and
who ascertained that he was then affected with 
a peculiar nervous disease the same
(chorea) which Jane had a few years 
since. In conversing with Mr Colburn 


about a year ago I asked him if he
retained the power of calculation which 
he possessed in his childhood. He said
no, and attributed the loss to the want
of its exercise. But why should exercise
sustain a faculty in existence which 
was spontaneously developed?”
“Account of Jane C. Rider the
Springfield somnambulist; by S 
W Belden MD. Springfield 1834”
p. 108
“The discovery of Zerah’s power 
of calculation was purely accidental 
Zerah not having yet completed his 
sixth year was overheard by his father, as
he repeated to himself in his play, parts
of the multiplication table. The father
surprised proceeded to examine him & 
[found] etc.


























































1 Diseases of children




[B illegible 31]
Proposed plan
name – history symptoms & causes
[Regar] plan of treatment minutely described
Other modes of treatment
Miscellaneous remedies
N.B. Collect all his remarks on 
art of practising medicine


Contents page
Introduction
Tumour of the head from difficult parturition 5
Cutting the frenum linguae 5
Congenital hydrocele 5
Management of children – as to 
Particular appetites – Preventive medicine 5
General nature of the diseases of children 6
General operation of remedies in children
Diseases within the month
Retention of the meconium 8
Jaundice 11
Acidity, Flatulence, Hiccough etc. 12
mothers milk & cows milk 12
Costiveness & its consequences 12:a
Vomiting 12:d
Diarrhoea 12:f
Prolapsus ani 12:l.
Aphthae 13
Eruptions in general 19
Strophilus interlinctus or Red gum 19
Strophilus candidus 21
Crusta Sactea 22



Eruptions of Dentition 24
Eruption resembling the itch 24
Venereal Eruptions 25
Infantile Erysipelas (Rose rash) 27
Sore ears (Intertrigo) 30
Tinea capitis 
[???phlicus]- [illegible] [illegible] on [illegible] [1821-2] 32
Dentition 34
Cholera Infantum 40
Infantile Remittent 55
Mesenteric Fever 61
Tympanitis 66
Worms 69
Volvulus 86
Nervous Rheumatism Infantile [remedy] 89:a.
Convulsions 90
Epilepsy 96
Catalepsy 99
Chorea 100
Ulcerated mouth 103:a.
Gangrene of the mouth 104
Parotitis or mumps 112
Tonsillitis or Quinsy 115
Rosalia or Scarlet fever 120


Croup or Bronchitis 132
Laryngitis 139
Epidemic catarrh resembling croup 141
Whooping cough or Pertussis 144
Rickets 158
Scrofula 162
Mesenteric fever
Hydrocephalus 164
Chilblains 176
Painful aff. from cold without
discoloration 177
Burns 177
The cause either is to be found in [???uctural] [illegible] for the 
[illegible] This will [illegible] men to trust their lives to 
unknown men, or to fictitious names in the newspapers, where
they would not trust property even to a small amount
# Formerly prescription of an experienced physician
very often set aside for that of the nurse or a 
negro woman


1
Diseases of children
1  In this part of our course I direct your attention 
to the history of man in relation to his habits, diseases, & their
remedies in his infant state
That this subject has occupied the attention of the 
learned less than any other branch of the medical
profession, is universally acknowledged
2 – It is unnecessary for me to enforce
the importance of the subject, by any remarks which 
might be made concerning the evil to society from 
a neglect of a part of the practice in which the community 
is so deeply interested
3 – I need but advert to the evils which must
result from the practice of committing the
management of the diseases of infants to a class in society
which is the lowest in point of intelligence
6* [the opinion of the nurse is sometimes taken 
in opposition to that of the physician – On this subject
the world seems to desert its principles of reasoning
on other subjects. If a point of law is to be decided men 
will not trust to a petty of the court, in 
preference to that of an experienced
If a text of scripture is to be explained, men 
apply to a learned divine in preference to the mere
servant of the church & on the subject of wearing apparel
it prefers the opinion of the master to that of the 
apprentice.]



4 – That this subject has occupied the attention of
the learned less than any other branch of our profession 
is universally acknowledged. (The French & Germans
however, have neglected it less than the English;
and the American physicians have been in the 
habit of paying more attention to diseases of children
than the Europeans)
8 Great attention has been paid to diseases of children
within the last 30 or 40 years
It has been most neglected in Europe, but less by 
the French & Germans than by the English
17 European practice differs from ours – but less so 
at present than formerly because the constitution 
of our countrymen are coming to resemble those
of Europeans
12 It is also the case that European diseases differ from ours on account 
Disease, here is [illegible] more violent owing probably to the greater
of climate etc. Angina [Trachealis] is much 
milder with them & requires much milder treatment
# vicissitudes of the weather



2
5 - The causes which have excluded physicians
from the treatment of [infantile] diseases infants, having ceased to exist
the subject is now receiving the attention which its
importance demands
6 – These causes may be enumerated in few
words – viz. the exclusion of the faculty from the
practice of midwifery – from the difficulty of
obtaining correct ideas upon the subject from its
obscurity – the prejudices of the public on this subject – 
attributing as they do intuitive skill to nurses 
and matrons * vid. page [illegible] & perhaps also the indifference
of the profession
7 – At the present period, however, the enlightened
physician watches the mother during the
whole period of gestation, receives the child upon its 
first introduction to the light, & prescribes for its
diseases from infancy to old age
9 – As knowledge however must on this subject, as
on every other, be progressive, it follows that this
part of the profession having but recently received 
the attention of physicians, has not attained
the perfection of the other branches
10 – American physicians need American treatises on this as on other medical subjectds
13 – European practice, as exhibited in 
their works, is too slow and mild to meet and
overcome the morbid excitement of acute diseases in 
our climate. [Chronic diseases may be treated 



They practice no deceit


3
with mild remedies, but acute diseases are made
worse by remedies if those remedies are not sufficient
to overcome the disease The action 
of the remedy falls in with the diseased action
and aggravates all the symptoms if it is not 
powerful enough to overcome the diseased action
IN such cases disease is to be taken out of the 
hands of nature. The powerful [enemy] is not to
be irritated unless there is a prospect of overcoming 
him]
14 – The difficulty of acquiring a knowledge
of the seat of the diseases of children, on account 
of their being unable to communicate their
sensations by language, has been made an excuse
by some physicians for neglecting the
subject of infantile diseases We may 
remark however that the difficulty of attaining a correct 
knowledge of a subject, cannot be given
as a reason why it should not be committed to 
men of intellect & science
15 – Though children cannot communicate their
sensations by language, yet the other symptoms by 
which we determine the seat of their diseases are more uniform
in their appearance & more certain in their indications than 
those of adults
16 Children are under no restraint from feeling
fear, [delicacy] or from false modesty In the infant, the 


mind does not react upon the stomach & destroy 
its function 
When Dr Harris published his essay on the
acute diseases of children Sydenham said to him
“you are the first man I ever envied and it is
my firm belief that your little book will be more
useful to mankind than 
# Adult patients also will often deny the existence of
dangerous symptoms; for fear they shall be considered as
very sick
The subject has not yet been thoroughly 
investigated. No regular course on it has been [illegible] until 
quite recently in [illegible] of the European schools. I recollect
the embarrassment under which I laboured under
at the commencement of my practice Cases frequently 
occurred which were not described in any of the books [&]
I was obliged to acquire all my knowledge on the subject from 
older physicians or from experience. My students have often
expressed to me the satisfaction they experience from an examination 
of my notes and they have often quieted the anxieties
of parents by reading extracts from them
# In my embarrassment upon being first called to a sick child
though familiar with the treatment of adults & having attended the first schools in the country I found my information 
& in books as to [illegible] nature or treatment and was
obliged to have recourse to the older physicians
29 [Dewers] is popular addressed to mothers, very prolix
& not intended for a text book but perhaps able [work] & is the
30 [illegible]
# Parents think a young physician will do well enough for a young 
children and are much more apt to call one in for such patients


4
mind does not react upon the stomach & destroy
its function We are at no loss how much to attribute to disease & how much to [illegible] #
17 – Still with all these advantages & notwithstanding the importance of the subject
it has been neglected & has received less attention than any other branch
18 – When Dr Harris published his essay on the 
acute diseases of children Sydenham said to him, you 
are the first man I ever envied, and it is my firm belief
that your little book will be more useful to mankind
all I have written” This opinion was not founded
upon the merits of the book but upon the fact that the attention 
of physicians would be drawn to this part of their
profession, not the least useful though the most neglected
25 Authors on this subject & their merits
26 Underwood 
Still the department has received less attention than
any other branches of our profession
27 Dr Rush in his works, has many remarks
28 Periodicals contain more or less upon the subject
21 – No courses in any of the schools
19 – Some physicians of the first respectability have acknowledged
their ignorance & given up to nurses
20 – I recollect the embarrassment I suffered upon 
this subject # It is a common complaint
22 Since I have lectured upon this subject, our students
at parting have expressed their satisfaction.
23 Young physicians are first called to children
because the older ones neglect them # hence its importance to them
24 Parents however seem, as a matter of fact, to prefer
a young physician, for a young patient! #



34 – I shall first remark upon a few surgical cases 
which occur to the young physician soon after the birth 
of the child
[illegible] cutting the frenum. I have never seen a case in which this operation 
was necessary. It is very common for nurses to insist that 
children are tongue tied. Dr [Eneas Munser] was called in such 
circumstances he remonstrated the nurse was instant until 
finally he drew the back of a knife across the frenum & the child
he told [illegible] [illegible] hurting and this with this [result]
was relieved to the great satisfaction of the nurse. If there is
a false frenum it may be divided.” this [illegible] [frenum] is never 
so short as to confine the tongue & cutting it is a dangerous operation
# They will tell you that this particular appetite is indicated
by the natural crying of the child
The mother will set herself to recollect some former
longing of her own
[illegible] 6 Hydrocele
Young physicians are often called on to prescribe for congenital 
hydrocele in young children The complaint is apt to excite alarm but
neither troublesome nor dangerous. It is readily distinguished from [illegible]
by its transparency, insensibility, & not yielding to pressure. In the course 
of my practice I have had to operate in but one case in children. Dr [Dewers] recommends
pouring considerable quantities of cold water on the part. I myself
have frequently cured it by washing the part with cold water in the morning
and applying camphorated spts in the course of the day. You [illegible]
direct the application of spirt & water, camphorated spirits, [muria??]
of ammonia, [opium], spirits of nitre, in short every discutient
Or you may direct astringent lotion, as a strong decoction of
maple bark, spriaea Fomentosa Geranum, Rhei etc.
Case in which I had to operate year old  probably neglected 2 or 3 inches long 
about as large as a small egg. Operate without a cannula  - with a lancet & catheter
& injecting syringe – water 1/6 or 1/8 port wine – children more irritable - vomiting



5
Tumor on the head
35 Children are sometimes born with a tumour
on the head occasioned by difficult labour
This may be distinguished from a tumor caused by 
a deficiency in the bones of the cranium, by a uniform 
hardness. “We may apply mur. amm. or spt & water”
36 – Cutting the Frenum
37. Hydrocele
31 Management
Appetites 32 A prejudice prevails in some classes of society 
with respect to a point in the management of children
Some children are thought to be born with a strong
appetite for some particular kind of food, which 
was possessed by the mother previous to the birth of the
child & inherited from her. It is thought that the child will [pine] & ultimately 
die, if this [illegible] appetite be not gratified #
It is probable that a belief in this doctrine has caused
many children to be killed by the administration 
of improper food A fact of this kind occurred
in Humphreysville, which nearly proved fatal to 
the child. Vide next page
Preventive
medicine 33 As a general rule medicine is not to 
be given to children in health for fear they should be 
sick. Some are nursed to death, while some die for want
of nursing. Some are fed to death while others are starved
Some are physicked to death while others die for
want of medication
injection immediately with [draw] healed [illegible] with swelling


The child cried much # - a council of females was
called who set themselves to make out what the
child needed Finally the 
mince pie was concluded to be
the article the child sucked down the inside & the 
report was that this effected a cure & saved the life of
the infant. Prof. I inquired of the attending physician who 
informed him that the child was indeed alive and well at
present but that it was made very 8ll by the mince pie
& came near losing its life. The crying of the child in 
this case was probably nothing more than a trifling increase
of the ordinary crying of very young infants, which 
is a natural and wholesome exercise # 
The al. can is large in proportion to the [illegible] of the whole 
system
# The above is a good example of the various prejudices
which have prevailed among [nurses] respecting the management
of children. Owing to the influence of enlightened physicians 
these are no disappearing. (examples to be given)


6
38 – Diseases requiring medical treatment
General considerations
39 – In investigating the causes and seat of the
diseases in infants the mucous membranes claim
particular attention
40 The action of this membrane is greater in 
the infant than in the adult constitution
Its secretions are often morbidly increased & are sometimes
diminished. It is subject to spasmodic action 
and to inflammation [illegible] with [illegible] or decomposed with effusion of 
coagulable lymph. “It is subject to turpidity & to
spasmodic action which by sympathy extend to the whole system 
41 The liver is much larger in proportion to the body the infants than in adults “& its secretions are much of [illegible] as to quality & quantity than in adults”
42 The secretions are much concerned in 
their diseases. They are changed as to quantity 
and quality
# Prescott child no ducts lived 3 or 4 
months and was excessively emaciated – there was no bile
in the stools There was no [previous] duct for the gall bladder
into the disorder



# There is greater susceptibility to action & tendency
to conversion
# Just as emetics are given to a stomach [complaint]
from excessive quantity of food


7
42 The nervous system of infants is more easily excited,
and more affected by the various causes of irritation
such as dentition worms acrid substances in the 
first primae via passages etc.
43 – The blood vessels are more rarely the seat o f
disease in infants than in adults – particularly, primarily 
so much as irritative
[acid] if they were affected the action is not [illegible]
44 – Consequently their fevers are fevers of irritation, rarely 
enteric or those of inflammation 
45 Operation of medicines
Children bear evacuation better than adults
witness the long continued diarrhoea without much 
debility following, or the salivation for mouths during 
dentition without a waste of vital energy
In operating upon the abdominal viscera it should be [illegible] it is
not for the purpose of mere evacuation, it is to produce
an excitement for the purpose of overcoming a morbid
excitement also to produce healthy excitement a case of 
torpor # The milder purgatives should be used, the
drastic being irritative.
Emetics
Bleeding
Do not bear narcotics vide p. 11


2 – In general the evacuation of the meconium should be
effected by the [colostrium] or first milk of the mother
which has a laxative property # The child should be
put to the breast within 2 or 3 hours from birth # unless [illegible]
Instead of suffering the nurse to feed the child for the
first 2 or 3 days the breast should soon be presented
for if the child feeds it is in danger of losing the 
instinct to suck If the [colostrium] does not bring
away the meconium we may begin with soda as
mentioned below or with cold sweetened water 
Some give a little cold water at first vide [infra]
5 – In strong children cold bathing may be employed
with advantage, but the bath should be made
tepid for weak ones & gradually used colder as the 
child can bear it
# “If from the exhaustion of parturition the mother be unable
to suckle let the nurse commence feeding at the end of 3 hours” vide infra
Give a grain of carborate of soda in a teaspoonful
of water until iii qts [have] given
# The meconium is frequently evacuated during parturition.
After birth also the al. canal is set in notion by the crying
and mother of the child and the stimulus of the
air upon it vide p. 10 skin. # Colostrium is of a yellowish colour
probably contains bile & is cathartic
# It was formerly supposed that the child
should not suck at first. The consequence often was
that the child lost the interest to suck



8
Retention of Meconium
1 – The first diseases of infants which claim the attention 
of the physician are those which arise from retention of the 
meconium. The meconium is a matter always existing
in the bowels at birth & having a dark green colour
when evacuated. It resembles tea but is more mucilaginous # 
It will ordinarily be sufficient to give a little molasses 
and water to the child until it receives the [illegible] or first
milk from the mother which has a laxative quality 
6 – If it is suffered to remain a train of diseases may 
follow. In the diseases which occur within the 
first moth after birth the retention of the meconium 
is always to be suspected as the cause
7 – The diseases caused by retention of the meconium 
are Severe paroxysms of pain in the bowels
indicated by crying & writhing – Tumefaction of the
bowels. Convulsions. Epileptic fits. Trismus
nascertium or Locked Jaw This last disease is
very common in some of the West Indian islands, but
I have never seen it in this place
8 – Whatever disease may arise from 
retention of the meconium the principal indication 
will be to remove the irritation by evacuating the 
bowels. This is effected by cathartics. A teaspoonful
of castor oil is generally sufficient. If [illegible] necessary


1st indic to remove meconium
2nd obviate effects
# IT will be sufficient to pour on boiling water instead of boiling
the materials in the water The strength however is of little consequence
Sometimes the most powerful remedies are to 
be used beginning with mild. These used
full doses of calomel, scammony 2 to 4 yrs – [illegible]
assisted by injection, & warm bath until the bowels
were moved Wait how long for the operation of each?
# By emollient injection, irritation is allayed, and if the
lower part of the bowels is excited the rest will be
Dose 2 to 6 pills each pill containing 1 gr. of 
(calomel)
# Chalk & calomel is a substitute for blue pill – perhaps
the chalk qualifies the cal & at least it
corrects acidity
Antimony should scarcely ever given to children
within the mouth
# A great part of the calomel has no effect
[illegible] it does not come in contact with the coats 
covered with mucus In cases where there was great
quantities of [mucus] I have given full doses of cal.


9
the dose may be repeated every 4th or 5 hours 
until half an ounce has been given
8 – If the oil is rejected from the stomach Senna & Manna 
may be given – zi of the former to zss of the latter
boiled in gill of water # & administered freely until 
the bowels are moved once in ¼ or ½ hour
“ Rx Sennae zi [illegible] ferv. 1 gill 1 or 2 teaspf every ½ hour”
9 – The operation of the cathartic
should be assisted by emollient injection #
10 – Fomentations to the bowels will assist the 
operation of cathartics & if spasms exist, will always
be needed for their relief
11 Cathartics of various kinds
12 The best cathartic which I have used
for infants within the first month after birth is the blue
pill (or [mellated] pill It rarely offends the stomach
and never produces griping By it the action of the 
liver & the secretions from the mucous membrane
of the intestines are excited more than by any other
cathartic except perhaps calomel. In my 
practice I have never known an infant salivated
by it. # 
13 In severe cases where the blue
pill is insufficient we must have recourse to 
calomel, which may be given in doses of from two 
to 10 grains. It is often necessary to give as large 
doses of calomel to children as to adults owing to the 
great quantity of mucus in the intestines by which 
they are defended from its action. # The meconium 


scammony or jalap as a laxative & had them
operate mildly If the cots were [naked] [illegible]
a dose would prove fatal for irritation
# This is a mild cathartic and supposed to act chemically.
# “Evaporate the [illegible] over the fire stirring it until 
thick then add chalk till it is of a consistence suitable
for pilling Each pill may contain 1 or 2 gr. of
Dose from 2 to 5 gr. Or it may be dissolved in herb
Fish, gall has been recommended [illegible] gall 
Rattlesnake has been thought to have specific
properties especially in fevers. This article
is bitter, tonic [illegible], laxative, & [illegible]
Continued from page 8
“The infant may be put to the
breast in one or tow hours from birth This course will 
produce permanent contraction of the [uterus] & tend to stop [hemorrhage]
& prevent milk fever” When an infant is first
born it is well to wet its mouth with half a teaspoonful
of coldwater and give it nothing else until it is applied
to the breat


10
while retained will likewise prevent the operation 
of the remedy by involving it in its viscid substance
14 Chalk & calomel may be used in doses
of 1 gr. cal. to 4 or 5 chalk repeated once in 2 or 3 
hours
15 Other cathartics which may be used are
or as recommended by Dewers
1 gr. carb. sod. to a teaspoonful of water repeated every 
“it operates”
15 minutes until 10 gr have been given. # Decoction 
of the flowers of the dandelion & the mullein 
Senna 2 dr. to with 4 dr. of aromatic herbs or seeds 
The bile of animals (ox gall) is a good cathartic
Perhaps we may consider it as acting as a substitute
for the childs own bile. It may be given in 
[catnap] tea milk etc. # 16 An injection of bitter or 
16 aromatic herbs will allways assist the operation of 
whatever cathartic you use & in mild cases frequently will be 
sufficient of themselves – superceding the necessity
of giving anything by the mouth
Continued from p. 8 The stimulus of sound upon 
the child, crying, irritation of the air upon the
skin, and especially muscular motion, excites the peristaltic motion 
of the child. The influence of muscular motion upon the
peristaltic action of the bowels, is considerable, as is seen in horses
while travelling, the costiveness of sedentary persons etc.


“The warm bath at the temperature of 98 or 100 assists the 
operation of cathartics renders their action more mild 
equalises the action of the system and nervous irritation
It is especially useful when convulsions are present and may 
be used at any period except in cases of extreme exhaustion”
# It is the most powerful antispasmodic for children
[have] acting upon the extremities of so many nerves
Jaundice
“Jaundice sometimes appears at birth indicated
by the yellow colour of the countenance and arising from obstruction
of the liver etc. Such cases are generally incurable.
The first remedies are the mild deobstructant 
plant, small doses of calomel etc.”



11
When convulsions are present the warm bath should
be used to assist the operation of whatever cathartic
is used, to render the operation mor mild, to equalise 
excitement and to remove irritation. This remedy
may be safely used at any period after birth #
After the cause which excited the convulsions has been
removed, if the morbid irritation of the
nerves continues, the bath will again be serviceable
18 Antispasmodics may likewise be used
such as valerian, aqua ammoniae, elix. asth.
artificial musk infusions of catnip etc.
We may use aqua amm. 3 or 4 drops
or carb. amm 3 or 4 gr.
or asafoetida a teaspoonful of the tinct.
in milk & water, or camphor by enema
Be [cautious] of giving narcotics to children
Some are more susceptible than others. And some children
are accustomed to [them] from birth. Case of 
a mother who had inured a child of 3 m. to bear
30 dr. of SS. I proposed to give paregoric, beginning
with 8 or 10 drops, and found that the child had often
taken with impunity 31 dr. of SS. to produce sleep



4 – “Child bed women are generally to be treated with 
mild diet for the first week after delivery, unless their
strength has been much reduced by parturition, when 
they may take port wine in moderate doses”
# “If light stools indicate a deficiency of bile the administration 
of oxgall will be found very serviceable 
vide [illegible]
If acidity is produced, add limewater, 
If diarrhoea is produced, use arrow root
instead of the water, or any other [fecula]
Children are apt to receive too much food; hence cow’s
milk should be diluted with water. Milk may sometimes coagulate
in the stomach of children, in large quantities and occasion much
uneasiness Meat should not be given under 6 mo. unless in 
particular cases which are exceptions to the general rule, where
milk disagrees or perhaps in the case of some scrofulous children


12
Acidity Flatulence Hiccough
1 – Very young children are often troubled with 
acidity, flatulence & hiccough These affections 
may be removed by a free use of magnesia, lime
water, or aqua ammoniae
2 – It will not always be sufficient safe? to 
administer these articles to the child alone. The 
mother or nurse must often take them likewise
3 – Sometimes the mothers milk disagrees
with the child. This will be known by the constant
disorder of the bowels of the child. by the evacuation 
and pain suffering after nursing both child
and [illegible] mother may seem to suffer without a cause
The stools may be slimy# The child may cry obstinately
5 – If the mother’s milk continues to 
disagree we may use cow’s milk diluted with one
third or one half water & “sweetened” or with arrow root mixed
first with a table spoonful of cold & then with one of hot
water, in order to make a homogeneous mixture 
6 – Children fed on cow’s milk are more apt 
to be costive. To prevent this give a little magnesia, decoct.
of dandelion etc. Peach tree blossoms are much 
used, but are too violent in their operation 


The injection will start the machine again 
The injection may be made of Eupatorium, catnep,
elderflowers mallows etc. etc.
Apply first whatever can be first prepared
counterirritants for instance. Spirit or 
mustard to the fat ammonia etc. ammonia to the mouth
and nostrils etc. endeavouring to rouse the patient
4 – [A young physician should be careful to know what to do in 
sudden cases (much depends on a favorable impression 
at first) Neighbors and friends usually assemble around
a child and the expect the physician will be able to prescribe
at the moment. In such cases set some of the bystanders 
to preparing a warm or tepid bath – no matter if 
eventually if it should not be used. Set others to preparing 
some other thing and so on. Thus while the attendants are
all employed he will be able to devise some course to 
pursue] I recollect an old physician in this situation
who was pressed what to do & replied “stop 
let us think about it”


12:a.
Costiveness & its consequences
1 – Physicians are frequently called upon to prescribe for
infants who are in health except that they are costive
Children fed from a spoon or bottle are mor to be thus affected
than those who are nourished from the breast. If costiveness
is produced by improper quantity or quality of the 
food as is sometimes the case, the diet must be changed
2 – Costiveness if not attended to in time produces
flatulence, watchfulness, startings, hiccough, diarrhoea
vomiting & convulsions
3 – A physician is frequently called to children
I fits, who have been apparently well until the convulsions
come on The safest and most efficacious prescription 
that can be made, is an injection & indeed is 
all the treatment that most cases will require. Let
a warm bath be immediately prepared & the patient put in 
it if the enema does not relieve. While the convulsions
continue the mouth is closed & we can operate on the system
mainly by the rectum & the skin
5 Be careful to make your directions for administering an
enema very definite, unless you know that the family are 
familiar with injections Case of a mason’s man hands & 
knees shooting somewhat off fright rolling over murder
The enema may consist of simple warm water, or milk 
& water, or of tea of thoroughwort or catnep etc. a table 
spoonful of salt may be added finally castor or other
oils may be thrown up in extreme cases the rectum has been filled with lard The water for the tepid 





12:b.
bath should be about blood warm. Be careful 
to bathe the child, & not merely to scatter or sprinkle
water on it. The length of time during which the child
may be kept in the bath may be from 5 to 20 min.
While the patient is in the bath if it is
sufficiently relieved to be capable of swallowing give a 
dose of calomel for a child of 6 months 6, 8 or even
10 gr. If improper food is the cause 20 gr. are not 
dangerous, for infants will bear full doses of cathartics
though very small ones of narcotics
In bad cases of convulsions the means to which 
we have it in our power to resort, are external irritants
such as garlic draughts to the feet, injections of [nervines]
the most powerful of which will be a teaspoonful 
of tinct. camphor thrown up in a gill of milk & water & the
warm bath until we can administer articles by the
mouth
“If the child be feeble & exhausted upon coming 
out of the bath give cordials or tonics”
Any quantity of food in the stomach & bowels
which is not congenial, interrupts the process of digestion 
& the peristaltic motion functions whose importance is 
second on ly to that of respiration. When these functions 
are interrupted the muscles are brought into convulsive 
action to relieve the system



Be particular in your enquiries about food for those who 
have the care of children are very careless and children
will swallow whatever is put into the mouth. I recollect
being called to see a very strange worm which a child 
had voided. The imagination of the attending physician 
& parent were excited. To me whose imagination was
cooler the worm appeared to be a piece of bark I enquired
if the child had had no slippery elm bark & found that it
had been chewing some. Then the supposed worm was accounted for
Rye flour is more apt to become acid than 
oatmeal
# Cal. sometimes by its irritation produces convulsions I have
known a family, all the children of which were thrown into convulsion 
by cal. & I was obliged to be very cautious & use blue pill injections etc.
There are several milk remedies such as dandelion
which is tonic laxative, & deobstrument acting on the 
liver, mullein fl. elder [blo??] tea
“The pollens of most plants has a laxative quality”
I have seen no danger from the prussic acid of the
[illegible] flower & it is much used [illegible] from [illegible]
also among the French they hold a place the French Pharm.
Wild liquorice [gal??] [Circa???] resemble
the dandelion
Moderate friction excites the bowels
Sometimes alkalie or chalk, though generally they are
rather constipating, prove laxative probably on account
of the acid combining


12:c.
II II Where is a tendency to costiveness, the use of oatmeal gruel
or porridge will be beneficial or a porridge made of wheat
flour with the bran, strained through a cloth & mixed with 
the milk with which the child is fed also rye meal gruel or 
rye bran gruel
If the health is not affected by the constipation 
be cautious about giving much medicine. It is always better
to cure this affection by food than by medicine. #
Castor oil from a teaspoonful to a table spoonful
is the best cathartic magnesia given with the milk is a good
remedy but not always sufficient. Elixir salutis is one of the 
most common family medicines. This article with castile soap
dissolved in it has been found very serviceable. The gall of 
animals may be recommended. The blue pill operates gently 
as a cathartic & is useful in changing the habitual disposition 
to costiveness. I have prescribed with advantage decoction 
of the flowers of the dandelion, or mullein. The flowers of the 
peach tree are much used for the same purpose but
“are rather too powerful for ordinary cases” “They are powerful even for adults”
& sometimes gripe unless combined with aromatics
Calomel may be used with safety # “In severe cases
mustard and ginger may be applied to the abdomen”
Mechanical manes in the form of suppositories 
are much used by nurses such as a piece of molasses 
candy or a roll of paper moistened with oil. They are
beneficial.
# If the child has been weaned pay particular 
attention to its food. Nurses are very careless.



# “No serious evil will arise unless young & anxious
mothers should give medicines and thus make the
child sick”
“If vomiting arises from dentition we must
remove the irritation Give laxatives, as magnesia, & 
narcotic
Children should be early accustomed to the reception of 
enemata to prevent subsequent prejudices upon the subject.
I recollect the case of a child about 12 who was suffering
from an obstinate constipation caused by an affection of
the lower spinal nerves which produced a partial paralysis 
of the rectum and bladder so that a catheter had to be introduced
& injections were [illegible] demanded. But all the
efforts of the nurses (women) were unable to administer an 
enema Calomel had been given until the mouth was affected, yet
without producing an evacuation. Finally the patient went
into an insensible state, and injections were given & 
produced free evacuation. I have heard adults say they 
would die before submitting to receive an enema.



12:d.
Vomiting
Spontaneous vomiting in infants arises from over distention of the
stomach. The discharge is made without nausea & almost without
effort, & consists of pure milk or milk coagulated. The mother
should simply be cautioned not to allow the child to nurse
so long at a time. # Children and old people vomit with 
more facility than the middle aged
If vomiting arises from the sympathy of the
stomach with some other part of the system which is in a morbid
state, the primary disease must be first cured & used for the irr. of stom.
For the vomiting itself in palliative we may prescribe lime water & 
milk. a teaspoonful of each; soda water, or any 
liquid affording an abundance of carbonic acid.
Vomiting from irritability of the stomach
or free [illegible] requires particular attention. The attendant symptoms will 
be paleness of the countenance, quick & feeble pulse, & cold
extremities. Irritants must be applied over the region 
of the stomach. They may consist of ginger, mustard, horseradish 
leaves, mint etc. aqu. amm. [illegible] essent oil dissolved in alcohol” The alkalies such as pearl ash, also 
soda water “lime water” may be given internally. Excite a discharge
from the bowels by injection or a calomel cathartic to remedy the irritated action of the stomach “[illegible] counterirritation”
The warm bath will be very serviceable, soothing the nerves
of the skin & by sympathy producing the same effect upon 
those of the stomach nervines also may be given We may try putting a little brandy
into the mouth or a small quantity of capsicum tea. Hot
cloths & fomentations may also be applied externally.
A large bulk of warm water water may be thrown up the rectum
in obstinate cases, use stimulating injections..


One of the most convenient modes of administering a large
injection is by a pipe fastened to a large ox bladder
Press the fingers against the end of the pipe which 
the bladder is fastened so as to make a valve and
prevent the escape of the fluid contained in the bladder,
until after the pipe has been completely introduced
into the rectum
# I used to carry this recipe about me when I practiced in the country
Frequently irr. of stom. is overcome by irr. o f
the rectum by an enema of salt & water or by a large
injection to produce a peristaltic motion downwards


12:e.
Ren “Remove the cause, which is frequently 
indigestion. If it proceeds from the teeth, lance the gums
The following is an excellent recipe # in these cases
Rx Cret. ppt zii sem. card. zi bi carb. potas. zfs grind
aqua bullientis 0 fs Give a tablespoonful every half hour
I am inclined to the opinion that the alkalis, such 
as pearlast act by creating an excitability
Emetics are particularly safe for children
much more so than for adults. Ipecac is generally 
the best unless the disease in which the emetic is indicated
is very threatening, when antimony should be used
Squills are indicated in emetic doses in complaints of the
chest “with [illegible] [illegible] but should not be administered when there 
is much inflammatory action in the system.
“Warwick’s powder a preparation of antimony,
was once popular and often administered without 
the advice of a physician. I have known it endanger
life Nurses should never prescribe antimony”


Some situations are more liable – low situations
[seashore]
Children shut up in low dark apartments suffer
from want of amusement.
If a diarrhoea from teething is suddenly stopped
the brain is apt to be affected. This affection of the brain 
is peculiarly liable to occur in children. There is no 
outlet to the brain


12:f.
Diarrhoea
This complaint sometimes affects children for months & even
years Some families are more subject to it than others & I
have known those in which all the children would be affected 
with diarrhoea from a period soon after birth until they 
were three or foru years old. The children who have this predisposition 
to the disease are born with diseased liver and bowels
& have indeed all the chylopoietic viscera in a disordered 
condition. Hence among the causes of diarrhoea we may 
rank a bad constitution. Other causes are want of 
cleanliness, bad food “want of sufficient clothing” bad air damp rooms, confinement
& want of exercise. Exposure to cold & moisture
A bad air probably causes diarrhoea mainly by 
its depressing influence. The effect of confinement and want
of exercise is very great. Young animals suffer in the same way 
Even vegetables seem to need motion for I think I have observed
a great deficiency of fruit & a sickly appearance of 
fruit trees after a season uncommonly free from wind. Confinement
is injurious in another manner Children need
mental stimulus from a variety of external objects. I have
known surprising cures effected apparently by the operation 
of this very principle.
Teething is a frequent cause & whenever
it is we must palliate & check, but may not stop the diarrhoea
From the sudden stoppage of a diarrhoea during dentition you may 
expect an affection of the brain to follow. The discharge from the 
bowels in this case is similar to that of tears from an irritated 



This will be convenient in many cases as in travelling
Other mints may be used spearmint is most agreeable
I have given this in the latter stages of the diarrhoea of
adults with advantage
Almost any cath. will often check a diarrh. Cal or 
blue pill is generally best
Judgment is to be exercised whether to prescribe an
emetic or a cathartic & as to the choice of a catheter
Ipecac however is almost always safe children bear
emetics well
Put the parents & the nurse upon investigating as
to [diet] Persons are apt to very careless about giving
things to children And they may have wrong notions as 
to particular articles
Prohibit solid oily food, crude
vegetables and esculent roots. Potatoes are very 
bad in diarrhoea so are the analogous roots. They 
contain indeed much fecula, but also much 


12:g.
eye, or of mucus from the lungs
The expressed juice of mentha vulgaris, boiled
skimmed and mixed with white sugar is an agreeable, & useful
article for the cure of a diarrhoea, which has continued but a 
short time & is not severe.
In the early stages of a diarrhoea, which 
is sufficiently severe to demand the attention of a physician
it will generally be best to commence the treatment with a
cathartic; though if fever accompanies it an emetic of ipecacuanha 
should be the first article administered.
Judgement must be exercised in the choice of a cathartic. Calomel
will be best if the child be not particularly feeble or of a very 
delicate constitution & for a feeble child the blue poll. I myself
was for formerly many years unable to take any other cathartic than the 
blue pill without being griped. Generally it will be best to combine
chalk with the calomel, as the latter is indicated for its deobstruent, 
rather than for its purgative effect. The dose may be about
2 gr. cal. with 5 or 6 of chalk
If improper diet is the cause the food must
be changed; & it will generally be necessary to be particular in 
our enquiries with regard to the diet for the parents may 
consider many things a safe which would be strictly forbidden
by the physician. Especially will it be necessary to attend to 
the diet if the child feeds instead of sucking. Every thing 
hard of digestion, such as salted & oil food should be prohibited
The diet should be arrow root and in case of diarrhoea this 
article will be improved if prepared with a little laudanum 
or wine sago taipica, which is probably a hydrate of 



besides They are apt to become acids & acrid in 
the bowels. In the Polyn. islands The inhabitants
living upon taro are very liable to diarrh.
West of the Rocky Mts Lewis & Clark found the 
inhab. subject to diarrhoea for living on a root [illegible] [illegible] men suffered in the
same way after they arrived among them
In the evacuations & the evacuations of children shd always be exam
[may] [illegible] that potatoes remain undigested
Cullen & Rush thought different of potatoes
The evac. of chil. should always be [illegible]
Pies cakes articles containing much sugar
hot bread should be prohibited Bread shd be toasted
The juice of meat will often be beneficial
No gravy (i.e. artificial or carbonized fat with flour etc.)
Potatoe starch, pure, is perhaps not 
inferior to the tapioca etc.
Boiled flour becomes s hard as stone
almost hydrate It is an old practice It is an
excellent preparation make a porrige of it grated
Tapioca I suppose is made by sprinkling
casserva root, powdered, with water & baking it
making a preparation what appears like gum arabic. I have not 
been able to learn how it is made, but have made
it this way a similar substance of arrow root
Arrow root & the tapioca are cooked
by first dissolving them with a small quantity of cold water
& then adding hot water. In this way [illegible] are avoided


12:h.
flour or roasted or baked flour made into a
porridge with equal parts of milk and lime water. The bread
should be toasted and butter should be used very sparingly 
gravy not at all. Casserva sago etc.
An article similar to tapioca, if not the same 
may be made in the following manner. Tie up a quantity of 
wheat flour tightly in a clean cloth & boil it for 5 or 6 hours
The result will be a hard substance which is to be grated &
“[illegible] milk & water or with lime water” 
made into a porridge this will be palatable & good Rice
in gruel, or thoroughly cooked by boiling 
The worst cases of diarrhoea are attended
with feeble pulse, cold extremities, dry skin, & 
generally a rise of fever once or twice in the 24 hours. Soften
the skin by the tepid bath which is [illegible] etc. and keep up an action on it by 
flannel unless there is fever & in such cases use also absorbents freely with 
tonics & aromatics. The chalk julep or white decoction will 
be as good a preparation as any. Rx Chalk [illegible] zfs to zi pul. cinnam. to zii
zii, bum arab zi carb. potas. zi water lb I. boil ½ hour Sometimes
[illegible] a similar recipe shd be used” The Europeans add [illegible] use [illegible]”
a little laudanum may be added. Of this feed freely, giving
say a table spoonful from ½ tab sp. to I once in an hour sometimes. As a tonic the
vitriolic or tonic solution of Moseley is inferior to none in such
cases Rx zinci sulph ziii alum zi water lbi Give from 
four to twenty drops. Tonics must sometimes be combined
with absorbents
Opium is always safe in cases where the 
bowels have been thoroughly evacuated. It is generally 
better to combine it with ipecac, which will determine its
action to the skin and act as a gentle tonic & laxative


The tepid bath is [illegible] as it may be called) 
relieves the irritation of the bowels through the 
skin
Chalk does not act mechanically or chemically it
has a specific action upon the stomach as much as
bark
Make white decoction in various ways if cinnamon
offends use some other spice Sometimes add
astringents or [illegible]
Tonic sol. sulph [illegible] ziii al. zi Mosely sometimes
used al. zii In 3 or 4 gtt it is anti emetic
In larger doses it may be emetic & cathartic
This is a state of the system similar to the collapse
of cholera Asiatica It is a collapse taking place
during diarrhoea. I have found advantage from
stimulating or acrid injections as salt & water, mustard
In chronic diarrhoea opium is often
invaluable. Some families are obliged to give it 2 or
3 times a day for along time to their children until they are so 
old as not to be liable to continual diarrhoea
The stools may be green clayey from deficiency of bile sour curdled [illegible] or very
fetid, so much so as to be very offensive turning the
stomach of the attendants.


12:i.
In cases of chronic diarrhoea where there is attending it
much sensibility and irritability of the bowels opium combined
with diaphoretics cathartics or tonics is an invaluable
remedy
Sometimes violent symptoms supervene vomiting supervenes & the diarrhoea 
stops the patients hands & feet grow cold his pulse
grows small, & if the most active measures are not
take used the patient dies in 24 hours. When this change
of symptoms take place we must resort to the most
powerful means of exciting counterirritation such as application 
to the epigastrium of mustard, horse radish leaves
ol. monardae punctulae, ol. turpent. etc. Such articles 
as pimento will be grateful and stimulating given internally
We may give calomel, opium & the carbon. acid, and use 
stimulating injections. “Effervescing mixture with SS. [illegible] appt”
Particular attention should be paid to the
kind of They may be sour & curdled, or mucousy, [illegible] clay colored, water
stools for much may be learned from their inspection.
Acid is often formed in the whole alimentary canal, producing 
sour and curdled stools which will indicate lime water
or other absorbents, with aromatics. The acid may 
arise from fermentation or more probably from secretion 
Such cases I have often cured by the expressed juice of the
spear mint prepared as above mentioned & given freely.
When the stools are green white, or clayey, give
opium to allay irritation. Ipecac to equalise excitement, & 
the blue pill as a deobstruent, the latter in small doses so as 
to move the bowels, but once or twice in the 24 hours. 
Alkalis are useful as 


# Noel’s plaister was made of white lead red lead castile
soap and olive oil, boiled till the red lead was so far decomposed
by the oil that the mixture was of a cream colour It is a 
smooth plaister and is less stimulating than [illegible]
Use soft charcoal by burning cork, which is
the popular kind or cedar Dose teaspoonful
to a tablespoonful in a convenient liquid
Lime water & other alkalies may always
be given They may be mixed with the food
without [injurious] the taste
When the disease has continued long & 
patient is [illegible] phlegmatic temperament we may 
bandage the bowels, to give mechanical support 
[Opium] also will be useful applied externally in this way
Adults from the Wt. I. with chronic
diarrhoea will look like a mummy
Bog water is a very soft water & contains
carb. hyd.
Astringents [illegible] tinct. vitriol
decoct. of oak bark with milk & sugar & spice
Bandaging & plaisters Take any adhesive
plaster and mix about ½ opium Or soap and opium
Acetate of lead is not a new remedy 1 2 or 3 gr a day
1 gr at a time continued as long as the relaxed state of the bowels
continues as long as they last lead [cholic] cannot take place for 


12:j.
are also enemata formed by dissolving castile soap
in mallows or catnip tea. If there is much griping with 
tumefaction of the bowels injections of camomile tea give
great relief. In diarrhoea of this kind the following is also 
a good stimulating & correcting laxative Rx castile soap zi
elix. sal. zi dissolve & give it 3 or 4 times a day of teaspoonful or ½ teaspoonful doses.
If the stools are fetid give charcoal
internally. It will correct the fetor & it sometimes cures
the disease. For sour stools vie last paragraph of this lecture
During the long continuance of chronic
diarrhoea it will of ten be advisable to apply mechanical
support to the abdomen. We may apply a plaister of
white diachylon [illegible] plaister alone or with opium or of lead and soap & a bandage.
In chronic diarrhoea the skin becomes 
brown, of a dark & dirty appearance, & very dry and husky
If the tepid bath does not relieve this symptom, we may apply 
water from peat swamps, which contains carburetted
hydrogen. Vide Duncan’s commentaries
In the last stages of diarrhoea we must 
resort to tonic solution to astringents, absorbents & aromatics
we may also use opium with cathartics, emetics & absorbents
& If we met with a great craving for salt food it should be 
gratified. The gratification of such an appetite will prove 
a stimulus, especially to the mind & consequently the more
powerful. We meet with similar cases among adults also. Case
of a man who could retain no medicines upon his stomach & 
finally recovered upon bread & cheese, given at his request
In the latter stages also of chronic diarrhoea, acetate of lead 



the [illegible] [become] very lax and there is generally a prolapsus ani
patient being [semiphlegmatic] I saw this article
much used in this way when a young man and though expecting
bad colic no injury resulted.
Prof. Smith was very fond of chocolate [illegible]
It sometimes acts like a charm
Spiraea may be given in decoction or
extract. [illegible][illegible] is not so good being unpleasant
having a fishy taste & offending the stomach Ger. mac. & [illegible]
[arom.] are pure astringents & unobjectionable on 
this score. I have prescribed sometimes one, or another,
according to convenience of locality where I 
happened to be
The root of typh. latif. is used as food by the aborigines
European physicians give [althea] [illegible] which 
is the true marshmallows
Usually when diarrhoea has continued 
long the kidneys become affected. Mucilage will then 
prove diuretic probably by their [illegible] affect. The terebinthinates 
will then be useful. The most common practice in 
this neighborhood is a decoction of white pine bark especially 
with a little milk it is called healing to the bowels. There is
also nutriment in it for the aborigines, sometimes live on it
When mucilages to wear out we may resort to terebinth.
The species of [polygnomic] knot grass are 



12:k.
may be given internally. There will be no danger
of the production of colic, by this remedy, for the bowels are
too much relaxed.
The astringents just mentioned may be various 
We have at least fifty indigenous vegetables, which may be used
given in decoction of milk or water such as the bark of the
currant, the raspberry, the various species of oak, of viburnum
chocolate of acorns etc. white pine bark in milk etc.
the roots of the [illegible] of the [geranium] etc. The viburnum
Especially deserving of recommendation are the spiraea tomentosa
& cornus circinata. The latter of which equalises excitement
Of mucilages we may have occasion to 
use a variety for irritation for any one article may become worn out & another be more grateful
We have typha latifolia, twigs of sassafras, hibiscus, malva
bran, flax seed, slippery elm, gum arabic etc. all the mallows, all the [illegible] marshmallows hibiscus palustris
called rose of [illegible] in the gardens root is [illegible] [illegible] & sub astringent 
Sour stools Be particular in forbidding the use of animal
food. If there be want of bile, give ox gall, lactescent plants
dandelion etc. with mild mercurials; e.g. calomel 2 gr. with 
6 gr. chalk. Aromatics also may be combined. Astringents
elg. [illegible] speraea cornus & geranium do well. Also the following
Rx calc. magn. zfs rhei palm. gr. 8 acaciae zi ol. anisi gtt vi
aquae purae zi Give a teaspoonful at a dose. “once in 2 hours”
In bowel complaints with griping attended with green
or sour stools Rx magn. ust zfs pulv. rhei grs viii pulv. gum ar. zi
ess. menth pip. gtts vi water zi dose, teaspoonful Spiraea & cornus




used – they are mucilaginous sub astringent & diuretic
Articles of a stimulating kind are often needed in 
the latter stages especially erigeron canadande (colt tail) [illegible]
The bitter [illegible] which grows in similar situations (ambrosia [elatio??]
is also used as a bitter apparently nervine in diarrhoea
Roman wormwood) [Cupron] is acrid, sub astringent & diuretic much 
used in the middle states improper when there is entonic action
case of cholerine cured last summer by this garden young
man called etc. chewing the plant etc. The other species
of erigeron have similar properties espec. E. phil.
Various recipes are given for diarrhoea in 
children Ex mag. zfs rhei gr. 8 [illegible] zi ess. pep. gtts 6 gum ar. zi
The popular remedies are generally absorbent [illegible] mucilaginous
astringent etc.
Much benefit may often be derived from 
copious mucilaginous injections mutton broth is the most popular
probably other broth (fat meat) would answer still mutton 
suet is less apt to become rancid. It is thought to be 
useful also as nourishment I have not though much 
of this may of nourishing
Laudanum may be added Also
laudanum & starch injections may be advisable to check the
excess of the discharge It will generally be best to begin with 
about 10 drops of SS. though a teaspoonful may be required
vide p. 2 [illegible] 2



12:l.
Prolapsis Ani
This is a troublesome symptom which sometimes occurs in 
diarrhoea. The protruded intestine should be immediately 
replaced. Most writers recommend to do this with a 
dry cloth, but this will irritate the sphincter ani & make
it contract. The smoothest and least irritating article
within my knowledge, is the crop of a fowl, or the neck
of a bladder, turned inside out & filled with warm water # 
Afterwards we may apply astringent washes & injections
of white oak bark or other similar articles, or
of acetate of lead. The latter article may also be given 
internally in doses of from 1 to 2 grains. It will 
have a tendency to overcome the relaxation.
Astringents are multitudinous
& have had a specific [illegible], which proved to be the
bark of [?strea] virginica At another time I had a specific
sent me which proved to be viburnum sentago all
the vib. are astringent
Prolapsus ani “The part is relaxed
and passes down and is then strangulated by the sphincter. For a
permanent cure we must resort to astringents & tonics, but the
part must be [illegible] by mechanical means If 
the intestine is not replaced, [illegible] or suppuration 
will be the consequence” “Take 1 bladder, cut
off the neck, turn it inside out, fill it half full of 
warm water, and tie up the neck”


“This disease was very common at the commencement
of my practice but is now rare. The change has arisen in a great
degree from the more correct notions respecting the proper management
of the mother and child which now prevail. It is possible
however that it may appear in [epidemics] and that case we
should expect that it would appear for a time and the disappear
# It frequently follows other diseases both in children
and adults
# According to the law of contagious diseases and
that it is of no use to prevent it
# Heat is a stimulus but too much of it produces a 
debility which may be [illegible] perhaps in direct debility
“Since a free ventilation of nurseries has been practical the
disease has been rare. laying aside the use of the preparations 
of alcohol has also been beneficial.” 


13
Aphthae or Thrush
White thrush from [illegible] (to inflame)
This disease often appears within the mouth 
is then generally unaccompanied with fever. In some
cases it is idiopathic but it more generally is a 
consequence of morbid affection of the primae viae #
It is frequently found in adults of robust constitution 
which have been very much debilitated by previous that disease
infancy and old age are most subject to it & in infants,
as was just mentioned it is often an idiopathic affection
In some families every infant is several with this
affection. The vulgar error however, which very generally prevails
that all children have the thrush at some sooner or late period other #
is contradicted by the fact that many children as I have
known never have the least appearance of it 
at any time “and it may probably in all cases, be prevented”
The most feeble and delicate children are affected with the most violence, hence & from the fact of
its being an affection of old age & a frequent sequel of other disease
in adults, it may be inferred that this is a disease of 
debility & this [illegible] will be confirmed by the predisposing
causes which we find to be, confined air, a
very hot room & improper food# It is caused among
the poor by bad air & among the rich by too great warmth 
& confinement. The fever likewise which accompanies it
in many cases is of a typhoid character.
# “Caused by neglect of the nurse by want of cleanliness
& is often the effect of costiveness”


# And have been led to prescribe remedies to prevent 
the thrush
“commences on the inner part of the lower lip & corners of the
mouth & extends over the tongue & inside of the cheeks & gums
sometimes all these parts are affected & sometimes only one of
them”
“It appears in small eruptions or vesicles containing a whitish
fluid resembling a coagulum of milk these vesicles
often coalesce so as to form patches”
“extend down the oesophagus to the cardia & here in all
known cases it has stopped”
Prof. Tully has seen p.m. [illegible] which the thrush the al canal [illegible]
“The feces are sometimes covered with aphthous sloughs”
“in its severest the eruptions are of a dark brown
or deep red colour”
“The alvine discharges are very acrid”


14
Symptoms – The disease is preceded by languor and sleeping
This is so generally the case that it is common for nurses to 
say that the child is sleeping for the sore mouth
In adults I have observed the same fact, & have predicted
the appearance of thrush from the drowsiness of my patient #
The symptoms of thrush are very obvious. It commences
with white specks upon the lips #, angles of the mouth, & 
tongue effervescence. # In severe cases the specks in crease in number
and size until they cover the whole inside of the mouth
the throat & are found indeed upon the 
stomach x & throughout the whole intestinal canal
though this is disputed. One thing is certain, whether these
specks or flocculi extend throughout whole alimentary 
canal or not, viz. that they are found upon the rectum,
agreeably the law that the orifices of tubes are
most affected The white crust will 
fall off and be succeeded by one of a darker colour.
The coats of thrush are often many times renewed
& in this case the formation of a new one is preceded
by unusually protracted sleep. A typhoid fever
may accompany.
It seems to be an eruptive disease
determined [illegible] the al. canal.


“In its milder form it is confined to some particular
part of the mouth or to the mouth itself. The eruption is
white & the mouth appears “as if a stratum of coagulated
milk were spread over it” & but one separation of
the curd like crust will take place. The general health
will be but little disturbed”
“In severer cases two or three successive crop
are formed & the habit being unhealthy, the food innutrient,
& the frame weak and atrophous, the under [surface] ulcerates
and spreads & a low typhoid fever ensues”
# “Your principal object should be to produce an
excitement in the bowels by some mild medicine”
# Because it is an eruptive disease however diaphoretic
seen to be indicated & those which [illegible]
action “The treatment is ordinarily a gentle laxative
but there is a choice in the kind of laxative. Some practitioners 
recommend oily medicines, as butter, goose oil, pigs foot oil
etc. But these articles do mischief As the vital powers of the stomach 
are weak, these oils will become rancid”
# In such circumstances the oils become rancid & 
consequently irritate. I never allow oils to be
given, yet it is a common practice to swab the
mouth with oils, especially goose oil (or [illegible]?)
# Chalk shd generally be preferred the other articles
dissolve more slowly & may act in part
mechanically”


15
It is thought that this disease has often
been prevented, by giving soon after birth a teaspoonful
of cold water & repeating the remedy every
morning, for some time taking care also that the bowels
be kept open There may be some foundation for
this belief inasmuch as the disease is brought on 
by heat and debility. “In families where the children
have uniformly been subject to this disease. I have recommended
cold water as directed that the room should be well ventilated
and the child not covered with too much clothing”
In mild cases & where the constitution 
of the child is robust, a gentle laxative will be sufficient
to remove the complaint # 
Castor oil is very often prescribed for it
& it may be proper to five it to assist the operation 
of other cathartics But there are several objections to 
this article. It does not affect the secretions so much 
as other cathartics. It does not evacuate the contents of
the bowels so thoroughly as others & it tends to 
# relax the coasts of the intestines, already in a state of 
morbid relaxation “It will not remove the mucus of the intestines”
For mild cases magnesia is the best laxative 
where it can be given in sufficient quantities. If the
bowels should not need a cathartic chalk or some one
of the other testacious powders may be given “as [illegible]
oyster shells, crabs eyes, crabs claws etc.” #
Because it is an eruptive disease however, diaphoretics 
and articles which translate action seem to be indicated 



# “Give at first the clear liquor of this infusion and if this does
not operate stir it up and give the substance
(1) “After the stomach and bowels have been evacuated the
ipecac should be given in small doses ¼ to 1/6 of a grain, to 
keep the bowels open, to produce a tonic effect, to determine
to the surface & to prevent convulsion Ipecac has
more claim to be considered as a specific than any thing
else. It obviates the morbid secretions of the bowels it acts as
a tonic never produces unequal excitement or other tonics
& it does not like astrigents produce constrictions Whenever
there is a tendency to unequal excitement it must be
obviated or tonics will do no good”
# I rely upon the ipecac though I use [illegible]
sometimes especially white root asc. tul.
# Indeed “if diarrhoea is present, prepared chalk is a
good remedy as is also charcoal: the best form of which 
is burnt oak for this can do no mechanical injury”
# “I have found this almost a specific” Since I have
used this treatment I have not lost an infant by 
this disease” Ipecac in small doses as an alteration 
approaches as near to a specific in any remedy can
# which is not to be expected
# Astringents must be avoided, though tonics are indicated
because they produce unequal & local excitement & 
stricture they must be given in the latter stages after excitement
has been [equalised]
A little borax may be given
Moseley’s solut. zinc ziii al. zi [illegible] 1 pt


16
In the commencement of the disease if the symptoms do 
not indicate the probability of a severe case an emetic
of ipecac is the best remedy Antimony has been recommended
but it is not a safe emetic for children within
the mouth Infuse [illegible] of ipecac in 6 teaspoonfuls
of warm water & give a teaspoonful every half hour
until the patient vomits or purges. # Ipecac has the advantage
over antimony in its tonic and antispasmodic
properties & in the mildness of its operation, never producing
alarming symptoms # 
If the ipecac empties the stomach and not
the bowels, a blue pill should be given of the size of
from 2 to 8 grains. If this be found insufficient, it may 
be assisted by a dose of calomel, or magnesia or an enema 
(1) After the bowels have been thoroughly cleansed
the ipecac should be given in small quantities a fourth or 
a sixth of a grain to determine to the surface & to prevent
convulsions # If this dose moves the bowels too much, we
may add “[illegible] or 1/6” one sixth of a 1/8 drop of Laudanum to each
dose The absorbent powder or the white decoction may 
be given at the same time#
Astringents should be cautiously avoided
until the stomach and bowels been thoroughly 
evacuated # “& if there is much fever” Where this has been done we may make
use of Moseley’s tonic solution, or cornus [circinata] [illegible] alba, or sericea or saffron safely & with advantage


It is to be remarked that chemical action is prevented by the
vital principle acting upon the food or articles introduced
introduced into the stomach, and putrefactive or [acetous]
fermentation if the vital powers of the stomach are [vigorous]
This principle applies to vegetables Plants taken up in 
full blown in August and packed in live [sphagnum]
will be preserved by the life of the sphagnum
In thrush the powers of life are weakened & not only
substances taken in but the secretions themselves are
subject to fermentation hance the use of obviating the 
effects by alkalies limewater magnesia, chalk [illegible]
absorbent powders
white decoct. Rx.
“To prevent the increase of vesicles of effervescences, syringe
off the acrimonious fluid as well as you are able, by some diluent 
or detergent gargle and expedite the separation of the
sloughs by invigorating astringents” vide Dr Good vol [illegilble] p. 30
“A little borax & ergot may be put into the mouth. But if the mouth
is dry & parched, this and other astringent shd not be used. In such cases
we should give mucilaginous substances as gum ar. slip. elm. or sassaf
X 5 or 6 gr a drachm? of each in a gill of water
# or viola pedata (parsley violet) or comfrey
We must be very cautious about administering it to infants


17
To correct the acidity which often attends this disease
we may administer prepared chalk or lime water
& milk Or Rx magn. usta 10 or 12 fr. elix. pareg.
xx gtts water zi given in teaspoonful doses every hour
If the stools are watery and the child is robust give
coct. ppt # vi gr. cal. 1 gr or the compd powder
of chalk in doses of vi gr. or a small quantity
fo rhubarb instead of the cal.
For watery stools give dal. 1 gr & chalk 6 grs or compd powder of chalk
It is too much the practice to scratch or rub 
off the aphthae in a violent manner with a brush
or swab. As well might the cure of any other
eruptive disease be attempted by violently rubbing
or scraping off the pustules. Rubbing the mouth with
a brush or swab until the bleeds is a cruelty which  
ought to be deprecated
Still something must generally be done
to the mouth in order to satisfy the importunity of 
nurses & prevent their mischievous attempts
A little borax and sugar X is as safe as any thing
If the mouth is dry it may be lubricated with 
muc. gum arab. slippery elm or sassafras twigs
When the mouth is in a very high state of irritation 
probably a small quantity fo sugar of
lead would be serviceable. I have not myself
ventured to administer it to infants within the mouth 
For the proper local treatment of ulcers vide ulceration 
of the mouth


From the sympathy which exists between these parts
and the surface, tonics should be combined with diaphoretics
I have given [illegible] [has] or [illegible] it is [illegible]
observed by tonic and determines to the surface
# It is mucilaginous sub-emetic & diaphoretic. It
may be given freely as a wash or administered
freely internally laxative diaphoretic soothing
antirritant “The other [illegible] may be as good”
The disease of which we have been speaking is 
a local disease


18
Ipecacuanha in this disease is emetic, tonic, diaphoretic
etc. alterative & since I have used it I have not lost
a single infant with thrush
The viola pedata (parsley violet in some 
degree resembles ipecac is its qualities & may be internally 
administered in its stead # “give a teaspoonful of 
of the decoction”
The peculiar kind of thrush of which I have been 
treating is a local eruptive disease of infants
but as it appears in children more advanced it
a critical determination of diseased action. It
is not unfrequently a favorable symptom, particularly
when it succeeds strong morbid action & 
[illegible] early in the disease In the latter stages & 
when the system is exhausted it is unfavorable
For instance in hydrocephalus, when the whole 
mouth will sometimes become sore, and the disease
seen to be translated to the mouth “from the brain to the muc. memb”
In the latter stages of any disease not
so fatal as hydrocephalus it is a very dangerous
symptom of exhaustion “In cholera infantum
it is a dangerous symptom. [illegible] there is not
translation from [illegible] essential part”


18 ½
Eruptions in General
Children of all ages are subject to various eruptions
These are generally occasioned by the quantity or quality
of their food. They are frequently cured by change
of diet alone & the greatest attention should always
paid to the diet is managing them Oily food particularly
nuts, must be strictly prohibited, as they often
cause eruptions. I have known some adults invariably
affected with eruptions about the lips or other
parts of the face after eating freely of walnuts
Fish & poke week may likewise [illegible] the eruption 
We may use the tepid bath for the purpose of 
cleansing the skin. The frequent use of the [illegible]
bath is important especially in chronic eruptive
diseases of children & adults vide p. 21 & p. 20
For infantile [illegible] [illegible] p. 1831-2 of Good
Case of a peculiar eruptive disease
vide [illegible] [illegible] P. 1831 1 [illegible] art.
The eruption was periodical, appearing at a certain hour every day
At first a light coloured opaque elevation of the skin about half an inch
log & a quarter broad like the sting of a bee or wasp. Soon after their appearance blood began to ooze
from them & producing a drop which concreted into a scab, & at the end of 3 days
fall off 8 or ten eruptions came out daily. Treatment was ineffective 
until a change of air & diet, which effected a cure
“Child 8 or 10 yrs of age about 5 p.m. it would complain of a pain
in the face then would appear elevation of the skin to the number of 10 or 12 
the issue was treated as if [illegible]
bark was tried also nit. sil. sulph zinc. arsenic & other minerals
emetics cathartics new diet finally fruit was recom ate freely 
of oranges & was benefitted. Then change of air & travelling were tried
or the first day the eruptions diminished & on the third disappeared
In such cases try changes of mineral waters & dieting”



19
Red Gum
Allied to thrush is that eruption called red gum
The original word was red gown (from a sort of spotted
red calico) which has been corrupted into red gum
It is called by [Willa??] strophilus intertinctus
It is a populous eruption & said to be peculiar to children
but this last is doubtful
The eruption is sometimes confined & sometimes
diffused over the whole body. The papulae rise
above the skin are distinct from each other & of a
rarely contain lymph
bright red colour. The vesicles contain by [illegible] only & 
terminate in scurf. Afterwards subsequent eruptions
makes their appearance. The constitution is rarely 
affected. Physicians are not usually called 
unless the nurse is inexperienced Nurses give saffron
Some physicians suppose this disease 
to be the same with aphthae. Dr [Willan] thinks they 
alternate. Dr Russell remarks “I think that aphthae
of infants is of the same nature with those
eruptions called red gum & differs in this respect
that one disease affects the skin & the other the internal
surface of the alimentary canal. Dr [illegible] thinks 
that this affection, preceded by sickness, arises from 
causes similar to those of aphthae, such as confinement,
heat, irritable state of al. can. indigestion [illegible]
If the disease be suddenly repelled
from the surface, vomiting & spasmodic affections 
take place. Hence the European physicians 


Belonging to the primary [page]
Probably the patient was not dieted so strictly as was
intended & I recommended change of air Oranges
however were beneficial. The was too fond
of good living, fond of oily nuts
There was a slight reappearance after it
but of short continuance
It was called [illegible], but improperly
The eruption was preceded by a warming sensation
of pain in the part.
“Red gum is an eruption of fine pimples of a red
colour affecting infants [illegible] within the mouth. It 
is a disease that rarely requires the advice of a physician
The cure is much better effected by diet and [regimen]
by the exhibition of medicines Still the physician
is frequently called in and he must prescribe something
if for no other object than to satisfy the friends
In order any case give a decoction of saffron & 
snake root to keep the eruption from [striking] in 
& keep the bowels soluble with tinct. rhei compd tinct
sennae magnesia, or other mild cathartics”



20
caution is not to expose infants with this eruption upon
them to a current of cold air, or to plunge them
into a cold bath. It is said that fatal consequences
have resulted from such imprudence
The child should be kept clean & 
be subjected to daily ablution of tepid water.
Particular attention should be paid to the quantity 
& quality of its food. If the eruption should be repelled
from the skin the tepid bath will be the best remedy
This disease often occurs within the mouth
& rarely requires the attention of the physician. [illegible]
tone of the mildest of the eruptive diseases
“We may give a decoction of saffron crocus? & snake
root to prevent the eruption from striking inwards 
& keep the bowels soluble by mild cathartics such as 
magnesia & rhubarb. Still more will depend 
upon diet than upon medicine. Wine & water or
one part milk & three water may be given”
[belonging] to p. 18a
“In managing most eruptive diseases more
attention should be paid to diet than to medicine. In 
most cases it is requisite that the quantity of food should be diminished.
If the food is milk, let it be three parts water, or
substitute whey. Infants should take no animal food & 
no crude vegetables within the year. Oily food and the various
kinds of nuts should be prohibited even for 2 or 3 years. A strong
child in the country, with abundance of air and exercise
might be indulged in such excesses with impunity
when a feeble child in one of our cities would be destroyed by them”


The eruption is so small as not to be observed
It is not my object to treat of eruptions in general
with minuteness but to give the general principles of
treatment food etc.
There are many eruptions met with [illegible]
children which cannot be classed or be found described
There is an affection of children appearing
within the weak, which is not described at all. In three
or 4 days after birth elevations of the true skin not of the cuticle upon the 
hands and arms & various parts of the body containing pus and [illegible] or as large, some of them as ½ dollar 
high [illegible] [fever] I have seen but few
cases they were mortal.  The books in such affections
direct bark & tonics. The practice proved
injurious. The disease as I have seen it has been 
inflammatory and required antiphlogistic treatment
It may however be typhoid sometimes perhaps.
If so it should be treated accordingly. I have seen but 3 or 4 
cases. There were inflammatory. I prescribed in all these cases & from an analogy more fancied
than real, between this & [illegible]
Eruptions are generally caused by 
improper quantity or quality of diet. The remedies
frequently get the credit of curing the disease when 
the amended diet cured the patient
Oily & highly stimulating food should be 
avoided. All the nuts one of the worst is the pea nut


21
Strophilus candidus
In this species of strophilus the papulae are larger then 
in any other of the genus. They are not surrounded with 
an inflamed base. They are very distinct smooth and shining & appear
like little pearls under the skin of about 
the size of half a millet seed. They may continue 
for some time. A close examination is necessary for
their detection. They appear on the bosom & chest
They may accompany other diseases
I have seen them accompany cholera infantum in the 
last stages & considered a fatal symptom
[illegible] dyspeptic consumption a dangerous
symptom The chest appearing to be covered
with an oil surface, looking like particles 
of water I have seen persons attempt to wipe 
them off as if water had been sprinkled on the part
Belonging to p 18 ½
Apples pears and fruits etc.
Cleanliness also shd be strictly practised [enjoined]
robust children, much in the open air, may have eruptions
about the face mouth etc. with impunity
when with the same diet delicate children, much confined, would have
fatal eruptions, diarrhoea cholera infantum etc. 


The appearance of the [former] [have] [illegible]
and the parents are often much alarmed. The disease is not
dangerous however, & leaves no scar behind
A scab is formed & the margin continues to suppurate
and matter forms underneath
“There is a thin [illegible] discharge from the part & the scab
comes off leaving a thing pellucid [illegible]” The disease continues
& this film is thrown off & the process is repeated 2 or 3 times 
It is sometimes occasioned by dentition
sometimes it is an effort of the system caused by 
disturbance in the al. can. “A prejudice sometimes prevails
with respect to this disease that it is an effort of nature 
& ought not to be checked It is a loathsome disease extremely 
unpleasant to both to the patient and the nurse & if allowed to continue
some time it would not be safe to stop the evacuation, at 
least without keeping the bowels open” 
Some [Phys.] recommend partic [illegible]
as specifics. Cal. or blue pill occasionally 
may be advantageous
Buckthorn has been much celebrated in 
this and other eruptions It is drastic& hydragogue
It is perhaps milder in form of syrup. Many families
keep it. Half a dozen berries will operate
If there is much plethora, the
neutral salts may be given Magnesia also both
for the indication & as a corrector
I have known the muriatic ether
much prescribed, but have not used it much
myself, substituting for it mur. ac. as below 


22
Crusta Lactea
This is the [illegible] larvata of Bateman
It appears on the lips, forehead & scalp in small pustules
yielding pus, which eventually coalesce & form large loose
scabs & perhaps extend over the whole face, down the neck
and over the whole body. This eruption never leaves a scar
behind it however long it may have continued. The skin is left smooth It is
more unpleasant than dangerous, as the children affected 
with it are fleshy and otherwise health. When it has
continued a considerable period of time, we must be 
cautious of checking it, as it is like a habitual discharge
from an ulcer
Treatment It is very common to give
laxatives, such as syrup of buckthorn, neutral salts, magnesia etc.
The sweet spirits of sea salt (diluted muriatic 
ether) is a very popular remedy. IT is given in doses of
from 5 to 10 drops, diluted with water & repeated 2 or 3 
times a day. I have seen this medicine given in 
hundreds of cases & am inclined to think it sometimes 
of service. It, at least give satisfaction to the parents 
& does no injury. If there is great irritability give 2 or 3 gr.
of cal. with chalk. In cases where I have thought proper 
to remove the eruption. I have given the muriatic
acid instead of ether, prepared in the following manner
Rx mur. ac. zi alcohol zi Give [3] drops night & morning
diluted with water


make [oxyg.] oint. by adding the nit. ac. to
lard until decomposition ceases, and the resulting
ointment is tasteless. It has about the consistence
of wax. Some add sulphuric acid but this is 
not decomposed & is acrid
Sometimes the ointments seem to irritate & 
then we use [illegible] The best is the sulph. pot.
zi to a porter bottle of water. Sulph. of soda
does not materially differ, but it is unpleasant smelling 
like bilge water.
In different cases apparently similar I have tried ointment
& succeeded in one, but failed in another, & succeeded 
by waste
I was led to adopt the use of sulphuret of
potash from the analogy between its solution & the water [of]
sulphur springs
“We may with advantage make application
of dry powders arrow root roasted flower hair
powder taking care to give a cathartic when we check
the discharge. We should pay particular attention to the diet
both of the child and mother making the food weak & [simple]
Laxatives will commonly be removed; a little magnesia
& sulphur so as to move the bowels once or twice a day
“A discharge like this may be checked with 
safety at the commencement, but when it has become habitual
it should not be stopped unless a drain is made
& kept open in another part.”


23
For this eruption I have found the oxygenated 
ointment, very efficacious in removing the scabs & healing
the sores It is always safe if well prepared. ‘It is made
by decomposing nitric acid with
lard’ Perhaps the [citric] ointment (nitrate of mercury
with lard) may be equally efficacious, but it is less
safe. A good ointment may be made by mixing
calomel zii with simple cerate zi or mutton suet zi
The sulphuret of potash is one of the best remedies 
for this & other similar affections Dissolve zii in a
pint of water & give a table spoonful night and morning
also let the part affected be washed with a solution of 
twice the strength “It sometimes [illegible] two or three days and [illegible] [illegible]” Some prefer sulphuret of soda
sulphuret of lime would also be equally efficacious
Such solutions small like bilge water & are analogous to the water of sulphur 
springs I have sometimes used the sulphuret of pot.
as an unguent. Sometimes liquid applications & 
sometimes unguents will succeed best, & if one fails we
may try the other “Calomel ointment may be applied
about the edges”
If the eruption should suddenly dry up 
& fever ensue, a dose of calomel should be given & be followed
by a few drops of antimonial wine 3 or 4 times a day 
or a small quantity of ipecac. White hellebore may be
given
Sometimes the eruption degenerates to a phagedenic
ulcer. In such cases I have used charcoal 
eternally also a variety of poultices. I have seen much 



The const. irr. may expend itself upon the skin
or upon the gland. syst. or upon the al. can. etc.
We must be cautious about suspending
them suddenly
“It is important in all kinds of eruptions
to keep the skin clean and soft & to effect this
we should prescribe the warm or tepid bath, every day or 
2 or 3 times a week. It removes itching and irritation, is always 
safe and almost always beneficial”
May be caused by teething or by food etc.
Such things often withstand various remedies & 
hence are prescribed for very empirically


24
benefit derived from the application of roasted flour. It 
absorbs moisture & excludes the air
Eruptions attendant upon Teething
Children are very commonly affected with eruptions 
when teething. They generally put on the appearance of a
fine rash, but sometimes consist of distinct pustules containing
matter
As they are symptomatic merely, they require
no particular attention to be paid to them & will 
disappear when the teeth get through. The worst consequences
might result from their sudden suppression; as
if this mode of action by which the system relieves itself
from the irritation of the teeth, be interrupted, there is 
great danger that the system will relieve itself by 
morbid action of the brain, or other parts more essential to life
Eruption resembling the itch
Another kind of eruption appears on children of one or 
two years of age. It sonsists of distinct pustules like
those of chicken pock, which form a scab, continue to 
inflame about the edges & contain a watery fluid
It usually makes its appearance in summer & if not cured
disappears spontaneously at the commencement of 
cold weather
It has often been mistaken for the itch, and 
attempted to be cured by [?dock] root, but without success.
The sulphuret of potash used as above is a good remedy 


The tepid bath is apt to be neglected but shd not
Dock root often fails in this. It is
often very successful in children’s eruptions. It is
a very old remedy (centuries) Sometimes goes
into oblivion & is again revived
Prof. Smith thought most highly of R. patientie 
6 feet high in gardens. Woodville mentions
R [aquaticus] I know not that either is better than 
our [common] [illegible] I prefer the [Robtusifoli??] or [horserock]
It is acrid and acts well when ext. [applied]
and is good int. like rhub.
R. crispus also has about the same properties but is
milder. R. sanguinea is kept by many for it is
as a specific for cutaneous eruptions. called also 
jaundice root & used in jaundice I have
used them all and cultivated than all The leaves
of the R. sanguinea have all red veins.
You will often have such cuticles
exhibited to you in families and be [illegible] of about
them. Hence the importance of a knowledge of their prop.
I have never known them in any but
the children of [foreigners] I am inclined to 
think the taint may be dormant.
The eruption at first resembles what
is called “horn pock” “sometimes resemble a [illegible]” The nurse was changed 
& though the new one was
health yet the ulcer appeared on her nipple


25
I think this kind of eruption might be cured by diet
and the warm both. In all cutaneous affections the 
warm bath is very important to relieve the skin
from every thing that may obstruct perspiration
Eruptions & other irritations of
the skin translate action from the viscera. Where irritated
action exists in the viscera they are symptomatic
Gutta rosea of drunkards is an instance of translation of 
action from the liver “When a cutaneous eruption appears
we may generally apprehend that the al. canal is disordered”
I cannot too strongly enforce attention 
to diet. Nothing will avail without it
Venereal Eruptions
These appear infants born of parents tainted with 
syphilis, though they may have no symptoms of it at the
time of the birth of the child. Some physicians are of opinion 
that this child may inherit the disease from its ancestor 
the parents having been apparently free.
The eruption appears in smooth hard, circumscribed 
elevations of the skin of about half the size of a 
pea 7 resembling a wart before it has seeds. They continue
to increase slowly in size for two or three weeks, & become
soft, containing a watery fluid in [honey] like substance Subsequently the skin
gets rubbed off & leaves an ulcer with ragged edges & sometimes resembling a chancre which
is very difficult to cure. I have known one instance
in which the ulcer was communicated from the child to 
the breast of the nurse. Children affected with this 


Eruptions sometimes depend upon morbid state
of the liver analogous to gutta rosea of drunkards
Prescribe to the liver
“The disease often proves very obstinate”
Mercury does not seem to act as in the
primary disease
Corr. sub. given in this way is as
safe as any other article
The bowels should be kept free
“I think the sublimate acts more on the skin & is therefore
preferable to other mercurials”
The plantain was once celebrated for the cure
of cut. aff.
I have known the plaintain in this
way apparently cure after mercurials had failed
Still the mercury might have prepared the system
The plantain is an old English remedy for bites of spiders etc.
It is treated of by Woodville & [Willan] It has as little acrimony 
I have some confidence in its efficacy. There is an old story about a snake & [spider]
I have known nondiscript eruption
which had resisted the prescription of several phys.
cured finally by diet & change of air



26
complaint have a pale & bloated appearance & the powers of
life are feeble
Treatment. Change the nurse if derived from her
Give corr. sub. in doses of 1/30 or 1/40 of a gr. Give the blue
pill in moderate quantities but it subl. is better Give the tepid bath. Try
the preparations of iron, such as the mur. ferri, or 
tartr. ferr. or the alkaline solution of iron. This complaint
is not so easily cured as the primary [illegible]. Sometimes
it will resist the operation of mercurials & all 
the treatment for scrofula. In this case send the patient
into the country & try simple vegetable articles especially 
the expressed juice of the plantain (plantago major) externally
and internally. It is a popular remedy for poison & is apparently 
valuable. I have known patients cured by the use 
of this, and of the air of the country. Still I think its 
main virtue to consist in its bland & mucilaginous quality
[In these cases the whole lymphatic system is
disordered & deobstruents are indicated. Now the expressed
juice of most green vegetables id deobstruent. For instance 
the farmers make use of green rye in the spring
for this purpose] Perhaps the expressed juice of the green
plantain is deobstruent


Infantile Erysipelas is an improper name
vide Gray [illegible] of Erysipelas
Good’s is an entirely different disease and his account 
will completely [illegible] Corresponds perhaps to the 
rose of the W.F. Goods account of the rash may do pretty well
The infantile erysipelas of Europe described in 
the books is a different thing # 
Resembles shingles this is accompanied with fever 
The primary affection is of the al. can. therefore
the attention is not to be directed exclusively to the skin
I commences with [illegible] [illegible] you are to prescribe
to the fever [illegible]
This disease is distinguished by the eruption 
resembling a rose in the shading off of the colour from 
a dark rose to a light colour & in the concentric circles As I have seen the disease
the rash has appeared in patches about the [illegible] thighs 
principally & the local affection gave no [illegible] and was
trifling while the constitutional fever was severe and dangerous.
The fever if not broken up in the commencement will
resemble a severe case of [autumnal] remittent
I have found no satisfactory account
of the disease in the books, not even in the W. P. writers. I have
however been informed a conversation with W. Indians that the 
rose is one of their most severe and dangerous infantile diseases
fatal in a week
and is treated by a vigorous administration of calomel
# I have never seen the infantile erysipelas described as occurring
in the European lying in hospitals contagious & terminating 
in gangrene I have seen common erysipelas upon infants 
however


27
Infantile Erysipelas
The classification of this disease id doubtful. It answers tolerably 
well to the exanthesis roseola of Good “but [illegible] febrile” there is no species in 
Bateman & Willan which corresponds to it
Efflorescence in blushing patches, gradually deepening
to a “dark” rose colour, mostly circular or oval, alternately
fading & growing brighter chiefly on the legs with irregular
appearance somewhat like concentric circles if the patch is not circular the general circumference
This is a disease of rare occurrence with us
I have met with three or four cases.
It is a severe and dangerous disease, apparently 
the same with the dangerous rose of the W.F.
As it appears with us it is very different from 
the erys. that described by European writers & which is sometimes 
epidemic in their hospitals. In children in this country
it is generally a disease sympathetic with a morbid state
of the bowel
The elevation of the skin is less than in erys. of 
adults the discoloration less deep in colour & the skin though
a little tumefied is as smooth to the touch as if not
diseased In the cases to which I just alluded, the erysipelas
began upon the thighs & extended all over the legs. It was accompanied
with considerable fever & a hot dry skin The colour of the 
efflorescence was purplish rather than red ‘We rarely see
watery or bloody vesicles, as in other erysipelas’ I evacuated 
the bowels thoroughly with calomel (for the sake of the excitement
rather than the evacuation) & rubbed the part affected 


The fever will much resemble that of infantile
remittent
“The spots are in patches from the size of a
dollar to 5 or 6 times as large They are shaded in concentric
circles from purple in the center to a lighter colour”
“If the disease is not checked there will be 
increase of fever, constipation and tumefaction of the
bowels irritation of the stomach affection of the brain, [illegible]
death”
Administer a full dose of calomel in the first place
and repeat it once or twice. Work off the cal. with other 
cathartics. The secretion excited by the calomel is
what we want. The cathar. subsequently given bring away 
Antimony in small quant. & nitre may be given
until the liver is subdued
“When the febrile symptoms run high
pulse tense, tongue furred skin hot it is a very dangerous
practice to apply discutients applications to the eternal
affection Acetate of lead applied externally will probably 
translate the disease to the bowels”
“Treatment I first give colored in full
doses to alter the secretions to change
excitement and promote evacuation, but do not depend
upon it as a cathartic I then give [illegible] or [illegible] & [illegible]
etc. to move the bowels I afterwards use the absorbants
or alkalies, or ant. or iped. in small doses, as the case
may require


28
It is attended with constipation & tumefaction
& [illegible] of the bowels; with hiccup & severe fever, & may 
terminate fatally with severe coma
“Pulse small & frequent child dies usually 
on the 5th or 6th day”
“Dr Dewers says that in the cases he has
seen the disease was not local but would spread rapidly 
over the body disappearing in one spot without leaving a trace
behind it & breaking out in an other & perhaps a remote
part thus changing from one end of the body to the other”
Treatment. “Evacuate the stomach with an emetic, as
ipecac” Clear the bowels thoroughly with cathartics, for the
sake of the impression on the system. Give calomel in a 
dose of from 5 to 10 grs. If it do not operate within three
or four hours repeat the dose. If necessary , work off the
calomel with senna (or scammony?) adding aromatics
if the stomach is irritable or with castor oil if the senna
fails using also some laxative injection & the warm bath
to assist. Then keep the bowels open with blue pill & 
“use some mild diaphoretic as aqua amm.” or  give antimony
from from 1/20 to 1/16 of a grain
Pay little regard to the eruption and direct
your attention to the bowels I have letters from physicians
who have followed my directions & treated the disease not as a 
local one but with cathartics which testify the complete success
of this plan of treatment. In the W.F. also where the


“As palliatives after a strong impression has
been made on the bowels by calomel, we may give sweet 
spirits of nitre, aqua ammoniae etc.”
I have tried various either applic. without benefit
I have
“In those cases when the treatment wa local only 
the patients have uniformly died. I have not lost a single
case to which I was called with commencement. I have
conversed upon this subject with medical [illegible] out from
the W.F. and find that the practice there coincide with
mine”
“When called to cases of some standing I have endeavoured 
to arrest the progress of the disease by a blister
as [illegible] in gangrene & in the erysipelas of adults. The 
disease would extend beyond the blister just as if none
had been applied”
There is an erysip. affection which occurs about the
head of children which resembles that of adults which 
I have treated with lead water


29
disease is frequent it is treated by the physician with 
calomel & cathartics. They give calomel 10 gr. & repeat
it in 5 gr. doses until 20 gr. have been given
I once saw a child with a swelling on one
ankle supposed to have been produced by the sting of a bee or bite 
of a spider, which had resisted the operation of poultices & lead
water. I gave cathartics but they did not operate, & the child
finally died
External applications of any activity
should not be used, Still it may be necessary to apply something
in order to satisfy the parents. The best will be roasted
four “dried [illegible] [illegible]. Warm bathing will be very useful. If treated
with lead water & cathartics not used, probably every case 
would be fatal. I have blistered in imitation of Dr
Physick, but never with any advantage
‘If the disease be followed by diarrhoea
give absorbents & aromatics such as compd powd chalk or white
decoction. If followed by weak pulse etc. give tonics’
I have not lost a case when called early 
‘This disease is supposed by some to be hereditary 
I have seen it affect infants on the scalp when it appeared to 
be a local affection merely In cases of this kind I have used
lead water with [illegible] continualy advantage & without any evil consequences’
Cathartics however should be more or less employed
in conjunction “afterward aromatics or tonics as the case may require”
‘It sometimes affects the brain’


[illegible] a more [illegible] or [illegible] intertrigo an attenuation
& sometimes abrasion of the cuticle. The vessels forming
the cuticle are diseased and the skin is formed
in an imperfect manner It occurs also about the
nates, [illegible] etc. where the skin folds upon itself & the
air is excluded sometimes an acrid discharge Cullen
thought it a very thematic affection. The skin looks
like a new skin upon these parts. it arises from 
want of cleanliness & from confinement. The stomach
may in a state of indigestion secrete an acid and the
skin may secrete an acid. Exercise cleanliness
treatment in general of eruptive disease 
When [illegible] flax they would
burn a rag and put it in an axe & rub their finger
on to harden the skin when chafed. A scorched rag is
beneficial & use absorbent powders first nit. [illegible]
might be used keep dry the parts
Nurses apply “powder post” which is made by [worms]
Sometimes it is a vesicular eruption
which upon the head is called [farrigo] & in some situations
is called ring worm
To the [illegible] or intertrigo occurring in 
various parts the nurses sometimes apply the membrane
from suet which is smooth keep off the air, prevents farther
chafing and does well. The absorbent powders as starch
alabaster etc. do well


30
Sore Ears
This forms a very important subject in treating of the
diseases of children. Nature has chosen the part behind the
ear for eliminating irritation from the system. Under this
head I shall speak of purulent discharges from the cavities 
of the ears & nose
Slight blisters and ulcerations behind
the ears of infants are very common & are in most cases, so mild 
as merely to require washing with cold water weak soap
suds & with cold water, & being covered with a scorched rag
or with roasted flour, to prevent irritation from the cap
Frequently the discharge is acrid & excoriates
the adjacent skin. Often a miliary eruption at the part
commences the disease & is followed by excoriation 
Affections of the brain are sometimes relieved
by a discharge from this part. The discharge is very important 
to children in time of teething & when affected
with bowel complaints.
If suddenly stopped fever may follow
with full pulse, tense constipated bowels & fulness of the fontanelles &
“often nearly all the symptoms of hydrocephalus”
cold extremities Blisters behind the ears will generally 
restore the child to health
When an infant is suddenly attacked with 
symptoms of hydrocephalus [illegible] disease, enquire whether it has had sore ears which have 
suddenly dried up, & if so, apply blisters behind 
the ears, for without them nothing perhaps will cure
the new complaint. The same is true of old sore legs stopping of the [illegible] & other charges
The theory of this, in all such cases, is the necessity, not 



The quantity of evacuation will not amount perhaps 
to more than a teaspoonful & the fullness of the fontanelles
[rain] in the head & plethora is not owing to the quantity of
fluid. The same plethora, pain in the head etc. will 
result from cessation of catamena which discharges will 
not amount to more than a table spoonful
So you may bleed to the amount of pounds 
in cessation of a slight discharge for an old sore leg
with out relief. while if you start the ulcer again 
by [illegible] or [mustard] the symptoms will be relieved
Case of a man with ulcers on the legs of 10 to [20] years standing
discharge stopped [illegible] pleurisy & aff. of liver the
discharge restored by [illegible] blisters caustic etc. cure affected
Sulphate zinc 10 gr. to oz or 2 oz
may be applied Solution [illegible] sil. is one of the mildest application for irritated surfaces vide infra
Oxygenated [illegible] is mildest & 
less apt to become acrid Sometimes when the aff
is of an erysipelatous kind [illegible] relax the parts & 
are injurious
Change the nurse also if necessary
If the child is fed upon milk by hand, add perhaps
a little magnesia or lime water 
Similar affections may affect the 
cavity of the ear & the cavity of the nose. If the 
cavity of the ear is affected in this way & neglected ulceration 
is apt to take place & the small bones affected
causing deafness. First reject milk & water or
carb. soda etc. [illegible] Finally if these means fail use
stimulating injections myrrh finally [vit.] sil.
In the use of [illegible] sil. external began with 5 grs to the oz & increase if necessary 
to xv or xx to the oz


31
of the evacuation, as is generally said, but of the habitual
action of the system.
This affection sometimes degenerates into a very 
troublesome ulcer, extending down the neck, accompanied with 
much pain & yielding a discharge so acrid as to excoriate the 
skin wherever it touches it Deep sores will be formed
& the affection may terminate in gangrene & death
In such cases it may be proper to apply 
emollient poultices of bread & milk; to which may be added
poppy leaves, or pulverized stramonium seeds or ac. plum.
Powdered gypsum is one of the best applications Alabaster gypsum
is the finest kind Some apply red precipitate but gypsum is far better. Case in which this alone cured;
Another physician advised red precipitate The oxygenated ointment if well made is a smooth
dressing for them & is the best kind of ointment, where 
ointments do not disagree, as it sometimes the case. The 
bowels should be kept open with cal. or blue pill.
It will sometimes be necessary to correct
the milk of the nurse by administering magnesia & confining
her to a simple diet
Troublesome & sometimes fetid discharges 
on the internal surface
from the ear arising from a kind of eruption may follow this eruption & may cause deafness if neglected I have known also the 
cavity of the nostrils & the frontal sinuses affected in the 
same manner. A cure may 
be affected in either case by exciting the discharge behind
the ear though it may be necessary to keep it open for some time 
If this fails use (in addition?) milk & water Milk 2 part water 2 part lime water 1 part Tinct. of 
myrrh if the discharge is fetid & troublesome a teaspoonful to a gill, as an injection for the ear
Sol. nit. sil. 1 or 2 gr to oz. water? externally


Be very careful in watching the symptom Case of a 
young man who had had such a discharge for years 
checked by astringents [delirius] inflammatory fever
ertc. bled cathartics etc.
Porrigo galeata ([helvetea])
Cuticles below the scales dotted, shining
Said to be contagious. I have never happened to see it so
though I do not doubt the fact. I have never seen more
than one in a family have it
A very troublesome complaint The 
hair becomes pale, perhaps the roots are affected in which 
case mercury is indicated.
Salivation seems to do no good I have 
seen it practised without any benefit
Recent cases I have cured very speedily 
with oxyg. ointment. Any smooth substance applied
to the part & excluding the air, will often cure as for in stance
a bladder, or the membrane of suet what is useful
also for [fret] Poultices do well, whether upon this principle
or moisture changing secretion
When a student I recollect there appeared 
a strong recommendation of poultices A physician of my 
acquaintance prescribed a poultice & left his patient. It adhered
the hair grew into it and the hard
crust formed a helmet indeed. It [was] a long time a
period of week, before it was removed When it came off
however, the disease was removed!



32
Tinea Capitis. Scald Head porrigo
This is a local affection & yet much influenced by diet. Sometimes
however it affects the system, or is sympathetic of a general affection 
of the system.
The disease consists of scaly eruptions, eventually 
covering the head with a hard & generally brownish
coloured crust. The hair often comes off.
Cleanliness holds of course the first place
in the list of remedies; the head should be carefully shaved 
and washed repeatedly with soap and water. Perhaps as
successful a mode of treatment as any will be to shave the
head closely and apply a bladder or affect skin in close contact with the
skin. It excludes the air. Sulphuret of potash zfs or ai to a porter bottle used as a 
wash & given internally tablespoonful 3 times a day has cured the complaint in a 
few days mercurials or corrosive sublimate will be useful, but do not always cure.
Sulph. prt. internally zii to lb i [illegible] ext zii to lb is [illegible]
The ueast poultice is good, but care should
be taken that it do not become dry on the head, which should be 
first shaved. The oxygenated and the citrine ointments
have been found useful, as had also the tar ointment which 
is made as follows Rx tar ziv wax zfs sulphur zi or is
Mercurial cathartics should be given from 
the first and particular attention paid to the diet. # vide last par.
The practice in this complaint has been 
quite empirical & a great variety of remedies, have been 
popular. Veratrum viride & v. albus & [apocynum] [androsaem??] 
olium have used for external washes. Syrup of 
buckthorn is recommended as a cathartic. Muriatic acid


Lunar caustic about 6 grs. to zi of water (rain water)
well water may decompose it
Decoction of cocculus indica, is given
internally & externally.
Cal. zii al burnt zfs red lead zfs z6 zifs spermaceti cerate head shaved & washed with soap sude every
night and afterwards apply this ointment. It is given by 
[illegible] & Bates [illegible] & called
Diet must be attended to 
Terebinthinate ointment as tar ointment
Tar ointment is made of tar and lard or tar & 
simple cerate
There is no difficulty in the diagnosis of the
disease. You will be called to prescribe for scalled head
and you will find that the nurses have not mistaken the
disease. It begins with small pustules the matter
[illegible] which is acrid and soon forms a scab over the whole
head.
The treatment must be principally local. But
mercury may be given occasionally. I have not derived much 
benefit from the common mercurial ointment. Citrine ointment
is good however. Also cal zif lard zi


33
has been used 3 or 4 drops in a wine glass of water
Finally the sorts of the various species of dock (rumex patientia, crispa
obtusifolia, sanguinea, aquatica etc.) have been much used
All the species have about the same properties, being acrid
purgative etc. They are given internally as cathartics, & 
externally applied, made for instance into an ointment, by 
pounding up the fresh root with lard. The following
is a recipe Rx yellow resin zii
best ale lb i finest flour ziii mix the all & flour thoroughly 
together & add them gradually to the melted resin.
# The tepid bath may be used when this is used always
take care to have a supply both of hot and cold water
in order to keep up the proper temperature. Ipecac may be 
administered to equalize excitement in some cases, & as a 
valuable substitute for this article we can use the
root of asclepia, tuberosa, which is expectorant, diaphoretic 
and laxative.
“Vary the remedies according to their affect
soften use decoct. rumex particularly r. obtusifol. 
called horse dock. It at firs increase, the 
irritation & secretion. Use it externally & internally”


The excitement of the al. can. is affected also of
the nervous system
Various cutaneous aff. different kinds also of
local inflammation, or erysipelatous phlegmous gangrenous 
scrofulous the inflammation varying according to the 
constitution scrofulous gangrenous
I have frequently heard Pres. Dwight
speak of the pain he experienced in cutting his wisdom teeth
suffered extreme pain for a whole summer
She did not appear to me to look like a person in the consumption I was puzzled [illegible] [illegible] I looked into her throat and mouth
and found she was cutting r wisdom teeth
# The irritation may continue for mouths, from 
the pressure upon the gum
Those who commence cutting teeth at 10 mo.
to a year or even later do not necessarily suffer more
Delicate & scrofulous children suffer more


34
Dentition
Among the causes of infantile diseases no one more
claims the attention of the physician than dentition. The bowels
and the nervous system are always more or less affected by it
& to this cause we are frequently to refer affections of the lungs
of the brain, of the ear, of the skin, of the glands, & of the cellular
tissue in general. On this subject there is however a difference
of opinion, for it is said by many medical men that children which are
healthy # well teeth with as much ease as adults. Allowing
for the peculiar irritability of [illegible], no doubt they do,
but in granting this we concede nothing, for adults often
suffer extremely from dentition. I well recollect the case
of a Mrs Waters perhaps about 20 or 21 a married woman and the mother of 
said to have a [illegible]
several children, who was supposed to be in the last stage 
a good deal of cough etc. had raised a little blood
on consumption & upon examination & found was cutting
the four wisdom teeth. The gums were divided & 
antispasmodics administered, when she recovered perfectly.
# Case of Mrs Purcell’s child had been sick
with diarrhoea and fever for some time a flush of fever 
coming on every day. I had previously extracted defective teeth
from the [illegible] mouth. I now looked into the mouth lanced
the gum over a double tooth gave no remedies
The period of dentition commences at different
ages times in different children, varying from the fourth to the sixteenth
mouth, but most commonly in 
the sixth. The two central incisors of the lower jaw appear
about the sixth month and are followed in about a month
or six weeks by the corresponding teeth of the upper jaw.


very [illegible] [illegible]
[illegible] cases I have known a double tooth cut
first in others an eye tooth in others all the teeth at once
You must always examine to see what teeth are
cutting You will perceive the gum swollen and harder 
Some children are born with teeth but
such teeth re merely attached to the gum and are useless
and should be removed
Sometimes there is too much anxiety about
dentition generally however not enough Case of a 
child mother called me insisted upon
# irregular distributions of temperature are [illegible]
[illegible] hot 5 [illegible] cold


35
Next come the inferior lateral incisors & after these the corresponding
teeth above About the twelfth or fifteenth or 20th month
appear the anterior molares & are soon succeeded by the 
cuspidati those of each kind in the lower jaw cutting
through before those in the upper. Next we have the posterior
molares. The last molar teeth are not found in the child & hence
their name, dentis sapientiae. They appear from the 18th to the
25th year.
The above is the order in which the teeth 
commonly appear, but they often come irregularly, sometimes
the lateral incisores, sometimes the molares, & in
a few rare instances the cuspidati appearing [illegible]
Some persons never have more than two incisores in each jaw
Occasionally we meet with families who are said to 
be destitute of teeth. I have known a family from Charleston,
who had this peculiarity. The fact however is in such 
cases that the teeth exist but not rise above the level
of the gums, so that they are not ordinarily seen 
Such teeth have this advantage, that they are not subject
to decay & are also very serviceable.
Whenever between the fourth and the eighth
2nd year? month symptoms of irritation exist, the cause of which is
not obvious, the state of the teeth must be examined. The 
symptoms of difficult dentition are fretfulness 
inclination to bit hard substances, putting the fingers into
the mouth, slavering, starting in sleep eruptions about
the face & on the scalp, flushings in the cheeks. # hot head


pupils contracted sometimes dilated sometimes
losing their brilliancy
In delicate children the eff. will be more
chronic & in vigorous more acute
The system relieves itself often by evacuation 
and this is considered often a good symptom as [illegible]
there is a great flow of saliva. The system relieves itself
by diarrh. by salivation by sweating [illegible]
by every mode of equalizing excitement which 
is the great principles on fevers & indeed in most diseases


36
and cold feet, irregular paroxysms of fever, remitting
fever vomiting diarrhoea irregular & green stools wine
small in quantity & voided with pain or in large quantities 
and of a pale colour bloating of the hand feet and 
face contracted pupils. All the symptoms indeed of extreme irritation
may be met with & we likewise find in many 
cases a tendency to phlegmonous inflammation suppuration in various parts of the
body particularly in the ear. Case of a child who was
thought to have an affection of the brain. A tumour was
found under the arm.
Sometimes dentition is accompanied with 
phlegmonous local inflammations in different parts of the 
body & suppuration of the glands about the ar by which 
relief is afforded
Ricketty children cut their teeth more
slowly than others but not in general with greater difficulty.


The child must be held, and the fingers
keep in the mouth to keep it off the tongue
# The guard being made with a spring, so that when 
pressed upon the guard will yield and permit the
lancet to descend (in the slit of the guard)


37
Treatment. The first and most important indication is 
to divide the gums with a gum lancet or other convenient instrument.
The operation is not usually painful the child will 
even press against the edge of the lancet. The relief is often immediate and permanent
Some relief may indeed be afforded by rubbing the gums with 
a hard & polised substance & by giving the child something
of the same kind to bit, but the most effectual relief will be 
afforded by the lancet. The chief difficulty in the performance
of the operation consists in confining the child. It
may be done while the child is asleep & often without
waking it. We must also be cautious not to cut the tongue
To prevent this it would be better to make gum lancets with 
a guard # For the double teeth two incisors
should be made & it may be necessary to make a transverse 
one in order to divide a band of a sort of ligamentory
substance which confines the tooth.
It is sometimes objected to cutting the gums
in particular instances that, if it is done too early, the
cicatrix formed by the healing of the incision will subsequently 
render it more difficult for the teeth to push themselves through
This is not true for the cicatrix though apparently harder [illegible]
less vitality in it than a part which has not been wounded and will be more easily broken through
Solution of continuity is more easily made by disease in a cicatrix
than in a part which has not been wounded vide J. Hunger. It is a 
common maxim that an old scar is apt to break out in to a sore
The gums should be divided as often
as there are any symptoms of irritation, until the teeth 



Some other diseased action may exist in the
system, and the irritation of the teeth be superadded
the lancing will only relieve the latter
# For the gums having been exposed for a long
time to irritation because [illegible], and perhaps
ulcerated and are kept irritated by contact with 
the hard tooth


38
get through I have repeated the operation three or four 
times upon the same teeth. In some cases however cutting
the gums relieves the symptoms only in part. Indeed the irritation
sometimes continues after the teeth get through # “use astringents”
If any disease from the causes attacks the child
during the period of dentition it will be very important to 
remove all irritation from the latter source, for otherwise
all the symptoms may be aggravated & a disease be rendered
mortal which would otherwise have been mild.
In children of a vigorous constitution dentition
is often accompanied with inflammatory symptoms which require 
an antiphlogistic plan of treatment. Lancing the gums
will then be useful as local bleeding & it may even be advisable
to bleed from the arm though a few leeches behind the ear
are preferable.
It must not be forgotten that in 
infants, the bowels afford a great outlet to diseased action
and to irritation: hence the frequent occurrence of a spontaneous
diarrhoea. If the patient is costive or if it has a 
diarrhoea, a dose of calomel should be administered & if
the bowels are soluble a milder mercurial, as blue pill
may be given. During the whole period of dentition the
bowels should be kept open by such cathartics as the state of 
the system may indicate, such as magnesia, rhubarb etc. adding
aromatics if the system is relaxed and debilitated & chalk
if there is acidity
If a diarrhoea suddenly stops and
vomiting supervenes, externally irritant to the [illegible] [surface] generally, injections, calomel


The skin shd be kept moist for diaphoresis
is one of the most powerful means of equalising excitement etc.
If there is much perspiration you may 
depend upon op. alone but whenever there is much 
[unequal] excitement opium alone will not do well and
ipecac shd be combined with it in small doses
# Also by drafts to the [illegible], by local irritants 
to the skin generally also keep the bowels from 
remembering that there is no outlet to the brain 



39
and the warm bath are to be used, as has already
been mentioned under the head of diarrhoea
Another & a powerful mode of equalizing excitement & relieving 
irritation is by diaphoresis. For this use the warm bath & 
small doses of ipecac & opium or of antimony and opium.
Opium will always be useful to allay irritation & particularly 
if combined with ipecac or antimony, & always safe when 
there is no determination to the head
Small blisters behind the ears relieve the 
symptoms of dentition & prevent the disease from terminating 
in hydrocephalus. # If these cannot be kept behind the ears
mercurial ointment or cantharides may be applied to the 
same part. Nervines may be employed either with our 
without ipecac
During dentition exposure to dampness & 
to currents of air should be carefully avoided & the patient
should be kept warm


X summer & autumnal epidemic
Indeed the effects of it sometimes continue through 
the winter
The desire often resembles spasmodic
cholera in the premonitory diarrhoea & the sudden
collapse 


40
Cholera Infantum
This disease appears in New Haven in the month of July 
August September & October. It rarely commences until 
the latter part of July & in October there are few cases except
those which have commenced in one [illegible] other mouths & continued
until this. Indeed cases are sometimes prolonged till 
the middle of November
Symptoms. It begins in various ways; most commonly 
with diarrhoea, which may continue for days & 
even weeks without any very alarming symptoms; At other 
times times with violent vomiting & purging accompanied with high
fever.
The discharges from the bowels very much in their
usually [illegible] from natural colour [illegible] [irritated] [secretion]
appearance. Sometimes they are yellow, brown or green, sometimes 
in small quantities & slimy and bloody & at others in 
large quantities & watery, smelling like water in which 
putrid meat has been washed. Worms likewise may be
found in all these various sorts of discharges “dead in the advanced stages”
The disease is usually accompanied with great
restlessness & often with severe pain, which increases
by paroxysms at intervals of from 
fifteen minutes to two hours
The pulse is usually quick and weak, the
head hot and the extremities cold. The fever is ordinarily remittent
but the exacerbations are frequently quite irregular
The disease is attended with thirst often [illegible]
and after drinking the child vomits.
The eyes often appear languid and hollow  


During the whole progress of the disease [volvulus] may 
occur Be on the look out for it
“The termination of this disease in hydrocephalus 
I have reason to think is more rare than is commonly 
supposed. Many cases of this kind occurring in my 
practice, I have reason to believe were cases of volvulus
Or varying from cholera morbus of [illegible] [remittent]
bilious fever sometimes putting in the form of cholera of [illegible]
at others that of remittent bilious fever


41
while in other cases they may have an unnatural
brightness as in pulmonary consumption indication a high
degree of mental [illegible] excitement “of bad symptoms” Sometimes the eyes are half
open during sleep, as is indeed the case in various bowel complaints 
of children when severe we often find the diseased action 
translated from the bowels to the head and terminating in 
hydrocephalus. Volvulus also may be another termination.
Sometimes the vomiting ceases
for several days and then returns, while the diarrhoea
continues the whole time
Duration As to the duration of the disease, it may 
be very rapid in its progress & terminate fatally in forty eight hours, or continue for
months, & the symptoms may vary very much during the 
progress of the complaint. A damp hot atmosphere will aggravate 
all the symptoms, while cool weather with the wind 
from the northwest will mitigate them. In different
seasons also cholera infantum will have symptoms peculiar
to the year, varying in this respect like other epidemics
Finally when it proves mortal, the child is
carried off in convulsions, or is worm out with emaciation 
& dies with aphthae while in some cases death is ushered in by hydrocephalus,
volvulus & other diseases
Causes. We may consider the cholera infantum 
as an epidemic sometimes an endemic confined to a particular season of the year
analogous (in its grade of action) to the cholera morbus o f
adult “This disease is perhaps most analogous to a remittent
bilious fever varied by the peculiarities of the 


[illegible] [illegible] will see in [Jackson] all that can be said in 
[favour] of the opinion. The very fact that it is often [illlegible]
disproves the opinion besides the fact that the disease does
not occur at all seasons during the period of dentition 
The disease is affected by the state of the atmosphere
being much aggravated by a damp state of the air 
always minded by a cool bracing northeast wind
The kind and gentle excitement produced by 
nursing is important in chronic disease
“Children should not be weaned till dentition is complete or till
1 ½ years & in the fall”


42
infantile constitution”
Dentition has been considered by some as the 
cause of cholera infantum but to this opinion I cannot assent thought it is held by Dr Jackson & many of our most respectable physicians
Dentition may indeed be an exciting cause; it often aggravates
all the symptoms & accelerates the fatal termination 
yet in the winter spring & months it does not produce the disease of
not unfrequently children are affected with cholera infantum
without any appearance of dentition
Worms sometimes make their appearance during 
the progress of the disease but they cannot be considered as
a [illegible] or cause of it. When they exist during the complaint
the irritation which they produce must be obviated by 
such anthelmintics as are not contraindicated by the state
of the system. “I think I have seen the [illegible] productive 
of unfavorable effects.”
The cholera infantum probably arises
from the same remote causes as the (cholera morbus) & the
bilious remitting fever of adults such as damp hot confined
air (which can be counteracted only by exercise in 
the open air) want of cleanliness & bad diet. Improper 
food may be both a remote & an exciting cause & the same
is true of a bad state of the atmosphere muggy or [illegible] of inequality of temperature & exposure to cold. The predisposing
cause produced by these remote ones is debility
Children weaned in the spring are mor apt
to have this complaint, & do not bear the disease 
so well as those at the breast. I would therefore advise
that in places where cholera infantum prevalent.
children should be weaned in the fall




43
Some consider malaria the cause
Like dysentery this is a disease translated from 
the surface to the first passages. The fever is of that kind which 
Sydenham calls febris introversa the action being of an 
irritated kind in general & rarely of an inflammatory 
Commencing at the skin & breaking up the balance of the
system by obstructing the perspiration the morbid action is
transferred to the mucous membrane of the intestines & involves
the liver, pancreas & all the glands immediately sympathizing 
with them.
Indications. The indications are
1st To evacuate the first passages; if this has not been already 
done by the disease itself
2ndly To translate action to the surface & in general to equalize 
excitement
3dly To excite healthy secretory action and regular peristaltic
motion of the bowels
4thly To avoid the causes of irritation and to remove irritation 
when it exists
5thly To restore the tone of the system & particularly of the
stomach and bowels
1st When the disease comes on like the
cholera morbus of adults, the stomach and bowels are sufficiently 
evaluated by the disease generally when the phys. is called and no evacuation s
are to be used. It is to be treated like cholera morbus
with aromatics as essence of peppermint, with Laudanum 


We must be careful not to prescribe for the [name]
of the disease nor necessarily pursue the plan of treatment
generally proper. Often you will find the patient so
much debilitated at first as to require stimulants & acrids
When we have the collapse stage and
a collapse may recur in any disease then the practice
of the nurses is correct in acting on the skin
Some recommend large doses of cal. [illegible] much 
smaller the [common] Dr Jackson recommends large doses
common in the commencement. Dr [illegible], 1 gr. doses
and salt & water I recommend cal. from 
1 to 10 gr Though sometimes small doses repeated may change
the secretion better than large, yet often a large dose 
will operate more kindly, then a small one [which] merely
irritates
“Dr Dewers recommends injections of salt & 
water 2 or 3 teaspoonfuls to a gill, instead of cathartics. Repeat
the injections till full catharsis is produced the morbid
action is changed, by translation of excitement from the stomach & 
small intestines [illegible] [illegible] with cal. ¼ gr. every [illegible] to alter secretion


44
with counterirritants, as mustard, horseradish & brandy on 
the epigastrium & abdomen with the tepid bath & with injections 
of starch and laudanum. But when it attacks
with a diarrhoea, accompanied with occasional vomiting
unless the constitution is very feeble constitution [illegible] extremely delicate the stomach should be evacuated
by ipecac and the bowels by calomel or blue pill
To vigorous patients & often give in the commencement 
six grains & would not hesitate to give 10 grs of calomel & an hour after give from one 
to ten grains of ipecac according to the age and vigour
of the patient for in this way the stomach and bowels are
more thoroughly evacuated than by giving the calomel
after the ipecac has ceased to operate In some cases
a single dose of calomel will thoroughly evacuate the
bowels, but in others it will only remove the contents 
of the stomach and small intestines into the colon & 
a dose of castor oil must be given or one of senna with 
aromatic seeds
The southern physicians, make less use 
of cathartics and depend much upon stimulating injection,
as of salt & water 3 teaspoonfuls to a gill. This 
practice does not succeed well with us. They also give
smaller doses of calomel. This also I cannot approve for
a large dose of calomel, ten grains for instance, will 
evacuate the bowels copiously and kindly, when small
ones produce scanty stools, with irritation of the stomach
and tenesmus. I may mention also that the French expectant 
plan of treatment adopted in Philadelphia will 
frequently be utterly inefficient.


Where excited has not been equalized, calomel
or any other cathartic may act upon the duodenum only 
and not produce
Such facts as there have been given rise to the
opinion that the disease arises from stricture but then 
the al. can. may be subject to unequal action as much 
as the skin
# a castor oil with elix. sal. aa zi every 2 hours
# Yet this practice shd not be adopted indiscriminately
where there is weak morbid action accompanied 
with coldness of [surface] etc. the exhaustion of cathartics
will be injurious 
This is the most important principle in the cure 
of diseases
Sometimes cath. cure the diarrhoea, where
the action is unequal. For instance the lower intestines
may be torpid and the feces accumulate, the bowels above
may be irritated and a diarrhoea of [small] liquid 
stools may pass by the feces



45
If calomel or any other cathartic produces watery stools
in which are small pieces of feces of an ordinary appearance,
and there have not previously been copious evacuations,
we may conclude that a thorough evacuation of the
bowels has been prevented by a spasmodic action of the
intestines which has constricted them in places, & confined, perhaps
a large quantity of fecal matter. Indeed this may be
proved by the success of the treatment, which should be 
the administration of a dose of opium with a little calomel to change action followed at an interval
of one or two hours by a dose of z ¼ and z ½ castor oil or elixir
salutis teaspoonful #. It is of the first importance in all typhoid 
diseases, particularly in those affecting the bowels, that 
thorough evacuations should be made #
2ndly so translate action to the surface and equalize 
excitement This indication will be answered by an emetic
at the commencement, as already directed & by small 
doses of ipecac, repeated throughout the disease, & also
by small doses of mercurial medicines opium being conjoined
in many cases, as will hereafter be mentioned. In 
some calls where there is much arterial action antimony is 
preferable to ipecac & the lancet or leeches may be indicated
but such cases are rare This indication is also answered
by applications to the abdomen of fomentations,
with decoctions of aromatic herbs sinapisms, blisters, burdock 
leaves, horse radish leaves, ginger in spirits aq; amm or the 


Ulceration of the bowels is generally preceded
by aphthae both are effects not causes of the disease
“An [epispastic] should not be applied after 
aphthae have made their appearance. If the pat. is languid
& sleepy we may suspect aphthae.”
Diluents may be used
Obviating irritation by opium is often necessary to have
the proper effect of cal. for instance Give opium first & follow
with cal. & often you will succeed in obtaining the effect of
the cal. when you had failed before
“Ipecac when it acts as a cathartic
is more apt to produce fecal stools than any other article


46
terebinthinate oils An epispastic upon the epigastrium 
is very useful to relieve irritation of the stomach & to prevent
ulceration of the bowels and aphthae. The warm bath 
will tend powerfully to equalize excitement will relieve
vomiting, quiet restlessness, produce a uniform perspiration 
& if used at evening, procure a quiet nights’
rest. It may always be used and at any time, unless 
the patient is in a state of exhaustion.
As a substitute for ipecac, the root of the 
asclepias tuberosa may be used. It is much used in 
infantile diseases as diluent, to determine to the surface
& to promote expectoration.
3dly For changing the secretion of the stomach and 
bowels and keeping up a gentle peristaltic motion I have found
small doses of mercurial cathartics with ipecac of opium
superior to all other remedies. If any article deserves the
name of a specific in any disease, it is ipecac judiciously 
administered in cholera infantum. It relieves this disease
with more certainty as certainly as than cinchona does intermittents. It
may be observed however that a man successful with one
remedy only m ay be compared to a mechanic, very skillful
with a pen knife! My method of administering the articles
is the following. For a child four months old, mix 4 gr.
of ipecac & 5 drops of laudanum in twelve teaspoonfuls 
of water & give a teaspoonful every fourth or fifth hour
& at the same time give so much of the blue pill as to 


You will know when the blue pill begins to have
its appropriate effect by the change in the color of the stools
Pills of blue pill may be given without much difficulty to children there is little
taste except of the saccharine matter. They may be given in food
[illegible] dried huckleberries which I have often called for in the
country where there was difficulty in administering remedies. There
is often great difficulty with respect to this. A child will
often scream at the sight of the doctor
Opium to allay the irritation of the stomach
and prevent the ipecac from being thrown of Ipecac
to equalize excitement & determine to the surface Ipecac
also, to qualify the opium
# Or if this cannot be done, introduce a paste of opium just within
the sphincter
# Case of a child in a family where 3 or 4 children 
had previously died of chil. inf. [Lax] & [illegible] habit
etc. I commenced the treatment
with the pill and ipecac 
I treated it mildly giving blue 
pill instead of calomel N.B. For such cases [illegible]



47
procure an evacuation from the bowels two or three
times in [never twice] in the twenty four hours. For a child a year old
take twice as much ipecac & laudanum with the same
quantity of water and give it in the same way. Sometimes
three times the quantity of laud. will be necessary; for instance
if the child has been in the habit of taking it or if the diarrhoea is very urgent
If the diarrhoea is urgent, it may be necessary 
to administer injections of starch and laudanum & 
to apply to the abdomen ginger & grandy volatile liniment poultices or other irritants
The enema may be made with three table spoonfuls of flour
& about 3 or 4 times as much laudanum as you give by the
mouth say 10, 15, or 20 drops. # I prefer flour to starch 
because the foreign starch often contains acid. The chalk 
mixture or white decoction may also be used.
# “Children of a bucophlegmatic temperament 
and lax habit are very apt to have this disease & with 
them I have sometimes commenced the treatment by administering
blue pill & ipecac.”
The success of this plan of treatment will be strikingly shown
by the following case. A child 10 months old was taken sick in this town
last summer, with cholera infantum, grew worse and was
directed by the physicians to be carried into the country
Unfortunately the child was carried to a situation not more
elevated than N. Haven & while there its strength decayed
and all its symptoms were aggravated. The parents despairing 
of it recovery returned with it to N. Haven & sent for me with 
a request that I would do something to alleviate its sufferings 


On recovery from the disease they usually crave [salt]
food and salt is a grateful stimulus


48
I found it in a state of emaciation, with hippocratic countenance
frequent vomiting, urgent diarrhoea, with stools fetid, watery 
and containing some slime and mucus, & leaving streaks of
blood upon the cloths. The countenance and gestures, expression 
of great anxiety, and there were frequent paroxysms of extreme
distress. I directed ipecac 5 gr. & laud. 10 drops to be put 
in 10 teaspoonfuls of water and a teaspoonful to be given once in 
four hours flannel wet with ginger and brandy to be applied
to the bowels & gave 5 oz. blue pill, & ordered the diet to be of
arrow root flavored with a little brandy. After the second dose the vomiting stopped, the
stools became less frequent & within 24 hours the complexion of
the stools was much improved. The next day the same medicines
were continued and four drops of the tonic solution with 
a little brandy and water. On the fourth day from my 
first visit, the child began to relish salt fish, which was allowed 
Capt. Dennison’s children
To correct fetor in the stools we should give
charcoal. Carbonic acid, by injection, is given for the same
purpose. The mode of injecting carbonic acid, is to place chalk
& vinegar in a bladder, and 
force the gas into the rectum, as it evolved. “This is 
recommended. I have tried it but not very thoroughly”




But if vegetable food undergoes the acetous fermentation
it shd not be used. The putrefactive fermentation 
however is more injurious than the acetous


49
4thly The most common cause of irritation is dentition 
The gums should be often examined, & be divided if they appear
at all swollen. All kinds of food that is hard of digestion 
should be carefully avoided though for children
somewhat advanced perhaps a small quantity of ripe fruit
may not be injurious If the child has not been weaned
the milk of the mother will be the best food; for those children’
who nurse are more apt to recover than those that 
have been just weaned. The act of sucking is highly soothing
and gratifying & operates like a nervine medicine.
The best food for children that have been weaned, will be arrow 
root, with a little brandy or wine as a condiment & as a substitute
for this & similar articles from the shots, we can
direct a porridge made of roasted flour. If in the latter 
stages of the disease the child craves any particular of food, as
salt fish, or salt meat, or wine or brandy, it should be given, & 
all kinds of medicine laid aside if the stomach leathe3s them; for 
strong disgust will debilitate by exciting nausea. Frequently 
however we can succeed in preventing this effect, by a different
mode of administering the medecine the sight of the spoon for 
instance may may give rise to the loathing & nausea.
With respect to food we may lay it down as a general
rule in such cases that when the powers of the stomach are
so weak that food must undergo fermentation in it, vegetable
diet should be preferred to animal.
For local irritations, various applications should be made
& various articles administered, especially in the latter stages 



“Tea juice? boiled beef a teaspoonful with pepper & salt
is grateful frequently & checks vomiting but at
first vegetable preparations are better”
vide supra
The chalk mixture made with a little opium 
in some cases or with astringents etc. a valuable [illegible]


50
of the disease or when we are compelled to try a variety
of remedies. When there is unequal excitement & unequal temperature
blisters may be used. Blisters sometimes produce perspiration.
To relieve irritation of the stomach effervescing mixtures
may be drunk, they are often more grateful. [illegible] we may 
fill the stomach where there is vomiting and dilute its contents with a tumbler of wine whey 
I have often succeeded with it
with a teaspoonful of aqua ammoniae in it as being thrown up will be no objection. If the disease commences
with much irritation in the stomach, it may be useful
to overcome it by counterirritation in the rectum produced by an
injection of soap suds or of salt and water 3 teaspoonfuls of 
salt to a gill of water, for a child a year old. Dr Dewers
relies must upon this latter article in the commencement of cholera 
infantum and repeats the injections until the bowels are
fully evacuated. He likewise recommends small doses 
of calomel, a quarter of a grain for instance repeated once in 
an hour until the bowels are evacuated. In cases of irritation 
of the stomach & torpor of the liver & portal system, this 
practice of salt & water & small dose of calomel does well. In chronic cases he gives magnesia
rhubarb & opium. With respect to small doses of calomel
it may be further observed that they will not answer when 
the intestines are much coated with mucus & that in some
localities they do not answer so well as in other places. On 
the shores of lake Erie for instance the physicians are obliged
to give large doses of calomel than we give
There are cases in which small doses seem
to irritate & large doses operate kindly 


“In the latter stages Rx magnesia grs 4 SS gtts
Rhei gr i.”
C. Florida not so pleasant but loses its mawkish & 
herbaceous taste by keeping (like peruvian bark)
The spiraea is though less inclined to act unequally 
in this state than most other astringents
If one astringent wears out try another
Oak barks
Rose [illegible] (salix [illegible} “A valuable popular remedy” 
has mucilage combined
seeming to resemble ([illegible]) [illegible] was formerly 
much used but is now superseded by native articles
It is well known that because These astringents are often prompt up is specific
[illegible] virginica was specified good [illegible] & [illegible] it
e.g. viburn. lentigo, raspberry, blackberry, [illegible] [illegible] root decoction
recommended by Dr Rush thought to deter to [illegible] used by many) [illegible]
bark has [mucilage]
There is apt to be a paucity of [urine] in this disease
as well as in Diarrhoea & dysentery and then diuretics
are indicated and are highly valuable


51
5th When in the latter stages of the disease the principal 
indication is to restore the tone of the system & particularly of the stomach
and bowels we must make free use of tonic and astringents.
Moseley’s tonic solution will be one of the safest and best articles
in this stage. If the bowels, by a habitual action keep up the 
diarrhoea, astringent will be more specially indicated such
as the compound tincture of vitriol. I prefer however, the 
cornus circinata to all other articles
C. servicea (red [illegible]) C. [illegible] C. alba nearly allied
Of astringent vegetables we can make choice
from a great variety which are indigenous & common. All
the various species of viburnum all the [potentillas] & the 
roots of the strawberry to say nothing of the bark of the oak & 
indeed most of our forest trees, are astringent & may be used
The spiraea tomentosa is much used in decoction or extract 
All the species of [illegible] are astringent & the C. [rivale] is a most
valuable article; as is also the geranium maculatum, which 
may be be given in wine & then we shall have red wine.
The sttici limonium (marsh rosemary) is not so agreeable but
is frequently more efficacious specially if the mouth is sore. Its taste resembles that of salt
mud. When given internally, it is boiled sweetened & has a 
little wine or brandy added. It is also used as a wash in 
case of the supervention of aphthae.
The erigeron canadense, called colt’s tail
& strangury weed has been found a valuable article in the 
latter stage of this complaint and of dysentery given in decoction.
It is acrid pungent like [illegible] bitter & stimulating & acts also
upon the kidneys as a diuretic. It seems likely to prove a 


Give it in decoction or in milk which will cover 
the taste of it
Balsam of copaiba or turpentine cannot be combined
with mucilage so thoroughly as in the white pine 
bark in milk & water diuretic & [sheathing] to the bowels
I have often used the expressed juice of spearmint
as in diarrhoea q.v. It is important in long continued bowel
complaints of children that the medicine shd be grateful
The diuretics are useful both in children and adults
(dysentery diarrhoea & cholera infant) because there is a
paucity of urine and acrid irritating secretions
In some cases of exhaustion we give opium constantly
in small quantities to keep up the [illegible]
Mucilages marshmallows or substitutes for
which hibiscus palustris hib. syrica hib. [illegible] hib.
(rose of [shora])
Mucilages by stopping irritation are
diuretic


52
a valuable article in the latter stages of bowel complaints 
provided there is not too much vascular action. It has been 
long used, vide Barton, the N.Y. Medicophys. Transactions etc.
In 1790 an itinerant came through N. Haven offering to 
cure the dysentery; and attracted a good deal of notice.
It was found that his [illegible] consisted of this article. The 
other species of erigeron have similar properties.
In the latter stages of the diarrhoea mucilages
should be given. They made of any of the various in articles in 
use, but perhaps the most valuable mucilage, will be that made
from the inner bark of the white pine, which will furnish a terebinthinate 
principle in addition to its mucilage
Often in the latter stages of the disease, great
benefit will result from supporting the abdomen by a bandage
and a plaister of white [diachylon] and opium or
a soap plaister (of [illegible] & soap) 2 parts sp. 4 pts plaister
In extreme exhaustion & debility from the 
long continuance of the complaint with cold extremities, aromatics
and stimulants may be required & we may give spiced tea
spiced wine or brandy in small quantities, or the white decoction 
and apply cloths dipped in brandy to the abdomen & to the extremities


Nothing has more affect upon complaints of the 
stomach liver & bowels than the state of the mind as
we see in dyspeptics
The
We are apt to suppose children not subject to 
notice of [illegible] children [illegible]
mental impressions. When the matter has been dissolved
in grief & abandoned to despair
I told them to tray as a last resort carrying
the child in a hack out of town the excitability was entirely 
gone the child might as well die in the back
as any where strange advice On the top of the [illegible]
about two miles out lifted up the child [sound] trees
grass birds, etc. opened its eyes before this had lain
with eyes half closed noticing nothing 


53
Finally when every form of medication seems to fail, our
only remaining resource will be change of air. This is a
most powerful remedy. The physicians of N. York and Philadelphia
are continually recommending it. We are apt to suppose 
that in children it can be only the purer air 
& the exercise of travelling that produces a good effect, when they 
are carried from home for their health, but on the contrary 
the change of scene seems often to have a more powerful effect
upon them than it would upon adults. Children that
have lain sick for weeks, instead of pursuing their accustomed 
amusement even though mere infants seem of ten to settle into
a state of utter despondency from long confinement & the
constant sight of the same unvarying objects around them, & 
appear to loath every thing offered to be done for them. This morbid
condition  of mind seems to be one directly opposite to that of
nostalgia or homesickness & is to be relieved in a corresponding
manner. I well recollect a child apparently 
in articulo mortis cold & vomiting nothing wd [illegible] the vomiting
entirely beyond the influence of medicine
or food. It was carried in a hack to the top of a hill
without the town N.Y. [illegible] where it had a view of the sound, & the
scenery of the country around. While there is brightened up
vomiting ceased and took food staid an hour or more & then was carried back to town, where it
finally recoverd.




54
The symptoms attending cholera infantum very very 
much and give rise to considerable variety of practice
It is probably owing principally to this circumstance more
than to any other that physicians differ from each other
in their mode of treating it.
Post mortem examination show that this disease
affects principally the mucous membrane of the stomach & the
small intestines; rarely the large ones. Sometimes coagulable
lymph is found in the intestines but less frequently than in 
other diseases. Sometimes the mucous membrane of the intestines
is thickening & according to Dr Jackson ulcers are occasionally 
found both in the small & also in the large intestines. The 
liver is usually enlarged without derangement of structure
Ordinarily the brain exhibits no morbid appearances, unless
the disease has made a determination to that part constituting
hydrocephalus 
N.B. The remarks upon asclepias tuberosa
introduced under the Head of [illegible] capitis probably 
belonged here


Fever of the bowels Acute [illegible] of [illegible]
Different writers give different names and do not always give
the same symptoms. The European disease differs somewhat
from ours. It is our infantile winter epidemic.
Typhus infantum of Prof. [Tully] “Disease of the bowels
bowel complaint, plague of the bowels, winter epidemic 
& [illegible] epidemic. Remittent bilious fever
(at south) Musgrave’s spurious [illegible] fever Duncan III or IV”
There is some [illegible] action but more of the
character of irritation like other infantile fevers
Rarely vomiting never diarrhoea in commencement
The morbid excitement often extends to the lungs
putting on the for [illegible] what is called in adults bilious pleurisy
The disease is not common at this time
though it was very much so formerly Probably it will 
return It is almost the only winter infantile disease
& so common has it been also that the nurses call almost
every disease in winter, of childr, by this name 
of choler.
The dis. is to be broken up in its [illegible]
by means various in various patients by a strong impression 
upon the stomach in a strong constitution but by 
an impression upon the whole system in the delicate
constitution Comparison to a weight upon a [illegible] If applied upon one part only it will break it not if applied to [illegible]
It is desirable that vomiting or at least
nausea should talk place from the cal. In enteric 


55
Constipation with Fever
or
Remittent bilious fever of children Musgrave’s spurious worm fever
marasmus acutis
This complaint has been known in N. Haven for more than 50
years by the name of choler. It is called in some places at the 
“It is unfortunate that we have no better [illegible]”
eastward, the plague in the bowels. It is a common bilious 
“It affects however the duodenum & small intestines rather than the liver”
fever produced by causes which operate upon the bowels a 
part of the system which in children more particularly invites
Children are attacked by it from the age of 3 mo. to 2 or 3 yrs.
febrile action. It is often inflammatory in its commencement
Sometimes it [illegible] in the form of typhus
Symptoms The pulse in the commencement of the disease is 
full, frequent & sometimes tense, the skin is hot and dry 
face flushed, respiration, short and laborious, tongue covered
with a white fur, the abdomen fuller and harder, than in health, & the bowels costive; the urine small in quantity
and high coloured & sometimes the fever is attended 
with cough & expectoration. This disease is a fever
which often affects the lungs and always the alimentary 
canal & liver, the secretions being suspended and the 
bowels constipated.
Treatment. This will be antiphlogistic in the commencement
of the fever & the first indication will be to evacuate thoroughly 
the stomach and bowels. This will best be answered by a  
single dose of calomel of from 5 to 10 or 15 or even 20 grains for a child 
from four to twelve months old We shall thus produce a strong
impression upon the whole alimentary canal & upon the
system at large. In entonic cases and vigorous habits a
little tartar emetic may be added to the calomel
Usually the calomel excites both vomiting and purging, but 
sometimes it is retained on the stomach and has no immediate 



cases it may be beat to conjoin tartar emetic for this
purpose.
Sometimes the cal acts upon the stomach & 
duodenum & excites the action of the liver, and spends
itself there, without producing catharsis
Sometimes it is necessary to repeat 10 gr
doses of calomel once in 2 hours until 40 or 50 gr have
been given and cause them to follow with liquid cath.
a [illegible] or jalap or scammony
N.B. If there is great difficulty in giving medicine
repeatedly, we may give powder of jalap in 
coffee or fermented liquor or we may give a teaspoonful
of the tincture of (not briony root but pure jalap
in milk & water which will not be tasted
Feeble constitution must have the warm’
bath. # Rx senna zjs man zi senega zii anise seed zis
liquorice zfs [illegible] ½ [illegible] This I have held the child with. remember large doses are needed
Rx scamm. grs 2 or 3 chalk & diaphoretic antim. this
was called Earl of Warwick’s powder & was kept in the shop
here. Tart. emet. would be a more certain prop. of art. It 
produced violent vomiting. Scammony is better united
with cal. however. # 
# Cautiokn about covering the [illegible] with a blanket
vide
# Cal. was finally substituted for the [diaph.]
ant. This Warwick’s powder used to be a shot preparation
in this town and parent would send for it. From the uncertainty 
of the strength of the diaph. ant. however, [dangerous]
vomiting sometimes occurred from the use of it 


56
effect. In the latter case a second dose may be
given two or three hours after adding from an eighth to a quarter of a grain of
tartar emetic for a vigorous patient Fifteen or twenty 
grains of calomel will often empty the stomach and
bowels freely & remove all the symptoms. The calomel
may however evacuate the bowels but partially & in some 
instances not at all merely moving the contents of the 
small intestines into the large ones. In such cases another
cathartic is needed for completing the purgative operation 
If the calomel appears to have no effect, it should be repeated
in 5 gr. doses every three or four hours, the patient
put immediately into the warm bath & we should
commence feeding the child as freely as the stomach
will bear with the following R fol. sennae zfs, mannae zi
steep in ½ pint of boiling water & if there is a cough, add
senedae zii & rad glycyrrizhe zfs. If the stomach
will not retain the mixture of senna the powder
of jalap or scammony mixed with tea coffee or milk must be substituted, giving 4 
or 5 grains in the intervals between the doses of calomel
Injections vide p. should be given to assist the operations of the
cathartics and repeated every 2 or 3 hours until the 
bowels have been thoroughly evacuated taking care
however not to commence with injection until the cathartics
have had time to operate
When we have succeeded in procuring stools
we shall find them to consist of viscid green mucus mixed
with half digested food. Sometimes in the progress of the disease they exhibit the 
appearance of small pieces of membrane, of 


There is a membrane [illegible] inflammation of the duodenum
similar to that of croup. This indicated by pieces of 
membrane preceded however by pain in the part
obstinate constipation etc. This is a strong indication for
calomel which however will not operate as a cathartic
until the violence of the disease is broken Warm bath
& injections will also be more particularly
In some violent cases of the fever where
calomel seemed to have no effect. I have known acid
as lemon juice advantageously combined with calomel
Among the cathartics and laxatives used in 
the second stage we have the wild liquorice or [illegible] [circa???]
which was formerly a popular article and kept in families. It is 
diaphoretic and laxative and possesses and also deobstruent properties
It is said that with this the Indians formerly [died] their porcupine quills
# The acids are sometimes used in combination with 
mercurials I should not use them unless when
mercury fails
Sometimes it affects the ear & produces suppuration 
& discharge. It may terminate in effusion into the ventricle
of brain. It may terminate by exhaustion Or may 
terminate in thrush “in which case there is a double translation 
1st from the bowels to the head & thence to the mouth oesophagus & bowels



57
& of about the size of petals of peach blossoms, 
floating in a liquid of the same colour. Such stools
as these latter are a sure indication that a farther evacuation 
from the bowels is needed vide p. 207 They are frequently 
evacuated by adults in bilious (or common cholic.
If such continue it is well to vary the cathartic and give
magnesia, or soluble tartar (peerlash & cremer tart.)
or phosphate of soda, or any other neutral salt.
generally the violence of [illegible] [illegible] & The blue pill may be substituted for the calomel & given
three or four times a day, until the stools change their
appearance or the mouth is affected, though this rarely 
happens to children under four years of age. These
stools rarely have any smell & as they indicate a want 
of secretion I the liver & glands of the abdomen, mercurials
are peculiarly appropriate. In some states of 
fever attended with stools of this kind I have known
the free use of acids with mercury very useful # 
After 48 hours the fever generally 
remits, and sometimes it continues in the form of a remittent
for six or eight weeks or more. Very frequently 
however it changes its seat in the course of 15 or 20 days
& terminate in a phlegmous swelling of some of the glands or in phlegmon
or is determined to the head
& puts on symptoms of hydrocephalus, which are best 
relieved by blisters behind the ear, a place which is the natural 
outlet of diseased action in children. They may terminate
naturally by a discharge of purulent matter from the 
cavity of the ear or fatally by effusion into the ventricles of 


I recollect two cases early in my practice, which 
continued 6 or 8 months. They were very violently attacked
They continued 6 or 8 months coma 
Hence we should never despair
In the latter stages it may be proper to 
give tonics or those articles which are called tonic
very unlike the vegetable tonics however. They produce a
[illegible] excitement
Giving arsenic is no new practice 
It is a safe and efficatious remedy, when the dis. continues 
as a remittent It comes after cal. & tart emet. producing 
liquid secretions. If long continued it must be followed 
by bark to restore tone and obviate the debility caused 
by the arsenic Arsenic can only be called a tonic
as it removes disease. It would never be given as a 
[illegible] is pure debility #
# I have used digitalis, in the latter stages to allay irritation
# In many cases the fever continues from habit
& medicines have little affect. There will be an accession 
of fever every afternoon. Here give sol arsen 2 drops
twice a day which is a full dose for a child ½ years old
If this has no effect give it [illegible] times a day”



58
the brain; in two cases I have known them relieved
by a thrush.
If the disease continue a regular remittent
without symptoms of hydrocephalus, it will be proper to give
tonics, such Moseley’s tonic solution or if the fever intermits or remits Fowlers solution of arsenic
the latter in doses of two or three drops the former
from 4 to 20 drops, 3 or 4 times a day. I have known a child
18 months of age cured in this stage of the fever, in the course o f
two or three days by taking 2 drops of Fowler’s solution 3 times
a day. This article however is liable to produce edema or dropsical
effusion & if it does we must substitute the tonic solut.
(beginning with about four drops) or some preparation of
bark. The dose of the tonic solution will depend upon the
irritability of the stomach If irritable from 3 to 6 drops will 
be as much as can be borne
After the inflammatory action has subsided
narcotics anodynes are necessary to remove irritation and
to procure rest We may use opium, either alone or 
better combined with ipecac or antimony # Indeed as the
skin is usually dry antimony is indicated in almost every 
stage. The warm bath also is indicated in every stage except
in the low typhus state of the fever when it would be too debilitating.
Epispastics & irritants are useful in the progress of the
disease, to translate action from parts essential to life & in 
the last stage also perhaps to keep up the action of the system. They 
may be applied to the abdomen if it is much swollen to the
head behind the ears where there is danger of hydrocephalus & 



Avoid too much heat to prevent tumefaction of the
bowels.
Terebinthinates a [illegible] oil may be needed proper 
If pneumonic symptoms blister etc.
“If the lungs are much affected, apply a blister to the
chest, give expectorants, and pursue the treatment required
in pneumonia. Senega & squills are good, but
are too stimulating for the earlier stages liquorice anise”
By this disease it is sometimes proper to do nothing 
and omit all medicines in mania etc. In those cases
as I have had difficulty to persuade parent to do nothing.
I have applied aloetic plasters 
to the bowels I think they have produced evacuations
injections also can sometimes be given
Case of a very [illegible] child
[furious] parents passed in review before him with 
roasted apples pears etc. after 26 hours he snatched
an apple relapsed in 26 hours they probably had over 
loaded his stomach however the same management 
finally succeeded afterwards of the patient recovered. vide p. [20?]
The same season I had 3 or 4 more such 
cases of mania which required to be cured by fasting


59
a large one to the chest if the lungs are affected.
“This disease is sometimes followed by thrush
when an emetic of ipecac will have a good effect. If the stools
are fetid charcoal should be given. If in the latter stages
there should be tumefaction and pain in the bowels, the
abdomen should be supported by a bandage. In the latter
stages also a decoction of the inner bark of the white
pine be useful. It possesses some tonic properties”
Sometimes in diseases of children the mind is 
affected, the patient will take neither solids nor liquids & struggle
till it is exhausted whenever an attempt is made to administer
any thing. If that is the case in this disease we must use
the tepid bath & we may a apply for purpose of moving
the bowels, a large plaister of aloes and ginger to the 
abdomen Frequently this derangement & morbid revengeful
disposition (according to Dr Rush an affection of the moral
faculty is so great that we must wait even for 24 
hours or more without administering any thing. It may 
require great prudence and judgment in such cases, to 
satisfy the parents.
Before leaving the subject I may observe,
with respect to the propriety of the course I have directed
in the commencement of the disease, that if the cathartic which 
we administer first produces emesis we may be sure that
the alimentary will be operated on, & also that we often 
require a remedy more powerful than the disease, just
as in croup.
“As to diet meat must be forbidden but sometimes salt food is craved. The weak chicken broth is good.



The dis. is something very rapid & violent
Fever as violent as the constitution could bear
Collapse from the violence of action
Parents considered the patient & dead
After the mustard was applied as soon as the
skin was reddened a blister was applied, which 
produced a sore 2 or 3 months in healing
“In one hour pat. revived”
Nervous system affected
Irregular action such as after collapse of
cholera Strong clonic spasms once in 15 min.
“Pat. kept under a constant [narcosis]”
Antispasmodics & tonics finally In two or three weeks [illegible] recovered some strength
It was called the child that died & returned to life again
The above is account of the disease as it
most commonly appears. It is different however in 
different years sometimes effecting one part of the system
sometimes another A practitioner keeps this [illegible] [illegible]


60
Case of a female child 2 yrs of age. The disease ran
the most rapid course I ever witnessed. 
The whole system became
affected; the pulse was full & frequent, the skin hot & the
tongue furred. In 24 hours the disease came to a crisis
and exhausted the excitability of the system; the pulse
grew faint, the skin cold and the respiration languid
the patient became insensible & was apparently dying
sinapisms were applied to the abdomen, ankles & wrists & 
heated bodies put into the bed, to restore warmth. After
the sinapisms had been on an hour and excited some
redness, epispastics were applied in their stead.
Ammonia & ether were put into the mouth & caustic ammonia
was applied to the nostrils to excite 
Inflammation so as to blister. Ether was also put into the mouth
In about two hours the system was resuscitated. Immediately a train of most violent nervous
symptoms followed the chill became convulsed
almost instantly. After trying antispasmodics in vain 
the convulsions were checked by laudanum, 6 drops,
every two hours. The laudanum lost its effect in 
two hours & needed to be repeated. The blister on the 
chest produced a deep ulcer which was difficult to cure
Finally tonic solution was administered. The child recovered
Child of Mrs “Moulth???]
Child of N. Beers’s vide p. 208
diseases and consequently meets with no new disease
For they do not make sudden transition as in botany plants
he is guided by symptoms & by the operation of remedies



Appendix to Mes. fever acute marasmus
This disease sometimes appears in an acute form
with great irritation Sometimes terminates in hectic Patient will run down
very rapidly [illegible] appearances enlargement
& [illegible] of mesenteric glands “Called” consumption 
of the bowels” or Marasmus”
Mesenteric fever is thought to terminate
in hectic Probably it does especially in scrofulous
patient and in those bad cases where the tubercles with a mesentery ulcerate
“The pain in the bowels is no usually very severe 
but of a continued aching kind generally better
removed by [camomile] injections than by anodynes”



61
Mesenteric Fever
Marasmus tabes [illegible] [illegible]
This disease arises from obstructed glands in the mesentery 
& is accompanied with morbid secretions of the stomach & 
liver bowels. It is sometimes the consequence of some other
fever. It is often connected with scrofula, & it is apt 
to be attributed to worms. The disease attacks children
of from two to ten years of age.
Symptoms. The fever is of the intermitting remitting kind, with 
irregular paroxysms attended with tumefaction of the abdomen, 
costiveness, indigestion, loss of appetite & very irregular
appetite & with paroxysms of pain in the bowels. The patient
complains much of its bowels, but the affection seems to be rather 
distress then sharp pain & is neither constant nor regular. The 
countenance is very pale except when the cheeks are flushed with 
fever & the limbs are emaciated
This is generally a chronic disease, but 
sometimes it is acute, & exhibits strong marks of irritation in 
the system. It may terminate in hectic. Dissections exhibit
an enlargement of the mesenteric glands.
Causes. It is sometimes as has been said above, the effect of
another fever. Among the poor, with whom it is most frequent,
it is caused by coarse and unwholesome diet. Children 
born of scrofulous or gouty parents are more subject to it
& hard labor by the mother during the period of gestation 
may have some influence in predisposing to causing this disease in the 
child.



Patients in this disease are subject to paroxysms
of pain


62
The indications are 1st to empty the bowels and to keep 
up a gentle peristaltic motion in them 2nd to change the
secretion of the chylopoeitic viscera.
3d to remove paroxysms of pain
4th to remove the obstruction in the lymphatics.
5th to impose the digestion & to invigorate the system generally 
1at To move the bowels and keep up a gentle
peristaltic motion mild mercurials as blue pill or calomel & chalk should be given & at
the [illegible] time friction as in almost all chronic [illegible] complaint should be employed, upon the
abdomen, and persevered in by the attendants. A very good
mercurial preparation, will be a pill of four parts gr. blue
mass and one 1 or ½ gr of ipecac adding a little opium ½ or 1/8 gr of the bowels
are very irritable. If this preparation 
is not sufficient calomel may be substituted in 
a dose of 4 to 6 grains. The tincture of rhubarb has 
in some cases answered well as a laxative & corrector
combined with neutral salts and aromatics
2nd For changing the secretions, we must rely 
upon the articles just mentioned, and also upon those
to be mentioned under the 4th head
3d For alleviating sudden paroxysms of pain injections
of a gill or a half pint of camomile tea have been found serviceable.
If these fail give a camphor injection
The pain is relieved by opium plaister



There is but a small quantity of iodine and [illegible]
effect appears to be produced than shd result from 
the small quantity of iodine
Neutral salts in connexion with tonics have
undoubtedly [illegible] deobstruent powers


63
4th For removing obstructions of the mesenteric fluids
burnt sponge has been thought very efficacious. I formerly 
questioned whether it had any superiority over soda.
Now it is supposed that all the virtues of the article are
owing to the iodine continued in it. It would probably be [illegible] better
better to give tincture of iodine in doses of 2 or 3 drops.
Still the burnt sponge containing carbon & alkaline matters
may have peculiar properties The neutral salts given
with tonics have some influence in removing these obstruction 
It has been proposed to use mercury by injection for this purpose.
I know not that it has ever been tried
For the indication I have been in the habit of
employing the muriate of lime & here given it in connexion 
with the mercurial pills mentioned under the first head 
It may be made by adding muriatic acid to chalk 
or marble & the dose for a child of 3 or 4 years, should 
be from 5 to 50 drops, given in tea coffee or milk.
It is best to begin with a small quantity, say 3 drops & increase 
by one drop at every dose until the stomach
is offended remembering that the stomach bears the article
best if much diluted. The muriate of barytes might be 
used; also the carbonate of barytes is used in dose of but
2 or 3 grains, it being a powerful article. But iodine is
probably the best article that we know of
Other articles containing iodine, have been 
used besides burnt sponge, as [fucus] [nodasus] & vesiculosus
[reckoned] vide scrofula



mur. [illegible] dose 4 or 5 drops in milk & water for a child of
3 or 4 years increasing to 50 even 100 perhaps
This [illegible] is not to [illegible] [illegible] it iodine as to be substituted
by the latter We are apt to neglect an old remedy as 
a new one comes on
The tepid bath shd not be used when the system
is too much debilitated
It excites the action of the mucous membrane
and of the skin not affecting particularly the blood vessel 
add a little spirit to make the opium 
[illegible] if necessary 


64
Muriate of lime has the important advantage of exciting
the action of the skin which is generally torpid.
Hence also the tepid bath has been used with 
success in this disease The flesh brush too if thoroughly 
applied several times a day will have a powerful effect.
5. To improve the digestion and invigorate the general system
Carbonic acid is a most grateful stimulant to the stomachs 
of patients in this disease. Hence soda water and other effervescing
mixtures, may be recommended spruce bar also & 
similar articles, if they agree well with the stomach. Aromatics 
as ginger & spice may often be added to them with advantage 
Among the tonics which are used to invigorate
the system. Iron is very often employed & frequently with good
success. The mildest preparations least irritating are the best, such as 
the tincture of the muriate, the martial flowers & the
alkaline solution. Still iron is apt to cause irritation
Cold bathing is a good remedy for invigorating
the system but if the patient is much debilitated, a cordial
should be administered previous to using it
When the patient is much debilitated I have found
anodyne plaisters upon the abdomen
give great relief (where opium did not agree) I have 
used Noel’s plaister (similar to dyachylon) with soap mix
opium zii with zfs of this plaister & spread it sufficiently
large to dover the whole abdomen


Children are very fond of potatoes but they should 
not be allowed, unless cooked so as to be dry and [illegible]
and then thoroughly mashed
Some vegetables as spinach, [illegible] & asparagus
may be allowed but only in moderate qualities
Preparations of meal of [illegible], especially fried, are bad
Rx dough roll it in flour and then cut
into thin slips, twist & bake them for [some] hours An excellent preparation
for dyspeptic batter than crackers called twisted bread
In making broth avoid adding rice, flour, etc. which 
will make the compound approach the nature of pastry 
and be more indigestible. Make broths as simple as possible
& season with pepper & salt


65
Under this head may be ranked the use of the terebinthinates
which have a valuable effect upon the mucous membrane of the alimentary canal
The best article is a decoction of white pine bark, which is
milder than any preparation of the turpentine of the shops
Regimen. Flannel should be constantly worn next the skin
to keep up an action in it. The patient should take exercise in 
the open air whenever the weather is good & damp
easterly winds should be carefully voided as they have great
influence in all chronic affections particularly glandular of the bowels. Friction & 
cold bathing have been already mentioned.
Diet. This should be carefully attended to Raw fruits, 
potatoes and other garden vegetables, corned beef & in short all 
articles which are not of the easiest digestion or which have any 
tendency to ferment & become acescent in the stomach should be 
forbidden & caution should be enjoined that the stomach
be not distended with liquids, so as to interrupt digestion.
The diet should be dry consisting of toasted bread & farinaceous
vegetable substance, as arrow root etc. well boiled & seasoned
with a little wine & spice. If meat be given it should 
be broiled & eaten, with condiments. In some cases a piece of 
lean beef that has been partly broiled & then boiled, makes
a broth that is grateful & sits well on the stomach. But if
there is much dyspepsia, broth of any kind a not good
If this fever terminates in hectic the mineral acid shd be used 



Undoubtedly however the affection may be produced 
by excessive purging vide next page
low states of fever in adults also for the 
state of the bowels occurs much oftener than some phys. are
aware of
“The gases may arise from the ingestion, from a 
fermentation of the natural secretions, or, as I think from a
direct secretion of gas by the intestines. this alone would see
to account for the rapidity of its production”
sometimes small watery stools


66
Tympanitis
In diarrhoea dysentery & constipation with fever & typhus fever
after these diseases have passed the first stage, the bowels of 
children affected with them, are liable to be affected with 
tympanitis. a troublesome symptom This state of the bowels may occur of itself about
the time the febrile action begins to subside, or it may be brought
on at an early period by the use of astringents, or by heat
produced, either by too many bed clothes or by hot articles
applied to the body for the purpose of exciting perspiration
it is important to examine daily the state of the abdomen in 
children affected with bowel complaints, that a tympanitic
state may be obviated, as soon as it begins to appear
The abdomen is [swollen] and elastic to the touch
feeling tense like a drum head under the fingers
We can tell as soon as the hand is applied whether the
swelling proceeds from inflammation, or from imprisoned
air, for in the former case the pressure will cause pain
The proximate cause of this state of the bowels 
I believe always to be a relaxation of the villous coat of the
intestines & a deficiency of peristaltic motion in consequence
of both which the villous coat falls down & forms a 
valve which confines the gas, while at the same time there
is a morbid secretion of all the chylopoeitic viscera 
which [illegible] the evolution of the gas
In the first stages of tympanitis, the alvine
discharge usually cease even if there had been diarrhea
& dysentery before & the little patients exhibit signs
constant [illegible] not acute pain
of great uneasiness from the unusual distention of the 



“It is thought by some that tympanitis is always 
occasioned by bad treatment in not giving cathartics enough at
the common [illegible] Such persons probably do not examine
the abdomen of their patients with sequels of severe bowel
complaints. Tympanitis comes on whether cathartics have
been used or not and nothing is more likely to bring it on 
than an excessive of cathartics at the commencement of the
disease”
The temperature had been raised above it
secreting [illegible] & the child might have died
“I am very partial to diaphoretic measures in general
but must confess it is often abused If carried to excess 
it rapidly exhausts the patient also if excessive heat as aplied
and the pat. does not sweat.” 


67
bowels. In the progress of the disease tympanitis the child frequently 
comatose. The tympany is not always to be regarded as 
a dangerous symptom it sometimes indicates a favorable
crisis, yet if it is accompanied with coma, there is danger
that the brain may become seriously affected. If symptoms 
of congestion in the thorax exist, the disease of the thorax
should claim our first attention, and the tympanitic
state of the bowels be treated as a [illegible] complaint
Treatment. The indications are to evacuate the flatus 
and excite healthy action of the viscera of the abdomen
If the disease has been produced or aggravated by heating
applications too many bed clothes or too 
confined an atmosphere, the heated substances should 
be removed, the bed clothes thrown off & air admitted
freely to the patient. In the summer of 1814 I was
called to a child sick with dysentery whose bowels became
extremely inflated in consequence of filling with 
the steam of boiled potatoes in [illegible] the bed in which he lay
The child because if much [illegible] & [illegible] was so difficult that it 
was thought to be dying; but upon removing
the potatoes throwing off the bed clothes & opening the
doors, the symptoms were at once amended & in the
end the disease was completely removed by the use of a little [cajeput] 
oil in water and laxatives
For removing the flatus of the bowels 
we may use enemata of the decoctions of aromatic plants or 
suds, such as catnip, camomile; the seed of fennel caraway 
or masterwort seeds or the essential oil of such suds may 


I prefer camphor to any other articles 3 or 4 [illegible]
IN colicky complaints etc. I have known more benefit [illegible]
injections of camphor in milk & water than from any [illegible]
articles and that too after the most violent purgatives
had vailed. I know of no article which operates
so well in relieving irritation of the pelvic viscera
[Anodyne] balsam Rx vol. [lin] zi [illegible] camph
“Sometimes blister the abdomen”


68
be injected in milk and water. But I think I have experienced 
the greatest benefit in the case of children from the 
injection of a teaspoonful 2 or 3 of the tincture of asafoetida in a 
gill of warm water. It unites more readily with the water
of a little milk is added
A pipe of ivory or the pipe of a common 
injecting syringe may be introduced into the rectum as is
recommended in hysteria, for the purpose of evacuating the
flatus. I have sometimes used an elastic catheter with success
The peristaltic motion of the intestines is
to be excited and healthy secretions induced For this purpose
we are to apply friction with dry flannel to the abdomen
and mild cathartics are to be given. The latter may be jalap
aloes rhubarb etc. with castor oil to work them off
If frictions do not succeed, we may apply volatile liniment
camphor, oil of origanum & finally epispastics
We may likewise give internally cajeput oil in 3 or 4 in sugar oil 
of mint, oil of caraway, asafetida zfs to si etc. which is [illegible]
to offer [illegible] its stomach & is not offensive to the taste
and magnesia with [illegible] & cubebs [illegible] [illegible]
or guaiacum 


Dr Good classifies [worms] according to their locality
yet he makes mistakes as to their locality
Much has been under the subject, and the
remedies are almost innumerable. It is rather difficult to select 
the most important parts of the subject


69
Worms
This subject naturally follows that of bowel complaints
From testimony which cannot be invalidated it appears that worms
of various sizes and forms have been found in almost every 
part of the human body. It is only in the alimentary canal
however, that they occur with any frequency and give rise
to symptoms, from which we are led to infer their presence
Those worms which are of anomalous kinds, or
are found in anomalous situations (oftenest perhaps in the lungs
& frontal sinuses) as they are of rare occurrence & as the indications
of their presence were either very obscure or altogether unknown wanting 
are interesting only as curiosities and will be passed over,
without any notice, except an occasional reference to 
the fact known with regard to them
“Worms in the alimentary canal are so 
common, as to have given rise to a class of diseases called
verminous & a class of therapeutic agents called anthelmintics.
The kinds of likewise of worms which occur in 
this part of the body have been thoroughly investigated & we
are in possession of a large mass of information upon the 
subject
I shall consider this subject under the following
heads 1st The kinds of worms found in the al. canal
2nd their origin & that of worms in general, found in the body
3d the general effect they produce on the system & the general symp
5th the morbid effects produced by each species, with their treatment
4th the general treatment of verminous diseases




70
II. The genera of the common intestinal worms are three; toenia ascaris & tricephalus
Of the tania there are two species. Tania solum or cucurbitana
& t. lata or vulgaris. Of the ascaris there are also 
two specis of a. vermicularis & a. lumbricoides.
1st Tania This a long flat worm varying much in breadth
and thickness which is formed by a chain of flat articulations,
united by a border or edge. The accounts of the length 
of this worm are almost incredible from thirty to a hundred
feet. Taenia solum (called also cucurbitina
or gourd seed worm & the armed taenia) is distinguished
by having the head forked and surrounded
with papillae or long fangs (holders) by which it fastens
itself to the mucous membrane. The broken off joints have
when discharged the appearance of gourd seeds. hence 
its name of gourd seed worm.
Taenia bata (or vulgaris the unarmed taenia) has an 
external form like a ribbon joints scarcely perceptible
& is white and seen transparent. The head is
narrower & smaller & the papillae not elongated
2nd Ascaris vermicularis & a lumbricoides
The first, a. vermicularis (thread worm, pin worm & when
existing in number called ascarides) is filiform, slender at
both ends & from half an inch to an inch in length & of the diameter of a small thread found
generally in the rectum & though not confined to that part of
the intestines. It feeds on the mucus of the intestines & produce
its young in immense quantities. It is found in the stomach 
& called maw worm





71
Ascaris lumbricoides (or [illegible] long round worm) is perfectly 
round & from four to ten inches in length bearing a striking 
resemblance to the common earth worm It is said sometimes to perforate 
the intestine with its mouth 
3 The trichocephalus now called [tric???] is a small capillary worm from 
an inch to an inch & a half or two inches in length. The body 
is about half an inch in length & Is terminated a tail which 
is twice as long & end in a fine hair-like point
In addition to these worms have been reckoned
two others the vesicularis & the gordius. The former is a 
small vesicle found in the brain (sometimes in great numbers)
& containing many small worms. It is now considered a 
hydatid & is excluded from the subject of worms & verminous diseases The gordius (horse hair worm) is found in soft
stagnant waters from four to six inches long & twisted into 
various knots & contortions” Good. They are sometimes found
in the earth in great numbers they turn black on exposure
to the air & resemble horsehair, hence their name
of horsehair worm They are very common in our vicinity They are rarely found in the human
stomach. I have known them coughed up in abundance from the 
lungs; when they had probably come from an abscess in the
liver. It gives rise to a severe disease among the [lapladens]. Vide Good. 
The maggots of the common house fly & the’
larvae of many other insects, have occasionally been met
with in the alimentary canal of the human body vide Good
What were formerly called vesicular worms
are now considered as hydatids. [Brera] or worms recommended 



An attempt has lately been made to revive the doctrine
of [equivocan] generation. The learned advocate has
attempted to fortify his opinion by the analogy of 
vegetables. But where the experiment has been made the 
seeds of the forest trees that come up as [illegible] may 
be found at the roots of the young trees
Hyoscyamus formerly was common here
but is not now However when the gourd is broken in the 
college yard Hyoscyamus springs up. It has also in the
soil brought from a cellar in Chapel St.
Leeches & a variety of insect are undoubtedly taken in in water etc.
In Duncans [illegible] we shall find an account of
a number of caterpillars [illegible] by a child produced by eating cabbage leaves
I think I have never known an instance of worms
in children while nursing


72
II II. The origin of worms in the human body
Worms arise from eggs. Some multiply by depositing
their eggs to be afterwards fecundated by the 
male. Others are propagated by copulation between the 
two sexes While a third kind of the taenia fecundate themselves.
I have spent much time in investigating
the origin of worms in the human body but must confess
that I cannot satisfy myself upon the subject.
It has been supposed that worms found in the human 
body are produced from eggs deposited by flies about 
the rectum, at the time of going to stool. Were this the
fact, they ought to be more abundant in summer 
than in winter, while the reverse is the fact. I am 
inclined to think that the rudiments of worms are 
contained in certain kinds of food as apples pears, cider
water & unboiled fruits and vegetables. In infer this
from the fact that worms make their appearance, oftenest
when such articles have been taken & disappear
when they are avoided. If confirmation of this view 
of their origin we find that children are rarely if ever affected
by then when under three months of age & seldom
while they are nourished from the breast. For though
some have asserted that they have seen worms in the
bowels of children within the mouth & even before birth 
yet the fact is not well ascertained.


Breras opinions, also adopted by Good speaking of the
fluke worm
There is no doubt of the fact of worms within [fetus in uteri]


73
Brera thinks that the minute eggs of worms are absorbed 
into the circulation He says “when we consider that the
eggs of worms are so small that they are not perceptible by 
the microscope of Hoffman and these eggs themselves are masses
of small eggs, nothing is more probable than that the eggs of worms
are absorbed by the lymphatic vessels, pass in to the circulation
pervade the system with the blood & are deposited in the various
parts of the body, where they enlarge and unfold themselves when 
circumstances favour their development.”
If worms are found in the foetus, the fact
will favour this idea that the eggs of worms are carried 
into the circulation. It may be remarked also that
the parts of the body which favour the development of their eggs
are those abounding with mucous
The hypothesis of equivocal generation 
is neither specious nor probable. It derives no support
from analogy aid from reason, nor countenance from fact
In its operation it is worse than useless as it tends to obscure
truth by substituting conjecture while it disregards with 
the most vague and licentious imagination the boundaries
between the animal and numeral kingdom & ascribes 
to chemistry what pertains only to animal life
When the creator first gave being to 
the natural world, every part of the vegetable and animal
system was brought into existence by 
an extraordinary exertion of productive power. They  were
not moulded by the slow operation of time & the cooperation 





74
of mechanical and physical forces, but he spake and it 
was done. But since that first act of creative power, we
find are that these creatures are propagated and perfected by processes
more gradual successive and [operose], many of
which may be traced by human wisdom and admit
of being regulated and controlled by human culture & ability
Rosenstein says “from the eggs of a fly proceeds 
a fly, from the egg of a hen a pullet and not a 
serpent, from the egg of a goose, a goose and not a fish
So from one worm is produced a worm and nothing else”
II II II. The effects of the presence of worms in the body
When the seed of worms are once developed in the human 
body, the health is more or less affected, and the morbid
symptoms which then appear are in proportion to 
the number of size of the worms the sensibility of the part
they occupy and the general morbid diathese which
takes place at the time, whether the cause or the effect of
the worms
Worms in the alimentary canal are less
frequently the original cause of diseases than is generally 
supposed, inasmuch as in many cases of disease where 
they exist, the disease was merely aggravated & not originated
by the worms & all the symptoms of worms from which it is 
common to infer their presence, may be occasioned by 





75
undigestible substances for a diseased state of the bowels
Worms are often also found to have existed & that too in 
great numbers, where the general health has been apparently 
good. I well recollect the case of a child in 
North Milford who fell from a height & was taken up in 
a state of coma from the concussion. A dose of calomel was
given him which brought away twenty or thirty large
worms. The child had been healthy to all appearance previous
to the accident.
Some physicians go so far as to say that worms
are necessary for the health of vigorous children that they 
are nature’s scavengers a natural provision to destroy the
superabundance of food taken into the stomach. Dr Rush
was of this opinion. The opinion supported by Dr [Parr] It is a fact beyond controversy that
very healthy children have worms with out manifesting
any symptoms of their presence until the supervention
of some other disease causes them to make disturbance 
in the system. It is but seldom that they are the excit. cause of dis.
The following are some of the ways in which 
worms are injurious to the system. They may be injurious
from their number obstructing the bowels and consuming
too much food. They are particularly hurtful by 
the irritation which they produce when the irritability
of the bowels is excited by fever. They sometimes threaten
suffocation by rising in the oesophagus & in one instance 
a single worm I have known to lie in the fold of a volvulus 
of the intestines so as completely to obstruct the passage 





76
Linneus attributed the dysentery to a worm or insect [illegible] dysenterical
[languis] the measles to a similar origin. Various
authors the itch, sigler, petechiae lusitanus the syphilis
martin the elephantiasis nyander, eruptive
& contagious diseases in general lancissi, plague, remitting & 
intermitting fever considering miasm [it] being a collection of insects # some authors, toothache Dr [Adam]
observes cancer itself is nothing more than an animalcule 
a worm or an insect. It would seem from 
such speculations, that a great part of the diseases
which flesh is [illegible] to result from a superabundance
of vitality and that as Good remarks in his [illegible] corruption is no longer the triumph 
of death over life, but of life in one form 
over life in another. Such fancies lead into the 
wildest speculations of equivocal generation & relinquish 
all principles & all limits in natural 
history.
# Vide N.Y. Rep. about the year 1815




77
Symptoms of worms. Those children are most frequently 
troubled with worms whose powers of digestion are weak.
The symptoms of the presence of worms in the alimentary canal
are very equivocal, for they may all proceed from other
causes. They are countenance pale or flushed sad and dejected 
livid around the eyes, eyes sunken
eyelids swelled pupils dilated itchings in the nostrils, head
ache after taking food, mouth water [illegible] filled with saliva, breath
fetid, great thirst, grinding of the teeth in sleep, starting
in sleep fainting vertigo, palpitation of the heart, irregular
pulse & cold abdomen bowels flatulent
costive or loose colic throbbing in the bowels severe from [illegible] the small [intestines & umbilicus] appetite irregular
& craving loss of appetite pain in the stomach when empty, which is relieved
by food urine increased or diminished turbid and milky, stools irregular,
containing much mucus nausea & vomiting Sleepiness particularly
after eating, bloated countenance swelled nose & upper
lip, paleness of the lips, irritation about the mouth, rubbing
the nose, itching at the anus irritation about the neck of the bladder dry & convulsive cough
difficult respiration sense of suffocation paroxysms 
of suffocation body emaciated frequent flushings of fever with irregular pulse convulsions, epilepsy
and partial palsy. Of course these are not all present
at any one time
Chorea catalepsy & epilepsy are produced
sometimes, by worms
Dry convulsive cough Diff respiration
In addition to the other symptoms there may be these of irritation
of the lungs producing cough also irritation of the brain




[772]



It will be impossible to class all the articles inasmuch
as we do not certainly know the modus operandi of many 
articles which yet have sustained their reputation for [illegible]
Much stress has been laid upon the operation of cathartics
in evacuating the [illegible] which the worms generate by their irritation, 
just as irritation in the lungs produces [illegible]. But then
the [mucus] although it forms [illegible] for them, an effect more 
than a cause, and the worms will make [mucus] enough for themselves
Probably many caths act by their acrimony upon the worms
themselves. Others by the violence of their operation dislodges 
them. “Aloes are beneficial in mild cases as a tonic
when there is no excessive irritation. If there is excessive sensibility
& irritability they are improper as they irritate the
rectum they may be given by injection When there are
symptoms of worms though no worms exist aloes are serviceable
in the form of elxiir prop.”


77:a.
IV.
[general
treatment]
In the treatment of patients afflicted with worms two 
general objects seem to have been pursued both in popular
practice & in that of physicians 1st to destroy & 
expel the worms themselves & 2d to obviate their effects
upon the system & at the same time by the improvement
of the general health of the patient, prevent their recurrence
and increase This second indication will often coincide 
with the first, inasmuch as a diseased state of 
the body is the most favorable for the multiplation of
worms
Of those remedies which destroy or expel 
the worms themselves we have three kinds
1st those that expel them by strong cathartic operation
2nd those that act mechanically upon them
3d those that are prisoners to them.
1st Although strong & even violent
purges may be used to drive out an accumulation of 
worms in the bowels yet they should not be often repeated
as they would increase the weakness & irritability of the 
stomach & bowels to such a degree as to favour this increase.
In general calomel will be the best cathartic 
inasmuch as it will tend to promote a flow of healthy bile 
& to restore healthy secretions. In Europe the gall of 
animals has been administered. One of the best forms 
for the administration of cathartics is that of alkoholic
tincture, for the sake of the joint effect of the alcohol
hence elixir proprietalis in teaspoonful doses & the tinct.


“The bark of the button wood taken from the north
side of the tree has been recommended. It is a nauseous bitter
& a cathartic good” #
“It is a question whether cowhage acts mechanically 
or whether it contains an acrid principle like that which 
exists in the nettle”
# One of the remedies that I have most 
reliance on for ascaride in tinct [illegible]. Fill a
bottle with the young inner bark fill the interstices
with [prosp] spirit & give I to zfs night & morning
It is an old remedy and better than tinct aloes
It is tonic & deobstruent”
Some of the acids to be narcotic, are more probably active
merely by their pungency, odour etc.



77:b.
of hickory bark or buds have been found very serviceable
Podophyllum peltatum is much used but is probably not better
than other cathartics. The best form would be that of a tincture
2 Mechanical remedies are not now used. Cut hair
has been given cowhage though some doubt whether the operation 
of this is wholly mechanical. I have thought that the root of
osmunda given in pieces acted mechanically The filings of
tin, formerly were much employed as was also an amalgam
of tin & mercury. There is a curious account in one of our
journals of a man in Kentucky who took a pound of the 
amalgam & was unable to expel it from the bowels The 
mass lodged in a part of the intestines & could be felt externally
It was very troublesome to him when riding.
Oil has been given with the intent that it should fill the 
respiratory pores of the tape worms & thereby destroy its
life. In Madame Nouffeurs recipe The supper of
panada is intended to act mechanically by its bulk.
3d The remedies which destroy the worms seem generally 
to be narcotics All articles of this class however do not
have this effect opium for instance. Particular animals
are sensible only to particular narcotics as for instance
swine are poisoned by stromonium while sheep eat it with
impunity. The most valuable article of this class
are the two species of spigelia s. [ma??ndica] & s. anthelmia



A strange notion has existed about a little innocent [illegible]
was considered as the narcotic agent
Similar reasoning has been used with respect
to denarcotising the opium Opium denarcotised would
be not better than bread
Spigelia zii in ¼ pt water to a child may be given in divided
doses. It is better to give a cath. e.g. cal. or ruhb
Spegelia from zfs to zf for an adult
Sometimes but rarely it operates itself as a cathartic
Sometimes convulsions are produced
Our pink is bad because it is gathered by [illegible]
packed in hogsheads & the rotten saved & the rest [illegible]
The emigrants from St. [Illegible] brought what they 
called worm syrup which they said shd be given in the
night because it affected the eyes
S. [anth.] is [illegible] S. [illegible]
about zi if S. anth.
“Pink is given more especially for the [round worm] & sometimes
for the tape worm”
[illegible] [illegible] & [areca] [oleacea] zii to zfs
“The French use the syrup of peach flowers & seeds 
They first give sulph either zi in [illegible] decoction male
form & an injection of the same. They probably act by 
their prussic acid”


77:c.
The former is the one commonly used in this country
and in England It is called Carolina Pink. This is a most
valuable article and is useful not only for its operation 
upon the worms but for its effects upon the system, in allaying
the irritation which they occasion. I have prescribed it for 
a cough & other symptoms of irritation where I had no reason 
to suspect the existence of worms Then given for its effect
upon the worm from half an ounce to two ounces should be 
given in decoction in the course of the night, accompanied with rhubarb
or some other cathartic to drive the worm off while in a state
of intoxication. It may be given in powder in a dose of from 
10 to 20 grs The French W. Indies s. anthelmia is used
& called wormgrass. It is a stronger article than ours
The French use the article in form of a syrup & give a 
teaspoonful at a dose.
Veratrum subadilla & helleborus [fetidis]
belong to this class and have been given in doses of 2 to 6 grs for
children In Europe the most famous article
of this description has been the Felix mas
Other articles of this class are camphor, prussic acid & tobacco
The bark of the cabbage tree (of which there are two species
vide Good) is found highly valuable in this way by the
West India physicians
Other articles which have been said
to be successful in cases of worms owe their success apparently 
to their acrimony in whole or in part, such as
the terebinthinate oils Oil of turpentine is the one commonly 


Various aromatics have been used, as chenopodium 
[illegible], rue tansy
“The leaves of cedar juniper & [illegible] powdered
20 grs They are acrid stimulating and tonic & may have
a mechanical action. It might be used to add to the
powdered leaves some aromatic as rue ol. tansy [worm]
wood etc.”
“Melia [azidurach] bark of root or plant
zfi to zi act as emetic cathartic & narcotic. Acts
more effectually at the south where the recent article is
used”



77:d.
employed should be given in large doses, when it will
prove cathartic. A concentrated solution of salt has been
strongly recommended given by the mouth or by injection 
Ether is much used by the French & perhaps has an effect
upon the worms. Some of the other antispasmodics 
which have been popular may also have some effect upon 
them such as asafoetida, petroleum the essential oil of
the chenopodium etc. Perhaps arsenic poison intestinal
worms I have known it cure. Ammonia may perhaps act on them
2 Of the remedies which are designed to have an effect
upon the system. In severe affections from worms our first
attention must often be directed toward quieting the excessive
irritation of the system, by antispasmodics. Various popular
remedies for worms seem to have little other virtue
The chenopodium anthelminticus & c. ambrosioides called 
worm seed & the c. botrys. or [juris]
oak ar probably valuable, mainly if not entirely a
nervine. They may be given in decoction or the essential
oil may be used. The garlics are used in syrup or decoction they are nervine
7 have considerable effect as condiments upon the intestinal canal. The 
ictodes fetidus is of this class & so are the empyreumatic
oils, petroleum given in a dose of 10 to 40 drops barbadoes tar etc.
For giving tone to the digestive organs
and exciting their sluggish action the tonics
the bitters & the aromatics are indicated while mercurial


[Artemesia] ][santonica] is no better probably than the
other bitter tonics Some confusion results from the appellation 
worm seed being applied both to this and to [illegible] botrys
c. anthel. & “Indeed anything which tends to [procure]
healthy secretions of the viscera. Of this kind are the
mercurial which produce healthy bile which is especially [illegible] 
to [illegible]”
# “Indian corn or maize has been supposed to 
favour the generation of worms in the body. The aborigines
of this country have been peculiarly subject to them perhaps
from this cause”
Worms are far less common now as are also colic dysentery et. than formerly when cold
water & cider were drunk instead of tea and coffee AT the
south likewise the negroes who feed more upon crude and raw
articles are more subject [illegible] of the plantations it is a 
rule to give a decoction of melia to the black children once
in 3 months #
Though you can cure worms generally by calomel
yet sometimes they will resist all treatment
Eupatrium perfoliatum is used for worms
Flowers of [zinc] are antispasmodic so also sulph zinc 
Dr Rush thought well of [sugar] especially when given in the
morning
Petroleum seems to be a valuable article a substitute
for turpentine It may be supposed dangerous, but I have
used it for many years without inconvenience I began with 
small quantities from fear of danger, but now I give 10 30 or 60 grs
It very often to produce no violent effects. Yet we must not conclude
hence that it is useless. Asafoetidae for instance produces 
nothing but a little [illegible] in healthy persons


77:e.
preparations & other deobstruents will be valuable 
adjuvants. The metallic tonics as the preparations of iron
& of zinc, the mineral acids, myrrh, bark, the various bitters 
& the astringents have been found useful I have used alum whey with advantage. Among us the geraniums
& all the indigenous aromatics & bitters have been given
in popular practice. Alcohol from its stimulating effect
upon the digestive organs will be a useful vehicle, for the
exhibition of medicines. Condiments used freely with the
food, will answer to the same indication
The diet of patient troubled with worms
should be dry & stimulating, rather than liquid & cold
raw fruit, acids cold water & all indigestible articles
should be avoided & in extreme cases I would advise that
neither food nor drink be taken but which has not been
subjected to heat. I have apparently cured patients by this
means. “[illegible] toasted bread [illegible] [illegible] vegetable
[illegible] though they occasion [illegible] dyspepsia”
A multitude of heterogeneous articles have been 
used as anthelmentics, besides those already mentioned; some of 
them are sugar; worm-wood; rue; peach flowers; bark’
of prunus virg; valeriana selequa used by the French; muriate of
barytes; injections of mur. of tin (Alibert); oxide of tin grs iii with
etr. of juniper (Alibert) mur. of amm. of linseed; mur. of amm.
[illegible]I with jal. or rhub 10 gr.; all the forms of ammonia; crude
mercury; merc. boiled in water; aethiops mineral; artemisia
[illegible] [illegible] ([illegible] [illegible]) & a. [illegible] [illegible]
[s?tonica] worm seed bitter & of some value; melia azedarach much
used at the south; butternut bark intensely bitter dose a tablesp. full of decoct cathartic & said to be narcotic;
allows asclepiadis I think I have seen the a. [illegible] then beneficial; etc. etc. 


Garlics seem to do well how it is difficult to 
say perhaps operate upon the worms. Garlic also 
will relieve the eruptions of worms. It is though also
that garlic prevents worms
I have a very good opinion of sulph ether
introduced into the rectum used by the Germans, Italians
nervine & antirritant. It is valuable both in cases for worms 
& in those of irritation & affections of liver severe pain in bowels etc.”
½ oz or 1 oz. iron filings taste by [illegible]
remedy worse than disease
Wherever leaves of [illegible] are recommended
you may give our common juniper For the imported [illegible]
loses its strength by keeping & drying
Rosenstein recommends cold water during the
operation of a cathartic He recommends effervescing mixtures
to destroy the worms by carb. acid
An old remedy of the tonic kind is alum whey
Rx milk & water equal quantities & put in [illegible] [alum] to [illegible]
give the whey [illegible] children takes it pretty freely; It is a 
given in cases of relaxation of bowels and for ascarides & round worm
It is of consequence often to have a remedy [illegible] and not require
to be forced down


77:f.
Various external applications have been prescribed
Oxgall & venice soap aa zi made into a liniment with 
oil of tansy or wormwood;
Aloetic plaisters; ether oz vi, bruised garlic zi, camphor 
zi (used by the German Brera) for a liniment; petroleum mixed with gall;
Most of the patent medicines for worms [illegible] or both contain calomel,
Storr’s lozenges are calomel with sugar & gum. These
are his white lozenges. His brown are resin of jalap,
gum tragacanth & calomel.
Good on the authority of the Germans recommends 
[illegible] milk
Electricity 
A popular article (cath.?) is decoction of [plantanus]
occidentalis strong bitter
For ascarides I rely as much as any thing upon a saturated
tincture of the juglans [illegible] & [illegible]
All the indigenous bitters as cherry bark [illegible]
melia [azedarach] zii of recent root is divided
doses ½ pt water. When dried & long kept it is apt to 
disappoint here.
It is acrid [as the] narcotic & cathartic
a powerful article The berries are also narcotic causing
lard to fall down not from [choking] as has been thought
The [planters] think it too powerful for [white] children!


Tape worms frequently produce headache 
[illegible] about the umbilicus
yet generally produce a sense of weight. Yet I have known 
persons evacuate them when they had not been suspected
Case of a man who had kept taking remedies for a catarrh
Finally a medicine ? brought away to his own surprise 
and that of his physician a tapeworm
Perhaps vomiting occurs oftener from tape worm
than from any other species
# “When the worms are very numerous, there is a sensation 
of something falling from side to side on a change 
of posture”


78
V. Symptoms of each of the kinds of worms with the treatment.
1st taenia solum. This worm generally inhabits the upper
part of the intestines & adheres so firmly as to be removed
with difficulty It is sometimes solitary but commonly in 
considerable numbers. When brought away from the bowels
many of the joints are separate & have the appearance of gourd
seeds hence the name. 2 T. lata or vulgaris This likewise
inhabits the upper part of the intestines and is usually in families
of three or four
Both are called by the common name of tapeworm
They may exist without any apparent symptoms of worms
or they may give rise to the severest affections In general 
they are attended by severer pain in the bowels & more violent
symptoms in general than the other worms. The diagnostic 
marks of their presence in great quantities, are
sense of weight in the abdomen, # irritation of the stomach
nausea & vomiting loss of appetite, irregular appetite
weakness of the chylopoietic viscera, bloated countenance
emaciation of the body etc. All these symptoms however 
may arise from mere irritation of the stomach of a child
Adults are more generally affected with
tape worms but children sometimes have them.
For the taeina solum t. lata or vulgaris or cucurbitina the
gourd seed worm the spirits of turpentine has been 
very successful. Though not prescribed by the physicians
it has been used as a popular remedy here for more than
T. lata
fifty years. I have known a man of intemperate habits 


No cautions are given about the use of the article (so far as I know)
But if it does not act as a cathartic immediately, it will produce
great irritation especially of the urinary organs
I recollect the case of a lady who had been treated
with aph turp. in N.Y. taking 2 or 3 ounces Violent vomiting
& catharsis had been produced and the tone of the 
stomach and bowels seemed to have been permanently destroyed
Worry had indeed been brough away, but then they would 
come away themselves & the relieve was fallacious
In delicate cases it had better be combined
with castor or sweet oil
In the case of the lady cath seemed to do no 
good, they would indeed bring away large quantities but
they would return in a few days. I put her upon arsenic 
but she left town and I have not heard from her
It is difficult to tell how arsenic operates whether 
upon the worms or producing healthy bile
For the t. lata the spts turp. seems to do 
better


79
take a wine glass full of spirits of turpentine to expell a
tape worm Though an habitual inebriate, he said he never
had been so drunk in his life & large tape worm of this kind? came
away # It is said sometimes to intoxicate & sometimes to produce irritation
T. solum
2d The t. lata is the most difficult of all 
worms to manage. Spts of turpentine do no good at
least in those cases in which I have tried the article In
T. solum
one case I gave zfs. In another I gave it in teaspoonful
doses. In the latter it operates freely as a cathartic
a single teaspoonful procuring as many as ten stools 
Worms were evacuated but they would make their appearance
again in as large quantities as before. Indeed
any medicine may bring them away for the bowels
are sometimes so filled with them that they come away 
T. solum
when the patient is walking, or is asleep. I have known
two quarts to be brought away in a day, & then a fresh
supply in a few days after!
T. solum
# Arsenic has succeeded better for this kind? with me than any other
remedy, which I have used. In the case of a child
5 or 6 years of age who had both the round & the gourd
seed worm the common cathartics were given with some
advantage, as some worms were brought away; but the
symptoms still continued and the worms passed occasionally
with the stools. Fowler’s solution of arsenic was 
administered in doses of four drops three times a day. In a 
few days worms ceased to be evacuated the symptoms 
disappeared & the child has once had no recurrence of the worms



[Osmunda] cinnamonea is bitter, subastringent
and perhaps deobstruent. So is polypodium vulgare
and perhaps more decidedly so
The polypodium vulgare & felix mas They 
are used in chronic affections of the stomach & bowels & thought 
they have not obtained much reputation for worry in 
this country yet they have sustained their reputation for
2000 years. It was used by Galen
“The [form] is tonic”


80
I recollect case of one patient, a woman, who kept 
passing tapeworms, in great quantities, for months. After failing
with medicines I threw them all aside & tried diet
All the food taken was roasted or boiled even the water
used for drink was boiled. She was cured. It must be 
remembered the healthy bile & gastric fluid will destroy 
those worms & from this fact results an important indication,
which I shall presently dwell upon.
Felix mas the male form has been considered
in Europe, as a specific for this worm. With us the
osmunda cinnamonea [illegible] ([hog brake]) has been used as a substitute for 
it. It is bitter, astringent & sweet. The polypodium vulgare,
which is tonic & deobstruent, & other forms may 
probably be used also
The famous fern remedy bought by the king of France of Madame [Nouffleur]
is as follows. Take a super of the following panada
Rx water lbi [illegible] fresh butter z 2 or 3 bread cut into small pieces
zii add salt zi & boil thoroughly. If the patient is costive
give an injection of water lb is in the evening olive oil zii salt gr. s.
The next morning eight or nine hours after the supper the
specific is to be given viz. Felix mas ziii in powder, mixed 
with 4 to 6 z of the distilled water of the fern or the
flowers of the linden tree the whole to be swallowed at a
dose. In children the dose is reduced to zi of the fern
Two hours after the fern is taken the patient is to swallow 
the following bolus R. cal. & scamm. aa grs xii
Gamboge grs V powdered fine & made into a bolus to be 
given at one dose to a person of vigorous constitutiokn


Ether acts especially upon the nervous system
on which account it has been used as an anthelmintic 
Alibert for taenia gives about zi in a glass of the
decoction of the male form in the [illegible] an hour
after his doze zi of the ol. ricini are to be given
in syrup or in composition the dose to be 
repeated twice & sometime three times a day
The worm is usually evacuated after the first doses 
Mr [Bonadier] directs an injection of the decoction 
of the male form to which zii of ether are 
to be added Mat. Med. art. ether


81
Mathieu adds to Mad. Nouffleur’s remedy the filings
of tine & the sulphate of potash
The French & German add ether to the same
remedy
Rothier’s method is Rx powdered savin grs xx
seeds of rue 15 cab. grs x oil of tansy gtts xii syrup 
of peach gr. s. make a bolus Take half in the morning 
& half after dinner, drinking with each dose a glass of 
vin. tincture of peach kernels
Dr Baurdier gives the following 
Rx sulph. ether zi decoct felix mas 1 gill taken fasting
4 or 5 an injection of the same decoction with 
zfs of ether an hour after zii ol ricini or zi of
the syrup of peach blossom the worm is discharged 
half organiz
Oil is used in order to kill the tape worms
by filling their respiratory foramina. Ol ricini has
been given for taenia & other worms in doses of 3 or 4 z
Liquid carb. amm. might be given for taenia
The German physicians are fond of giving 3 or 4 
ounces of castor oil They are fond likewise of peach flowers
Within 5 or 6 years the bark of pomegranate has
been recommended. Paris says bark of the root [illegible] probable
however the office preparation is meant viz rind of 
the fruit which is the most astringent substance to 
the [illegible] which we have [illegible] also cathartic! I have
not [illegible]
N.B. The male form is astringent, and is given
to enable the bowels by the tone it gives, to bear the [strong]
cathartic afterwards. Hence the union of these give in [illegible] [illegible] may be useful



I have seen the worm occasionally in rain water
I recollection one man of 60 who informed me he had been
troubled with then nearly all his life until he removed his [illegible] Change of place
may effect a cure by change of water
Probably [illegible] of our cholera are
troubled with this worm delicate children only suffering much
children troubled with them will be faint, have
turns of colic etc. you will be called [illegible] Give an injection, and no worms will 
come [illegible] yet give afterwards a strong cath. & or repeat
the injection and worms will come away proof that they 
were not in the rectum They probably breed in the duodenum
I have known but one case in which they were vomited
up. The subsequent cath. will bring away 
smaller worms 
More is done by diet int his worm than by 
any thing else
Alcohol in this morning especially its bitter
tinctures. Condiments are useful. Worms are less common 
now because condiments are more used. It is said that
the aborigines when they cannot get salt used potash ashes
by a condiment The aborigines are said to be very subject 
to worms
# Ascarides sometimes produce severe pain at the 
umbilicus and colic
# “Ascarides though often found in the rectum
are generated in the stomach & small intestines. Hence they 
are sometimes no discharged till the second or third operation
Hence they are sometimes thrown up by vomiting. I have examined this point carefully 


82
3d Ascaris vermicularis. This worm is always troublesome
when it exists in considerable numbers though it is but seldom
that they exist in healthy persons in such numbers as to 
give rise to morbid symptoms. They are very common in 
children, and not rare in adults & are called by the
generic name ascarides
These worms are commonly found in 
the rectum & hence are often said to inhabit that part 
This is a mistake they multiply abundantly & lodge in 
the rectum as they daily pass void by sphincter. Sometimes
they exist in the stomach in vast numbers (hence called
maw worms) so as ever to threaten suffocation by rising
in a ball into the esophagus & sometimes they 
cause severe griping pains by their presence in the 
small intestines #
They pass in the stools & sometimes come
away spontaneously at night, they are said even to 
make their way to the vagina & urethra of females producing
troublesome symptoms X Ascarides are most troublesome
in the latter part of the day & the first of the 
night, when they excite an intolerable itching 
at night [illegible] probably than feeding They give rise to symptoms of general irritation
& sometimes to a cough # Ascarides are particularly 
injurious to dyspeptic patients & they themselves may give 
rise to the symptoms of severe dyspepsia such as craving
appetite, indigestion, faintings. Flatulence, cold
extremities pale & sallow countenance, cough etc. The irri


“They are attended with violent itching
about the rectum general irritation convulsions
irregular appetite pale urine flatulence want
of vigorous action of chylopoietic viscera increase of mucous
secretion darting pains in the abdomen stomach 
& chest faintness cold extremities the symptoms of
dyspepsia sporadic cough”
Tobacco injections & tobacco smoke injected are
very useful and will often cure. It is not safe for children
I have seen great prostration produced in children & I have
known an adult killed by a tobacco injection #
A physician who had been much troubled
with ascarides told me he had tried merc. oint. externally 
with advantage. “I have used it but was rather disappointed
# When the ascarides are in the small intestines, tobacco
smoke will do not good & by its debilitating effect will
favour their existence
“Injections of camphor and milk 
have done more to remove ascarides
than all other remedies I have used. The injection 
immediately removes the irritation produced 
by the ascarides & the ascarides themselves. It
may be made of milk ziv to spts camph. zi
This is the form in which I have used it, probably 
an emulsion is as good, perhaps a
better form” M. M. 


83
which they cause sometimes, in children brings on convulsions
Whenever, finally, they exist, in the alimentary canal
they are accompanied with great quantities of mucus in 
this part. They feed on the mucus of the intestines, the flow
of which they excite by punctuating the mucus membrane
Treatment It is very difficult to cure a patient
troubled with ascarides. The most immediate relief is
given by injection. If the worms are in great quantities & too much 
“Tobacco smoke is one of the most powerful means we possess for the
involved in mucus, they may be completely removed by 
cure of these troublesome worms”
injecting tobacco smoke. Injections of warm water or milk & water will
relieve for the time being by washing out the rectum & if
a quantity of aloes zis to ½ pt is added a still better effect may 
be expected though camphor being a nervine & a poison to the 
worms would be a still better addition. Injections of milk 	
and water, with camphor zii tinct camph to ½ pint, 
will if preserved [illegible] destroy them 15 grs of [illegible] [saladilla] have been injected. Still the frequent injection,
required in bad cases may debilitate the bowels
& consequently invite the return of the worms.
For internal administration. I have found
a tincture of the buds or bark of the hickory given in doses
from a tea to a tablespoonful one of the best articles both
for removing the worms & for preventing their return
Drastic cathartics should not be depended upon 
for they weaken the bowels & increase their irritability & 
hence favour the production of the worms. On the contrary 
calomel & tonics should be given to restore healthy secretion
Aloes if given should not be in large doses, for that will
irritate the rectum still further, but in smaller ones as a tonic


Oily articles shd be avoided as butter, because
they relax the [illegible] of the intestines Potatoes, vegetables 
All kinds of pastry avoided
All the metallic tonics are useful as tonics
They are thought also to be unfriendly to the worms
It is said that forth ascarides a pint or a quart
of sea water has been drunk with advantage, producing
vomiting & purging. Salt is a good remedy. Dr Rush proscribed
a teaspoonful of salt in the morning to a gentler one
much troubled with ascarides. He told him after trial than 
the remedy would not do. Dr Rush gave him, then, for worm
powders # 
For the worm the [illegible] the pink shd be the remedy vide [illegible]
“Rhub & cal. are the best cath. but all are useful For children Rx
tinct. [illegible] Fowlers solut. cold water” 
“Common salt ground up with cochineal to colour & disguise
the article. The gentleman reported that the last prescription 
had answered well. Dr Rush also believed
in sugar. This more doubtful
The asclepiasis have been much used especially 
for this worm especially A. incarnata called wild hemp It is 
dried pounded to a fine powder mixed with molasses & given in doses of a teaspoonful
Or [illegible] down and make a strong decoction [illegible] the [illegible] with it
molasses and give freely until it moves the bowels
This much used by the practitioners of the state more than any 
other article after calomel. it is an article which may always
be obtained growing in clayey situation and is safe
The other asclepians are similar & may be used S syriaca
is the most laxative


84
To prevent the return of ascarides, condiments should be freely used
such as pepper, ginger etc. in short all warming and bitter things
In extreme cases let the diet be so regulated that nothing shall be 
received into the stomach which as not been subjected
to heat. Mercurial ointment has fasted in my 
hands.
4. Ascaris lumbricoides the long round worm is perhaps
more commonly found in the alimentary canal than any other
This worm more than any other is found to have existed in 
the stomach or intestines while the general health has been good
is the presence of worms not suspected.
Strong purges may be used to remove
them & alcoholic tonic tinctures given to prevent their increasing.
For this latter object the carbonic acid has been recommended 
in the London Med. & Phys. Journ. & in confirmation 
of the idea I have used soda water with advantage
Melia azedorach or pride of India a decoction of the bark
is much depended on at the south for their young negroes
who are much subject to worms. It loses much of its virtue when dried. The spigelia is also
sued but of this I shall speak under the head of general 
treatment.
I recollect with an aff. of the liver
wh often vomited up dark [gravous] blood, which had evidently been 
long in collecting. Finally he was said to have thrown at 
a snake. Many eyewitness testified to the snake & to its eyes 
& teeth. I saw it. It was a very large round worm of the kind


To be distinguished only by the violence of the
symptoms. The same itching at the arms will exist as of the
ascarides, but non violent etc.
“Treatment similar to that for ascarides. It
is more common than is generally supposed. Many 
of disease & death by irritation from an unknown cause, are probably 
owing to this worm. In examination the contents of 
the bowels should be placed upon linen cloth and then
this worm can be seen.”
For the gordius Linnaeus recommended the angelica
Archangelica (not our viz the [atropur????])



85
5. The tricocephalus is but seldom met with 
The irritation produced it may be so great as even to bring
on delirium & will be manifested by screaming
throwing of the hands & [fat] etc. I have found this worm in a 
fold of the volvulus of the intestines vide Volvulus.
I should try narcotics for this worm, but 
cannot speak from my own experience. I should recommend
also an injection of a table spoonful of ether in a gill of
water or mucilage. Ether given in this way will undoubtedly 
pass the valves of the intestines in a state of vapour 
Vesicular worms, according to the old division of verminous
diseases, are met with commonly in the brains of adults & 
are attended with the symptoms of vertigo, convulsions
apoplexy & hydrocephalus.
Cases of worms & of colic are much less frequent with 
us than formerly; owing to the change in our mode o f
living. They are said to be very common among the 
aborigines of this country



One volvulus may be received within another
a second, a third and fourth time & [illegible]. The whole may 
then become inflamed, the vessels may run
from one to another, and the whole become one complete mass 
of organised matter or sometimes [illegible]
“It may occur in any part of the intestines except the rectum
though the colon is often received into the rectum”
The symptoms of the two kinds [illegible] [illegible]
owing to the different susceptibility of these two portions of the 
al. canal, and the diff. ages of the subjects of each
Nor located in books vide Ed. med. & surg. J
where the best account of it is given. Good merely mentions it
as an accident that is found sometimes to have occurred in ileac
passion
“Predisposing of exciting causes”
The cavity of the natural stricture may not be large than a goose quill, & such 
children will be very liable to an occurrence of volvulus
This is not a primary disease. It occurs more
in some families of [illegible] fibre & [illegible] phlegmatic
temperament
It may occur from debility of constitutional
or that of the bowels [illegible] by bowel complaints etc.
Local violence One instance, in here the child 
was apparently thrown into it by being carried over the shoulders


86
Volvulus or Introsusception
This is a disease with which I was at first very much perplexed
especially as I derived little satisfaction from the books
Volvulus or introsusception is the reception of one portion of
intestine within another. It doubtless exists often in a 
slight degree, when there is a strong action of the bowels
& are inverted peristaltic motion & the bowels disengage
themselves. Sometimes there is a double involution, or one
involution within another. In some cases likewise the 
cavity of that portion of the intestine is entirely obliterated by 
the tumefaction of the coats. I have always found in post 
mortem examinations, that the upper portion of intestine was
received into the lower & not vice versa the involution having been caused apparently 
by inverted peristaltic action
This affection of the intestines occurs oftenest
in children though adults are liable to it. It would seem also 
that some families of a leucophlegmatic temperament & 
delicate constitution are particularly liable.
It may be caused by a natural stricture
of a portion of the intestinal tube when it will be incurable
It may arise from extreme irritability; local violence
& injury may occasion it, & the irritation of worms may 
bring it on. Drastic cathartics may bring on volvulus
& hence should be cautiously avoided where there is a liability
to it. Bowel complaints, as colic, cholera, dysentery
etc. sometimes terminate in one or more volvuli of the
small intestines. The disease is more frequent in the 
summer, when debility is greater & bowel complaints prevail 


“Symptoms incessant irritation one or two copious evacuations
but usually these have ceased entirely before the physician 
arrives constant efforts to vomit, resembling hicup constant
efforts to pass stools & nothing passes but mucus streaked with blood
Generally mistaken for hydrocephalus
In bowels complaint of delicate children look out
for volvulus It is much more common in some seasons than 
in others. About 10 years ago they were quite common. I had
many letters from our students, who met with the disease
& disagreed with the phys & gained [reputation]. They 
frequently sent me such accounts.
Sometimes there will be a partial involution of the
large intestines [illegible] to relaxation of inner membrane what descends
like a funnel & may be felt by the finger #
In the large intestines there is not very much irritation
than is torpor of al. can. not much vomiting except upon 
the administration. There is no purging
You may sometimes determine that of the
large intestine by heaving the peristaltic action discard
& stop at the [illegible]
This is most common in adults. The symptoms
are more mile
# It occurs in females who have had long continued effetion
of uterus, occurring in females about cessation of [catamen]
and from long continued bowel complaints. The [inner] membrane
will descend like a funnel An injection will perhaps 



87
Symptoms These will be different according as the 
affection is of the small or of the large intestines
1st Where the small intestines have one
or more volvuli the symptoms [illegible] vomiting or
Symptoms like those of violent injury to abdomen vide case 1st 6.89
a constant endeavour to vomit as often as once in ten 
or fifteen minutes the matter thrown up being a greenish 
fluid or simply mucus. In severe cases the vomiting is 
attended with a discharge from the rectum at the same 
time. The stools are fecal at first & copious but afterward 
they are small in quantity & consist principally of white mucus streaked with blood
the blood not being diffused throughout the mucus as
“no fecal smell generally”
in dysentery, but in streaks or specks. These symptoms 
are attended by others which indicate great inquietude or irritation
such as throwing the h ands & feet, rolling the 
head paleness of coutenance This set of symptoms resemble those of hydrocephalus
& hence volvulus is often mistaken 
for this disease. The pulse is small and frequent
“[illegible] usually occurs in 24 or 36 hours”
2 A volvulus of the colon or rectum 
is not usually attended with much vomiting unless this
is excited by cathartics. It is attended with the ordinary 
symptom of constipation. There is no evacuation 
from the bowels unless at times a little blood and
mucus. If the passage be not completely closed, an 
enema thrown-up will remain & not come away if
completely closed. it either cannot be thrown up 
or it returns immediately. Blood often follows the introduction 
of the pipe. Indeed the inflamed part is often 
so low as to be reached by the pipe & admit of being felt
by the finger.



come away immediately. [Schyl?la] of feces may come away 
And large quantities of mucus may come away sometimes 
½ a pint. This is not apt to be fatal. Treat by a strong
inject prescribe for the [illegible] with conium [illegible] etc. mechanical 
means
The more cath. you give the more the unsolution is
increased therefore give more
Give mucilaginous injection, in involution of the 
small intestines, sufficient to fill the intestines. If it is
said that the injection will not pass the valves. I answer 
that whether by sympathy or in whatever manner, I am satisfied
of its utility # 
Give [illegible] enough to allay irritation 
I have treated # patients for 8 or 10 days without 
evacuation & cured them 
Not long since I had a case in what
I suppose there was such a volvulus, for the attendants
could not make the child receive injection. “thought
the bowels were swelled” The child was suffered to 
get 8 or 10 days without evacuation & eventually died
of another disease with which this was connected
# In the incipient stages, filling the intestines
with warm water [illegible] recovered. I was led to it from 
its [illegible] strang. hernia I am satisfied it acts well as a 
local nervine etc.
I would recommend the injection of ether 
in cold water table sp. to a gill warm wat. will make it fly off. The inject of it
is practised by the French & Germans. Other antispas. might be [injec??]
is asaf. petroleum etc.


88
We may often hear a rumbling noise proceed as far as 
the stricture & then stop.
Treatment The indications of cure are principally,
to relieve the excessive irritation both constitutional & 
local & to attempt the restoration of the involved intestine
chiefly by mechanical means
When the small intestines are affected we
must give opium and aromatics & depend mainly upon
these as internal remedies, until the intestine restores 
itself. As an adjuvant the warm-bath will be valuable
& fomentations or irritants, as mustard & horse radish
leaves may be applied to the abdomen. Soothing injections 
also may be copiously given. The quantity of opium 
which will be safe at a dose may vary from half a drop to 30 
None but the mildest cathartics are safe, as blue pill
and aromatic tincture of rhubarb I have succeeded in giving 
only a decoction of senna & the blue pill [Savage]
When volvulus is in the large intestines
all our remedies must be given by injection. The 
warm bath etc. may be used & we may also attempt
the restoration mechanically, by means of copious 
injection repeatedly given & thrown up with force
Two cases are related of young men cured by inserting
into the rectum & keeping these for a considerable time 
as spermacete candle with a quantity of opium at 
its extremity.




The first case which I had I treated for constipation 
with repeated cathartics, which are thrown up etc. The
attendants complained that they could not give the injections when
I ordered I was ignorant of this case Tried warm bath & 
every remedy for colic constipation etc.
Upon examination at first the colon was
apparently wasting at the sigmoid flexure where there
was a large tumour which we thought to be a malformation
It proved to be a repeated & insolution of the intestines Inflammation 
had taken place & the whole was adherent, some
[illegible]
Afterwards I was called too late, to a similar
case which upon an examination showed circular appearance
Afterwards called in consultation to a child
said to have hydrocephalus all the children of which family 
had died in a strange way. I pronounced the disease
not hydroc. but some could not say what was the matter.
No treatment was serviceable. Examin showed volv.
of small intest. Symptom is above. vide p. 204
The children of the family were subject to 
diarrhoea & were leucophlegmatic. I afterwards 
[illegible] the family and was very cautious about cath.
giving nothing stronger than blue pill or tinct. rhub. The
family raised 5 or 6 children afterwards
Case of a student [unaccountable]
Dr Munson & Dr Smith at a loss. [Cath.] retained & yet
not thrown off by vomiting Sitting by him I observed
a rumbling noise Which he said upon my enquiry, he
felt & which stopped. I felt the stricture. Spermacite 
candle, sharpened, opium at [end]. kept up about a [illegible]
[renewed] afterwards injection passed up 
Case of a gentleman on the wharf similar cured


89
Cases. A man over whom a cart had passed without
leaving any external injury, died with all the symptoms 
of volvulus of the small intestines. On dissection the duodenum 
was found cut entirely in two. One remarkable
physiological fact occurred in this case; a cathartic
was given by the mouth & produced a regular 
evacuation from the anus, although the intestine
was completely severed.
An interesting case occurred to me
in which the worm ascaris tricocephalus was found
to be the cause The worm lay in this fold of the intestine. Grace Linsey, a delict schoolgirl
on was taken with slight in disposition for 3 or 
4 days the rejected her food by vomiting then came
on constipation with vomiting attended with great
restlessness & throwing off the bed clothes, cold extremities,
low & small pulse the tongue not much furred,
little or no thirst, no tumefaction of the abdomen
no determination to the head. She was visited on 
Tuesday and died on Saturday. A blue pill was
given & followed by 15 or 20 grs. of calomel in divided
doses No effect was produced though they were 
not rejected. Opium and stimulant were tried but
were not retained. There is no pain but faintness & 
an uneasiness about the alvine & urinary passages.
Both copious and small injection pass up well but
produce no evacuation. On Wednesday injections produce
stools which are clay coloured. Black vomit came
on two days before death. P.m ex. liver very pale
little bile in the gall bladder no marks of inflammation cavity 
containing the intestines very dry as in cholera. Two volvuli were found one in the
ileum which was disengaged with difficulty, & one in the jejunum 


In other cases with similar symptoms I have had supposed 
there was volv. caused by worms, but have had no opportunity 
to examine Vide p. 204
[illegible] Lindsay’s case continued. After the examination 
we accidentally observed some of these worms minute 
& coiled up among the mucus on the cloths. The worms seem
more calculated to irritate the bowel than any other “If it
could have been known that the worm was there, perhaps tobacco should aught have
succeeded
# It is called leg ache in slight affections 
alluded to by DR Rush
Affects the legs, calves of the legs
[illegible] continues extends up to the [illegible]
coats” It is a disease manageable in its commencement
Being a severe disease it calls for 
decisive remedies
The indications are to allay pain 
equalize excitement & promote peristaltic action
by opium by diaphoretics by cath.
Cal. in full doses some would call 5 grs a
full dose some 10 But if 5 gr. should be given
every hour it would amount to a full dose. You 
may give 10 gr. 2 or 3 times repeated. AT the
same time apply warm bath & fomentations
not regarding your giving cath. Put drafts
at the feet. Follow the cal. with senna, salts etc.
But do not be too anxious about the calomel’s operating
immediately It is better that it shd lie sometimes in 
[illegible] vessels
With the cal give opium also guiacum 
& guaicum with dovers powder the latter
to act on the skin and the whole to produce a 
decided [nerve] action affect on the al. can. and on the whole system


89:a.
Nervous Rheumatism
Infantile neuralgia
This is a disease which has never to my knowledge
been described in the books, though it may have existed unnoticed
I first met with it some years ago, but it is [not] some years
since I have seen of a case. It may occur again
It occurs in the winter and spring mouths & 
occurs after exposure to cold especially after the feet have
been in snow water.
Children are the only persons that I have
known attacked # 
This disease is in its symptoms allied to neuralgia
acuta. The affection leg ache is probably allied
The attack is sudden after exposure to cold 
with excruciating pain in the inferior extremities sometimes
rigidity of the whole muscular system more or less disorder
of the digestive passages (apparently the muscular coat of the
intestines is affected) abdomen frequently tense
and full stomach sometimes irritable. If the disease advances
there is nausea, vomiting, tumefaction of abdomen
(appearance of tetanus?_ (coma?) etc. and the patient dies
in 4 or 5 days
The indications of treatment are to equalize
excitement by acting upon the whole surface of the alimentary
canal and skin at the same time introduce new action in the system
commence with a full dose of calomel 5 to 10 grs or 20 & follow
it by senna and manna, or castor oil and enemata
“I do not expect that cal. [illegible] I as above will operate at 8 years therefore follow it.


Immediately after administering the calomel I put the patient
into the warm bath or the feet in to the tepid bath,
wrapping them afterwards in flannel or boil cedar boughs
in water, roll them in cloths and apply them to the body & 
feet. Irritants also may be applied to the extremities and
to the abdomen
Sometimes it will be best to repeat the cal
in the course of 2 hours. The stools will be fetid and
dark but this must not be considered as an indication 
for further evacuations as the appearance may be caused by 
the calomel, and is a sign that secretion is beginning to take
place. After producing free evacuations by your cathartic
you must keep up a regular course of exciting the secretion 
by cal. & guaicum with Dover’s powders, especially if 
pain continues & keep up a diaphoretic action by Dover’s
powders calomel and camphor alternately increasing 
doses if necessary. Calomel and gum arabic, as an emulcent, 
& calomel and decoction of cedar twigs, as a diaphoretic
may be given
Give the calomel first in divided doses
If cold applications are made to the extremities, to 
discuss the inflammation the disease is translated to the
stomach and death is the consequence
I called in the first stages, & am always successful in effecting
a speedy cure



The irritation of the system is so great that secretion 
is prevented hence the production of
secretion
I have been called to patients with [illegible]
where little had been done the abdomen was
swollen the patient went into a comatose state
& died and that too where the disease
was not of the most violent form
After the bowels are thoroughly evacuated
depend upon diaphoretics camphor guaiacum and 
[illegible] etc. giving so as not to offend the stomach 
and beginning gradually 
It is a violent and excessively 
painful disease and it is a great satisfaction to the 
phys. to cure it
Dark stools [illegible], satisfied
“The pain usually begins in the calf of the
leg and extends to the contiguous parts. Sometimes it is attended
with tetanic spasms & a constant rigidity of the abdominal
muscles. The stomach becomes in these cases irritable,
and nausea & vomiting prevail. In the progress
of the disease the abdomen becomes full and tense, with 
constipation.”
“It should be our leading object to make the
muc. men. of al. can. & the cutaneous system active [concert]
After the operation of cathartics, if the pain is severe give diaphoretics 
with opium, as Dover’s powders. Camphor & cal.
in small doses as an alterative. If the stools are watery & fetid
give opium ¼ gr. guaiacum 1 or 2 grs. camph. 1 gr. Ipecac ½ gr.
with cal. repeated till some effect is produced not to salivate, but
to this children are not so liable as adults”


Young physicians are often called in a case of convulsions
as their first case The neighbors & friends (women) have assembled
in great numbers and their sympathies are excited. Hence
an impression is made with respect to a young physician’s talents which 
will be of great service or detriment
Morbid condition to brain so that ordinary stimuli
produce convulsive action
Convulsion fits may continue 5 m or from 1 to 2 hrs


90
Convulsions vide costiveness 12:a
This is a very common disease of infants. The mortality from 
it is truly appalling nearly one seventh part of the whole
number or deaths of patients under the age of puberty
by the bills of mort. in Phil in 20 years
Medical writers commonly make two 
kinds of convulsions idiopathic and symptomatic, the
former arising from some morbid condition of the brain 
and nerves and the latter from some other disease, or from 
irritation. Children are subject to both kinds & most
of the diseases of children may be expected when they prove mortal
to terminate in convulsions
The causes of symptomatic convulsions
are as various as the agent capable of producing irritation
though the causes of convulsions in one child will not 
necessarily produce them in another. The susceptibility to 
them varies with the age of the child and the peculiarity 
and degree of delicacy of the constitution.
Convulsions may arise from the sudden suppression 
of evacuations to which the system has become
habituated. Irritation from teething is a very common 
cause. Worms in the alimentary canal may excite convulsions.
But perhaps the most frequent cause is the 
presence of indigestible substances in the primae viae.
irritating the nerves of the stomach & through them those of
the whole system. Over distention of the stomach, even with 
food of a healthy quality interrupt the progress of digestion
& the food undergoing action [illegible] fermentation 


“Or the excessive quantity of food may produce
convulsions from the mere stimulus of distention”
“Dyspepsia is a cause”
This is an important maxim in the first children of 
young mothers Their anxiety of mind will often affect their
milk


91
in the stomach, becomes noxious matter & excites convulsions
In the season of fruit we may always suspect this as a 
cause in children old enough to eat it. Calomel has been
known to be so irritating to the system as to bring on convulsions
Costiveness also is a cause of convulsions in children
A change in the quality of the milk of the
mother or nurse, produced by improper food or
by strong affections of the mind, in some instances
is the cause of convulsions in young children. Hence 
not only the diet of nurses should be regulated, but their
minds kept tranquil. It may be observed also that the 
countenance of the mother or nurse as also those of the bystanders
has more influence upon children than is commonly 
supposed. Even a child but 3 weeks old, will be strongly affected.
In some families there is said to be an hereditary 
predisposition to convulsion among the children.
For the treatment we have two indications
1st to remove the exciting cause where this is local & 
2nd to relieve the irritation of the system
1st We must enquire into the causes with 
with care. If evacuations are found to have
suddenly ceased they must be restored. The guns should
be lanced. Anthelmintics should be given if there are worms
If improper food is suspected we must be particular 
in our enquiries, or we may be misled by a [vague] & 
general answer. When the convulsions have been brought
on by improper food or by food in large quantities
recently taken the stomach should be evacuated by an
emetic of 5 or 6 grs 4 to 8 of sulph of zinc or of ipecac.


# How long should we wait after giving one cathartic
before we try another? the child being in convulsions 
all the while?
The equilization of temperature will do a great deal
to remove convulsive action Besides the soothing of the [nerves] etrc.
Some rely on one and [illegible] or another
Oil of a amber is not in my opinion better than many others
The oil of amber apparently is the [illegible] the oil of [capal] brought from its E. [illegible]
It is recommended to dissolve the oxyg oil in [illegible]
[but] it is slow of solution It dissolves readily in either


92
If the offending substances have probably passed the stomach
& the irritation is in the bowels, these must be evacuated as
speedily as possible giving and injection to begin with [illegible] it to [illegible] cathartic. Sometime
it will perhaps be best to give a dose of calomel
large enough as to operate both as an emetic & cathartic.
Frequently large & repeated doses of cathartics
will be needed in order to overcome the torpor produced
by an excessive quantity of food. The food also diminishes
the cathartic operation is the case with the French
[dinner] pill. We may give calomel, 5 to 10 grs. or scammony 
3 to 4 gr. jalap 2 to 3 gr. senna & manna, castor
oil, neutral salts etc. If dry cathartics fail to produce
the desired effect, the liquid should be tried. Sometimes
will be acted on by one kind when they will not by the 
other # If one fails after 3 doses try another & assist with injections
Begin with cal. & follow with the others
2. If the convulsions continue after the removal of the cause we must
rely upon antispasmodics or even at the commencement. Of these the warm bath must
be considered the most powerful remedy in convulsions
of children always [illegible] & often efficacious. Its influence is immediate and extensive.
Antispasmodics, as pearl ashes or aromatic herbs, may be
put in to the water of the bath
Of antispasmodic articles a great variety are 
used. Oil of amber Dr Rush called his sheet anchor in 
spasmodic diseases. It is useful internally, and applied
as an external irritant along the spine. The artificial
musk a preparation of amber is in my opinion a better
article than amber itself, for all cases where amber is 


“# Seneca oil is more limpid & pure & approaches nearer to naphtha”
Soot is a [illegible]
Soot is efficient as a nervine tonic & deobstruent
It is sometimes very efficacious in jaundice & dyspepsia It was
very popular in Philadelphia with ashes for stomach complaints
“The British oil is manufactured in this country from 
Barbadoes ter & spts turpentine”
The nostrils may be rubbed & it may be given
internally “also rubbed on the skin”
Though so offensive to the small yet children taking 
the tinct readily
potash [illegible] & [illegible]
All the alkalies & alkaline earths are antispasmodic.
They are not nervine properly. There yet
seems to be abundant testimony to their antispasmodic
properties. They are to a certain degree tonics. i.e. they 
have a specific action on the mucus membranes. I have maintained [illegible]
they operated by generating excitability a view supported by Jobe
vide Hufeland’s Journal in Lond. Med. & Phys.


93
indicated. The mineral oils from whatever source obtained,
such as petroleum, seneca oil, British oil, are
little inferior to the oil of amber I prefer the seneca oil 5 to 30 drops #. The eympreumatic oils
are useful antispasmodic and soot is often given by nurses in 
decoction
Ammoniae in any form is a good antispasmodic 
A solution of ammonia in spirits often contains an empyreumatic
oil of this solution we may give to a child from 2 to 
6 drops in an ounce of water. Either the spirt, the carbonate
or the aqua ammoniae will be useful in alleviating spasms 
in children either applied to the nostrils, rubbed
upon the skin or given internally. Dippel’s animal oil, a
very fetid substance distilled from bones in a state of putrefaction owes to antispasmodic
virtue to the presence of ammonia. It is too disgusting
Castor and valerian are good articles
of this class, but in cases of children they are too bulky & a sufficient quantity
cannot be introduced into the stomach. A more
powerful article than these is the asafoetida fetid gum 10 or 20 40 
drops of the tincture. This is a very valuable remedy to 
give by injection using for this purpose either the tincture zii
or a decoction
all the alkalies are antispasmodic & 
are proper for children. The most powerful is 
pearlash given by injection, zi to zii in lbis of water 
I have seen more sudden and permanent effects in cases
of spasm produced by injection of this kind, than by any 
other remedy. It has been successful in cases both of 



In for [illegible] who have [resumed] in convulsion 2 or 3 days
when a variety of narcotics had been given. I have seen
surprising effects produced by the injection
These applications sometimes fail & we 
cannot tell to what sort of cases they are Yet we must have
a variety of resources if we would be able practitioners
Opium is powerful, but though it
frequently relieves, yet it sometimes aggravates the symptoms
I have given it with great success in paroxysmal convulsions
anticipating the paroxysms yet in these it will sometimes
fail



94
infants and of adults. Sometimes however this remedy 
fails & I am not able to point out in what particular
“We are compelled sometime to practice [illegible]”
instances it is indicated. All the narcotics
are antispasmodic. Opium is a powerful antispasmodic
and may be given to patients of any age when the condition
of the system does not contraindicate it vid. lect on m. m
I have given opium
where the convulsions were violent & returned
at stated periods with fever preceding. When the
convulsions appear at regular intervals, as once in an
hour, or day, opium in repeated doses may be considered
a specific.
Counter irritation may be valuable adjuvant
in the treatment of convulsions. Oil of [origanum]
& similar articles may be rubbed along the spine
 drafts may be applied to the feet and wrists & mustard
horse radish leaves etc. to the abdomen.
When the convulsions are frequently repeated
in children and become in any degree periodical, a
cathartic of calomel given once or twice a week, rarely 
fails to prevent their recurrence. If this fails I give
stramonium or other narcotics
If convulsions arise from organic affections
we can expect to effect more than to palliate
instead of curing the disease.
“Counterirritation by mustard, horseradish etc. may be
useful”


An injection can do no harm can always be administered
and if one cannot administer articles by the mouth
Irritants may be applied immediately e.g. mustard
horseradish garlic N.B. we do not need powerful vesication
for the tender skin of infants. Even garlic sometimes vesicates
Ammoniae to nostrils & in mouth
Be sure that you have [water] enough to [illegible]
the child completely for the nerves are apt to think that it 
is sufficient to half [illegible] child & then sprinkle
or scatter water over producing an equal excitement
Friction may be applied while in the bath & after
coming out [illegible] with dry flannel
If the irritants have been applied before
the bath taken then off when [illegible] about to immerse in the
bath & put them on again if necessary after coming out
If the child seems to be in a state of asphyxia 
the emetic may not take effect; then irritate the fauces
the child being lard on its abdomen supported by the
hand of the nurse



95
When you are called to a child in convulsions, without 
previous sickness, direct an injection to be immediately
administered and the warm bath to be prepared. if the
injection does not relieve, put the child in the warm bath 
previously adding pearl ash in proportion of zfs to a gall.
of water. Let the child remain from 5 to 15 minutes taking
it out when it begins to grow exhausted. When taken out
of the bath let it be wrapped in flannel & put into a 
warm bed. Then apply irritants as mustard, horseradish
garlic, or aqua ammonia to the abdomen feet and wrists
Apply aqua ammonia to the nostrils and temples
As soon as the child can swallow give a dose of calomel;
If the countenance is pale or livid the
cause may be suspected to be some offending matter in the 
stomach & an emetic ipecac not [illegible] generally should be given. We may often
succeed in exciting vomiting by irritating the throat with 
the finger or a feather & this method should be tried
when the patient cannot swallow & is known to have taken
improper food or when it is desirable to hasten the 
operation of an emetic. The child will vomit with much
more ease if it is held lying with its belly upon 
the nurses’ hand, which this supports the abdominal 
muscles
If the child is much agitated at the 
sight of the water which it is to be immersed, let
the tub be covered with a blanket & the patient gradually 
lowered into the water there will then be 
no difficulty




96
Epileptic fits are very frequent among children
Epilepsy is defined by Good A “spasmodic agitation & 
distortion, chiefly of the muscles of the face; without sensation
or consciousness; recurring at periods more or less
regular.” One side is generally more affected than the opposite
The limbs may be fixed and rigid with twitching 
of particular parts. The pupils may be contracted or dilated
& the attack may be followed by coma. The attack may 
be abrupt and without warming or may be preceded by 
hilarity, or a giddiness or other unpleasant sensation.
Sometimes there is what is called the Aura epileptica, a
sort of formication, creeping up the body for which the 
ligature may be applied
The fits may be kept up by the constant 
presence of the cause such as malformation of the brain etc.
or, by habit & while in the former case the disease
will be incurable, in the latter habit will be very 
difficult to break up.
The causes of epilepsy may be, malformation 
of the brain tumours of the brain derangement of the system 
produced before birth by syphilis & rickets or the same
causes as those which produce the rickets & in children oftener than after preventing the disease
may also arise though more rarely from mere excessive irritability of the system, even’
without any exciting cause of irritation such as indigestible substances
in the alimentary canal or suppressed evacuations
Among children however epileptic fits are
most commonly excited by teething, suppressed evacuations
& the irritation of a morbid condition of the bowels or of 


In scrophulous children remedies for scrofula
may be given. [illegible] rickets I have often
found advantage from blisters behind the [ears]
I have found the cath mode of treat successful 
for children within the year especially calomel
In some cases the most powerful cathartics are
required
If there is acidity of the passages so that cal. seems
to gripe much [illegible] chalk any quantity from 5 to 10 
It is immaterial whether the action is chem. or certainly 
the effect is good
The system being very irritable ordinary stimuli
or rather a little more than ordinary brings on [illegible]
Hence improper articles improper exertions of mind & body
etc. Careful management & [illegible]


97
indigestible substances in them.
The treatment of epilepsy must vary
with the causes which produce it but does not differ materially 
in the case of children from that of convulsion fits
In epilepsy from rickets I have used the
cold bath with advantage. In children our attention 
in the treatment of epilepsy must more especially be directed 
to the alimentary canal. Cathartics are far more valuable
with them than for adults. I have almost always succeeded
by means of a course of mild cathartics & 
joined with one of tonics, such as the tonic solution 
& the different preparation of iron
When called to an attack brought on 
by offending matter in the stomach and bowels, we should
commence the treatment with a strong cathartic in 
order to thoroughly clear the alimentary canal
calomel is the best article but if the bowels are loaded with 
mucus so that calomel fails to operate we may conjoin 
1 or 2 gr. of gamboge & of scammony & 5 of jalap & this
though powerful, will yet operate kindly. In 
the subsequent treatment calomel should be given 3 or 4 
times a week; though if there is a deficiency of mucus
in the bowels an abrasion as it were the blue pill will
be preferable or chalk may be conjoined.
Among infants most cases are curable
by careful management, both of the physician of nurse
The diet should be regulated with great care Generally 
however there is a morbid appetite, & a sub-[insanity]


There is often a difficult, particular waywardness
[illegible] like into [illegible] etc.
In children more than a year old I have given stramonium
so far as to dilate the pupils keeping the child under
the operation of it I have not prescribed it to children
under 2 yrs or 18 m. I recollect one case in which 
the convulsion begun to subside as soon as the pupils began to 
dilate
I would not prescribe to [illegible] but to [all]
symptoms e.g. tonics all the nat. ton. tinc irr. cap.
lead
I would give the lead where cathartics, from 
the excessive irritability of the al. can. aggravate all the 
symptoms Lead will produce a torpor or sub paresis
contrary to this Narcotics also will meet this condition
Opium will occasionally, but not generally 
Why it is we know not but the fact is that phys. do 
not depend on [illegible] ep. seems to cause a determination
to the head


98
with regard to food. This subderangement of the mind
manifests itself also in other ways by oddity of appearance
gesture & action. A strange propensity for climbing for
instance is met with & epileptic children will often be so 
active & so artful as to be very difficult to manage
For more particular treatment see my 
lecture on m. medical articles stramonium & nit. silver
[illegible] turpentine from 10 gtts to zi diluted
stramonium, camphor, opium atropa belladonna
& most of the more powerful narcotics Arsenic
zinc is one of the best of the metallic tonics
Actual cautery, [moxa] etc. have been highly extolled
“In epilepsy caused by rickets or by the same
causes as those which produce ricketts. I have used the 
cold bath with advantage”
“Mercurials followed by mild cathartics
[Seontod??] etc.”


The child will be still breathing languidly
The parents think it dead If you look at it carefully 
you will perceive as languid treating & looking at
the eyes you will often perceive a little convulsive motions of 
the balls pulse not much disturbed
The child continues a few [illegible]
with paroxysm & comes out with a scream like
an adult from nightmare
Not dangerous
In a few instances [somerset]
Case adult patient [illegible] a chair stands fixed eyes fixed
come out with a stare irritable & sub derangement
for a few days Afterwards [somersets] “asleep
once a sleep twice”
Case a girl last year gather up [illegible]
[somerset], even 50 times than cataleptic then exhausted
This case changed from chorea to catalepsy Repeated
bleedings did not change the emaciation etc.


99
Catalepsy
This affection when it affects children, is called in 
poular language still convulsions. It is a very rare disease 
among adults, but among children I have met with several
cases of it
In catalepsy the muscles are universally 
or partially affected with a tonic spasm. The patient remains
fixed in the position in which it happened to be
when seized appears asleep, is insensible and scarcely 
breathes. The eyes are commonly fixed, but sometimes have
a little motion. The paroxysm may terminate with common 
convulsions. The length of the paroxysms I have known
vary from a few minutes to three hours & in some cases
they are frequently repeated
The disease arises from the same causes
in general & requires the same treatment
as epilepsy & convulsions. Cataleptic convulsions 
sometimes follow other convulsions & in some instances
have been brought on by drastic cathartics
In adults catalepsy is often followed by irritability 
& a degree of mental derangement.
“Catalepsy arises from the same causes and
requires the same treatment as epilepsy chiefly 
by cath. & antispasm. Sometimes children are
affected with catalepsy without it being observed
When I commenced practice I thought the notion of
still convulsions a mere whim”


Dancing before the [illegible] of St. Vitus
Dance [illegible] 3 or 4 well persons
Comes on gradually parents complain that
their children are getting into bad habits Awkward
motions
The dis. is not benefit. by [illegible]
I recollect a gentlem. 40 or 50 yrs told
me he had chorea when a child & recollects perfectly 
the indignation, horror & disgust when so long as to be 
unable to speak [illegible]
Hand carried not to the mouth
Sometimes the motions finally become regular
“The dancing master” feet blind [illegible] then 
hands then body then stop like a statue then begin 
one foot like a [falling] [illegible]


100
Chorea Sancti Viti
This is a disease not to be mistaken in its ordinary appearance
the voluntary muscles are but partially subject to the well
and their motion is convulsive. It occurs oftenest in 
females of relaxed habit & about the age of puberty
especially if they have grown rapidly or been much 
confined to the needle or to study.
In children this disease is often caused
by irritation in the primae viae Chorea also arises in 
some cases from a peculiar irritability of the system in 
which ordinary stimuli produce convulsive action
This irritability may be accompanied with 
relaxation, or with increased action together with a
determination to the head. Indeed it is said sometimes
to be connected with inflammation of the brain 
 & hydrocephalus. With those who are predisposed
to this disease, particularly if they are females
about the age of puberty affections of the mind may bring it or
epilepsy sometimes runs into chorea, or alternates with 
it. Finally, the disease may come on in a very gradual
manner, so as not to be suspected, causing a strangeness
in the gestures walk etc. which at first is attributed 
by the friends to the formation of bad habits.
This disease is rarely fatal and is not
difficult to cure in patients under the age of puberty after
that period it is seldom cured. When the disease is
of long continuance a great variety of remedies are generally 


“When I give cathartics in chorea it is not for the 
evacuation but to produce a new action. All cath.
will not act favorably. Hamilton’s views in prescribing 
cath. are not generally correct.”
There sometimes irritation of al. can. from accumulation
of feces about the coecum. Hence Hamilton’s
plan of purgatives Purgatives will cure but [general]
by impression on system
It is said to arise from a tonic infl. of 
brain I have read periodicals have not so
I have seen all kinds of treatment tonics, cath
narcot. electric. galvan. cold bath etc. etc.
Perhaps no disease prescribed for more [illegible] periodically
We find one and another article fails and are obliged 
to go the whole [illegible] off [illegible] narcotic etc.
# “In one case of chorea I tried the arnica until the
head became affected. The patient began with a decoction of zii
the flowers & increased to zfs without any abatement of the disease”
Prof T’s [illegible] [illegible]
Nux vomica has been used with success in many 
cases but there are other narcotics which act more powerfully 
& more certainly I have not used it deterred by [Ba??]
[Surrey] who found it injurious for some convulsive cases 
“Stramonium succeeded in a case following
epilepsy”



101
tried and the one last given is apt to be considered
as having effected the cure; but I am inclined to think that 
in many of these cases the disease instead of being cut
short by the treatment and run its course and then ceased 
of itself
The most common indications are [for] narcotics
and tonics with antispasmodics as palliatives & 
permanent counterirritation along the spine in some cases.
In children however cathartics are commonly indicated; though
in general the plan of treating chorea by cathartics, has not
succeeded very well in my practice. Dr Hamilton however
depended upon cathartics and had better success, though it may be remarked that those who act on that treatment are also the metallic [illegible]
When there are symptoms are symptoms of worms, of hydrocephalus, or of
inflammation, of the brain or when the disease follows epilepsy
we must treat as for those diseases; & if it the chorea
is the result exclusively of the peculiar irritability above
alluded to, narcotics must be our chief dependance. 
The principal articles which I have employed
in my practice are conium, conium & iron
sulphate of zinc, sulphate of iron & other metallic
tonics. Various narcotics are used, as the nux
vomica in doses of 1 or 2 grs of the seed in pill or 15 or
20 drops of the alcoholic tincture; and antispasmodics
as valerian musk etc. may be used as palliatives
Cullen’s favorite tonic was the ammoniuret of copper 1 to 4 gr.
I have lately used it with advantage in pill 2-3 hours in creasing
other tonics are mineral acids, nitrate of silver, bark
& the arnica montana #, which is a narcotic & tonic & 
was successfully used by Dr [Monsen] in chorea” Dr. T’s copy [M. ?]




“Sulph zinc 1 gr. may be given 3 or 4 times a day
nit. sil. 1/6 to ¼ gr. succeeds best in relaxation of the blood-vessels”
“Evacuate the first passages and restore the healthy
secretions & irritability of the system by tonics & antispasmodic
“I have rarely effected a cure by cathartics though I generally 
begin with them The cure with antisp. & tonic is slow 2-3 [illegible]
with narcotics more speedy but uncertain”
A good deal may depend upon the careful management
of the patient keeping him quiet & amusing him especially 
avoiding the irritation of the [pressure] and the impertinent
curiosity of strangers
The young man in a debilitated 
“So camphor has sometimes been given in mania to 
such an extend as to produce epilepsy & sub-apoplexy & this 
sometimes cures the mania”


103
double the quantity, when the head began to be affected still
there was no considerable relief The patient was finally cured
by taking the bark in substance zi a day.
One case which came on in the gradual
manner above described & was brought to a high degree
by a dysentery proceeded so far at least as to present
the peculiar symptoms of hydrophobia such as horror of
water etc. convulsives perfectly [like] that frothing of the mouth etc. died in coma exhausted
narcotics tonics etc. no effect excitability exhausted by [illegible]
This disease may affect the mind causing
it to run upon particular subjects especially upon that
of numbers & calculation. I once travelled a short
time with a book pedlar who had the odd gestures of 
chorea & had also this facility in calculation, being
in this respect fully equal to the famous [Serah] [Colbourn]
[Serah] [Colbourn] though furnished in Europe with 
the best advantages for education never improved
and this result I ventured to predict, when I first
heard that he was to be educated. I have seen several
such cases. # They have a peculiar articulation & expression
of countenance; and are deficient in memory and
judgment. Vide [illegible] 12 [illegible] for [Serah] [Colbourn]
Case girl at stool good talents studied
hard [stand] out of schools [illegible] Cal. narc. cath. tonics
operated but
[Elateri.] 1/16 gr. once 4 hr in about 24 
hours deadly sick nausea prostration vom. purg.
disease broken up. It may be diff. to class this
A year after similar causes brought on a second attack #


Connected with acidity gives great pain not
dangerous
“This is a troublesome and not unfrequent 
complaint, arising often from improper food 
and that stab of the stomach which causes acidity. In 
a torpid state of the stomach when the healthy action 
ceases or is feeble, chemical action commences, and
the acetous or putrefactive fermentation, prevails according
to the contents of the stomach”
“If our remedy fails try another for there are no two
exactly alike & the judicious physician will discriminate as
they are indicated”
Among the astringents should be mentioned the rose
willow It is one of the pleasantest astringents & is a popular 
remedy in canker It seems to combine a mucilage
Almost any of our wild willows may be used
Nitrate of silver may be used It is often however
difficult to touch the ulcers and we may then use astringent
washes.
Rhus glabra and R [typhina] are good astringents
vide hosp. [illegible] sub. [illegible]
The poison of R [vernex] I have more than once known
communicated in more than one instances by using the wood as
fuel. I recollect a man’s [illegible] to me on account of an eruption 
on his legs. I told him he was poisoned. He replied that
there could be no cause for it but a pair of the pantaloons
lately dyed black. Upon investigation I found that
the poison species of sumack had been used by the dyer
by mistake for the common one. Young persons are more 



102
Cold bathing is sometimes advantageous tepid is seldom proper
Electricity has been used. I have seen little benefit from it
Setons, issues, tartartar emetic ointment along the spine & 
other modes of counterirritation, are employed & may be advantageous
but where the irritability is great they do injury
If the disease is not translatable it is made worse by counterirritation
In the treatment of patients affected with 
this disease, we should bear in mind, that they are the
subjects of great mental sensitiveness & irritability
The presence of strangers in injurious & the remarks of bystanders
upon the patient may cause an amount of mental
irritation little suspected.
I have succeeded in curing chorea by 
elaterium though this is an article not mentioned by writers
as applicable to this disease. A young man debilitated
by confinement as a clerk in N. York was thrown into
convulsions and derangement of mind, by a sight of distress
while on board the packet for this place Elaterium was
given to prostrate the system & break up the habit. It was
successful & this led to its employment in chorea. I have
completely broken up the latter disease by an eighth of a grain
of elaterium & this is the only case which I have broken up
vide end of this article
Case a female delicate 14 yrs of age had not menstruated had been
treated with cathartics, epispasmodics and narcotics, which 
palliated the symptom. The patient then took arnica for
10 or 12 days beginning with moderate doses (zii to a pint
of boiling water being given in 24 hours) & increasing to 


I have found [illegible] which however was Dr [Rush’s]
favorite remedy in females about the cessation of the [illegible]
useful
Friction antispas. electricity etc. had merely palliated
The case then [illegible] to indicate tonics
[illegible] the other remedies had [illegible] effect or not recovery
rapidly upon bark
Sometimes connected with pneumonic affected
or with [organic] eff. of the heart In some of these cases 
[illegible] of copper 1 to 3 gr. rarely more than 2 gr. nauseating article [illegible] in such cases more
especially
As the [disease] advances sometimes [illegilble]
difficult [illegible] swallowing dark [tongue]
# [illegible] of them the book pedlar and [Minot]
[Sheri] [illegible] [illegible] Both these had this facility in [calculating]
# At this time there was not excitability enough left to enable
the elat. treat. El. shd not be cont. more than 


103:a
Ulceration of the mouth in children
This is sometimes a troublesome complaint and one that
does not readily yield to remedies. It is commonly called
canker. The complaint consists of one or more ulcers, which 
commence with an inflamed point or with a white slough
situated commonly near the frenum but sometimes extending
over the whole inside of the mouth. The edges of the ulcers are
inflamed & elevated & their surfaces excavated, as if they had
been eaten out with caustic. The child drools much
and nursing is evidently very painful to it. A febricula
attends the first stage. The bowels are slow and digestion
not vigorous indeed the complaint often arises from improper
food and is connected with that state of the stomach
which causes acidity
Treatment. First excite action of the bowels by magnesia, 
if there is acidity, blue pill, if there is torpor, or calomel grii & chalk grvi. After this give
tonics & astringents as Moseley’s tonic solution 3 to 12 2 to 10 gtts 4 to 6 brak compound
tinct. vitriol 4 to 5 gtts & the vegetable astringents as geranium in a [ter] spoonful of water
statici spriaea cornus etc. a little laudanum may be added
For topical applications we may use the
vegetable astringents just mentioned, catechu, kino etc. or
the following which has been recommended as very efficacious RX sulph. cupri grs x, cort. peruv. zii acad. gum zi
mellis et aquae aa zii make a soft paste to be applied to the ulcers with a 
pencil. A weak wash of corrosive sublimate may be used
Sometimes a mild caustic is serviceable, as nitrate of silver
A wash of opium or of opium & corr. sub. is sometimes the best
viola pedata makes a valuable wash. Asclepias tuberosa is
escharotic. [Post] [illegible] case


affected by this poison than old. When young I have often
been poisoned myself by boing near the plant
merely. Now I can brush past it with impunity provided
it does not touch my hands or face. Some
persons are not affected at all. The uncertainty of its
operation is the only reason why it is not used in 
medicine. Corrosive sublimate is a good application
for the affection of the skin. Yet the disease is
a specific one and must generate run through its
regular course. A similar disease is produced by 
the oil of the shell? of the cashew nut
Ulceration of the mouth continued “The disease
sometimes attended with severe pains, as severe as in tooth ach
in which case opium is serviceable. Case of an adult use
veg. astring. copper, zinc, opium, nit. silv. & at last corros.
sublimate. This last would not be safe in the case of children.
Intense pain was produced, which was remedied by holding
it in the mouth There was a profuse salivation but it soon 
ceased and the disease was entirely removed. The surface of the
ulcer was destroyed by the sub. & the dis. being local this effected a cure
# I have turned my attention particularly to the question whether
cal. produces it. I have known the dis. to allow dysentery
It was an old notion that cal. broke down the crasus of the
blood and it produced a tendency to gangrene. But 
in the venereal wards of hospitals you will see patients 
with sloughs all over the mouths and yet no gangrene 



104
Gangrene of the mouth
This is not a primary disease but a termination of other
diseases making its appearance soon after their abatement
I have known it follow dysentery and other affections of the
bowels, but not any disease in which the blood vessels
have exhibited an inflammatory action. It seems to follow
diseases of the nerves rather than of the vascular system
Children are generally subject of it.
This disease is sometimes accompanied 
with much pain & at others with none ordinarily with little or more. One of the first
symptoms is a constant inclination in the child to pick
some part of the mouth with the fingers where the gangrene
first commences either the teeth gums, less or cheek 
That part becomes spongy & has a fungous appearance in 
the course of a few days discharges a [illegible] matter, has
 a livid appearance & finally becomes black and dry 
the adjoining parts of the face become tumefied and indurated
and the disease continues until a considerable part
of the face becomes completely [sphacelated] when the 
patient dies It may continue sphacelatal in [illegible] etc.
the sphacelus being hard dry & black like a piece of leather
This disease has been attributed to the 
use of calomel, but it is entirely unlike that produced 
by this article, and occurs also in cases where no 
calomel has been given. # In those cases where calomel has been freely 
given the disease is not so apt to occur vide case 4th
I have known a similar affection occur
in the leg of a child, & an irritative fever preceded by rheumatism.
Commencing with a spongy and orange coloured spot
which afterwards become hard & black, the gangrene 


livid purpled as though the blood had settled
pulse small not much disturbance of the circ. syst. except that it was large
# & Prof. Smith & myself could not get down much medicine 
and were obliged to [illegible] [illegible] with external applications
We [illegible] injections and a great variety of external application 
blisters
“When the disease appears with tumefaction I think
leeches might be of service. This was called by Dr Smith congestive
inflammation. In other cases of gangrene, leeches would not be of service
It is not easy to [class] the operation of charcoal It
has been called a tonic, but it does not much resemble peruv.
bark and we do not gain much by classing it with it
It seems to act by generating an excitability
Charcoal shd be made of soft wood or of lamp black 
burned over again in crucible, as is sometimes done by the
apothecaries


105
extended up the leg and the child above the knees on both sides died [illegible] No applications 
seemed to have any effect. The child was irritable &
The disease under consideration is nearly allied to 
that called swelled tongue, but the latter oftener attacks
quadrupeds 
The treatment should be stimulant & antiseptic.
Acrids as capsicum may be used & the arum 
triphyllum accidentally has been known to cure.
In one case which I shall relate charcoal appears to have
effected the cure.
Case 1st The first patient that I saw affected
with gangrene of the mouth was an adult female who had the typhus 
fever. The gangrene commenced on the inside of the 
cheek & when I first visited the patient a portion of the
cheek as large as a dollar had sloughed off out? Great
part of the food taken into the mouth passed out at the
hole in the cheek. The patient continued in this state
for eight or ten days & then died The attending physicians
informed me that she has received the ordinary
treatment for typhus fever.
Case 2nd The next patient affected in a similar
manner was a girl seven years of age. Previous to the
gangrenous affection she had had a most excruciating
disease, which affected the knees legs and bowels I have
called it nervous rheumatism & shall notice it in another 
place. For this she had taken large doses of purgatives




106
calomel & opium, with diaphoretics & tonics. In three
or four days the pain ceased and the fever almost
entirely disappeared. The guns presented no symptoms
of salivation & there was no increase of saliva.
In five or six days after the fever subsided 
the patient complained of severe pain situated in the right temple
& extending down to the shoulder like that which had been in the extremities. This was removed by opium
to complain of the teeth
Soon after she began to work at the molar teeth of the upper
jaw, on the right side, at the same time she had a cough
which was accompanied with an expectoration of white
viscid mucus, and the breath became very offensive, resembling
the effluvia of an anatomical room where 
subjects have been kept a long time. The appetite
was tolerable, however the patient took animal food, with 
relish, and the bowels were easily moved with a little
rhubarb
the patient world at the teeth until she had removed two 
of the molar teeth with her fingers, she still continued
to pick at the gums. The cheek of the side affected
became hard, swollen & red. In forty eight hours a 
black spot appeared in the centre of the swelling. This 
spot the patient immediately began to rub with her fingers & 
soon made a hole through her cheek. The gangrene 
continued to extend, for a week & at the end of that period
had proceeded as far back as the angle of the jaw
affected the throat & perhaps the aesophagus The patient then died, having taken
food and medicine will until within forty eight hours
of her death.




107
Peruvian and oak bark, opium & camphor were
very freely given the affected side of the mouth between the 
teeth & the cheek was filled with superfine bark & poultices
of bark were applied to the face In the last stage affected
perhaps the lungs
Case 3rd Another case occurred in [illegible] subject a child etc.
A female child, about 5 years of age was attacked,
in the winter of 1813 with “constipation with fever”
the complaint being principally confined to the bowels The 
attending physician gave a dose of calomel and worked
it off with senna and manna. A considerable quantity 
of matter was discharged from the bowels, but from its appearance
further evacuations were deemed necessary, and several
doses of castor oil were given. On the fourth day I was
invited to see the patient. I found her with considerable fever 
of the typhoid grade, attended with pain in the bowels and
head. There was also some swelling of one cheek & the child
complained of one or two of the double teeth of the upper jaw
on that side. These she frequently attempted to pull out
with her fingers & finally succeeded in extracting one of them
The cheek afterwards became swollen, inflamed, and hard to the touch
& in a short time an orange coloured spot, appeared, upon
the outside near the centre, which soon became livid,
and the gangrene spreading rapidly, the child died, in 
eight days from my first visit. She became delirious previously 
to the cheek becoming livid & afterwards, was comatose.
In this case the disease seemed to affect the brain 
as it does in some cases
Bark, opium and camphor were truly given & antiseptic





108
poultice applied to the face as bark [illegible] [fermenting] [poultice]
Prof. Smith saw this patient
soon after my first visit & agreed with me in the opinion 
that the case would terminate fatally. He informed
me that he had seen but one case of the kind before & 
that he had attributed that case to an injudicious
use of calomel After seeing this patient however, he considered 
his former opinion as incorrect since in this case
there were no marks of the effects of calomel & there was no 
probability that the single dose of calomel, given in the
commencement of the illness, could have produced such 
an effect, especially when repeated doses of other
cathartics, had subsequently been given & 
had operated freely 
4th Case. The next case which I met with was that
of a female 12 or 13 years of age, who had the dysentery,
in the summer of 1815, accompanied with much typhoid
fever & rather a larger discharge of blood by stool than 
is common in dysentery.
The child had been sick for some days
before a physician was called. I did not succeed in 
my attempts to determine the diseased action from the
bowels to the surface by diaphoretics & the warm bath, & 
the disease ran its course and nearly exhausted the patient
When it began to decline, the stools to present a fecal appearance
& the appetite to return, the friends were 


There had been some aphthae and I was on a 
careful watch


109
much encouraged I, however, began to expect a fatal
result for I observed, between the anterior incisors of the
lower jaw, a fungous enlargement of the gum, the apex of merely a slight discoloration [illegible] & swollen between two teeth 
which had a purplish appearance somewhat as appears in salivation sometimes. I apprehended gangrene
in the case (perhaps from the countenance) and on the first
symptoms of it informed the parents, who however, could see 
nothing alarming in the small swelling between two of
the front teeth. I began early with oak & peruvian 
bark, and at the same time gave freely of brandy and
porter. As this course had no effect I applied 
bark and diluted sulphuric acid to the part affected
& also covered with the lunar caustic. Still the treatment
had no good effect the gangrene extended under lip and chin became
black and the child died
Case 5th A child about 3 yrs of age cousin of the previous one [illegible] had a dysentery,
in the summer of 1815 [illegible] as there was another
member of the family sick in oil uncommon & interesting
manner viz the case of chorea resembling hydrophobia was much neglected Her fever was typhoid
& the stools sometimes bloody and sometimes of a 
green mucus. After a course of 15 days and amendment
in the symptoms took place the stools
became less bloody, the green stools more rare & though
the patient was extremely weak but no reduced low as the previous one, the appetite returne
After convalescing gradually for six or eight days, there
came on a samous discharge from the nose, small in quantity
but very fetid which reminded me of gangrene


# In this case I examined the gums to see if there
was any appearance of salivation and found the gums etc.
Two teeth and a piece of the alveolar process came out
The disease did not spread so rapidly as the other ones
In addition to bark, tonic solution etc.
I gave charcoal


110
of the mouth which I had not been on the look out for AT this period the patient inclined to 
keep her fingers I her mouth. # The gums were very clear
and bright & adhered firmly to the teeth, except on the 
left side of the upper jaw, where the gums of the biscupides
appeared discolored and discharged a samous
matter. I declared the parents that in my opinion 
the case would terminate fatally. The child complained
of pain in the face and teeth. The cheek opposite the teeth 
became swelled and hard and of an orange colour. I declared to the friends
that mortification had taken place 7 pointed to a black
spot on that cheek which happened however to be accidental. I was mistaken for the next day
it was found that the black spot was produced by a piece
of burnt apple skin, which was washed off This encouraged
the friends; yet within 24 hours sphacelus took place 
the apple skin was
in the very spot where I had supposed that I had seen
it. This gangrene ceased to spread after 
the spot became as large as the end of the little finger
 A circular piece sloughed out and left a hole in through
the cheek of about a quarter of an inch diameter
The disease abated, the affected teeth and a piece of the alveolar
process came away the lips of the wound produced by the sphacelus
healed up & the child recovered
I recommended the same treatment in this case as in 
the preceding, but having no confidence in it, & abandoned
it and gave charcoal to the amount of perhaps a pound
or a pound & a half a day I h ad pudding made of 
half charcoal & half flour, sweetened with molasses & sugar
& fed to the child for the appetite was good. Tonic solution 



When the disease commences of itself
# At the time when the disease called the scalled
tongue was very prevalent affecting cattle principally with 
swelling of the tongue & salivation but to some extent human 
beings with swelling of tongue cheeks etc. It was found that
acrids as [arum] were the best remedies
pulse 120 tongue then [brown] fur, considerable pain



111
and compd tinct. vitr. were also given & I commenced
the treatment with white oak & peruvian barks & yeast
poultice. I attribute the cure, however, to charcoal.
Case 6th This was an idiopathic affection. Martha Denison
a delicate constitution about 12 yrs of age was attacked in 1819 with symptoms of gangrene
of the mouth. There was severe pain in the teeth and jaws
oppression at the stomach and symptoms of fever. I discovered
the purplish spot in the cheek & “the gums soon put
on a spongy appearance” In this case I commenced
the treatment with an emetic, which operated favorably 
I gave it to [illegible] the excitability of the system
& gave relief. I then gave stimulants, bark, brandy & 
opium & kept in the mouth between the gums and cheek a paste made of powdered
bark wet with brandy and laudanum. The patient
recovered, but the two front teeth of the lower jaw became
very loose and there was occasional pain & 
suppuration for nearly a year. It was about a year before
the teeth became firm. [Superfine] bark was occasionally 
used.
Case 7th In 1820 I visited a black child in the last
stages of this complaint. At the time when I saw it, it
could not swallow. It lived however in this situation for several days
I have seen several children in the latter stages 
Even if there is no chance for a cure it si desirable to be able
to give a correct prognosis Trouble has sometimes arisen
from the opinion that such cases were produced by calomel
A student of this school in [Litch.] cty from notes of 
my lectures



It is known by an [illegible] swelling in the throat
some fever etc. etc. 
In some seasons it prevails extensively & 
affects persons of all ages. In some seasons these diseases
which are called contagious affects one description 
of persons in another another owing to mode
of life etc. “It rarely affects a person the second time. It is said
that if it affects the parotid of one side only it may occur again”
I have treated cases of this disease with 
great anxiety. I have never known cases of greater 
irritation than from this disease
“It is milder in children than in adults & is
seldom translated to the mammae or testicles till after puberty”
“Sometimes the swelling of the testicle is simultaneous
with that of the parotid gland or [previous] I have seen
several such cases”
“The first symptom observed is sometimes
a soreness of the testicles. They at length become 4 or 6 times
their natural size a suspensory bandage will be 
necessary”
“In some cases there arises suddenly, [illegible]
pain in the head pulse full and tense eyes red & all 
symptoms of phrenitis”


112
Cynanche parotidea Mumps
This disease is an inflammation of the parotid glands & is generally 
moderate in its symptoms Sometimes however it is translated
to other parts & is then a severe disease endangering life. It is milder
in youth than in adults & in general it is only after the age of puberty 
that it is translated. The parts to which it is translated 
occasionally, are the testicles & the prostate gland in males
the mammae of females more rarely & sometimes the brain or stomach
I have never myself seen a case in which the inflammation was
transferred to the mammae but do not doubt the fact
Sometimes it appears first in the testicle or at least simultaneously in that
& the gland This disease has been considered contagious
In my opinion it is not, but on the contrary is liable to be
epidemic. When its prevailed in college, the students who 
left in order to avoid the contagion were attacked as early 
and is certainly as those who remained. I have noticed 
that it made its appearance pretty regularly once 
in seven or fourteen years
The fever which accompanies the severer
forms is either of the inflammatory or the typhus grade or may be merely irritative & 
should be treated accordingly When the testicles are affected
they are painful swollen sometimes to an excessive degree & 
sometimes so highly inflamed as to indicate venesection 
When the stomach is affected “it puts on crythomatic inflammation”
and there is hiccough, subsultus tendinum, irritability
of stomach and frequent vomiting. # When the brain is affected
there is pain of the head & eyes, with hard and tense pulse
When the parotid glands only are affected the
# These symptoms may come on after the affect of test. [illegible] continued, some
[illegible] begin to subside.


Dr Rush observes that applying a blister
directly on the infl. prevents the system from being
affected. I do think blisters keep the aff.
in one part “In some seasons an emetic at the commencement
or a blister will prevent a translation”
Having [learned] the importance of attempting 
the breaking up of diseases I cast about
one year for means to interrupt it & found emetics
quite efficacious
Stramonium
After the testicles have been affected some time 
and the affection begins to subside the symptoms sometimes change 
There is subsultus tendinum the stomach become affected 
vomiting is frequent with hiccough etc. In this case apply 
mustard to the stomach & feet etc.


113
a generally mild and more inconvenient than painful
A translation makes it worse; more so when the translation is
to the stomach than to the testicles & most of all when to the
brain. Sometimes the complaint is very severe, the fever lasts
three or four weeks and the patients are many years in recovering
from the disease
Treatment. The disease is often broken up by an emetic
in the commencement It is best to stop it in the first stages
if possible. Mild applications to the inflamed parotids
we generally sufficient, such as ammonia or volatile
liniment. Dr Rush however recommends blisters to the parts
affected, in order to prevent a translation.
When the disease effects the testicles & give emetics
and apply discutients to the local affection. I also 
apply blisters to the inside of the thighs. They relieve the 
testicles when they are swollen & prevent translation to the 
stomach For a discutient was we may take the following
Rx mur. amm. ziii; camph zi; brandy or vinegar 1 gill;
water 3 gills. When the inflammatory action is high, bleeding
may be practised. It will be well also to use a suspensory 
bandage.
If the stomach is affected in the manner above
described
we have a difficult case to manage. Epispastics must be
applied to the scrotum, counterirritants to the epigastrium
to ally vomiting, with effervescing mixtures internally for the 


Ether is best given in effervescing mixture (carb amm. & 
lemon juice) Carbon ac. makes stimulants more diffusible
& hence causes them to be [used] gratefully and often to be well borne when 
otherwise the would not be
Case 18 grs plethoric parot. gland & testicles swollen
head affected Relieved by bleeding decidedly entonic
the only entonic case which occurred In the 
progress of his case stom. became very irritable abdomen
sore & tender excessive irritability Did not 
recover his health completely for years was left dyspeptic
& with nervous irritability.
To correct irritability of stom. lem. juice
[illegible] is most grateful add [doses] of aromatics
lime water also external blistering etc.
Tonics or metallic tonics myrrh 
asafoetida (nervine also) hops lettuce
These cases are so obstinate and will 
give you an opportunity to try a great variety of
remedies cajeput oil on sugar ol. valerian
Though the cases may be apparently alike
yet you may find one article best for one & another for [another]
A very distressing hiccup, accompanied
with spasms might have been mentioned in connection 
with the vomiting give ether lavender cajeput
oil also & valerian which are called terebinthinates 


114
same purpose diffusible stimuli as ether given
to rouse the system opium ipecac, as tonic stimulant, diaphoretic
& nervine 7 finally to allay irritation of the system 
in general antispasmodics as castor & counterirritants to the
extremities effervescing mixtures absorbents, also, as chalk & magnesia, cathartics
cantheride & occasionally emetics may be indicated.
When the brain becomes affected, the lancet
should be freely used, cupping, leeches & blisters, applied
to the head of the neutral salt given as cathartics
Antimonials nit. [illegible] cal. & neutral salts # 
Some cases will require a vigorous antiphlogistic 
course of treatment, others with typhoid fever
will require in the [illegible] a stimulating & supporting one, while others
again will have symptoms of irritation chiefly & require 
a corresponding treatment
In the progress of the disease uniform
perspiration will be valuable
Angostura serpentaria, qualified
with cardamom or cubebs The old writers
recommend also [contrayerva] I have much used it
atonics of a peculiar character resembles much 
agrimonia eupatoria which I have used for it
in the country where it is easily obtained the latter is non 
astringent
# “Cold to the head and warmth to the feet avoid mental
irritation recovery is usually speedy adults most
liable to this translation”



I consider [quinsy] an affection of the mucus membranes
and [tonsils] nearly allied to catarrhal aff. There
is a catarrh aff. nearly allied in which there is a
thickening of the membrane. This diathesis may also 
run into croup
Good classes angina maligna with 
quinsy Here is the evil of nosology For scarlet
fever gradually runs into quinsy. We must have
science and nosology but still we ought to 
know the errors which nosology is apt to lend [illegible] & 
the imperfection of science
I have the advantage of not [illegible]
having seen the disease but of having had it myself
often
[illegible] with an unpleasant sensation
a relaxation a disposition to hawk and throw off
[illegible] In this stage it may certainly be cured
After the symptoms comes on swelling, or moderately 
succeeding to this a chill then swelling with 
pain perhaps extending to the [illegible] The tonsils enlarge
The fever is considered enteric or a common but
unless among the labouring men in the country it is 
more usually subacute
One tonsil is perhaps more enlarged
than the other perhaps one goes on to suppurate & 
the other becomes of the natural size and appearance 
The uvula and fauces swell and respiration and deglutition 
are prevented. Sometimes ulcers from at first
upon the tonsils. Examine each case and do not be
too positive in calling it quinsy for this & scarlet
fever do blend
These symptoms continue 2 to 36 or 48 hours
I do not know that I have ever seen a fatal case of 


115
Cynanche Tonsillaris Quinsy
This diseases has been called
“I include also under the term quinsy all effections of the upper
part of the aesophagus and pharynx which resemble quinsy in 
their grade of action”
Quinsy is an inflammation seated in the larynx glottis & fauces
The characteristic symptoms is swelling of the tonsils
Sometimes it is seated lower down in the pharynx than the tonsils, but this 
does not alter the nature of the disease
In some cases it is complicated with catarrh. Those who have once had this disease are very liable to a return of it
“The disease common at the age of puberty that before or after”
Quinsy may be divided into two stages
1st Predisposing debility indicated by relaxation of the uvula
and tonsil, irritation about the fauces, weak deglutition,
general languor, with cold chills and uncommon sensibility
to cold. This usually continues from 3 or 4 to 12 hours
the progress of the disease being sometime rapid and sometimes
slow
2nd As the disease advances we find, soreness, pain, redness
and swelling of one or both of the tonsils & an inflammation 
of the mucous membrane of the pharynx; deglutition
in exceedingly difficult; there is a severe cough & especially 
a spasmodic one upon taking food or drink, there is
much heat about the throat and about the head & sometimes
pain in the head, with a pulse so full and tense as to 
indicate bleeding. Sometimes there is an excruciating
pain in the ear. “rarely cough unless complicated with catarrh”
This stage may continue three or four
3 to 7 days days. It terminates either in resolution, or suppuration.


of quinsy though I have seen many that I thought 
would prove fatal. I have known a patient
continue unable to swallow for 3 days and yet recover
When however it is in the form of swelled tongue it may 
prove fatal. “An entonic fever may attend, with fullness
of pulse much headache excruciating pain extending to the 
ear; but for more commonly at least in my practice, the pulse
is little affected, and the disease is almost not entirely local”
# riding on horseback and having the snow melt on 
his throat & [conduct] off the [caloric] rapidly
# and shd carry a piece of alum in the pocket
“It is important to distinguish this disease from 
roseola (scarlet fever) There is an erythema of the fauces
distinct from both which yet may terminate in either
[illegible] The diagnosis is generally easy but there are cases
where it is extremely difficult & indeed there is no definite
line believed the two especially in the first stages
We must bear in mind that quinsy is commonly 
more inflammatory that it is not apt to ulcerate
& we must be guided somewhat by the prescribing epidemic


116
The suppuration is generally in the tonsils, but in some cases
where the disease is seated lower down, a part of the aesophagus
suppurates. “The tonsils often remain permanently enlarged”
Causes. Quinsy occurs must often in the latter part of autumn
& in winter. It is caused like catarrh by alternations of heat
and cold by exposure to cold & especially by exposure
to cold storms of rain or snow. # Sometimes it is connected
with dyspepsia & it may be brought on by irritating 
substances, as acids, acting upon the mucous membrane
of the stomach. I recollect a case of a young man who 
was attacked with a severe quinsy in consequence of drinking
freely of cider made cold with ice
Persons who are subject to quinsy should be very cautious 
about exposing themselves to the alternative of heat and cold # 
Diagnosis. This disease has sometimes been mistaken for 
scarlet fever. It is not difficult however to discriminate
between them by attending to their prominent symptoms the
quinsy being as inflammation of the mucous membrane etc.
The first stages however of scarlet fever, resemble those of
quinsy, and the difficulty of discriminating between them 
is at that period much greater. In deciding upon any 
particular case we must be governed by somewhat by the nature
of the prevailing epidemics


Chewing camphor will also but not so well break up quinsy
in the forming stage but chewing this article
is apt to produce pleasant symptoms in the stomach 
and head Other stimulating applications 
would probably answer as [guaiacum] & any 
alcoholic tincture “The prophylactic plan of carrying
alum in the pocket etc. has succeeded in hundreds of cases. Indeed
when called in the latter stages I often tall them I can do 
little except to prevent it in future”
When the dis is fully formed and when 
there is much pain in 
the neck running up into the [illegible] fomentations
and the vapour of warm water, the steam bath 
by throwing over the patients head a blanket and
having a teapot of warm water
A blister also in the above circumstances
will relieve the pain and give great relief 
An emetic also will be often very 
beneficial in the commencement of the second stage
There is often an excessive quantity of acid in the stomach 
Case A young man in very hot weather [illegible]
a large quantity of cider made very cold with ice was taken at night
with great pain and difficulty of swallowing
The patient was very anxious to be cured that night
A large quantity of tartar emetic was given in excessive
doses until a severe orgasm was produced then seeing
to [illegible] stricture of the upper orifice of the stomach the 
[illegible] & secreted from every pore from the violence of
the action of the system finally he [illegible] away, and
continue in syncope for 10 or 15 mins came out of his 
fainting fit, the tart. ant. acted as a cath. and the patient
was entirely relieved of the difficulty of swallowing [illegible]
was merely feeble and exhausted from the prostration of the [tart]




117
Treatment In the first or forming stage. Quinsy may 
be easily broken up by keeping a small piece of alum say 
of the size of half a pea in the mouth, and swallowing the 
saliva until the symptoms have left. Various other astringents
may be useful in the first stage. I have given the astringent
barks and bitter roots, catechu etc. & have also combined
with them the mineral acids chlorine etc. “But all these things will be injurious in the 2nd stage”
When the disease if farther advanced a more
energetic treatment is necessary. If the tonsils are largely swelled astringents will merely aggravate. IN this stage it may often
be broken up by a strong impression made by nausea
and vomiting. A strong emetic 3 grs tartar emetic with 8 grs of ipecac # may be given & when the 
disease arises from a chronic affection of the mucous membrane
& acidity of the stomach, an emetic will remove it. In one
case I gave half a grain of tartar emetic once in 15 min. 
until the system was affected, I succeeded in conquering
the disease. The patient was in extreme pain & exhausted 
he fainted previous to fainting he was unable
to swallow after coming to, he could swallow & the
disease was removed. “But if the case has advanced a 
little farther, emetic will do no good”s
Gargles will in general do harm 
rather than good, where there is much inflammation.
If the irritability is extreme mucilages may be given, and 
when there is great difficulty in swallowing a cloth wet with 
spirit and water ay be applied over the mouth and 
nostrils. Cold water applied externally & internally has
been recommended but is dangerous. It may be used however
as a preventive.
# Eupatorium etc.


I have known some phys. generally successful [illegible] breaking
up quinsy with cold water but as I predicted
there was danger of the translation to the brain he lost
one patient in this way “It may be used as a preventive”
When the trails are much enlarged it is
customary to bleed I would bleed it there was
much fullness and strength of the pulse I have often bled
and seen it done without the beast benefit still however 
without any injury as I could perceive “V. S. is important
when there is danger of affection of the brain”
Scarifying is generally practised. It is
sometimes beneficial but often it increases the disease
as is the case when a boil is scarifyed I do no t
know that I can point out the circumstances
which it is beneficial but if there is much irritation 
I think I would not scarify I have often
had my own throat scarifyed without benefit
Perhaps it is as often as once in 20 cases
that the disease proceeds to suppuration. But if 
you puncture the swelling be careful 
to see where you introduce your lancet Case of [young]
an opening was made which subsequently caused a troublesome sore the
swelling burst of itself
In various cases astringents was useful 
Lister’s [scoriae] (devils bit button snake root) it acts 
a little like seneka stimulating the fauces it operates considerably 
in a decoction It has been much used not of
much consequence
I have not much confidence in gargles
The patient cannot gargle
But you will give great relief
by washing out the mouth with warm water or with 
mucilages or with a little old spirits and water which 
is very grateful to the patient Wash off the [illegible]
which [illegible] Great advantage is derived from 
injecting with considerable force with a syringe & washing on 
the parts Spirits & water will be grateful & reviving


118
When there is redness and swelling but not extreme
irritability, scarification is beneficial. If there is irritating
soreness or inflammation scarifying will aggravate it
After the inflammatory stage is past, blisters
may be used I have not been successful in scarifying
Bleeding may be necessary, if so it will 
be indicated by pain in the head and a full & tense
pulse.
When suppuration is about to take place
poultice may be applied externally & vapor inhaled The 
latter remedy may be administered, very well in 
the following manner. Put a vessel of hot water in the
bed, by the side of the patient & cover him with a sheet. # 
Touching the tonsils with nitrate of silver, is 
highly useful
If the ear is affected, wet a piece of cotton 
with strong ammonia and apply it to the dear. it produces
a pungent sensation and often gives relief
The [liatris] scariosa is used in quinsy
in the form of a decoction of the root. It is expectorant, diaphoretic
& diuretic. It is called “devils bit”
“After the inflammatory stage is established
apply blisters”
“If the irritability is extreme apply mucilages”
“[illegible] & diaphoretics have been used 
in the early stages and are undoubtedly serviceable”
# If you cannot well distinguish where suppuration has
taken place, you had better not attempt to open the tonsils 


When the swelling is great poultices are very beneficial
Dove’s [Dury] poultice Devils dung asafoetica
Album graicum blown through a quill!! much used
by my predecessors in this place
Cathartics are proper early in the disease
neutral salts if the fever if phlogistic
Diet & regimen
Give while the patient can drink, nitrous
ether & water or a acidulated drink etc. Feed
with arrow root etc. for the diet
When the inability to swallow has 
continued sometimes the action is not enteric & the
patient shd not be bled nor exhausted by cath.
The disease is at this time principally local & 
from want of food etc. the pulse becomes feeble spirit
and water injected into the throat will bring grateful and 
reviving [illegible] exhausted patient “Apply poultices keep the bowels
open with enemata” “Inhale vapour of ether”
Various gargles are recommended
such as chlorine muriatic acid & water etc.
but when there is much action they are apt to irritate
Camphorated gargle vapour of camphor
etc. There are a variety of these things which are
mere palliatives
The difficulty of swallowing is not caused 
so much by the swelling as by the soreness and pain 
for I have seen patients declare themselves much relieved
and able to swallow when upon looking into the throat
I could perceive no change in its appearance



119
“Scarification is recommended but I could never succeed
with it. If the disease were pure inf. scarif. would be of service 
but it is an irritation infl. & scarific. increases the pain & 
infl.” In [illegible] case a free scarific. made the case worse in 
every respect” There is a stage when scarifying is beneficial
when there is redness & swelling but not extreme irritability”
“Leeches have been applied in the inflammatory
stage externally and to the tonsils. It is difficult to make
them take hold on the mucous membrane, but they would
be more effectual there”
“Suppuration does not take place in one 
tenth part of the cases. There is free secretion but no solution 
of continuity upon extermination” “When suppuration
is likely to take place use poultices and inhalations of vapour 
poultices of bread and milk with stramonium are serviceable
Gargle or syringe the mouth with spirits & water or
camphor”
“When the disease is seated farther down 
in the larynx it is essentially the same”
“White dry pigeon’s dung in a poultice with 
bread and milk was used by Dr [Monson] He thought the
phosphate of lime of service” I prescribed it in one
case and they mistook for it devils dung (asafoetida) 
& it did wonders. I did not tell them of their mistake”



[illegible] state of fever is a better
classification than Good’s. Good separates the disease
under different classes making one part are [illegible]
disease another an aff. of the blood vessels
“Scarlatina & angina are sometimes considered 
as separate diseases, but they seem to be only different forms
of the same disease”


120
Scarlet Fever
This disease has been called by various names, among
medical writers, though the popular English appellation
has been scarlet fever with little or no change. Canker
rash however has been its common popular appellation in 
New England, until of late. Under the name scarlet fever 
I include both scarlatina mitis & S. maligna & likewise the
paristhmitis maligna or ulcerated sore throat called also malignant
sore throat & malignant quins. Other names that
have been given are Scarlatina mitis & maligna 
cynanche maligna paristhmitis maligna 
scarlatina anginosa 
Enanthesis rosalia is defined by Good
Rush a scarlet flush appearing about the second day 
on the face neck or fauces; spreading progressively over
the body; and terminating about the seventh day; fever
a typhus. This author divides rosalia into two varieties
simples or mild scarlet fever which he considers as
being slightly contagious & paristhmitica with an ulcerated
throat & a rash not so regular
as that of the other variety. This he calls highly contagious
Under the name scarlet fever I included
both the common mild scarlet fever with a rash & nothing more and the most malignant forms
of ulcerated sore throat with the intermediate varieties
considering them all as being but different degrees of the same
disease
This disease with its varieties a naturally associated 
with pneumonia quinsy influenza etc.



Quinsy is an exception persons who have had
it are more liable to another attack
So too in tropical climates even have what
is called a seasoning
As a matter of fact this disease is theoretically 
considered contagious practically not so no precautions being
taken the patient not being separated nor the friends and
neighbors refraining from coming “The notion of contagion
may sometimes be useful in keeping away idle visitors
case in Guilford”


121
Scarlet fever often appears as a sporadic and
sometimes as an epidemic disease. In general it affects children
and women more than men. Dr. Rush’s opinion Some say that the disease never 
persons over 40 years of age. When epidemic however it attacks 
persons of all ages, though even then the majority of cases
are among children and persons of delicate constitution.
In general persons who have once had the 
scarlet fever are not attacked with it again, still this
rule is liable to many exceptions for I have known repeated 
instances of a second appearance of the disease in the
same person. This partial security from a second attack
is met with in various epidemics & we may say in general 
that a person who has had any one of several different
diseases the same general diathesis is less liable to have another
Scarlet fever is said to be contagious especially 
in its severer forms The fact is disputed but this is 
the general opinion. Some fevers are perhaps contagion & among
them some forms of this may be so. It certainly, however
appears to follow the laws of epidemics and I am inclined
to think that the facts which have led to the opinion 
that it is contagion are better explained by reference
to those laws. It is said sometimes to go through the country 
like the influenza.
Like other epidemics, those of scarlet
fever exhibit appearances
in different seasons, being sometimes milk and
harmless & at others highly malignant & dangerous
It has occasionally been as 



# And because blisters applied produced
mortification
It swept off whole families
The fever considered a typhus It is not always
so It is sometimes [sub-entonic] always however
of a typhous grade



122
as the plague. About a century ago this disease prevailed
in this state in its most malignant form, sweeping off whole
families. It was called the black canker because the sloughs
in the throat turned black & this name, though the influence
of tradition, inspires terror in this town even to the present day
Since that period the disease has probably been growing 
milder up to the present time. In 1794 however it
was very severe in this town in Litchfield county & over the state more malignant than it has
been since. Subsequently to that period adult males have
been less affected. The last severe epidemic in this town was in 1803.
Though sometimes attended with inflammatory 
symptom. Scarlet fever as a general rule, is of the typhoid
or typhus grade & when malignant puts on the form of typhus 
gravior or gangrenous state of fever
Symptoms. This disorder, when not malignant, nor
irregular, commences with ordinary febrile symptoms general
disturbance of the functions of the system, chills alternated
with flashes of heat & pulse in most cases frequent and soft
In severe attacks there is much nausea, sometimes
vomiting, pain in the head back and limbs & great prostration 
The tongue
of strength. In 1803 the disease frequently commenced
with pain in the teeth or in the ear is the first symptoms
In the progress of the disease there is more
or less tendency in proportion to the violence of the
disorder. In severe cases there is often great heat and dryness
of the skin & perhaps the color mordax. In such cases also 
we frequently with an acrid discharge from the eyes & 


“When delirium is present it arises rather from inanition 
than repletion IT is accompanied with subsultus”
Swelling of the tonsils is rather a favorable
symptom Swelling and suppuration of the
glands in the neck
haemorrhage for the [illegible] & petechiae
may occur


123
nose which excoriates the skin wherever it touches.
Irritability of the stomach & vomiting are common & sometimes there
is a troublesome diarrhoea. Petechiae may make their appearance.
Case at [Hotchk??] town Haemorrhages sometimes take place; & in case of 
heat on the surface and what Armstrong calls congestive state
of the system, a slight haemorrhage from the nose will be
beneficial. Finally in the ordinary malignant forms of the disease 
the breath is very fetid.
The epidemic of 1803 was characterised by 
great irritability of the stomach vomiting & diarrhoea pulse
very low and feeble. In this epidemic after obviating the
inverted action (of the stomach) stimulants were indicated.
The throat is more or less affected from a 
slight redness to a deep slough. Sometimes there is a high degree 
of inflammation of the uvula & tonsils at others a relaxation 
indicating astringents both conditions accompanied
with a high degree of tumefaction.
A common appearance, in the commencement of the severe form
of the disease is that of a white coat upon a part of the tonsils
In the progress of scarlet fever, the affection of the throat 
may be more or less troublesome. It often terminates in ulceration
& sometimes in gangrene
In three or four days from the first appearance
of febrile symptoms or rather on the second day of 
the fever the eruption appears in the form of a fine rash
as described in the definition. In about as many days from 
its appearance about the seventh day of the disease it disappears 


Peculiar dulness of the eyes hollow sound
of the voice patient appearing much like a night walker
The first case of the kind which I saw I had no doubt 
about The friends had doubted whether he was sick enough
to send for a phys. I declared at once that he probably 
would die. This was a case of pneumonia notha
Most resembles measles Ordinarily distinguished 
readily sometimes with difficulty
If scarlet fever is accompanied with 
a running of the discharges from nose with catarrhal symptoms, and is somewhat 
distinct in its eruption (hard under the touch under
the skin) and such cases occur it cannot be distinguished 
from measles except by the general character of the epidemic
I used to notice in the first commencement of my practice
that on the first breaking out of the epidemic the older phys. used to 
wait and observe several cases before they decided upon the name 


124
with branny scales & in ordinary cases the patient is then
out of danger. The eruptions, however may vary much & even
be altogether wanting the local morbid action being determined 
wholly to the throat. Ataxic cases will have no eruption.
The worst cases of scarlet fever are those
which transcend ordinary febrile action. In these the patient 
is scarcely sensible of being ill, appears dull and languid, his
countenance indicates torpor of mind, he has little irritability of 
mind and is indifferent to surrounding object, his extremities
are cold & his pulse small frequent and feeble & 
perhaps intermitting. Upon examining the throat ash coloured
sloughs are found upon the tonsils and uvula. In these
cases life is extinguished without any reaction 
of the system in the course of 24 or 48 hours, unless the tendency 
to death is obviated by the most powerful treatment.
These ataxic cases resemble the ataxic cases of yellow fever
pneumonia typhodes etc. which have sometimes been called 
walking cases
The scarlet fever is liable to be confounded with 
measles, the disease which it most resembles. The marks of 
discrimination are these. In measles the eruption is less diffused
is in pimples or circular dots more pointed & partly distinct & partly in clusters & the pimples produce a palpable
roughness of the skin. In scarlet fever the eruption is diffused
like erysipelas & consists of innumerable points or specks under 
the cuticle, intermixed with minute pupulae In some
cases the eruption is in irregular patches & in others are uniform flush 


“Symptoms of pneumonia rarely attend scarlatina”
This is one of a series of epidemics. It is usually followed
or succeeded by measles & is followed by hooping cough
For only it probably existed only as an epidemic now
we meet with sporadic cases continually 


125
while no roughness is felt, except in a slight degree upon 
the arm. The two diseases differ also in the time at which 
the eruption appears. In scarlet fever it shows itself
upon the face and arms on the second day, but in measles
it is not seen upon the arms till the fourth day.
The scarlet fever is distinguished also by the absence of the
catarrh, cough & determination to the lungs, suffusion
of the eyes & the red and swollen state of the eyelids, which generally 
attend upon the measles. The latter disease also
is generally accompanied by an inflammatory fever instead
of the typhus which characterises the former.
Still these two diseases of ten blend together
so as to make the discrimination very difficult. It is barely 
 possible that they are the same disease, though it may 
be objected to this view, that scarlet fever likewise is occasionally 
seen to blend with influenza # 
Epidemics of influenza are followed by [measles & scarlet]
The prognosis in this disease will be obvious
upon attending to the malignancy or the severity of the 
symptoms. In its severer forms it is always a dangerous
disease & in its highest malignancy one of the most fatal
while in its milder forms there is but little danger.
# It is sometimes difficult to determine whether a particular 
case should be considered as one of scarlet fever, or of quinsy
A case of scarlet fever in which there is no eruption & the
tonsils are inflamed &swollen can be distinguished from one
of quinsy only by attending to the state of the pulse, the prevailing epidemic etc.


I have known it appear as an epidemic
when it required nothing more than nursing
One idea which I wish to impress particularly 
upon your mind, is that you must investigate the particular
epidemic which you have to treat for no previous one
will probably have been similar


126
The treatment of this disease must vary according
to the diathesis. Epidemics of scarlet fever will differ
widely in different seasons & different places & require very different treatment
In a country where intermittent prevail the treatment will 
be different
This has been some dispute about using the
lancet in this disease. This will depend the degree of inflammatory 
diathesis. As a general rule emetics are indicated, 
but not always. Cathartics are generally improper 
but sometimes are required. In short indiscriminate treatment
is as improper in this diseases as in any other.
In this milder forms of scarlet fever, we
may employ the usual treatment for typhoid fever, & administer 
those remedies which translate & keep up action 
and equalise excitement, as diaphoretics, the warm
bath etc. For the mildest form it will be sufficient to 
give mild diaphoretics such as wine whey & elder flower
tea, with perhaps a little antimony, acidulated drinks
& gentle laxatives
As the fever is generally of a typhoid or
typhus grade, emetics are of especial importance in its 
treatment. They affect particularly the mucous membranes
and may be repeated in the course of the disease, for the
purpose of throwing off the accumulated mucus. The violence
of the disease may often be completely broken by an emetic 


“In some epidemics when there is considerable action cath. of cal. are
important especially in intermittent districts Rx cal. & 
jal. as for remittent bilious fever”
“When there is tremor paleness, cold sweats, vomiting
diarrhoea, cathartics might destroy the patient We must
rouse the patient by counterirritants etc. and then we may go on 
with the treatment by emetics of ipecac etc.
“Dr Rush bled but f.s. is very rarely indicated 
and in such cases as approach to A.  tonsillaris” “Still it
[illegible] all forms entonic atonic etc.
“If malignant give bark & the min. 
acids. If the system does not respond give cantharides 
& capsicum oil of cinnamon cloves or cajeput”



127
at the commencement. All writers agree in recommending
them. [Witherin] advises ipecac grs vi & tart. ant. gri for
an adult followed by a strong decoction of senna
Dr Rush recommends the turpenth mineral 2 to 6 grs with the view
of strangling the disease in its birth. Sulphate of zinc is a
good emetic & is preferable in the latter stage. It is local
in its action & tonic in its effect. It operates speedily and
produces less exhaustion. Vomiting by snake root has
been practised
In the irregular forms of scarlet fever, this
practice is more questionable & if emetics are given they must
be preceded by stimulants to rouse the powers of the system
Cathartics are sometimes needed & calomel
is to be preferred The judgment of the physician however 
must be exercised & the character of the epidemic studied, 
for great caution must be exercised that the system be not weakened 
by them & in extreme debility they should be preceded
by stimulants. In some epidemics they will destroy the pat.”
In some epidemics bleeding may be 
proper, but the apparent indications for it will generally 
be better answered by leeches about the throats and [temples]
In malignant cases where the powers of life
are very feeble no evacuations are to be used. External 
irritants are to be applied to rouse the system such as ginger
mustard brandy a paste of mustard spts. turpentine & 
aqua ammoniae etc. Internal stimulants must be given 


Ammonia with bark opium etc.”
“Tinct. canth 20 drops once in 2 hours till
there is some effect.”
“Serpentaria with ammonia acts as a tonic
and diaphoretic”
Where there is a prejudice against cold affusion
with water alone spirits or [illegible] or camphor
may be added


128
[illegible] to 4 [illegible] 3 or 4
such as capsicum Capsicum especially when the stomach is debilitated 4 to 5 grs [illegible] Cantharides in 20 drop doses. Ammonia
camphor quinine, mineral acids etc. Carb. amm. & cantharides 
may be given to excite the system & be followed by 
bark and brandy to keep up the excitement.
Diffusible stimulants also may be required, such as chloric
or sulphuric ether 20 gtts to a teaspoonful of water
for a child. In small children if there is difficulty in getting down
medicines the bark may be given by injection, or the body covered 
with it, by means of a bark jacket.
In severe cases, not of the most malignant
form, the heat and dryness of the skin are often very 
great & calor mordax may exist. Cold applications to the 
skin, especially those of stimulating kind will then be beneficial. The cold bath
cold affusion, or sponging with vinegar & water or spirits
& water may be used according to circumstances. The cold 
bath or affusion of cold water may be superseded in case of 
prejudices on the part of the [illegible] or objections from other
causes, may be superseded by sponging the body with vinegar
& water If the case is attended with extreme debility 
and relaxation of the system or if
any chills are present sponging must be used
& [illegible] with caution. If the cold applications produce a chill or
if the eruption comes out irregularly. I should advise 
the tepid bath to determine to the surface. In the advanced
stages of the disease when debility & relaxation are
great the vinegar & water should be made tepid & spirits
may be added. The rules with respect to these applications 
are the same as in typhus. In the atonic form of 


“In children with disturbance of the stomach
and pain in the bowels at the same time the eruption not
coming out well use the tepid bath It obviates the tendency
to convulsions and makes the disease regular In the most
malignant forms it is inadmissible”
“If there is irritability of the stomach give chloride [illegible]
4 grs 2-3 hours absorbents counterirritants”
“In the latter stage of protracted cases emetics of 
sulphur zinc or copper are very useful”
“Withering advises in the typhoid state, after evacuating
the stomach & bowels to give senega freely This 
would be injurious in a malignant case”


129
scarlet fever, the cold bath or cold affusion must not be used
IN 1803 I used sponging with vinegar and gave internal
stimulants at the same time as min. ac. alc. brandy
For children the tepid bath is invaluable in scarlitina 
particularly in the early stages of the disease and 
when the eruption is not fully out, or where the eruption is 
irregular. It is questionable however, how it would succeed
in the most malignant form of the disease
If there is great irritability of the stomach
with vomiting, absorbents and counterirritants are to be used
& in malignant cases capsicum, tinct. canth. & care to be given
In cases of vomiting saffron & snakeroot
If there is much diarrhoea we may 
give # white decoction with opium, injections of laudanum
etc. astringents etc.
In ordinary cases, when the eruption has been 
regular & ends with branny scales, about the seventh day
the case is out of danger But when the disease is protracted
sulphate of zinc or Moseleys tonic solution is
to be given as a tonic. The latter article in a dose from 
a teaspoonful to a tablespoonful is an emetic in cases 
of great morbid action. Emetics of sulph. zinc & sulph.
of copper have been recommended also of acetate of copper 
The latter article is also escharotic tonic & caustic. The chlorides chlorates are adapted 
to this stage of the disease
[illegible] [chlorate of potassa]
grii to vii


“In those cases that require stimulants blisters
may occasion gangrenes”
“When there is tumefaction of the tonsils use
blisters paediluvium & gargle with the mur. ac.
especially the [oxymorestic] diluted with 6 parts water”


130
The treatment of the local affection of the throat is of two
kinds, external & internal When there is much inflammation 
about the throat, with the uvula elongated, the
tonsils enlarged an inflamed & the pulse full I apply 
epispastics externally. Blisters, mustard, oil of origanum 
ol. monard punct. etc. may be applied to the throat
Gargles are injurious in bad cases & perhaps
of little use in most. Still in ordinary forms of the disease
from four to six ounces of any mild astringent acidulated
perhaps with muriatic acid may be thrown in by 
a syringe. The marsh rosemary is considered better than 
any other astringent. The alum root (henchera amer.) is
useful both as a gargle & given internally. For the latter
purpose sweeten it & add a little brandy
When there is not much tumefaction & 
considerable relaxation of the parts stimulating garbles
are good, as capsicum & brandy astringents may be 
added. In gangrenous cases quinine is good if it can
be got down. In the latter stages of the disease it may 
be useful to touch the ulcers in the throat with nit. silv.
“Vinegar & lemon juice may be 
used as a gargle”
“If the ulcers are thick and leathery
apply nit. sil.”



“I have seen the brain affected and much spasmodic
action subderangement pain in the head 
and all the symptoms of hydrocephalus with a bloating
of the whole cellular membrane pulse frequent & extremely 
quick and all the marks of irritative actions
For 3 or 4 years I have used tinct. dose in 4-5 & sat. tinct.
canth. in 10 3 or 4 times a day giving also the tonic
solution and keeping the bowels open”
“It produces eruptions on the skin, heat dryness & 
soreness of the fauces febrile action & if continued 8 or 10 
days I think it would be useful. I would try it were the
disease severe and epidemic, whether I thought it contagious 
or not”


131
The sequel of scarlet fever is dropsy. In children
especially an anasarca and sometimes an universal
dropsy comes on after the disease has subsided. The 
first two cases which I met with were in the severe epidemic
of 1803. I treated them according to the direction 
of the books, with bark & brandy opium & lost my patients 
Considering this as an affection of the absorbent and nervous
system I treated the subsequent cases which fell
upon my hands with tinct. cantharides & tinct. digitalis
The digitalis allayed the morbid action of the exhalents 
& absorbents & the cantharides acted as a diuretic.
“Give of each 
2 or 6 drops every 3 or 4 hours It [opens] [illegible] in these cases the
effect of irritative action hence the propriety of digitalis
Hanneman proposes to prevent the recurrence
of scarlet fever by the administration of moderate
quantities of atropia belladonna an article which produces an
eruption upon the skin, similar to the rash of scarlet
fever. The influence of belladonna, upon this hypothesis
is similar to that of vaccination in preventing small 
pox.



The termination of the chain of actions in health
in some diseases & if we say nature cures the disease
then we may say when the tendency is [inevitably] to death
that nature commits suicide. The latter is true
of this disease Yet if this chain of morbid actions is 
broken up by a powerful impression the constitution
will take on its ordinary action
Scarce any disease is more curable
when taken in season yet it would not be proper
for a physician to say he could cure all cases
then pretending infallibility
I shd doubt whether Good had ever
seen the progress of a single case. He says nothing 
about the first stage.
The tendency of the disease is to destroy 
the patient not by infl. or irritation but by 
suffocation from a foreign body in the trachea
The stages run into one another, and 
yet a phys. watching the progress would naturally 
divide it into three stages
Always curable in the first stage unless complicated with some other disease
rarely in the second almost never in the last yet
I have known cases cured in the last stage
The peculiar sound of the cough is 
alarming (in the first stage) even to those who have never
before heard it
Dr [Hesark] I have been told divides the
disease as I have done into 3 stages and directs to give
2 grs. tart. ant. combined with ipecac. I shd give
for the effect not according to the quantity. I put out 3 or 4 gr
and give till the effect is produced
rarely over 10 grs


132
Croup
This disease has been called in America by the popular name
of hives which is probably a corruption of heaves called rattles
The name given it by Good is empresmia bronchitis. The 
most common scientific appellation has been cynanche
trachealis or angina trachealis
The persons attacked by croup are
I have never [illegible] 3 and [illegible]
almost exclusively children from 3 months to 12 years 
old # in one instance I have known it attack
a person 60 years of age When it occurs in adults it
succeeds other diseases I have known 2 or 3 cups of [illegible]
“Croup sometimes though less frequently than most diseases, blends with
other diseases as catarrh” Some have considered the disease as
contagious, but though a few facts appear to favour the
supposition, they are not numerous enough to establish a 
general law.
Croup usually occurs in the winter
and spring, when it is brough on by exposure to a cold
and damp atmosphere. Children upon the sea coast are
more subject than in the interior of the country, because
exposed to more variable weather and more frequent [thaws]
& notwithstanding the greater warmth of the climate on 
the seacoast For when the air is filled with 
vapour, the caloric of the body is conducted off with 
more rapidity than in a dry atmosphere, even if the
temperature of the latter is colder.
# It is principally confined to persons under 5 years of age
though it sometimes attacks persons of all ages, and 


It is not precisely entonic or atonic & hence
might be called specific in peculiar
It is said that in croup the exhalent
arteries are affected & in catarrh this [illegible]
vessels Whether the different vessels are affected or not there 
is certainly a different action
“I have thought croup might destroy life by 
coating the entire surface of the lungs with a mucous
or membranous coat thus preventing the decarbonization 
of the blood”
“I have never seen croup without more
or less spasm; & probably in fatal cases it is always a 
spasmodic contraction that closes the passage to the lungs 
which is only diminished by the membrane. I never
saw a case on the other hand of what is called
spasmodic croup which did not if neglected put on the
membranous & inflammatory form”
A similar [membranific] inflammation
exists in the duodenum


133
Croup is a specific disease of a peculiar kind and
is never malignant. It comes on with all the symptoms
of pyrexia and consist in an inflammatory affection of
the mucous membrane of the larynx and trachea, which
causes a remarkable shrill sound in breathing & a ringing
cough by which those who have seen the complaint
cannot fail to recognise it. The proximate cause is a 
peculiar inflammatory action of the system, 
determined to the exhalent vessels arteries of the trachea
and bronchial vessels, where there is produced an exudation 
of coagulable lymph similar to that which forms
on the membranes of closed cavities from inflammation & 
entirely different from secretion of the mucous glands
whether healthy or unhealthy. This coagulable lymph 
which is thus exuded, always forms a membrane which 
lines the larynx and trachea, if the disease proceeds
to a fatal termination, and causes death by suffocation. 
This appearance is always found in the
tracheae of those who have died of the disease.
The membranific inflammation distinguishes 
croup in its nature, from catarrh which is in all its
varieties, an affection of the mucous glands



Most diseases attack in the night
“Diseases are cowards, they mostly attack in the
night” Rush.
“The peculiar ringing sound of croup is made in 
[expiration] that of hooping cough is inspiration”
# As is the case when respiration is impeded
by any foreign body there is a great deal of
irritation
# when the nose discharges [illegible] [illegible] it
bronchial vessels secrete mucus and a new
action takes place the patient will be apt
to recover
# The patient was subject to asthma
and the croup was neglected until the latter 
stages finally died
+ “I have known this to happen only once
In this case the friends were not alarmed because the
child had been subject to catarrhal affections & the symptoms 
received no attention till the last stage”
# Frequently appears to be [illegible] in the
very commencement of the disease


134
This disease sometimes come on like a
catarrh and continues two or three days without any 
alarming symptoms, until suddenly, & often in the night
the peculiar symptoms of croup appear. At other times 
the first symptom of the disease is a severe paroxysm of 
suffocation attended with the hoarse & shrill ringing noise made
during expiration like air through a broken tube & the peculiar ringing cough. The cough
in its progress is attended with more or less of spasmodic
action. # It is always dry; and when it becomes loose
or when mucus is expectorated the disease is broken up 
and there is no further danger # It rarely continues so long as five
days and is sometimes fatal in twenty four hours. Sometimes,
though rarely the membrane of coagulated lymph is
coughed up. I have met with but one case + In this the 
membrane was thrown up three times, at each subsequent
time forming lower down than before # 
No disease resembles croup so much as
suffocating catarrh yet there are obvious marks of discrimination
The latter disease as I have seen it is not attended
with much cough and the difficulty of respiration is
not in paroxysms but constant & commence with the disease. The pulse is often quickened
and when the system is prostrated may be low. #  In suffocating 
catarrh the powers of life are to be raised by external
irritants & excitement equalized by the inhalation of the vapor
of [illegible] of warm water etc. “Mustard” “If pulse tense
bleed”



From the earliest of my practice I 
have been in the habit of dividing it into 3 stages
[illegible] that they are perfectly distinct, but [illegible]
person would naturally take this view
Quiet between the [per.] apparently 
not much affected during the paroxysms Between the paroxysms pulse natural & eyes bright. You will 
know this disease in this stage only during the par.
Parents in this place know the disease in this stage
and send forth phys. 
In this first stage, the disease 
must be broken up by a powerful impression 
upon the system This may be done many ways
Some are partial to a [illegible] & some to another 
“That which is best administered is best” A local
effect upon the stomach will not answer
I have relied more upon tart. ant.
than any other & found it answer all reasonable
expectations. I have preferred it to any other
I have occasionally used other [illegible]
I have found seneka better as an auxiliary
than as a commanding [remedy]



135
Croup may be divided into three stages each 
of them requiring different treatment. 1st The forming stage
2nd The inflammatory stage & 3d The last or suffocating
stage
1st In the forming stage, the cough
is severe & hoarse & occurs in paroxysms of from five minutes 
to have an hour in interval. “There is little or no fever” The
pulse is regular and small, & sometimes trembling. The patient
is often chilly. In this stage the disease may with
certainty be cured
“I have not lost a patient & have not saved one
in [illegible] when not called till the second paroxysm 
had commenced”
In the treatment of this stage we must depend
upon emetics. Large doses must be given moderate
ones do no good. A dose should be administered sufficiently 
powerful to affect the whole system and call into action 
every muscle. We must be regulated not by the quantity 
but the effect for we must calculate to overcome the diseased
action completely by the operator of our remedy.
I have given three grains of tartar emetic to a child three
months old, & kept up the action by the large doses of seneka
repeated every half hour for six or eight hours
Tartrate of antimony is the best emetic to 
commence with and may be given in a dose of from 3 to
six grains of strong tart em. After its operation a constant nausea must
be kept up by seneka or some similar article, for some
time in order to prevent a return of the disease. The seneka
excites a new action in the system. It may be given
in decoction. Take zfs or zi of bruised seneka to half a pint of
water, & boil away a quarter. Give a table spoonful for a 



It has so happened that with us the [serpentaria]
has not answered so well as tart ant. It acts 
on the fauces perhaps more [illegible] than tart. ant. 
but does not affect the system act upon the skin 
& determines to the surface so well as tart. ant. We have 
not used it however except in the latter stages & perhaps have
not given it a thorough trial
Sanguinaria vide p. 212 has been used 50 perhaps
a hundred years. Three generations of physicians
in one locality have used it and relied on it
in croup with as much success as upon other articles
These mode of using it was in strong decoction 
without weight & give a table spoonful until 
the desired effect is produced till vomiting is excited
or the disease is broken up There are however
forms of the disease where it fails even in [illegible]
“Much has been said of the good effects of calomel
Give in large doses 20 – 30 [illegible] acting as an emetic it is
serviceable but when catharsis is produced, the emetics 
would fall in with the catharsis. I never could in such a 
case make the strong impression on the system what I 
[illegible]”


136
does once in half an hour or as much as the stomach
will bear. Seneka has been relied upon by some as
a specific in croup, but it is inefficacious when inflammation 
is present, being a stimulant, and it is too slow in its operation
for the first remedy. After giving it as the first
article, other emetics seem to lose their influence; acting
as cathartics; but after the violence of the disease has
been broken up by other emetics, you may avail yourself
of the nauseating & deobstruent effects of the seneka & effect
a cure. Dr Rush preferred the turpeth mineral 2 to 6 grs
as the first emetic. The physicians in Wallingford for 5 years
make a strong decoction of sanguinaria, and give it
until emesis or a cure is effected. This article may be
used instead of seneka in the way above directed
In connexion with these means the warm
bath and fomentations may be used as adjuvants. Much 
has been said of the good effects of calomel in this disease
You cannot rely upon calomel for the cure of the disease
It is too slow in its operation. Never give calomel until 
you have broken the violence of the disease 
After emetics have operated and you have availed your 
self of the operation of seneca & sanguinaria and the disease
still exists, give from 5 to 10 grs of calomel
By this producing an orgasm in the 
system more powerful than the disease & continuing it until 
the latter be overcome, croup may be cured with more certainty
than most other diseases. All diseases should be attended



I know that there are some very respectable physicians who rely
upon calomel For this purpose they 
give very large doses and produce [illegible] & [illegible]
I should prefer it as an auxiliar. I have often 
used it but after the emetic or with the
emetic or before the emetic
A variety of other men [illegible]
India tobacco which though not allied in 
botany are so in their operations The common 
tobacco is generally applied eternally to the pit of the 
stomach. Lobelia acrid & emetic loses some of its virtues by drying
In its recent state 1 gr will often excite full vom.
Indeed I have known vom. prod. by merely 
chewing the capsules & [illegible] without swallowing
by the impression upon the mouth	
Dose of tinct. 20 drops to a t. sp. according to age
Other acrid narcotics as veratrum & colchicum
may be used
In this forming stage bleeding is not
indicative by the pulse, nor by state of the
system and you will obstruct your efforts to excite
a powerful effort of the system if you bleed
2nd stage
In this acrid emetics are injurious
seneka is too stimulating Sanguinaria had I have
seen all the symptoms aggravated by bloodroot in [illegible]
the high entonic stage
# “If the disease is complicated with a similar
affection of the stomach & duodenum give calomel & other
cathartics”



137
to in the beginning & it is owing to the imperfection of 
or our art that every disease is not broken up in 
its first stages. When however croup supervenes upon other
diseases, it is more dangerous. “Those who practice in the
country rarely see the disease in the forming stage. I had one
winter 20 cases of croup all in town recovered most of the in the country died”
2nd Country practitioners however seldom see
this first stage which I have just been treating of when the 
tongue is not discoloured, the fauces have a natural appearance
the pulse is unaffected respiration natural & ordinarily 
no inflammation about the tonsils. On the contrary 
they too generally arrive when the disease is in the
second or inflammatory stage the disease has effected in which the bloodvessels the skin is hot and 
dry, the face flushed, the pulse tense & sometimes full the
tongue furred, respiration between the paroxysms difficult
tongue furred, respiration between the paroxysms difficult
and the cough so severe as to threaten immediate death vide p. 213. In this stage 
we should immediately bleed from freely from a large orifice the arm or jugular vein
freely, even until syncope is produced put the patient
in the warm bath & let him also inhale the steam of warm
water, and give calomel and other cathartics. # Never
give emetics in this stage until after depletion by V.S. 
when we may give 4 grs. of tart. ant. in a table spoonful
of warm water & apply epispastics to the throat” in the commencement 
apply a blister” I dread to be called in this stage of 
the disease, for it is the almost always fatal venesection 
sometimes succeeds but very seldom. I would not apply 
leeches cupping would be better & perhaps friction might be serviceable.
Digitalis has been recommended, but 



In this stage inhale the vapour cover
the child & nurse in a chair with a blanket
In this stage cal. & cath. may be given
In the first stages I have conserved it very unfortunate
to find my patient under the operation of a
cathartic It feels as if my hands were tied
The excitement is of a different kind from what is wanted
And emetics are apt to produce hyper cathartics
Where the dis tends to the [illegible] the
[illegible] a specific. This is known by the
cough being less hoarse, by fever, by constipation 
fever more intestinal membrane
will pass off from the duodenum I was formerly 
disposed to cure this form of the disease [illegible]
& described it as such
In the second stage epispastics
over the whole chest also diaphoretics
and tepid bath When the cough is milder
and beginning to be loos after being principally 
broken up in the first stage give cal. in 2 or 3 gr
doses once in 2 or 3 hours
In the 2nd stage remedies have been
given to obviate the fever & digitalis has been used
with good effect It was used as a depressing agent
It operates by its narcotic power however. here refrigerants
are of little efficacy
In what may be seen to be the last


138
I have not used it. It is at best but a doubtful remedy
in inflammatory effections though calculate to remove more irritations. Sanguinaria diminished arterial
action like digitalis and operates powerfully as an
emetic. I have not succeeded with it in the last stages of
croup & have not used it in the first. [?ronchotomy] has
been proposed, but does not promise much benefit, as the
disease is seated below the place for operating. “Dr Smith did not recommend it”
After depletion and especially after the disease assumes
a bilious form you may give powerful cathartics
The pt. begins to thrown his head back death may happen any moment
3d IN the last or suffocating stage* you may give emetics
of turpeth mineral sulphate of zinc or even
corrosive sublimate to throw off the membrane. Something may depend upon changing
the emetics & sulphate of zinc may be tried. The cold bath
is said to have been successful in this stage, but the fact is
not well authenticated. I have used calomel and the
warm bath with advantage.
Child of Mr Culver
[last] in chronic stage
“I regret that I have not tried 
affusion of cold water in the last stage. It is 
said to cause the membrane to be thrown off & to procure
relief even in the very article of death”
vide p. 182
*”In the last stage respiration is constantly laborious
head thrown back pulse often irregular
& intermittent sometimes strong”
Chronic form “Sometimes though rarely the disease is only partially 
subdued I [illegible] on in a chronic form. Calomel
vapour best tepid bath are the appropriate remedies”




139
Angina Laryngea
Empresma Laryngitis of Good, q.v. for a definition & 
an account of the disease
In this disease the symptoms differ somewhat
from those of croup, though the cough is similar
The disease is seated in the larynx glottis and fauces & the
characteristic symptoms is swelling of the tonsils. The cough
is spasmodic and is excited by taking food with drink in this respect also indistinguished from croup. The
disease is more violent and rapid than croup, as the inflammation 
being seated in the narrow part about the glottis
produce suffocation sooner. The respiration is more difficult
than it croup particularly between the paroxysms
This disease more commonly affect adults
The first case that I saw was that of an old man in whom
the disease was brought on by exposure to cold after a pneumonia
From a relation of his symptoms I prescribed
seneca which only exasperated the disease, so that when 
I saw the patient he was unable to speak or swallow. A 
small red spot appeared on the tonsils. venesection, epispastics,
pediluvium, inhalation of vapor etc. were resorted to with 
no abatement of the symptoms. Venesection was performed a second
time & as soon as the patient was able to swallow, 4 grs. of 
tartar emetic were administered. Some nausea and vomiting
with considerable catharsis followed. The vesication 


“Angina laryngea is mor apt than croup
to recur several nights in succession”
“The slough were thick and leathery. Sloughing
even under blisters. In one instance blisters did not
heal in 4 mo. Lunar caustic applied to the tonsils & 
uvula & inflamed parts proved serviceable
# “In one case of A. laryngea I gave sanguinaria 
It was too acrid and increased the cough etc. It might 
do good if we could avoid the local effect of its
acrimony”



140
was extensively returned & the patient recovered.
Much the same treatment is required
as in croup but it should be more prompt and with earlier
venesection. For the inflammatory stage comes on earlier
and the disease runs a more rapid course
Last year this diseases differed in its appearance
from the former years
It has often followed certain affections
of the tonsils called black canker. The tonsils are inflamed
in black canker and sometime covered with a leathery
crust. This comes off and leaves an ulcer. If the inflammation 
extends to the larynx, symptoms of croup 
supervene
Case of black canker. Two called in the
last stage gave blood root with disadvantage # Still at 
this late period calomel and other cathartics in large
doses produced free evacuations and the child recovered 
Cathartics appear to do better than emetics. In one case after 
giving cathartics I used the vapour bath and applied 
a large epispastic over the whole sternum. Though at
so late a period the disease abated. A large slough however
was produced by the blister which required three 
months to heal. The morbid action on the skin being
similar to that of the tonsils
Vie p. 187


Sometimes comes on with a sudden paroxysm of
suffocation sometimes gradually 
“Distinguished in its commencement
from croup by the quantity of mucus in the bronchial
vessels”
“in the case which I have attended, 
not much febrile action attended the disease”
Proximate cause a morbid action of the lining
membrane of the lungs accompanied with a viscid secretion 
of [mucus]
By vomiting the disease may be relieved & apparently 
cured but may appear again in the course of 
an hour
The quantity of mucus is greater than in 
any other catarrhal affection”


141
Catarrhal epidemic resembling croup
Peculiar catarrhal affection resembling croup suffocating
catarrh
This disease is characterised by a severe hoarse 
cough, much resembling that of croup. The disease is distinguished 
in its commencement from croup by the excessive quantity of
mucus in the bronchial vessels which causes the suffocation 
The disease resembles croup likewise in the mode of its attack
which is sometimes sudden with symptoms of suffocation, and at
other times gradual with paroxysms of coughing and intervals
of perfect ease The turns of coughing are so violent in this
disease as to produce a livid colour of the face. The extremities
evident determination to the head
are cold and the head is hot from the quantity of blood
thrown into the vessel of the head by coughing. The evacuation 
from the bowels are healthy and among children with no disease which I am acquainted
affect the bowels so little ass this.
The proximate cause of the disease is a morbid
secretion of mucus on the lining membrane of the lungs & 
trachaea with obstructed perspiration. The quantity of
mucus thrown out by this membrane in this disease is astonishing After
the disease is fully formed, great quantities of viscid mucus
may be brought away by vomiting, to the great relief of the
patient for a short time, and yet within an hour the patient
will appear to be suffocating from the the quantity again 
collected in the bronchial vessels
In the commencement of this disease, the indication
is to break it up at once by a powerful emetic, of
tart. ant. unless the system 


The principal indication is to break up the disease
by a powerful action on the skin on the stomach
the duodenum and the fauces It is best affected by 
tart. ant. which is more difficult in its action than
[ipecac] though is very delicate constitutions ipecac 
may be practicable
# prevent accumulation of [mucus]
The bowels shd be evacuated not for the purpose
of curing the disease but for the prevention of an
accumulation of feces which would be irritating
In all diseases of the lungs examine
the state of the skin and particularly that of the lower
extremities for perspiration upon the upper extremities 
[only] may be a part of the disease
I have known the lives of several patients saved
by the use of the vapour bath
I formerly [illegible] and used [illegible]
for transmitting vapour by transmitting air through
boiling water
It was old practice to apply cat-skins
fowls split open (to the feet) etc. with the intention of
communicating vitality


142
is too much weakened to bear this treatment. This is a 
general principle viz, if possible to break a disease in its
commencement by means of a strong orgasm. Often the
emetic is to be repeated, and it may ever be necessary to give
four or five emetics 1 gr [illegible] tart. emet. each in the course of a day. After the disease 
is somewhat broken up, and epispastic applied upon the 
breast will assist much in allaying its violence #
If the disease still continues or if when first
called we find it fully formed and powerful emetics inadmissible
the primary indication will be to open the pores of the skin and
keep up a gentle perspiration, by small doses of antimonial wine
to which may be added in all quantities of camphor by elix. [illegible] & in 
some cases tinct opii by fomentations and especially by 
the warm bath and the inhalation of vapour. To affect the 
latter object the child may be placed in the warm bath & 
a blanket thrown both over it and the nurse, so as to keep
the child in an atmosphere of vapour. Long continued 
perspiration invariably relieves the symptoms. I have known
an instance in which the skin of a sheep warm from the animals
body was wrapped round the naked body
of the child with beneficial effect.
In small children when the stomach ceases
to be excited by emetics the throat should be irritated 
by a feather or the finger, when we wish to produce vomiting 
For we must never rest satisfied with merely endeavoring
to palliate the symptoms. In small children also the
mucus should be wiped out of the mouth by the finger or a cloth 
This disease prevails most in the winter and spring months & does not
occur every year. The first patient that I treated for the disease suffered
from it a year. I gave mercurials & finally the silver pill (nit sil)





143
I was puzzled with the first cases of this disease
which I met with. Some of them continued for weeks
and months I was obliged to use perspiration,
by warm bath to vapour bath emetics etc. I determined
to break up the next cases in the commencement
with tartar emetic repeated until full vomiting
was produced walking my patients. This 
plan was more successful
A s a general rule break up 
all diseases if you can
“The complaint is epidemic or rather
endemic. It has been mistaken for croup, but it
differs As croup formerly occurred no mucus was raised
in the earlier stages, and when there was an excretion
of mucus we considered the disease cured
But of late years the two complaints are somewhat blended.
Mucus is thrown off sometimes without permanent
relief”
“There is often in this disease a disturbance of 
the brain and nervous system resembling epilepsy or chorea
produced by the cough”


A distinction was formerly made by some
writers and some practitioners, between hooping cough
and [chin] cough the latter being a spasmodic cough
without the hoop. Such a distinction will not hold
good there is no difference
“Linneas and Rosenstein attributed it to an insect
others to malaria”
There had been a very severe winter & no one
had left the island for months


144
Hooping Cough Pertussis
Called also chincough
This is a disease which generally attacks children
yet occasionally, adults are the subjects. I have known persons
of 60 years of age affected with it. As a general rule also it
does not affect persons a second time. I have known about 
20 or 30 exceptions & among them was the late president Dwight at 60 years
Hooping cough generally appears as an epidemic.
With respect to its origin there is considerable difficulty 
in making up an opinion. It is said to be contagious 
to arise from a specific
contagion which affects a person but once. Dr [Dewers], however,
says “We confess that we are inclined to believe that it depends upon 
causes of a more general and pervading influence that 
contagion.” Dr Cullen asserts that he has said a disease which 
though evidently arising from chincough contagion never put on 
any other form than that of common catarrh. In the tenth
volume of the medical commentaries DR Willey gives an account of
the breaking out of the disease on Block Island under such 
circumstances that it would seem that it could not have originated
from contagion. When the disease prevails many become effected
where every precaution is taken” When the disease has been extensively 
prevalent I have not been particular about keeping patients
apart, perhaps however it is best for prudence’ sake to consider the disease
as contagious and to treat it as such. One fact I have noticed
that in particular seasons may have the disease who have had it
before.” Some suppose that it is contagious only in the first stage 
others in the second “Some think it caused by malaria or
animalcular”


“The stricture may be overcome by not
attempting to inspire, but to expire till the lungs are
emptied the pat. can then inspire without difficulty
I have known persons subject to this kind of hooping
without cough Adults are sometimes attacked in the night
with paroxysms of suffocation they start from bed when 
the recover their breath there is hooping but no cough, at
least at first The more they struggle to catch breath 
the greater the difficulty there seems to be a spasm of the
glottis Let them make no effort to inspire but expire 
the little air remaining in the lungs & they will bye relieved at
once. The disease is liable to recur bathe the feet at night 
give paregoric wine whey diluents The disease is not described


145
Some suppose this disease a peculiar inflammation of the
mucous membrane of the trachea and lungs, others that it arises
in the bowels
This disease often commences with the 
symptoms of ordinary catarrh & continues without alteration for
some days.  Sometimes the peculiar mark which gives this
cough the appellation of hooping & distinguishes this disease
from every other does not appear until the 3d or 4th week
It is impossible however to distinguish the disease until this
peculiar hooping makes its appearance. When the disease
is prevalent it will be safe to treat every severe case of catarrh
among children as one of this disease
The phenomena peculiar to this disease may 
be the described. Several frequent expirations are made in 
succession by spasmodic coughing, and a full inspiration is
then necessary to restore air to the lungs. The air as it passes
rapidly into the lungs produces a loud sound called whooping
The sound however is made more by the structure of the passage 
than by the rapidity with which the air is drawn into the lungs
I have known persons subject to this kind of whooping, without
having a cough caused by a spasm of the muscles of the trachea 
larynx? to which adults are sometimes subject. (Goods laryngismus?) 
A similar sound is also made in croup, when 
the air is expired after the passage becomes constricted
The patient is aware of the coming on of a 
paroxysm of coughing by an unpleasant sensation in the throat, & 



The cough is violent in proportion to the shortness of 
the paroxysm


146
it is common for children support themselves during its continuance
by changing to a chair or other support near them. During the
paroxysm the blood is returned with such violence to the head as to 
produce a livid colour of the face & often in 
bleeding at the nose. Very violent paroxysm sometimes
in young children terminate in convulsions or death The paroxysms continue
until a quantity of mucus is thrown up from the
lungs or the contents of the stomach are evacuated by vomiting
They are short in proportion to the facility with which the mucus
is brought up or rather in proportion to the rapidity with which it is secreted
It is the secretion of mucus, not its removal
which gives relief to the irritation of the lungs 
Many suppose that this mucus which is generally in considerable
quantity is the cause of the paroxysm of coughing instead 
of the effect of it. The peculiar irritation of membrane in 
a paroxysm of coughing produces a secretion of [illegible], and 
when a sufficient quantity has been secreted it is coughed up 
like the secretion of tears from an irritated eye
and the paroxysm is relieved “The mucus sheaths the part & the ceases”
The disease continues from one to six
months It is often kept up by habit. The cough is usually more violent by night than
by day. Violent cases are often attended with considerable fever
and in the worst cases respiration is laborious between the fits of
coughing. The disease may terminate by apoplexy or suffocation
or by ulceration of the lungs and hectic & sometimes by 
permanent visceral obstruction “or apoplexy or suffocation”
Whooping cough is not dangerous to adults
and I have never known a child over two years of age die
with it. It is most dangerous to infants and the younger the 


It is usually dangerous to children within the mouth
It is apt to wear out very young children especially 
if they are of a scrofulous tendency
It is frequently accompanied with a morbid sensibility
and irritability of mind and hence in the latter
stages a change of air and of place is salutary as in 
cholera infantum The same despondency of mind takes place
as in chol. inf. q.v.
The disease is a fever spending itself upon the
lungs and trachea, and affecting also the glandular
system
Some phys. think this dis. like common
catarrh, is always inflammatory in its commencement, and 
requires antiphlogistic treatment. But we know that
pneumonia may be highly typhoid & require treatment
opposite to [enteric] pneumonia. If infl. of the lungs exists
the antiphlogistic treatment shd be adopted in its fullest
extent I have seen antimony as efficacious in this dis
as in pneumonia. In general perhaps mild
antiphlogistic diet & treatment will be proper.
In some cases I have thought the
veins lost their power, and in such cases the
blood [illegible] has been prescribed & with advantage
It is a catarrhal fever at first and to be
treated as such


147
child the greater danger in children under the age two years
The anger, to be apprehended from the disease will also depend
upon the debility of the child when attacked. The cough may be
violent and attended with frequent vomiting yet of the patient’s
appetite be good there will not be much danger
to be apprehended. A moderate hemorrhage from the nose
is often salutary
Treatment. If the disease is mild and the constitution
good little need be done with the way of treatment. But if inflammatory 
symptoms supervene with a tendency to pneumonia
the antiphlogistic treatment must be adopted. Bleeding
will often be advisable. A small quantity of blood
taken from the arm proves serviceable. In general greater 
effects may be expected from the application of a few 
leeches to the breast or neck than from bleeding at the arm
but when decided symptoms of pneumonia appear, & the blood 
seems to be transmitted with difficulty through the lungs.
I would recommend venesection. In this case also the 
bloodroot will be the best article for internal administration
In most cases the disease comes on like
a catarrh, and should be treated as such, with mild 
antiphlogistic regiment [illegible] important part of the
antiphlogistic treatment of this disease is the keeping 
the bowels open. Costiveness frequently attends the disease & should
be carefully avoided. In general it is better to obviate 
this symptom by diet as far as it can be done 



Begin with antimony in small doses 1l or 2 drops ant wine & 
in [illegible]
For very delicate children however it may be better
to give ipecac
Almost all the writers recommend vomiting [Best]


148
rather than by medicine. The best cathartics for the
indication are those which excite the secretions of the stomach
and liver. Sometimes the disease has a tendency to produce
congestion of the liver and obstruction of the mesenteric glands
and in that case also mild mercurials should be given 
and their use continued as long as any symptoms of congestion 
exist.
All the medical writers on this disease recommended
vomiting in the first stage
Tart. ant. is in ordinary cases the best emetic. Sometimes
for a child from two to six months old two drops of antimonial
wine will be an emetic dose while for another
of the same age 20 or 3o drops may be required. In 
affections of the lungs children will bear antimony better
than in those of the stomach and duodenum. In some
constitutions antimonial emetics produce (in this disease)
a sort of spasmodic stricture other emetics also may produce
this effect a symptom which must be relieved by diluents 
and opium
In general antimony in small doses
may be given to children of any age, either by itself or combined
with a small quantity of paregoric or any other mild preparations
of opium. Given in this way it removes febrile action and 
congestion of the lungs, and determines to the surface
When the disease has proceeded with 


You may see the fontanelles swell in such 
cases. I recollect a child in the whooping cough going
into the country I told the parents not to suffer the child
to be vomited. A physician in the country said the child 
must be vomited of course all the books directed it
in whooping cough He vomited the child. It went into
convulsions and died
# Here insert the recipe for hire syrup or 
compd sys. of squills p. 150
I have known the lives of some patients saved 
by 
this antimony internally had lost its power produced no effect


149
violence for some time and there is much determination of
blood to the head, threatening convulsions or apoplexy from 
distention of the blood vessels, or when the patient has become
debilitated vomiting by emetics should not be practises
or but cautiously.
When the system and particularly the
stomach has become debilitated. Ipecac is preferable to 
antimony, given in emetic doses, or in small quantities 
as an alterative diaphoretic and antispasmodic. And in the
latter stages likewise on account of the debility, sulph. tinc. is a good
emetic using 5 or 6 grs. with as much of ipecac
If there is not much febrile heat, and there is much 
viscid mucus in the stomach and lungs, and emetic of
squills is often serviceable # particularly I [illegible] phlegmatic temperaments syrup of squills vinegar of [illegible]
In this disease if there is danger of convulsions 
from vomiting, blood root and similar articles should
be given. The hive syrup or compd tinct. of squills may be used
In children under three 6 months, whooping
cough may be much relieved (respiration being promoted)
by vesication on the breast. A blistering plaster may be applied but
I have more generally used the following. Rx common or mild
tinct. canth zi targ. ant zi Dissolve the ant. in the 
tinct. & apply a linen cloth with the mixture till [illegible] or partial vesication 
is produce & then dress with simple cerate In this way we have the vesicating & irritating
qualities combined. This external use of tart. em. was
recommended 20 years ago, in the Lon. med. & ph. Journ.


This disease may be cured in its first stage but it
ordinarily runs a regular course & the treatment is generally palliative 
brown mixture
You will perceive that this is a strong decoction
of seneka and squills, with a large proportion 
of tart ant. shd be given cautiously 4 to 30 drops 
Narcotics have been strongly recommended
e.g. atropa belladonna & hydrogen of the former
for 2 gr of the leaves in powder Alibert recommends
the fresh bruised root


150
A popular remedy in whooping cough in Godfrey’s cordial, made
of molasses and water with a little laudanum and oil of [illegible]
“Hive syrup” (or compd syr [illegible]) is made as follows Rx bruised seneka root & 
squills zz z8 water lb 8 boil and evaporate one half
strain and add honey 4 pts boil to lb 6 Add tart.
ant. gr.i to every ounce Give for an emetic 8 or 10 20 drops
to a child 4 mo. old & repeat the dose every 15 or 20 minutes
until vomiting is produced
The “brown mixture” is as follows elix. pareg. zi; ant. wine zfs;
ext. glyc ziii pul. gum ar. zii wat. zvi trit. & boil 
dose from ½ teaspoonful to tablespoonful
This has been very extensively used
This disease has been prescribed for more 
empirically than most others; a fact which proves the
difficulty of curing it It is a popular notion that it must
“run its course” & under the influence of this many parents
object to its being prescribed for. Undoubtedly this
like every other disease must “run its course,” if it is not
cured; but this is no reason why the cure should not be 
attempted.
Ammoniae asafoetida (especially if
the cough is kept up from habit)


1st antispasmodics 2nd tonics
# An emetic is occasionally administered with advantage 
“I have prepared this from seneca oil also
from gun copal”



151
2nd In the second or chronic stage tonics & 
antispasmodics are indicated. Sulph. of copper or of zinc
tinct canth. cinchona, arsenical solution etc. may be required 
to rouse and support the system & as antispasmodic
tinct. asafoet. petroleum Artificial musk etc. and also
the narcotics, as hyoscyamus, conium, stramonium, belladona arnica, opium etc.
When the cough is kept up by habit, # asafoet.
is often administered to children with advantage. It may 
be given in tinct. or decoct. & if it cannot be given by 
the mouth it may be thrown up in an enema, using 10, 20, or 
30 drops of the tinct. It is a valuable [illegible] the taste is less
unpleasant than the [illegible]
Artificial musk or oxygenated oil of 
amber was first introduced by Prof Hufeland of Jena
as a specific for whooping cough and has since been found 
very useful in other spasmodic diseases vid. Lon. M of ph. J.
vol. 1: p.181 van Swieten’s comm. etc. Rx nit. ac ziiifs
cl. succini zi. And the acid gradually, ina temperature 
of 100 [degrees] or in the sun. Prof. Hufeland triturated
x or xii grs. in a mortar with a few almonds & diluted with 
z 5 or 6 of water & gave a teaspoonful every 2 hours to 
a child a year old. This preparation was very celebrated 
and very effectual, for a time, but afterwards fail 
was thought to be ill prepared. The truth was the diathesis had 
changed. Probably it will be as affectual at [illegible] time
I have given the above article in tinct. Rx zii 
of the oxyg. [illegible] [illegible] lbfs alcohol dose 10 to 12 20 gtts
It is much more soluble in ether. I frequently dissolve zi 
of oxygenated amb. in zi of ether dose 1 to 2 drops on sugar 





152
It may be prepared indeed of any strength, to suit the
convenience of the physician. Probably gum copal oxygenated would
answer the same purpose as amber as there is every reason 
to suppose that the two are essentially the same
amber being gum copal mineralised Case of a vein of 
olibanum or Frankincense found in S. America.
Opium is not indicated in this disease
except when it is qualified and its action determined to the
skin by antimony ipecac or camphor. Hyoscyamus
is better than opium for in the cough it produces no constipation
and the tincture is very pleasant. I have not
however used it in this disease. Conium has been recommended
by writers of the first respectability, but later authors do not 
speak of it with much confidence. It deserves a trial
when other things fail. Alibert recommends atropa belladonna 
1/6 gr. of the root or leaves powdered & given in milk
I have used I have more confidence however stramonium in the [illegible] & think it preferable
most of the narcotics
to any other narcotic It is peculiarly calculated
to remove spasmodic action depending upon irritability 
of the system or kept up by habit From the relief obtained
by its use in asthma I was led to employ it in this disease
and from those cases in which I have tried it I am of opinion 
that it is a very valuable remedy in it 
The ripe seeds of the stramonium are best the full dose of 
these for adults is gr. ii for a child  1/10 gr. or more according 
to the age



Mercurials occasionally blue pill rhub & 
ipecac enough to keep up a gentle excitement in the 
bowels
Not unpleasant to the taste
An old [illegible] Chalmers ([illegible] of silver) recommends sulph. cop. & 
tinct canth in wh. cough
# [ago] more used than any other Lately the ox. bis.
has taken its place dose the same used  for irritating
cough & irrit. of stomach


153
Carb. potash is a good antispasmodic used externally 
and internally. It is not only antacid & antispasmodic but it appears to 
me to produce a peculiar excitement upon the stomach
and aesophagus, which makes the more susceptible to 
the impression of other articles. Pearlash zfs & water z8 with 
cochineal enough to colour the solution has been considered
relied on by some physicians
a specific. The cochineal merely colours the solution.
is an article from which I never could perceive
any medicinal effects when used alone. I have tried the
experiment & could perceive no medicinal effect from it
Tonics. I have given the sulphate of zinc
more than any other tonic in this disease, and have experienced 
the greatest benefit. Sulph. tinc given by itself,
sometimes produces spasmodic action, the effect I attribute
to its being used in substance & hence I always
give it in the form of Moseley’s tonic solution. This 
preparation is both conic and antispasmodic is easily 
taken and retained on the stomach of very small children
Sulph. copper possesses properties similar 
to those of sulphate of zinc. It is administered in the 
low stage of whooping cough. In this place the preparation
of it called compd tinct vitr has been used
according to the recipe in the 10th vol. Duncan’s Commentaries
in doses of 3 to 30 drops according to the age of the patient
The oxide (or flowers) of zinc & also bismuth 
formerly much used in spasmodic cough 30 grs
have been occasionally used 1 to 3 grs 1 to 10 to an adult
The Peruvian bark is a good remedy in 
the last stages. The only objection to it lies on the difficulty 


It sometimes happens that the physician is 
not called in until the latter stages. As one resort we
may have recourse to irritate along the spine
It is an opinion very extensively prevalent to that
it is of no consequence what kind of food a child takes
when he has the whooping cough But great attention 
shd be given
Removal from sea side to country 
and [illegible] country to sea side either is beneficial


154
of administering to small children, a quantity sufficient
to produce any considerable effect. This difficulty may 
now more be overcome by using sulph. quinine ¼ gr to 1 gr Dr Chalmers of 
South Carolina recommends a combustion of bark, sulphate
of copper and cantharides
Tinct. cantharides has been long since
recommended for whooping cough. It is useful when the system
requires an inflammatory diathesis to be produced. Its action on the stomach 
is probably similar to that which it has in cases 
of gleet and leucorrhoea the stomach being in a relaxed
state & requiring to be excited to a healthy inflammatory 
action
Irritants, as oil of capsicum canth. [illegible] or ol. orig.
or vol. lin. rubbed along the spine have been used in 
the latter stages. They should be tried when you have reason 
to suspect that the spinal marrow or the nerves proceeding 
from it are affected.
Attention should be paid to the diet of children
in the whooping cough avoiding potatoes, oily foods etc.
Change of scene & change of air especially by 
riding should be resorted to in bad cases, to tranquillise 
the patient & furnish mental excitement. Sometimes the little
sufferers will be excessively irritable constantly worrying and teasing until 
this is done requesting first one thing & the other to be done. It is the worst of such cases, medicine does
little good, even the irritation produced by administering 
it may counteract its beneficial effects.


violent palpitation throbbing of the heart
a soft flowing pulse and a jarring feel of the pulse under
the finger ([illegible]) (The French call an enlarged heart
hypertrophy I object to the [name])
For this I have given nit. sil. 1 or 2? gr.
(in the chronic stage of [illegible]) Digitalis & also
[languinaria] (tinct. 2 or 3 gtts.) This article is dangerous for
children because it accumulates in the system
Lead has been recommended 
I have been doubtful with respect to its propriety in affection 
of the lungs etc.
# Pneumonia typhoides 1815 the system seeming to lose the
power of [illegible] the blood and the bloodroot was
given to promote venous absorption The digitalis
might probably be given in such cases but is not as
well adapted. I used the blood root and found
as much benefit as could or [expected] from any article


155
If the patient having the whooping cough happen to be teething
the treatment recommended for dentition should be employed
The patients are very liable to have an 
inflammation of the lungs from taking cold in any stage
of the disease & in such cases the remedies for pneumonia
should be administered, such as antimony bleeding
epispastics, bath etc.
The disease I think sometimes determines to the
head & produce a relaxation of the sinuses & 
[illegible] likewise produces a relaxation of the ventricles of the 
heart the immediate cause being the violence of the cough
In such cases I have used lead, but not in sufficient
quantities to enable me to recommend it Iodine has been
recommended 2 or 3 doses 3 times a day Nit. sil. languinaria & digitalis
When in the progress of the disease
the circulation becomes much affected the pulse frequent,
soft, flowing with occasional intermission
respiration high frequent and laborious, with a bloated
and sometimes analogous to # a livid countenance, the blood root has
done more than any other remedy not failing in any 
instance to give relief & palliate sympt & in some cases the relief has been
permanent. I gave the bloodroot repeatedly, the last
spring, 1815 to my patients in the whooping cough. To a
child a year old 5 to 10 or 20 grs of the dried root, according
to the urgency of the case, infused in 6 or 8 teaspoonful of
boiling water. Give a teaspoonful every hour, until 
vomiting is produced or the patient relieved. Children 


Sometimes the dis. will be very mild and yet leave 
the system in such a state that a slight subsequent disease
will carry off the patient e.g. in 1815 the dysentery
attacking children would often be very slight and yet
would carry off every one who had had the whoop. c.
in the spring. The attack would be mild and insignificant
of dysentery and yet the pat. would go into 
a [illegible] very speedily like cholera
Elaterium has been recommended I shd
be cautious in trying it except in very vigorous children
I can speak with confidence of arsenic. Excepting
occasionally prussic ac. I know of no remedy which 
so completely cures the wh. cough except prussic acid in 
some cases.
Case child 2 gtts night & a [illegible] in a
weak countenance pale, eyes dull face bloated muscular
strength weak muscles soft & flabby Parents
much [illegible] cough gone recovered colour & 
strength upon bark I have known several such 
cases and have known no ultimate injury result from this practice
Yet parents are afraid


156
who had the whooping cough that spring were very liable
to be carried off by the dysentery of the following summer
none died in 1815 of the disease but many in consequence
of it, with hydrocephalus and dysentery
Prussic acid dose 1/3 of a drop to begin with and arsenic
occasionally cut this disease entirely short; and these are 
the only articles which I have known do so, without leaving
a vestige of the disease behind. The former is a dangerous
article to use, from its want of uniformity and strength
Fowler’s solution of arsenic gtt more [illegible] is safe but does not answer
so well in the first stages. If it makes the patient feeble
livid bloated & with swollen lips etc. it must be stopped & perhaps
bark administered. It has cured the cough in the 
second stage. Dose 1 drop 1 or 2 drops twice a day. Sometimes is only palliates
Case. June 1815. A child of Capt. Totten’s a boy 
of 5 yrs of age rather full habit had been affected
with the cough for a fortnight before I saw him 
I found his pulse very frequent soft convulsive & with intermissions
face swollen and livid, circulation much increased on 
slight palpitative [illegible] motion of the body in the symptoms aggravated to an
alarming degree by a paroxysm of coughing. Previous t the
disease a remarkably even tempered and pleasant child he
was not on the contrary very irritable. Trifles irritated his
mind, and when irritated, all the symptoms of his disease
were aggravated. He took an emetic of ipecac, with 


The sequels of this disease are numerous
Sometimes the heart is affected as above and continues
so for years. Sometimes the glandular system
is affection. Sometimes the lungs. There is a lady in 
Philadelphia who had (under my care) suppuration of
the lungs whoop. cough now healthy hence never despair
The stomach and abd. visc. are
sometimes affected in a chronic way requiring 
dandelion mercurials hop [illegible] etc.
It is very tedious to attend children in the 
chronic stage an account of the excessive irritability
When bath recommended
Cold bath doubtful. I have known patients killed
by being brought from the country and plunged in the
sea bath
“Good speaks highly of rhus [illegible]. It is
given to produce a distinct action on the system which shall
overcome the diseased action. It determines powerfully to 
the surface and has a powerful exciting effect on the
blood vessels while it does not produce a determination
to the brain. I should not recommend this article and 
it is so uncertain in its effect. On one person it will
have no effect at all, when in another it will cause
swelling of the eyes, blindness, fever, & great irritation


157
but inconsiderable & temporary relief. He was directed
to take the bloodroot every hour, as much as the stomach
In relieved the violent symptoms
would bear. It was continued for two or three days, and the
palpitation of the heart was much abated, the circulation
was less irritated, & the livid colour of the face was gone still did not cure
When costive he was benefitted by full doses of cathartics.
because the system was [illegible] deranged heart lungs etc.
I considered the case a fatal one and expressed that opinion 
to the parents. The cough and other symptoms continued
though in a less violent degree disease chronic an epispastic was applied
to the chest very irritating (changed clothes often in the day [child] run upon various subjects)
Patients strength began to fail and tonics were given
white vitriol bark cantharides Finally the patient refused
to take any medicine and was left to his own appetite
called obstinately for it took cake for food for several days then baked pears then [illegible]
Afterwards recovered but was unable to run “for some years”
without a palpitation
If this disease should again prevail
I think I should atropa belladonna as a prophylactic.
As the disease continues the stomach
may become very much debilitation and require 
compd powd of [contragerva] cat carilla etc. etc.
“Ledus palustra are narcotic”


It is not certain that the dis. did not exist before
It may have existed before but no general account
given of it. It may have been known in diff. places by 
diff. varies and it [illegible] have been known than the 
diff names meant the same disease Diseases are not
apt to appear suddenly. Still at this period, there
[illegible] cause operating for the increase of the dis.
Belly usually large and limbs small
Joints unusually large
Often morbid cravings of appetite
Yet the same causes operating in a higher degree
produce cretinism
There is no difficulty in recognizing the disease
You will be struck at first sight with the large size of the
head the blue [veins] of the forehead paleness of countenance as you cast your eyes
down you will notice the large joints


158
Ricketts
This disease according to Underwood was first noticed
in England in the year 1628. It is said to have immediately 
succeeded the increase of manufactures, when people left the villages
to settle in large towns, where they wanted exercise and a
pure atmosphere
Children are rarely attacked with this disease
earlier than the sixth month and not usually until after
that period. The symptoms are soft flesh muscles & cell. sub. relaxed general relaxation 
of the system paleness of the countenance unless the face
is flushed with fever, which when it exists is of the hectic kind a fever of irritation
pulse, usually quick and feeble,
tumefaction of the abdomen appetite and digestion bad tendency to acidity
veins of the head [illegible] and blue the sutures of the head not firmly closed head large fontanells unusually 
open joints large in bad cases all the bones of the system enlarged & softened
One effect of the disease is that the teeth are cut later than 
usual. Ricketty children are usually precocious in 
intellect. Their mental faculties are developped more early 
but are not capable however of so much improvement, as
those of others. Evolution of the mental faculties does not
proceed with the tardy progress of the assimilating function 
The child learns to [illegible] very early and exhibits an acuteness
of intellect beyond his years with the exception however of those
cases so severe as to have a tendency to cretinism It is a common 
saying that very forward children are not likely to live long
and the precocity of scrofulous & rickety children may have contributed
much to the production of this impression.


Too much heat may produce an indirect
debility
Undoubtedly aff. the brain & nervous system
Give mercurials occasionally Do not produce salivation
and do debilitate by mercury
Frictions are very efficacious exciting the skin
The reasons why friction are not more successful is that they are not perservered 
[illegible] the al. can. etc.
The cold bath is the only strengthening remedy which 
acts suddenly
No effect can be produced by any medicine
equal to the astonishing effect of exercise & amusement in many 
cases of chronic aff. of stomach & bowel.


159
The causes of this disease as in some instances a predisposition
transmitted from debilitated parents sometimes
a syphilitic taint of the parents In others bad nursing
the children being kept wet and dirty and confined in 
close & damp apartments or if the child has been carefully 
fed and kept clean debility produced by confined air
too great warmth, too great variety of food and as some think
too much saccharine matter in its diet. Inanition may be
a cause. The disease prevails among the Alps
and is perhaps there caused by the combined influence of 
cold and moisture
This is a disease of debility nearly allied to 
scrofula & cretinism affecting the viscera of the abdomen generally, the
lymphatics and the [isseous] system. The chylopoietic viscera
are probably first and afterwards the mesenteric & lymphatic glands generally 
the indications are to give tone to the system 
and excite healthy secretions
The diet should be dry and nutritious
and such as is not only easy of digestion but rather stimulating
and the bowels kept open by cathartics which act on the
secretions. A dose of calomel with a little ipecac will 
be useful. The cold bath should be used every day Take the child out of bed in themorning bathe & return. If the
Cold bath of salt water is [illegible] tonic
patient be very feeble it should be begun with at of a temperature 
of about 80 [degrees] and gradually used colder
The child bath is equal to all other remedies It is more tonic if made of salt water 
As a substitute for exercise, frictions will be very useful
But exercise in the open air should be like whenever the
weather is good in a carriage or on horseback and exercise
should be so managed as to afford amusement and mental 



The [guephalin] [polyapt] & also the gr. marg.
(which is less odorous) are also used Their agreeable odor
if there is no other advantage will prove grateful
stimulus & promote healthy secretions
Take the child out of bed and plunge him
in water (about 70 at first) and replace him in bed
Yet in exhaustion of fever the cold bath
gives a shock from which the system will not react but
yet in the debility the cold bath is highly beneficial whether
we can explain it or not.
It may be necessary to vary the tonic And 
it is desirable to have a variety of tonics to [chorea] from 
also carb iron & tinct. carb. iron ac. fer. alkaline solut
The sulph. zinc is not inferior to iron and is not subject
to the inconveniences of iron not producing inconveniences Mosely’s sol.
The compd tinct vitr. although apparently [illegible] is yet
certain in operation and has been long used in this vicinity
A tinct. of potash is thought very useful to 
rub the body with. It is a popular remedy & has sustained
its reputation in this neighborhood for many years
Lime water made of caustic lime is more tonic
than the carbonate That made of shells is thought better being
pleasanter than that made for stores probably not as pure
but containing muriate of lime. Be careful to see that the
shells are thoroughly burnt so as to fall in powder when 


160
stimulus by the sight of scenery vegetations, flowers etrc. The patient
may even be benefitted by being carried in the arms into the garden
and amused in this manner. It must not be forgotten
that this cheerful excitement has a powerful effect on the secretions.
Feather beds should be prohibited. They are too 
enervating, and hard ones should be used in their stead.
Beds made of the sweet fern (comptonia [asph??folia]) are
popular & do very well. They not only from their hardness
check the profuse perspiration of the hectic diathesis, but correct
the acid smell of the sweat which is very common. IN general 
heat should be avoided as too relaxing
I have rarely failed of curing the disease by 
the cold bath as the principal remedy, using tonics however as
occasion may require. The tonics which we may use are sulphates 
Phosp. & mur [illegible] 3-10 grs
of zinc & of iron muriate of iron martial flowers of iron
etc. and the plan has been tried of applying finely powdered bark eternally in a 
quilted jacket of flannel. It is difficult to give bark in substance to small children. Astringents may be indicated & 
there is often a degree of acidity so great as to indicate a free use
of absorbents
The alkalies as pearlash may be beneficial internally
& frictions with pearlash & water zfs to a pint may be recommended.
Of late iodine has been given in doses of from 
2 to 4 drops of the alcoholic tincture 3 or 4 times a day, given
mucilage or other convenient vehicle. This article when persevered
in has cured a great many cases. It should be [given] at first
in small doses & the quantity be gradually increased or 
a disgust towards it may be created


Phosphate of [illegible] was popular
Forgetting that the deficiency of [osseous]
matter may be defect in the action of the secretions
Though the theory was wrong yet the practice
was found beneficial absorbents
Give a solution of the acid of about the strength
of lemonade The phosporus is preferred to the phosphoric
quenches in the water you will then have, not as is
too commonly the case merely smoky water but lime 
water of full strength These preparations are called
tonics by Good called stimulants (too loose as use of the
word) Long before I had any explanation in [illegible]
I thought I observed that these articles created a susceptibility
to the operation of tonics apparently as generating excitability


161
It has been supposed that the proximate cause of this disease
is a deficiency of phosphate of lime with bones but 
this is an effect, caused by want of action as those vessels which 
secrete this substance. The proximate cause, as it is called, is in 
this case the disease itself. In consequence of this notion 
burnt bones have been much prescribed. They are probably 
useful not as supplying the matter of bone but as an 
absorbent & perhaps as a tonic
Acids especially the phosphoric have
been given. Phosphate of lime has been used with benefit
muriate of [illegible] and barytes were
formerly much prescribed.
The worst cases are those of children
born of syphilitic parents for these tonics mercurials and 
the cold bath will also be the treatment.
I give them corr. subl. 1/30 gr with
no injurious effect


Nearly allied to ricketts and often as sequel
of it ricketts often running into it Sometimes appears
with ricketts sometimes afterward Ricketts occur with 
the year. Scrofula occurs later. Ricketts children
are more generally of a scrofulous temperament
The tendency may exist in the parents and yet
be developed only in the children from the causes of 
bad food [illegible] pain etc.
These swellings may continue
in children of 5 or 6 [illegible] or within the year with little or
no change but increasing of size in spite of poultices filling the whole neck
I have found poultices apparently injurious promoting the
relaxation but blisters would stimulate and bring on 
a suppuration. The pus will not be healthy but curdy 
and whey like The edges will be ragged, not unite
readily, and will leave a bad scar. Scrofula,
ulcers are said to be distinguished by a smooth overlapping
margin. the disease may continue for months
and years with little or no change of it does not attack
a part essential to life as the lungs, producing tubercular
consumption attacking the liver producing a peculiar
atonic infl.
I have seen cases of scrofula that were [entonic]
They were injured by tonics and benefitted by cal. and ant. They 
would have borne bleeding



162
Scrofula
This is a disease of the lymphatics and affects persons of a peculiar
temperament this temperament is characterized by a fair, thin, translucent
skin, light hair, blue eyes, sometimes black hair and eyes delicate 
fullness of lips & nostrils usually texture of skin and cellular substance general laxity of
muscular fibre usually delicate organization mental faculties 
developed early on in ricketts. Person who have been affected with ricketts
in infancy are after affected with scrofula in after life.
This peculiarity of constitution, when a morbid action 
is superadded, gives rise to the following symptoms
First small swellings appear about the neck, slow in their 
progress & with an imperfect suppuration. Small holes
form in the swelling and discharge a subpurulent,
watery and flocculent fluid. These scrofulus 
ulcers when fully formed are distinguished by smooth spongy 
and overlapping margins & by very lax granulations. The disease forms tubercles upon the lungs, liver
kidnies & ovaria & causes a great enlargement of the mesenteric
glands
This morbid condition and action may 
be transmitted from parents to children. It prevails especially in cold and variable climates exists most in 
large manufacturing towns where it is caused by bad food
and air, want of cleanliness all of them debilitating causes
It is sometimes also in persons predisposed, a sequel of other
diseases particularly of small pox, hooping cough & measles
Treatment. more may be accomplished in 
the treatment of scrofula by diet, exercise, sea air etc. than
by remedies. Scrofulous swellings should be treated by 



Avoid cold vegetables & watery diet give animal 
food articles containing nitrogen as infants are said to 
abound more in albumen and adults to be [illegible]
“Iron zinc copper silver tonics & antispas. are useful”
“Conium 2, 3, 4 grs with carb. fer. 10-20 grs”
# “I have used with advantage mur. lime 3-4 drops increased 
to a tablespoonful & also mur. [illegible] 3-30 drops given
in milk & water or in coffee. They are tonic & act on the lymph. & gland. syst.”
Articles containing [illegible]
In [anthelmint???] vesicular [illegible]
F. idealis ([illegible]) (sea cabbage) has been given for worms and
some families learn their children to cut it
A mucilage may be made F [vesiculosis]
[illegible] which with bran has constituted a popular poultice
for scrofulous tumours
When there is loss of tone & an ill conditioned discharge 
cantharides with opium is a valuable excitant
Never continue any remedy after it debilitates
by exciting disgust and nausea
Mercurial plaister of the shops (gum ammoniac 
& blue ointment equal parts) has been much used 
especially for scrof. [swell.] of the joints In these [illegible]
become extensively effective and become spongy
A man at the westward was very celebrated for 
curing scrofula. He used wild violets but was not particular
as to which species he used



163
blistering van Heuvel’s child a round of remedies had been tried [illegible]
Occasional purging with calomel and rhubarb
and ipecac in a pill will be useful
Preparation of iron, carbonate of iron with conium etc.
muriate of [illegible] 3 drops or 6 and barytes in [illegible] you give a teaspoonful iodine
scrophularia mar. [Cistus] Canadensis uva ursi
Mr Daggett Havanna Dublin Eliza Collis
Vide p. 209
Iron no prep. perhaps are better than myrrh
mixture or Jenkins’ pills (carb. per. [illegible] camph.)
“Bark & quinine”
Different preparations of [illegible] & barytes # Now
superseded by iodine. I have seen more powerful
affects produced by 4 dr. tinct. iod. persevered 
in a long “5 to 20 gtts within the year 2-3 gtts ter in die”
Various vegetable articles I think very highly 
Rock rose or Cistus Can. (Helia [illegible] [pity] it is changed)
Some years since a person went to Long Island to be cured
of scrofula to a family famous for curing scrofula returned much benefitted should his remedies
they [illegible] [illegible] & [illegible] always used than 
afterwards, when [illegible]
[illegible] from Havan. neck filled up 
cured by [illegible] had been salivated W. I. without benefit
Eliza Collis scrofulous cough much [illegible]
cured by [cistis] vide p. 209.
Scroph. maril. has been popular has been
much used by empirics I have seen it sold at a great price 
brought from the west a very common plant It has been 
celebrated for accelerating parturition probably with out foundation
The article has probably little or no power. Yet it is advantageous
to know such articles in order to [illegible] [illegible]



Two entirely different diseases but are classed
together and may be treated together
“H. externus is correctly named hydrocephalus”
“No fever ordinarily attends. The disease
consists in loss of town in the absorbents”
Of late iodine has been recommended 
[illegible] two years since I was called to a patient with 
had enormously distended [illegible] [upon] gr. cal. & 
2 drops tinct. iod. [illegible] recovered
Tinct. canth. Face pale and bloated child sleepy and [illegible]
I know one child who recovered, but at at the ages of 5 or 6 years died of H. 
internus. If the patient recovers he is more liable to the acute disease
afterwards. Puncturing the membrane has been tried with success,
and the application of bandages then supporting the 
child. It is said that puncturing of the pressure
has [illegible]



164
Hydrocephalus
Divided into two species externus and internus
In H. externus the water is formed between the membranes
of the brain (between the brain and its membranes?) In H.
internus it is in the ventricles of the brain
H. externus make its appearance at birth
and is usually born with the child. # In its ordinary form
it is fatal (It is almost always fatal when it makes its appearance
immediately after birth and always so if born 
with the child)
Stimulating and discutient applications
to the head have been recommended. Epispastics are 
said to be serviceable. (Blisters have been found serviceable
they should be kept up for a length of time) Mild mercurials
cal. or blue pill & the muriate of lime or sometimes [illegible] pressure by bandaging . If
the disease is accompanied by rickets the cold bath 
is indicated and has been found serviceable
I have known one child recover from 
this disease and other who has been mending under
medical treatment for 2 years past. I do not know whether it recovered
# H. externus appears to be nearly allied
to those watery tumours which affect the spine.
In consequence of a partial opening of the sutures of the
cranium, or the absence of a portion of one of the
bones the dura mater and scalp are protruded by the
pressure of the contained water & form a swelling on the
outside of the head. Puncturing this tumour is suddenly 
fatal (is as fatal as the same operation performed on the tumor
of the spine.


Arachnoid inflammation, arachnitis, apoplexia hydrocephalica 
(Cullen) encephalitis phrenicula of Rush
cephalitis profundu of Good We might multiply 
[illegible] but perhaps this is sufficient
The disease different in different cases
A great deal has been written and great deal
of confusion exists
“In this species of hydrocephalus the effusion 
of serum is into the ventricles of the brain. This
serous effusion is the effect of the disease and not the
disease itself & hence it may follow diseases of
various kinds. I consider the name very improper”
# “The vomiting if it cannot be ascribed to improper 
food in the stomach is an important symptom in 
the diagnosis”



165
Hydrocephalus Internus acutus
Under this unfortunate name I propose to treat of all
those cephalic diseases which are less violent in their action
than phrenitis (or are less inflammatory). I shall 
principally confine myself to the disease as it appears 
in children
“Symptoms different in different cases”
The disease commences with the following
symptoms (one form of the disease is well described by Dr
Quin) vide [illegible] vol 2 p. 315 The patient is languid inactive and drowsy 
more or less feverish at times apparently free from any 
complaint (drowsy & peevish at intervals easy and
apparently free from any complaint) The appetite is
poor and irregular (week) & (Nausea &) in many 
cases vomiting # occurs once or twice a day. The skin
“Exacerbation towards [illegible]” 
is generally hot and dry (towards evening) and if a perspiration 
occurs it is partial. Soon after these symptoms. The 
patient is troubled with a headach. The seat of the pain 
varies in different cases, sometimes it is confined to one
side of the head (Soon after these symptoms commence
the patient is affected with a sharp headach either 
in the fore part or crown) It is a common observation 
that the headache alternates with the affection of the 
stomach, the vomiting being less troublesome when the pain 
in the head is most violent. The pain occasionally 
attacks other parts of the body (& sometimes principally confined
to the back of the neck and the space between the scapulae)
At this period the patient is averse to the light, cries
much & sleeps little While asleep the patient shows 



# “The tongue is commonly clean & in this respect this
aff. differs from remittent bilious fever, in which the vomiting
& febricula are attended with a yellow fur upon the 
tongue”
One side of the face body one arm or one leg more affected or moved often is perhaps
a severe a pathogen sump. as any other. This is an
indication of paralysis I have known [illegible]
patient recover from paralysis 


166
signs of uneasiness grating grinding the teeth. starting
and screaming in sleep as if terrified. The bowels are usually 
constipated though sometimes relaxed. The pulse in this early 
stage does not indicate much danger (These symptoms 
however are subject to great variations). These symptoms
are succeeded by affections of the eyes. One eye is turned
in ward to the nose its pupil is dilated The pupil contracted in this early & dilated in the latter stages. Sometimes both
eyes at the same time are affected in this way both turned
inwards & both pupils dilated. In this stage the 
vomiting becomes more constant and the headache
more excruciating, the pulse is frequent and the breathing
quick. # If these symptoms supervene to typhus fever,
the pulse becomes more slow Exacerbations of fever
take place towards evening. There is often a flush upon 
one cheek (flushing is usually confined to one cheek)
Perspiration if it appears is usually confined to the
head and chest. A discharge of blood from the nose
at this time relieves the symptoms of fever (& removes the
flush from the cheek) for a time & any favorable symptoms. Delirium often takes
place at this time and is violent in proportion to the age 
of the patient All this time the disease is undergoing a change. As the disease advances the pulse becomes
more slow and unequal & the patient becomes 
less sensible to (the pain in the head) his sufferings 
Lethargy succeeds the disturbed sleep and restlessness
of the early part of the disease. The strabismus and
dilatation of the pupils increase & the eye loses its sensibility
Loss of vision (The patient after sleeps with one or both eyes half
closed) The patient in this stage often takes medicine & 


# “Even in this stage patients have been cured
by the strong impression on the system made by tartar em.
pushed so far as to produce colic” vide infra
Sometimes when hemiplegia takes place the 
disease puts on a chronic form
In the


167
sometimes food will sometimes however
he obstinately refuses to take any thing. The bowels for
the most part continue costive. #
To these symptoms succeed a quick small
pulse (almost imperceptible) bad symptoms in 
the last stage sure forerunners of a speedy dissolution 
(a difficulty of breathing in many cases the flushing of the
face is succeeded by extreme paleness sometimes in this 
stage petechial eruptions appear on various parts of the
body & the patient dies in convulsions or sometimes a hemiplegia
takes place two or three days before death
The disease sometimes runs through its stage in 4 or 5 days
at other times it requires as many weeks. The dilatation 
of the pupils in some cases does not take place until 
the last stages & perhaps sometimes not at all. In 
all cases the proper treatment should have been 
pursued before strabismus, blindness or coma
takes place, because very little is to be done afterwards.
A constant rolling of the head & moving one
arm and one leg are among the most important 
early symptoms which indicate a dangerous affection
of the brain)
The disease sometimes puts on the form
of an intermittent. When the disease has terminated
in effusion the case is probably always fatal.


much dissatisfaction after
existed When an ordinary fever terminated in hydrocephalus 
thinking that the phys. was mistaken at first
“I think this disease is rarely an idiopathic
affection. It supervenes upon other diseases & generally 
depends on disease of the stomach & bowels”
The disease when from ext. violence may 
exist without any [pathognomic] symptom


168
Causes external violence teething worms
Other fevers forming a crisis by effusion into the ventricles 
of the brain. Typh. fev. & dysent. in children terminate in [illegible]
I have known more than one instance in which it followed [illegible] of hip joiont
This is very rarely an idiopathic affection 
unless it may be considered so when it arises from external
violence Vide L. J Pringle on dis. of [illegible] When it does arise from external violence
it rarely puts on the same symptoms or the same appearances 
after death
All the diseases of children from infancy are
liable to terminate by hydrocephalus & hence it is important
to examine all the symptoms which may indicate
a determination to the brain & check the tendency
if possible
Case A girl 14 years of age, had symptoms
of affection of the brain from a fall upon the occiput she complained
of pain in her head for two or three months before she died 
& occasionally had regular epileptic fits [illegible] [mouth] The pain 
the head was relieved by cupping and epispastics to 
the head, but she finally died in an epileptic fit
On dissection the dura mater under the cranium, where 
the injury had been received was thickened and the vessels
were injected with blood. The ventricles contained half a
pint of water. Dropsy in the brain Yet the
pat. had no dilatation of pupils etc. The dis. put
on the appearance of epilepsy occurring once a month.


More common in some families than 
in others 


169
Causes. Hydrocephalus is a disease nearly allied to with scrofula
& like that seems to run in families. Delicate children
in whom the mental faculties are more early developed
are more subject to it. Hence the common observation 
that the child is [illegible] forward that it will not live
long I think persons of a scrofulous habit 
are more subject to this disease & that of the hip joint
When there has been no local injury to the brain, the
disease commences with affection of the bowels, or it is a 
sympathetic affection from disease of the bowels
In the progress of bowel complaints in children, the
[illegible] and the small veins become turgid. This enlargement
of the vessels seems to invite the blood to that 
part. In consequence of this child may die
with symptoms of hydrocephalus, from the turgescence
of the vessels, without any effusion into the ventricles
In typhus fever, in dysentery and in
other bowel complaints of children it is not uncommon 
for children to die with symptoms of hydrocephalus


It is a good symptom in hydro. to have a 
discharge from the [sch??der???] membrane


170
Diagnosis “In its early stage, this disease is scarcely 
to be distinguished from remitting fever When 
from the anxiety of relatives & of the physician, a
diagnosis is eagerly desired, the following circumstances
may perhaps assist in forming a judgment
If there is occasional vomiting, with febricula
the tongue at the same time remaining [illegible], there is
reason to apprehend that the primary irritation has
its seat in the brain and that it will prove a fatal
case of hydrocephalus. But if along with the fever 
and vomiting the tongue is covered with a thick
yellow fur, we may hope that the complaint is confined
to the digestive organs and that the disease is
nothing more than coler or remittent fever.”
Ed.reviewer
Diagnostic symptoms between idiopathic
arachnitis or cerebral fever, and infantile remittent
or fever from intestinal irritation choler
In cerebral fever the abdomen is
flattened, not tumefied but in intestinal fever it 
is tumefied. In idiopathic cerebral fever 
the secretions of saliva and that form the schneideran membrane are diminished. Unless complicated with aff. of muc. m. which is rare. In cerebral
fever the tip and edges of the tongue are red 
In intestinal covered with a thick fur. In cerebral
fever the pain in the head is severe and excruciating; 
in fever from intestinal irritation it is obtuse.


# the sides of the head, back of the head on 
the forehead
Perhaps a constant rolling of the head & 
movement of an arm & leg are among the most important
symptoms
Different opinion ben entertained
about the nature of the disease Some 
have been so anxious about determining the exact
nosological nature of it disease as to refrain
from prescribing until the first stage has gone
by. Prescribe for the symptoms at all events
and make up your mind about the nature of the
affection as fast as you can. Too much discrimination 
cannot be exercised & cultivated yet where 
we cannot determine the exact nature of the disease
we had better treat the existing symptoms & the obvious 
indications
# It varies in scrofulous constit. there is 
no such state It may approximate in some cases
And I might cite the opinion of 20 others
The [illegible] it is sometimes entonic & sometimes 
tonic. It more frequently [illegible] determined 
Why shd not fevers terminate in the brain as well as [illegible]


171
In intestinal fever the patient more frequently directs 
his hand to the nose & about the face in cerebral puts his hand to his head # 
In cerebral affections the head is hotter than the abdomen;
but if the disease originates from the bowels
the abdomen is the hottest. “There in a very few cases seen
picking at the nose in cerebral fever but in general the rule
holds good” “The state of the bowels is not pathognomic”
Dr Beddoes thinks the disease belongs to 
inflammations & that at an early period he should be
inclined to bleed as largely as in pneumonia #
Dr Withering observes “in a great many 
cases if not in all, congestion or slight inflammation are
the precursors of aqueous accumulation
Dr Rush thinks that instead of being 
considered an idiopathic dropsy, it should be regarded 
only as an affect of primary inflammation or congestion
of the brain
“Dr Rush says” It appears that the disease in its first
stage is the effect of causes which produce a less degree of 
that inflammation which constitutes phrenitis & that its
second stage is a less degree of that effusion which produces
serous apoplexy of the brain
Dr Darwin supposes torpor or inactivity
of the absorbent vessels of the brain to be the cause of 
H. internus
Dr Whytt in his treatise on the disease
observes that this and every kind of dropsy depends
upon the fact that more fluids are thrown out by the exhalants
than [illegible] the absorbents take up



I chiefly depend upon calomel for a cure if it cause
too much evacuation check it with opium
There is no evacuation from the brain therefore
the disease must be overcome by altering the secretions
counterirritation etc.
Bleeding with leeches from the temples
seems to translate to the surface and give relief vide
John Hunter.
Case young man apparently as
desperate a cure as ever I saw not scrofulous we
concluded to try tart. emet. gave it without
much weight in about 8 or 16 hours he complained
of violent pain ion the bowels and all the
symptoms of the head were relieved
[illegible] “Irritant to the schneiderian
membrane in the last stages are recommended
by Dr Malachi Foote of N. Y. in the Med. Rep. 
for about 1810. Turpenth min. 1 gr. with liquorice 20 grs 
[apreynum] [myrici] ipecac etc. are the best [stermentatories]” 



172
Treatment Evacuants Bleeding general & local
cathartics calomel and jalap gamboge
Counterirritation local bleeding cupping epispastics
behind the ears and to the whole surface of the head
Salivation should be induced but cal. often
relieves without altering the secretions
There has been a difference of opinion as to 
the application of epispastics to the head. If venesection 
be indicated they should not be applied until after 
bleeding. I prefer cupping and blisters to the back
of the neck and behind the ears
I think some advantage may be derived from applying
to the spine ol. orig. ol. capsc. etc.
Where considerable entonic action has existed 
I have cured this disease by giving tartar emetic until 
colic was produced. give perhaps a grain 
& continue its exhibition until the symptoms abate #
“gr doses every 2 or 3 hours”
Sneiderian membrane dry snuff
malachi root Irritants applied to the schneiderian
membrane have cured the disease in its last stages
Rx 1 part turpenth mineral & 10 parts powdered liquorice 
for a [ster??tatory]
Green tea is sometimes given



In the progress of the bowel complaints of
children the sinuses may become enlarged & a determination 
of blood [illegible] to the brain and 
produce symptoms of hydr. I have known
pat. apparently die of hyd. & yet upon dissection
no water be found in the [ventricles] in this
case some say that the water was absorbed in death 
this is entirely improbably. Certainly many of
the symptoms of hydr may be prod. by other
causes e.g. excessive doses of narcotics is stramonium
belladonna
It shd be remarked that many 
cases supposed to terminate in hydr. in cases
of [termination] in volvulus
“All the diseases of children are peculiarly 
liable to terminate in hydrocephalus. Hence
the importance of caution on the part of the 
physician. He should examine all the symptoms to check
the first beginning of determination of diseases
action to the head V.S. keep the bowels open 
blisters behind the ears cupping leeches”


173
Hydrocephalus from bowel complaints
If in the progress of any of the bowel complaints of children
morbid action should be determined to the brain, Epispastics
should be applied behind the ears and irritants to the feet
Cathartics are useful to obviate this determination. #
In some cases perhaps the determination 
[marise] from nervous irritation. In such cases the 
tepid bath gives relief “Strong green tea” Some
physicians of respectability have in formed one that they have used digitalis
in hydrocephalus with very good success. I have not used
it myself but should consider more adapted for that
form of the disease which arises from irritation, than 
any other
Hydrocephalus from disease of hip joint.
Child of Ezra Hotchkiss child of Horace Edwards.
“I have known hyd. alternate with disease of hip 
joint Case Narcotics etc. till suppuration”
Afterwards died of hydrocephalus
# I have cured a patient by giving him calomel and lemon 
juice in sufficient quantity to move the bowels. It increases the
secretions and improves the tone of the bowels


“I have seen a case in which the child
fell 8 or 10 feet upon a pavement & broke his skull
like a squash shell yet he recovered in 2 weeks and
did well. When the fracture is so extensive there is 
less danger of compression of the brain” The same case?
Hyd. from injury by a fall is not common 
in young children the sutures are not firmly 
closed (the bones are softer & more yielding)(
# He had other severe wounds as a compd
fract. of the radius yet he never suffered 
his head


174
When the disease is produced by violence
Depressions of the cranium in children
from blows or falls are not of course fatal though dangerous. A child
four months old fell head foremost upon the hearth striking
upon the vertex. The head was much flattened & the
parietal bones bulged out on each side. The child did 
not suffer much from the injury. The bowels were kept open 
by mild mercurial purgatives. In these the head assumed
very nearly its natural shape. A boy of eight years fell 
six or eight feet and struck his head against a stone
A depression of the cranium was made larger than the bowl
of a spoon. He suffered very little inconvenience from 
the injury #
There is less danger when the skull is so 
much fractured as not to cause pressure upon the brain 
If a child has received a fall we may apprehend
danger from the following circumstances. If the
fall has been upon the occiput the brain is more commonly 
injured than if the face is upon the os frontis. If the child
vomits after the fall and is very sleepy there is danger that
the brain will suffer.
Treatment If the child vomits or is
comatose after the fall upon the head and there is no
wound that bleeds the patient should lose blood and
take a dose of calomel, one or both according to the urgency
of the symptoms & the death of the patient. All the exciting causes of fever should
be avoided and the patient kept as quiet as maybe.
The symptoms should be carefully watched and if at
anytime there should appear to be a tendency to an affectation 


# for local bleeding is as important a general
bleeding
“[illegible] all causes of irritation, as light noise
heat, food. Keep the pat. perfectly quiet”
“Apply an epispastic behind the ear, or
better upon the injured part.” “Blisters are very 
useful” “Use counterirritation & the tepid bath”
# In torpor of the br. [illegible] al. can excite the latter
may excite the former and excessive action in 
the former may be translated by it act on the 
latter “Give strong cath. cal. gamboge jalap etc.”
“Afterwards give cal. in small doses as an
alterative If it causes too much evacuation check
it with opium”
“In N. Haven we have followed 
Abernethy’s plan of treating infl. of brain for 
40 years”



175
of the brain the patient ought to be bled & leeches or cupped. #
The bowels should be opened with calomel and small doses
of the same remedy frequently given as an alterative
After depletion epispastics may be applied behind the
ears and upon the part of the head where the injury 
was received. 
There is no outlet to the brain & 
consequently more evacuants are needed than in most diseases 
Frequent cathartics are useful as evacuants and 
also to translate action from the brain # 
When effusion has taken place the 
case is probably always fatal Yet I have had 
a pat. with dil. of pupils, who cont. so & paralytic
for months & finally recover
Vide p. 200


The treatment consists of local applications
A variety are used One of the best is [illegible] zii alc. zi
An equally good or a better application is seneka oil but the
smell is disagreeable. Cold water is applied but
though it relieves the pain and the insupportable itching
it is doubtful whether it is of any permanent benefit
Basilicon [illegible] [illegible]
absorbents to ulcers


176
Chilblains Pernio
This is a local affection to which children and old people
are most subject. Some are much more liable than
others. [illegible] [illegible] more liable. The parts affected are the toes heels fingers, hands
face, ears and with ladies who wear short sleeves
in winter. It is caused by exposure to extreme cold & to cold & damp air
& on the feet, more especially by walking through 
melting snow. It is most common in the early part of winter
This affection should be prevented by avoiding
an exposure of the parts to the air, by keeping the hands
warm with soft leather gloves & by keeping the feet warm 
with stockings and shoes
The skin of the part affected becomes tumefied
and hard & of a deep purple colour, there is a 
pungent pain in the part accompanied with an insupportable
itching; & these are often so great as to prevent the patient from 
sleeping. If the disease advances, the cuticle breaks and
discharges a thin fluid. Sometimes a deep ulcer is formed
The treatment for the first stage should consist
of stimulating application as if for a burn. I prefer oil of origanum
alcohol & seneca oil are good applications. Spirits of 
turpentine will ordinarily do well, though in some idiosyncrasies
it acts as a poison. Cologne water may be 
applied or alcohol two parts with one of ol. orig. #
For the ulcers you may use the oxygenated
ointment ointment of red precip. citrine oint.
# or apply a plaister Dyachylon or Noel’s 


Not being able to have any fire on board
for some days
[illegible] to pain of a neuralgic kind as [illegible] were a toothache
One of the best applications is a cataplasm of stramonium
seeds give internally opium narcotics & 
stimulants
Apply [illegible] & narcotics
Followed by no infl. to supp. etc.



177
Painful affection from cold
We sometimes meet with a painful affection of the feet 
without discoloration, or any other visible mark, which 
has been brought on by long exposure to cold without
freezing. Sailors coming upon our coast from the I. in winter, from 
a warmer climate are liable to it.  The affection may 
be a very painful one and give great uneasiness both
night and day
It is relieved by the external application 
of stramonium & epispastics or rubefacients, and fomentations
Cathartics and opium may also be given internally.
Singular effect of cold in Wm Daggett 


Burns are dangerous in proportion to their extent
[illegible] young physicians are called to prescribe for
burns it is important for them to treat them in the best manner
About 30 years ago a great controversy existed in England
between those who advocated [stimulating]
In recent cases stimulating or exciting applications are 
the best provided the burn is not very deep. About 30 years since 
spts turp. were much used. It in some case and these are 
not very rare
Case myself [water] boiled over into my shoe
I immediately poured spts tupr upon the stocking then 
took off the stocking applied a cloth dipped in spts turp. put
on a dry stock. & boot rode out of town and suffered My father
was a man of florid complex. & thin skin He was burned in n
a similar manner
Ol. orig.
Linseed oil is smooth mixed with limewater
alcohol or proof spts good when the skin is [illegible] off
Others use camphor Others stramonium in ointment contain
what [illegible] when the article s off
Carrot poultices etc. exclude the air
Cotton does well except when the cuticle is off if it is
used then you had better smear it with oil


178
Burns
This subject belongs more particularly to surgery, yet as
burns occur most frequently among children, and you may 
be suddenly called in on such an occasion, when it is important
that a remedy be speedily applied. I have thought
proper to make some remarks on the subject.
For the treatment of burns very different 
modes have been recommended. A long controversy was
carried on in one of the English journals with respect to the
phlogistic or antiphlogistic treatment, one party being in 
favour of cold applications in cold water and the other of
stimulating ones as spirits of turpentine The truth seems
to be that in adults where the injury is not extensive and
the powers of life are strong cold applications do well, but 
they are dangerous for children especially if the injury is extensive.
Burns upon the abdomen will not admit
of cold application even in adults
It is necessary that reaction take place
If there be no reaction of the system, no pain, no inflammation
the child dies. The cause of its death is the irritation of 
the nervous system, extended to the stomach, & hence
the death is preceded by cold extremities and vomiting
Where cold application are proper such
applications may be made as scraped potatoes, cloths
wrung out in cold water etc. But if it is necessary 
to produce reaction and inflammatory action stimulating
remedies must be used. And we know from 
experience that these remedies do effect a speedier cure 




Cold applications may do well if immediately
e.g. dip a burnt arm immediately into cold
water. But stim. app. are better. I have tried
both. Cold applic. very dang. in extensive burns
of children Case scarped potatoes no infl. livid
appearance of the burn extrem. cold [illegible] death
In such cases apply stim. app. & give ether, elix.
[illegible] etc. etc. In these cases the child dies of irritation
not infl. It seems to be necessary for a regular [course]
of continuity of action in infl. & suppuration
The best and mildest application as has
been proved by experience is petroleum or seneca oil
In one case I tried the experiment of applying seneca
oil upon one hand & ol. orig. upon another (both being known
alike) one hand was easy the whole night the other painful 
(the burn was a very extensive from the clothes taking fire)
In the suppurating stage use 1 part seneca oil
& 3 parts cerate
These cases are very troublesome to treat
In the above case the system was exhausted by the extensive
suppuration the bowels had to be kept open & 
large quantities of opium to be given. I gave columbo
bark and various tonics and aromatics
Turner’s cerate is a good application
chalk may be sprinkled over it
In the progress of the suppuration a pale
flabby fungus almost like a blister and is difficult to 
manage I have applied a sol. nit. sil. also nit.
sil. & laudanum [illegible] cop. sometimes after these
I have succeeded with ac. op. in ointment green basilicon
i.e. verdigris ground fine & mixed with basilicon
But if you apply only applications after these caustics 


179
The reason is that we apply to the part a stimulus
less powerful than that which produced the injury
and thus render the diminution of the excessive excitement
gradual. On this principle holding the injured part near the
fire is beneficial
Another important indication in the treatment
of burns is to exclude the irritation of the external
air Hence the popularity of some applications as cotton.
sweet oil etc.
1st Of stimulating applications. Spirits of turpentine
will answer for a robust and healthy person but not
for a slender & feeble one; and it must be remembered
that from a peculiar idiosyncracy it is a poison to some 
persons. In general spirits of turpentine is liable
to cause irritation and may be suspended by better 
articles. Being burnt myself a complete cure was effected
without the least appearance of inflammation, by this article
but in the case of my father such violent irritation was
produced as to oblige him to desist from applying it
A common remedy in this town is the oil
of the origanum majorarum called burn oil
mix ol. orig. zii with ol. oliv. zi or mix it with
alcohol or cerate. Cloths may be dipped in the diluted oil
and kept constantly applied
Of late years I have used seneca oil
and prefer it to either of the two already mentioned. In 
several cases I have tried both this and the ol orig. & 
found that the seneca oil relieved more speedily & 
with less irritation. I usually apply the seneca oil & 



the fungus [illegible] Apply rather chalk or fine alabaster
or scorched flour
The sooner you apply stim. appl. the
better ol. turp. produces [illegible] etc. seneca oil
does not
Case a woman thief etc. etc.
we rolled immediately in the snow was thrown by it into a state
of syncope life almost extinguished was burnt universally 
except on the legs covered by the stockings was wrapped
in sheets dipped in a mixture of ol. orig. & 
spirits


180
then cover the part with cotton to exclude the air. I let them
remain till suppuration takes place, particularly if the skin
is broken. When suppuration takes place, apply a poultice
to the loose dressings and then apply simple cerate
or a cerate made by melting together beeswax and lard
and stirring in seneca oil while the mixture is cooling 
This last is an admirable application for burns Dr
[Mons??] said he knew none so wild. It protects the raw 
surface from the cold air and keeps in the animal heat
In the latter stages of the cure, the oxygenated ointment will 
be a soothing application
A popular remedy is stramonium, used
in the form of a plaister of the seeds or leaves. It answers 
well and I have known no ill consequences to happen from 
its use though it is said that in extensive burns it is dangerous
Cotton is a popular application, used by itself
For slight burns it will answer but if they are so
extensive that suppuration is to take place, it should
not be applied in this way
Other remedies that are useful upon the
principle of excluding the air, are the oils as sweet oil & 
lamp oil. Linseed oil mixed with one third part lime
water, is especially recommended
When suppuration takes place and 
the cicatrices do not form well, oily application should 
be laid aside and if there is considerable discharge
apply absorbents, as plaister of paris, chalk & chalk & cerate
i.e. apply chalk first & cover with cerate.


Note from Dr Woodward of Wethersfield extracted
from Dr A. Talcotts notes “Apply immediately spts turpentine
to the inflamed parts and cerate of limewater & 
linseed oil equal parts on cotton to the vesications
2nd If pain & irritation ointment of stramonium
3d To prevent fungus Rx white lead a teaspoonful
lard 2 tablespnfl. ft. ung. Orgrate or
chalk and apply simple cerate over it.
I have seen a metastasis at the end of a week to the bowels
with diarrhoea & tumefaction or the bronchia with 
croup Treat with opium & bark Dr S. B. Woodward”
N. B. I extracted this principally on account
of the definite direction about the difficult treatment
required according on the burned part is vesicated or
not a point on which the above notes of DR Ives
do not seem to be sufficiently precise


181
Should there be a fetid discharge from the burn, it may be
remedied by pulverised charcoal. Sometimes the ulcers are 
very difficult to heal and repeatedly break out afresh
A fungus may arise upon the part if so it should be touched
with caustic. The eager of the ulcers may be touched
with sulph. copper or nit. sil. chalk then applied
and the whole covered with cerate.
If the burn is on parts liable to unite in 
healing, as between the fingers and toes, care should be
taken to prevent the union. A bad cicatrix is often
formed which it is difficult to prevent or cure.
Internal Treat When the constitution has received a severe 
shock and the extremities become cold and the powers
of life being to fail, the system must be supported by 
stimulants & cordials & the excessive irritation relieved 
by opiates. Laudanum ammonia, spirits, alcohol
ether are all good. To a child from 5 to 10 years 
old 15 drops of laudanum may be given; warm-applications
may be made & warm aromatics drinks as ginger tea & 
mint water administered. Elixir paregoric is one
of the best preparations of opium in such cases
In a case in which a large quantity of
sulphuric acid had been drunk by a boy who immediately
afterward, ran to a brook
and drank of the water. I merely give mild mucilaginous 
drinks & the patient being of a strong constitution
recovered





182
Croup from p. 138
In what may seem to be the second type of patient
may go off suddenly. If he throw his head back
in order to enlarge the chest it is a bad sign
I have found the treat. by tart. ant. so 
infallible in the first stage & in general so useful that I have not been tempted
to desert it. If I am called rather late and
find ext. ant. acting locally upon the stomach, I seldom
succeed in curing the patient.
Other emetics may be used when the excitability is worm out for [illegible]
Calomel is proper in the latter stages, [illegible]
the disease is partly broke up by antimony
If the first stage is not interrupted
[illegible] the child may be playful between the paroxysms 
and though the pulse is not affected, yet the second will 
surely come on
In the second stage bleeding is to be first 
resorted to in order to prepare for emetics bleed even to fainting
conjoining the warm bath for the same etc.
Exciting and irritability [illegible] in this 
second stage do mischief. I have seen sanguinaria do much
mischief. Even after bleeding purges is not advisable
for as has been remarked there is a constant tendency 
in the system to the return of this inflammatory symptom
Cal. may be given though if it act by 
the bowels it will be useless. I have seen bleeding and the 
vapour bath palliate the symptoms. Scarcely ever
will the patient recover



183
Croup
In the latter part of the last stage the child
throws its head back. This is a dangerous symptom.
Now the patient goes into the last or suffocating
stage. The patient lies on its back struggles
violently for breath countenance livid appears apoplectic and often goes into convulsions
and in these convulsions sometimes dies
Sometimes in this stage you may hear a
flapping of the false membrane. This is sometimes
thrown up and great relief is afforded and 
the friends think that all is over. Soon however 
in most even of those cases a membrane is formed
lower down & the patient ultimately dies
In this stage the metallic emetics
have in a few cases succeeded The sulph. 
cupri & the sulph. zinc have each
cured Cal. is recommended & may be used 
The cold both has been recommended It may be tried
as a dernier resort.
In the second stage after bleeding blisters
shd be applied over the whole neck & chest
Dr Hosack recommends bleeding from 
the back of the hand immersed in warm water
After bleeding has succeeded in 
subduing the symptoms cal. & the warm bath shd be
used


184
Croup
This disease has been divided into acute & 
chronic but without much propriety
Sometimes it continues for some time. I have
known one case which continued 3 or 4 weeks
In some seasons a different mode o f
practice is better. I have known seasons in which 
cath. & diaph. were the best treatment Although
for the first 15 years of my practice I considered nothing
more unfortunate than to find the child under the 
operation of a cathartic. In these cases, it was the
form in which the duodenum is also affected in a similar manner
Case Wallingford [emet.]
failed & cal. & diaph [illegible] Others that season 
occurred which required the same treatment
Bronchotomy has been recommended
I have seen it performed but never with success
It has sometimes succeeded But in the cases 
which I saw the membrane form lower down, and 
the patient die


186
You will see by looking into the throat
the tonsils perhaps red & the epiglottis certainly inflamed



187
Angina Laryngia
Another form of the croup has been called
angina laryngia [illegible] the croup you can see nothing
by looking into the throat In this the epiglottis & 
the [illegible] glottidis are affected From the larynx 
being affected, the actions & more spasmodic
Frequently comes on while eating
Case of my child While apparently well was taken while
eating with the peculiar croup & respiration of croup 
& became alarmed & treated
This is the form which attacks old people 
probably Geo. Wash. died of it
Case The first time I saw this disease the pat. had had pneumonia & may nearly recover when he went into the cold open air
without stockings. I was informed that he was taken
with difficult respir. & without seeing him prescribed seneka injurious ultimately refused
to swallow anything as the act brought on a spasm
I tried bleeding, blisters, vapour
& after awhile persuaded him to swallow when I gave him 4 gr. tart. ant.
in a cable spoonful of water


188
Angina Laryngea
The dis. is brought on by eating
And if you examine the throat you will see a redness
perhaps upon the tonsils, and will certainly see the
epiglottis inflamed
Bronchotomy promises more in this
form of croup
Readily distinguished for the other by 
difficult deglutition paroxysms being brought
on by an attempt to swallow
This firm 
It is not of much consequence to 
distinguish the forms except that laryngea is 
more rapid And you must avoid acrids
in this form as they irritate the fauces & produce
spasmodic action
For the spasmodic symptoms give
in the latter stages of it asafoetida which also acts upon 
the secretion tinct. ant. & opium
It must be remembered that this disease
cannot be cured by bleeding alone. It is too far out
of the circulation. But by reducing the system very 


189
Croup concluded
When croup follows other diseases it is more
rapid and dangerous they are very apt to die
particularly when following ulcerated sore throat
You may treat by emetics blisters metallic
emetics etc. but you have not so much 
strength left in the system to act upon 
In the latter stage where we wish to 
throw up the membrane the stomach may lose
its excitability to a particular emetic then you are 
to change the em. I have succeeded in throwing 
up
Upon dissection a membrane is 
found formed But sometimes it is wanting and in 
A laryngea then probably is not [time] for a 
membrane to form 
Vide p. 211
low and suspending the functions you may change the secretions 
perhaps 


190


191
Scarlet Fever
Withering in his first edition separated ulcerated sore throat
from scarlet fever. In the second he changed his opinion
Where there is much heat and fullness of the
pulse I would much prefer a strong dose of cal.
followed by antimonials [to] commencing with emetics
Or is Dr Rush & the elder DR Barton thought best turpeth
mineral
Epispastics are to be used with caution
& adopted this rule viz to apply them where there
is much tumefaction [illegible] & enlargement approaching the
quinsy. Scarlet fever after resembling quinsy and
is with difficulty distinguished except from the previous
affections of the family and neighborhood
Mineral acids have been considered
specifics Chlorine was much used in this town
in [1801] etc. as a fumigator. You may give it internally 
with advantage
A great variety of gargles are
used generally stimulating ones are better as those
of capsicum (with salt say in cider water)
In some cases capsicum does not do well
If the patient is too weak to gargle use a syringe


192
Scarlet Fever
Chlorate of potash was used with advantage
to quiet the stomach. It allayed irritation etc.
Ammonia and amm. with camphor
& gum arabic
In the progress of the disease mineral emetics, 
as sulphate zinc will be useful to excite the system 
acting speedily they do not exhaust sul. zinc 5 to 20 grs 
mosely’s solution was the form most used
Sulph. copper 2 to 5 gr. also as an emetic
Acetate of copper was formerly kept as a nostrum in 
some families ½ to 1 t. sp. of sat. sol. of common verdigris
2 to 3 gr.
In some cases and seasons cath. are
required. I have treated children without a
single cath & yet in the same family I have given ant.
followed by cal. & worked off by salts and senna
If a diarrhoea occurs early it must
be attended to white decoction



193
Scarlet Fever
Dr With. lays great [illegible] upon diuretics
particularly senega giving it throughout the 
disease. In moderate fevers diuretics eliminate morbid action will
Serpentaria may be given freely throughout 
the disease adding bark alcohol ether 
or wine Diuretics & diaphoretics
Irritable state of the stomach is to be
counteracted by irritants by aromatics white decoction
etc. etc. a little alcohol upon the fauces voiding a great
bulk of liquid
Case of a boy in delirium his father 
was forcing down articles which he was puking up 
I put into his mouth spoon dipped in brandy 20 or 30 drops his eyes opened immediately 
said it was good continued it in tspfl doses through the night
saved his life
Scarlet fever occasionally passed by insensible
gradations into quinsy and is of an inflammatory 
character. No one character will distinguish them
No one mode of practice will answer in all 
cases though if any indiscriminate mode of practice is
to be followed that by emetics and stimulants will be best
In many cases no evacuations at all are to be
used if this you must judge by the symptoms
In the same family I have lately treated one or two patients
with antimonial and nitre and another who had been
worn down by fatigue and watching with feeble pulses vomiting
coldness etc. was treated by external heat, brandy in moderate


194
Scarlet Fever
quantities, counterirritants spiced tea etc. to stop the vomiting #
(One of the best articles in fevers of a low grade
is spiced tea or hot spiced wine or brandy. The strength is apt
to give out first, and an excitement kept up in the mucous
membrane of the stomach will have a beneficial effect)
# The first patients in this family I had evacuated freely
both by vom.  & purging etc. while this patient had no evacuation 
goodness & was supported throughout the whole progress 
of the disease
After I had seen the disease in 3 or 4 epidemics
I thought I had seen the disease in all its forms but I
found oftenwards that I met with different forms still 
Not only different epidemics differ, but different cases during
the same epidemic may require widely different treatment 
In the malignant epidemic of ’94 I was informed by some
physicians that they met with cases in which there was increased 
action though the many cases of the epidemic ran rapidly in the [illegible] gangrenous
state
In 1803 we generally gave emetics
It is said that in the malignant form the eruption 
is a bad symptom. I do not think so. I think it better
for a general eruption to come out the action is less unequal than 
if a scanty or no eruption appears
I hesitated in 1803 much about the application 
of blisters & I finally found that the rule was a safe and
beneficial one to apply them where there was swelling
of the tonsils
In this epidemic I gave bark, the mineral
acids, alcohol, wine, and (for the first time) tinct. canth
Tinct. cant. [illegible] zi to pt. give 20 gtts once in 2 hours ½ as much to a child


195
In many cases [illegible] requires to be qualified & corrected
by serpentaria or carb. amm. If wine injures
the stomach and [illegible] too locally continue carb. amm.
which will render it diffusible with white vinegar
will have somewhat of an effervescing mixture Use also
effervescing mixtures, as soda water, with brandy
or ether, or aromatics tincture. It is no objection that
you thus combine stimulants and refrigerants, for you 
thus get diffusible action and obviate unequal excitement.
The min. acids may be given in form of 
punch The sugar will be grateful & useful
A diarrhoea is apt to take place in the 
commencement of the disease. Use white decoction 
laudanum & injections of starch & laudanum RX
starch 3 bal. sp. SS. 30 gtts to 2 t.sp.
Pay great attention to cleanliness of the 
patient
Where there is fainting apply ammonia and ether 
& spirits at the nostrils keep them applied to the nostrils
to prevent fainting, I have never known any injury 
done by over excitement by these articles thus applied
Capsicum is used in tropical [illegible]
in very strong decoction. Salts and vinegar has been 
much used as an antiseptic gargle?
For the diarrhoea use tonics, bark,
contrayerva has been though valuable. Avoid injuring
the stomach by distention


196
A variety of garbles (or injections by a small syringe) are
used. [illegible] rosemary has been thought a specific & carried
hundreds of miles into the country Use others when pat. is disgusted
with one # 
Sulph. cop. ac. cop. nit. sil. ([touched])
apply these with a swab
What is called the leathery inflammation 
is sometimes met with. in which the skin dies at first and
afterwards comes off & then a discharge follows. This affection
sometimes extends down the throat. In such cases
apply blisters to the sternum Touch the part with
nit. sil. in such cases. IN one of these the blister on the
sternum produced an ulcer which was 3 mo. in healing
and in another though the affection with throat was relieved
the ulcer for the blister destroyed the little patient
# [illegible] oak bark etc. pomegranate combine brandy 
aromatics etc.
It might to be remembered that in the
latter stages of ulcerated sore throat where there is an
accumulation of [many] a phagedenic ulcer, 
emetics of sulph. zinc give tone
and excite action also when
Acetate copper in the latter stages
used in an emetic as a tonic or locally
applied as a caustic
When the stomach fails in the latter
stages we give capsicum in pill or strong 
infusion (2 tab. sp. to the pt makes a strong infusion give 
to an adult a tablespoonful also acrid oils
There seems to be an erythematic infl. of the mucous


197
membrane of the stomach hence acrids are indicated to excite action
Bark jacket also it seems to 
have some effect
In the latter stages also a cath. will
frequently be beneficial an accumulation
of feces may exist given mild cath. as castor
oil or perhaps a dose of cal. an
emetic also may be needed
One thing to be guarded against
in young children is the supervention of dropsy
In 1803 I had 3 cases all the writers
considered the disease as one of weak [illegible]
action and requiring tonics bark etc. Not
successful Bark does not generally do well when there
is unequal action
I have known in such cases the brain
& nervous system apparently much affected I have
given in such cases digitalis and cantharides to
produce as new excitement and ally this irritation in 
the nervous system
Case related patient very low from a disease digitalis
was given and elaterium being advised was given
when the patient died upon the second evacuation
In general treat these cases with diuretics 
a moderate use of cath. narcotics & remedies
etc. Digitalis is the best narcotic but be cautious 
giving it to children
In ordinary cases of such dropsy 
a cath. will remove it and frictions & exercise 
in the open air. Various articles are popular as ol. [mor]


[199]
[illegible] ol. gaultheria various irritants etc. and to 
encourage the attendants to persevere in rubbing
you may suffer friction to be made with these mere
dry friction though probably just as good does
not seem to them like giving medicine
Various astringents may be 


200
Hydrocephalus
The management of the pat. is equally important with
the medication avoiding in proper diet alternatives
of temperature, and all debilitating irritating and exciting
agents all the exciting causes of disaster. Sometimes
a patient may (after a fall perhaps) continue one
two or 3 years not entirely [illegible] and yet not quite sick
and finally die of eff. of the brain
Sometimes in strumous habits canth. internally 
may be advantageous
Blisters translate action 
The applications of remedies to the 
Schneiderian has been thoroughly treated by Dr Malachi
[Foot] in the N.Y. Rep. about 20 years ago.
The subject has not bee sufficiently attended to Give in 
the way turpenth wine (mixed with liquorice) verat.
vir. apreyn. [illegible] myrica cerifera etc.
If a discharge can be excited relief is afforded
Salivation can rarely be produced in children
In some cases where there is paralysis
the acrids and some of the narcotics as strychnos
Blisters are applied by some to extreme
parts of the body I sometimes change the place of
the blister to the back of the neck etc. But the back of 



201
ears is more efficacious. It seems to have a grater
affect upon the constitution to excite a discharge from 
this part
If the symptoms indicate bleeding
bleed leech also. If there is much infl. about the
mouth scarify the gums as a depleting measure
“In grade of action the fever of hydroceph
may vary from high entonic inflammation or phrenitis
to low strumous fever. If the action is too high or too
low counterirritation will fall in with the morbid
action We must first bring it to the “blistering point” 
(Rush)
“Blisters to the head are thought by some to be 
dangerous and the ears or neck preferred”
“In irritable cases and scrofulous habits, strong
cathartics are hurtful. Give blue pill especially when 
the bowels are primarily affected. But in entonic
phrenetic fever, use the drastic cath. & tart. ant.
ut supra after depletion”
“Scrophulous predisposed mesenteria
glands generally affected the fever analogous to hectic
never entonic pulse soft, frequent, quick I have
tinct. cantharides with advantage in this variety”




[204]
Volvulus continued from p. 89:a:1/2
“Cases I was called to a child 2 years old which 
had symptoms of irritation and was obstinately constipated
It had been carried on the belly upon the shoulders
of another person Gave a cathartic Ordered an
injection but the attendant said it would not [illegible]
The cathartic was thrown up patient died
Upon examination after death no color could be
found. In the upper [illegible] rectum there was a tumor
which seemed of solid flesh as large as the doubled fist
inflamed. The color had been completely removed from 
its place”
“I was called to another family 
where the children had died when 5 or 6 months old as was supposed
of an affection of the brain. This child appeared well when born
but was very costive etc. Upon p.m. [illegible] 2 inches of the
small intestine were found contracted
to the size of a goose quill the coats were thickened & 
the course the cavity must have been extremely small This
contraction undoubtedly existed at birth. This contracted
part was received into the part below it, and no
[illegible] could have availed”
from p. 99 ½ “In another family they 
had lost all their children at about such an age. They 
supposed the disease to be hydrocephalus. The older physicians
called it so. I told them I could not tell what 
the disease was but it was not hydrocephalus I had
then seen no case of volvulus. There were strong 


205
marks of irritation the face was pale and much distress
was depicted with countenance the head was rolled
back and hands tossed violently. There was vomiting and
tenesmus and a discharge of mucus streaked with blood
Cathartics had been given under the impression that the disease 
was an affection of the head The cathartics aggravated the
disease which ran a rapid course and the child
died. The small intestine was found received into itself
and its cavity obliterated. This obliteration of the cavity
would not of itself cause death; for a patient may 
continue several days with perfect torpor of the bowel.
It is the irritation as in cholera morbus which is the
immediate cause of death which [illegible] death usually 
occurs within 24 or 36 hours”
“Called to a child one year old
constant vomiting stool, mucus streaked with blood
Directed mucilaginous injections & fomentations combined with opium
Gave opium freely internally 10-15 minims to allay 
vomiting. The symptoms subsided gradually & in 
3 or 4 days the feces passed off without any cathartic”
“Was called to an Academical student
had given cathartics and they did no good. Called
in older physicians. They were in doubt respecting the
case and advised not to do any thing as we might do
hurt. As I was sitting by his side I heard a motion 
in his bowels. I noticed that it passed down to a certain 
point and then stopped. Upon examination I could 
distinctly feel the involution. I tried injections and 
some [illegible] of them would stay. Ordered a spermacetic
candle with opium upon its extremity to be passed up 
the rectum and allowed to remain. It was s


206
passed in to the length of 10 inches. The opium allayed irritation
and the application by repetition replaced the part & the 
patient recovered another case cured
by a bougie”
“Opium by taking off the spasm and
restoring the natural function of the bowels may be
said to act as a cathartic just as in spasmodic
colic”
From p. 56 “I have given when I 
could obtain it, the [resin] of Mandrake podophyllum peltatum It operates
kindly, and more certainly than any other article. If
the western gentlemen who have so much mandrake
and whiskey, would furnish a supply. I think it [will]
supersede every other article”
“If there is torpor & a stuffing or infarction 
of the bowels we must use injections to assist
cathartics repeating them every 2 or 3 hours. If other
cathartics do not operate give castor oil which will 
promote their operation”
“The particular kind of injection 
is not important and may be left to parents
Thoroughwort, camomile, mayweed 
catnip, dandelion, weak soap suds salt
& water a tablespoonful to ½ pint water


207
Continued from p. 57 “The stools resemble
meconium. In the progress of the disease they exhibit
small pieces of a membrane of a dark green colours,
about the size of the petals of peach blossoms 
floating in a dark green fluid. The membrane of 
coagulable lymph, resembles that formed in angina
trachealis and sometimes as in that disease
it is formed in such quantities as to cause obstructions 
Still in this case it may not destroy life
the action of this part not being so immediately
essential to life. Stools of this kind sometimes
attend the bilious colic of adults. They are an
indication that farther evacuation is needed
Continue the 
calomel or combine it with magnesia or soluble
tartar, or phosphate of soda or other neutral salts


208
Infantile remittent continued from p. 60
“Cases A child had violent fever gave calomel & cathartics
warm bath symptoms abated. In 2 or 3 weeks the
regular symptoms of hydrocephalus appeared; & the patient
seised in the greatest danger. In a short time these
symptoms were relieved by a violent and dangerous
attack of thrush The patient was very much exhausted
lay several days very low gradually emerged and 
after a long course recovered.
“Case of a small little boy
5 or 6 years of age After 5 or 6 days head affected
& became maniacal very irritable and cross swore
profanely would bite and strike all who came 
near him. If any thing was attempted to be administered
he would shut his mouth. If his mouth was pried
open he would close his throat with his tongue Advised 
his parents not to trouble him nor notice him to pass by 
him with drink roasted apples etc. but not to offer
him any thing. The first day to he took nothing second
day took roasted apples etc. readily but ate too 
much mania returned, but soon went off & 
patient recovered” 
“In one case the pat. took 
nothing for a length of time. Recovered by use of 
[even ato] & external applications as aloetic plaisters
to the bowels etc.”



Scrofula continued from p. 163.
“Scrofulous swellings are very difficult to excite
to suppuration I have however then poulticed without
effect for 2 or 4 months Of late I have disused poultices
& have applied blisters as soon as may be to excite invigorate the
absorbents and act as discutients. They do not disturb the
system. If there is suppuration the relaxed state
requires stimulating applications lunar caustic vegetable
astringents etc.”
“Case of a young act 18 with bad cough
swelled neck scrofulous temperament Gave laxatives
blue pill afterwards rub & spec. Then gave decoction 
of [cistus] [canadensis] for several weeks and pat. recovered
“ A physician (Smith) on Long Island (from an
old recipe) has acquired reputation by the use of cistus
canadensis combined with uva ursi at the same time
enjoining a strict & spare diet as in dyspepsia”
“I have given with cist. canat. 1/8 gr. corr.
sub. & also decoct. scroph. maril. which is thought 
by the vulgar to be a specific It has been sold as a nostrum
to facilitate parturition called nerve root.) I
think it useful in scrofula”
“I have known the comptonia [illegible] folia
given internally. It is tonic & has balsamic rpoperties”



“The remedies particularly indicated are tonics & 
deobstruents such as will not produce congestion 
such as uva ursi cistus scrophuloria contrayerva 
agrimonia (entire plant or root angostura etc.”
Sea bathing is recommended, but if the
lungs are affected, it will not be advantageous. A 
sea voyage to the eastward has been of service the constant
motion of the vessel stimulating all the vital organs
to healthy action The change of air is beneficial & at a
distance from the shore there is no danger of taking cold
In chronic complaints attended with a want of vital
energy I direct a voyage to the east rather than to the
south



Croup continued from p. 189
“Vapour bath Inhalation of warm water in 
a [pour] blow a current of air through hot water upon the pate & 
by means of a coffee pot with two spouts”
“Tobacco or snuff applied to the patient”
“Croup is an epidemic disease & of course it will vary 
at the different periods of its appearance We must take
into account the prevailing diathesis I have described the
disease as it has usually occurred in my practice”
“The proxim. cause of the dis. is a
peculiar morbid action translated to the traches for
the disease arises from general causes acting on the system. 
In catarrh diseased action is seated primarily 
with mucous membrane.
The exciting causes of croup act on 
the surface and with different diathesis the same
crises might produce pneumonia, dysentery enteritis
or cephalitis “Disease determines to the weaker part
as the rod attracts lightning” Rush Water & snow
cold damp air a [illegible] & low situation sudden 
changes as when the wind blows from Canada or the
gulf stream are the exciting causes



“In the treatment sanguinaria, if given early in strong
decoction very freely, so that enough of it shall be
given & still it vomits or relieves the symptoms, in very 
efficient practice adopted by Drs Jared Potter & 
Kirtland
“But if inflammation has taken place
& the second stage has arrived seneca and sanguinaria
are both too stimulating and I have seen them do hurt
sanguinaria is less stimulating than seneka
For p. 137 “Some authors state that the 
disease is entirely inflammatory not regarding
the forming stage. If the forming stage is wanting
we must rely solely on the antiphlogistic treatment”
“This disease has a direct tender eye to death 
The physician must take it out of the hands of nature”
“When croup supervenes upon catarrh as it
frequently does of late year the mucous secretion and expectoration
usually cease suddenly
“When croup follows diseases that prostrate
the system powerfully as angina maligna, there 
is little chance for recovery. The sympathies of the
system are broken down and Archimedes can find
no fulcrum for his lever”



“I used tart. ant. at the commencement of 
my practice and succeeded with it as well as I
could wish I therefore contained it, but only in
the early stages & to produce a powerful orgasm. If it
acts upon the stomach only it aggravates the disease
Other practitioners rely upon different
articles & probably with equal success bearing in 
mind however that a powerful impression must be
made Decoct. sang. to prostration & vomiting
seneca or lobelia inflam with the same view”
“Sulph. copper & zinc & acetate
copper useful to assist in the latter stages or when 
other emetics are worn our. So also hives syrup 
which is much used at the south.”
“For six or 8 years past croup has been 
occasionally different from the pure inflammatory.
It affects the lungs and duodenum& calomel and cathartics
are the remedies to overcome this form. The cough is more
frequent and loose the paroxysms less distinct there
is pain in the epigastrium vomiting & a membrane
is formed in the duodenum which passes off.
I have called it angina duodenitis.
The same year ulcerated sore throat came on with it
the slough leathery & like a burn it seems to 
be intermediate between A. tonsillaris & A. maligna


The application of lunar caustic by a pencil or brush would
prevent croup Blisters to the throat & chin were
useful yet a blister would produce the same action as
existed in the throat, forming an ulcer very difficult 
to heal Slough ¼ in. deep 3 mo. in healing. In 
one case the blister cured the croup and the ulcer
killed the patient It is desirable to translate
action to parts less essential to life. Cal. & carth.
would translate it to the duodenum Emetics & 
powerful treatment do hurt here. The vapour
bark is good.
“Croup sometimes recurs several nights in 
succession A. Laryngea is more apt to do so”
“When crop assumes a chronic form
emetics irritate inhalation of vapour blisters
opium diaphoretics & expectorants”
“In chronic croup the inflammation 
in erythematic and not membranific. The 
vapour bark often does wonders Tartrate of 
sanguinaria in ¼ gr. doses Tinct. hyoscyamus
gtts x
N.B. Dr Woodwd treat of subacute ([S?bertonic]) & typhoid croup the latter contraindicating
tart. em. & requiring sanguin. turp. mer. calom. etc. & sometimes
capsicum, ammonia & even perhaps wine & alcohol.




“One of the most extraordinary examples
on record however of the effect of disease in 
developing of perceiving a certain class of relations
is that of [Zerab] Colburn His history 
is well known When quite a child in his sixth
year, without any previous instruction, he
could by mere intuition perceive the relations 
of numbers with so much readiness and
precision, as to solve almost without reflection
questions in arithmetic which would
require a long calculation to enable others 
to answer. How he obtained this result
he could not tell. The answer seemed to 
present itself to his mind with the same
readiness and conviction of its truth, that
the proposition tow and two make four
does to us. These facts I saw are well
known, but it is not so well known, that
this power was the effect of disease. That
such was the case I have very little doubt
This was the opinion of a very distinguished
physician who saw him at the time, and
who ascertained that he was then affected with 
a peculiar nervous disease the same
(chorea) which Jane had a few years 
since. In conversing with Mr Colburn 


about a year ago I asked him if he
retained the power of calculation which 
he possessed in his childhood. He said
no, and attributed the loss to the want
of its exercise. But why should exercise
sustain a faculty in existence which 
was spontaneously developed?”
“Account of Jane C. Rider the
Springfield somnambulist; by S 
W Belden MD. Springfield 1834”
p. 108
“The discovery of Zerah’s power 
of calculation was purely accidental 
Zerah not having yet completed his 
sixth year was overheard by his father, as
he repeated to himself in his play, parts
of the multiplication table. The father
surprised proceeded to examine him & 
[found] etc.