Materia Medica by Dr Fordyce No 4. Materia Medica Index Page No Particular sedatives 1 Effects of astringents 4 Action of particular [illegible] 8 general effects of relaxants 19 Particular relaxants [23] Strengtheners 30 Effects of the bark bitters etc. 39 Means of weakening the system 57 Effects of evacuation by bleeding 61 general effects of antispasmodics 69 1 Lect. 45th Sedatives Acids eternally apply’d are powerfully sedative. seem to be equally so, whatever once we use provided they be of the same strength If [so] concentrated they act as stimts Out taste is perhaps the best criterion of judging, the vinegar shd be the standard for diluting them. Acids are usefull as sedatives in all cases of deep seated inflams as in those accompanying fractures dislocations strains In erysipelatous the inflam of the skin [&] integuments they are improper They are very usefull as gargles in infl. of the mouth & throat Neutral salts are somewhat sedative externally employ’d Alcohol a powerfull sedative somewhat astringt but not stimulant is very usefull in erysipelatous inflam as those arising from burns, the bites of poisonous insects etc. provided it can 2 be apply’d before a blister is raised if pure it acts too powerfully as an astringt it shd be diluted then 2, 3, 4, or 5 times its quantity of water It has been disputed whether sedative or relaxing oily medicines were most usefull in burns, sedatives seem most proper in slight cases. All metallic salts are sedative when diluted with water & particularly usefull in inflam of the eyes the chief of these are white, blue vitriol & sacchar. saturni these are more proper in chronic, than in acute [illegible] of the eyes. Preparations of lead are seldom usefull in phlegm: inflam: they sometimes [illegible] or [illegible] & mortifict. [illegible] hazardous in [illegible] attended with great pain they have not this disposition. In excoriations preparats of lead are apply’d with propriety, particularly 3 [cerasse], as also lapis caluminaris & alum. this last is particularly usefull in inflam of the eyes, mouth, & throat. Prep of alum when apply’d to the eye have a disposit. to coagulate its humours [illegible] renders it necessary to be changed frequently. Alum [illegible] made with the white of an egg shd be changed every ¼ of an hour. All the vegetable astringents have been apply’d as sedatives, particularly the [certicosa] of Lineus. Some of the farinaceous seeds as [illegible] have been apply d as sedatives particularly in erysip. inflam. Lastly, opium & poppies are [illegible] sedatives and may be apply’d externally in all inflam. with success particularly of the [???table] parts 4 5 the contract. produced in animal fibre by astringts differ from that produced by the living power in that the water [illegible] combined is in the former seperated & cannot be recombined. The blood vessels are allways full of blood, an astringt. then can only make the vessels press more strongly upon their contain’d fluids, but can’t make them diminish in diameter but in proport. as they are emptied of blood, by larger [illegible] Astringents do not act equally upon all the blood vessels but act more powerfully upon the small & accumulate the blood of course in the great vessels Astringents may act more partict. upon the external, or internal vessels in which case the opposite set are dilated The actn of astringents upon the muscular fibres is permanent, whilst that of its acting upon the living power is temporary. 6 Astringents differ, in some of their acting parts or solely upon the part to which they are apply’d whilst others more universally upon the whole system these later have their actn of shorter continuance than the former they act upon partr parts. Astringts are strengtheners in consequence of their power of accumulate the blood in the greater & internal vesls the strength of the patient being always in proport. to the [qy] of blood contained in the greater vessels It is [illegible] holds good only a certain length, as astringts may be used so as to produce weakness when used to excess They may be used with advantage in restoring the tone to muscular fibres that have been relaxed or weaken’d by over act. hence they are usefull in strains [illegible] after the inflam: is gone When any of the glandr secretions are increased they stop or diminish them in quantity. they also diminish the natl secretn but we never use them so 7 Precautions on the use of astringts in increased secretions If there is inflamatn [illegible] secret. is the natural cure in place of stoppg. such secret rather promote it, to carry off the phlegmonous inflamat. of [illegible] part is increas’d secret. may be in conseq. of a stimulus applied. if we stop the increased secret. whilst the stimuli remains inflammatn is produced. The immedt. cause of secretion is a quantity of blood in the glands of the [part] in conseq. of the contract. of some distant part. was there not to be increased secret. inflamatn would be produced. before we cure such secret. by astringts we must take away a qy of blood from the part by relaxants. in watry secretns. where there appears to be no phlegm inflam. we may use astringt properly if there shd be sympt of plegm: inflam we shd avoid astringents untill the 8 increased secret. has carried off the inflamatn. [illegible] as to the use of astringents we shd evacuate the feces contain’d in the intestines. In secretions from the urethra produced by the applict. of [illegible] matter it is questioned whether astringents are proper. In increas’d secretns from the bladder we use remedies to take off the [illegible] of the habit, as the use of astringts wd be of little use there being a const. stimulus from the urine In haemorages we used sedative asts: In hamorages from the gums astrts are of great use. Of particular astringents [Fossils] astringents act on the system Vegtle astringts act for a longer time, [boles] are compds of calx of iron & clay their activity depends upon the iron. 9 Calcaresur earth has some slight astringency & may be exhibited in diarrhea with out any danger of increasing inflamat. Boles have become employ’d in bruises when the inflamatn has been previously removed they have been used in purgings but have no great efficacy. Alum is a powerfull astringent but we shd give it in such a form as to be certain of the dose. Lect: 48th May 4th 1772. Boles acquire difft colours as red, blue etc. from the calces of iron particularly with which it is mixt hence the [illegible], common bole & they have been advantageously externally employ’d in form of plaisters to restore the tone to relaxed muscular fibres. some of them as the lapis hibernicus contain a considerable portion of alum in their composition, but alum is exhibited alone with much greater propriety & certainty in the dose. 10 Alum is formed naturally by clay being mixt with pyrites which being decomposed the v: acid unites with the clay forming this earthy salt alum as thus formed generally contains a superfluous quantity of acid which may be [separated] from it together with a quantity of water contained in its crystals by exposure to heat the burnt alum is thus prepared differing from common alum only in being more active from the quantity of water evaporated The best mode of exhibiting alum seems to be by forming a whey of sweet milk which may be drunk the sugar & mucilage contained in the milk in some measure covers its taste, and renders it less disagreeable Iron has been employ’d with the vitriolic acid forming green vitriol, with the muriatic acid forming [illegible] [illegible] in spt salis and with sal ammoniae sublimed forming the flores martiales 11 The calces of iron and the flores martiales have greater astringency, and less stimulus than the neutral preperations with the acids Iron has sometimes been used as an astringent in diarrhoeas [its] calces particularly, as already noticed, in the different boles 12 Iron has astringency, but its power as an astring. is mixt with a strengthening & irritat power hence its uses in the chlorosis, fluor albus [illegible] Iron is always dissolved in the acids of the stomach so that it may be used in its metallic form with propriety. it is filed down. if the filings are of a large size they do not act powerfully [qty] if fine, will be as effectual as [qy x] [illegible] it may be rendered still more active by restoring it from its calcin’d state by exposing it to heat in a crucible with [flower] we then obtain it in a very fine powder mixt with the charcoal of the flower, all its difft calces are active It is employ’d externally in boles and 13 When combin’d with acids it is more active we use 3. [illegible] with vitl acid green vitriol & mur. acid The mart. in spt solis, [illegible] tartar by digestn in wine. Iron has been exhibited mixt with alkalis as in the flor. martiales. It has been exhibited combined with sulphur but is unactive the sulphur rendering a mild & inefficacious Lect 49th May 5th 1772 Lead seldom used as an astringt. generally as a sedative, can seldom be used, to stop internal increas’d secretions from its dispositn to [illegible] in paralytic weakness of the intestines. Zinc has been seldom used internally & then not as an astringt has been used externaly as such, never used in its metallic form, found in the earth calcined [illegible] lapis calaminas found in the earth exceedingly hard must be reduced to a fine powder by exposure to a red heat for some [time] & then powder it. It has been internally employ’d as an emetic its ore has been much in use externally for [illegible] as an [astgt] 14 when zinc is exposed to a red heat it puts on the appearance of burning and emits a very fine white powder a form of fumes, this called flowers of zinc. [illegible] or cadmia another calx formed from its combination with copper. all these calces are the same qy [cadonia] is procured in the soap manufactories, is more soluble in water than [illegible] White vit. formed by exposing [pyrites] mixt with calamine to the air. the vitc acid contain’d in the pyrites unites with the zinc the salt is seldom pure, but have a little vitriol of the iron or copper mixt. shd be dissolved in water, & crystalised then called [illegible] of vitriol preparation of zinc have an astringency that renders them very usefull, particularly for making the skin grow upon excoriatn & ulcers. Astringt. juice contained in a variety of vegetables, and it seems to be nearly the same in what ever one we find it. Agrimony etc. have been very properly used in fomentations of erysip. inflamt. act here as sedatives. [illegible] have been used for the eyes not very powerfull their flavour part recommends them Radix tormintilla has been used as an astrin: in dysenteries 15 Rhubarb has a [illegible] of astringency, but small, when compared with its purgative qy the purgative power may be extracted by infusion in water & the astringency aft. The husks of all red fruit contain more or less of an astringent juice. The [Viscus] [Queronas] contains the astringency of the tree, upon which it grows Uva ursi has been lately employ’d in cases of the stone in the bladder inefficacious [illegible] Japonica & sanguis draconis two resinous bodies, mixt with an astringt. juice of a red colour, obtained from trees unknown operate quickly & universally principally usefull in hemorages, may be properly combin’d with alum in this [illegible] & under its effects more lasting may be used in substance advantageously. Lect: 50th May 6th 1772. Narcotics act also as astringents, Acids and salts as astringents & sedatives. 16 17 The action of the relaxants is not so obvious to the senses as that of astringents, hence some have thought that the effects produced by them were produced in some manner difft. In inflamat. of the intestines when the rectum in contracted so that no stools can be procured nor glysters injected by the applic. of the [semicup???] or warm baths we can remove these contractions so that injections can be easily thrown in. when the urethra is contracted so that a suppression of urine is produced & the catheter cannot be introduced by fomentg the parts affected we take off these strictures hence we see that certain substances properly come under this class. Lect: 50th May 7th 1772 The terra japonica sang: draconis are sometimes used in dysenteries, the bark of the wild ash employ’d rather to take off the irritability of the system. The cortex granatorum does not act so quickly, but is more permanent in its action. 18 Oak bark contains a pretty powerfull astringt juice, is employ’d advantageously in fomentations of weak & [relax’d] [illegible] The semirabia has a difft kind of astringency from most others seems to act solely on the part to which it is apply’d [illegible] that astringt taste chiefly used in dysenteries & gleets where the system is greatly relaxed. The logwood is pretty powerfully astringt employ’d mostly in dysenteric cases its astringency similar to that of the other vegetable astringents acts universally ¬ like the semirabia The most powerfully veget: astringent is the juice of the oak collected by certain insects as the galls are employ’d advantageously in gleets, flour albus, & [illegibles] of every kind may be externally used in relaxation of the ligaments & cannot be employed in substance may be extracted by spts or water shd be used in decoctions, or infusion 19 Lect: 51st May 7th 1772 Relaxants are medicines that diminish contractions of the moving parts. As astringents do not decrease so relaxants do not increase the diameter of all the blood vessels their action is not equal but ore determined to the small than the great vessels Relaxants by encreasing the diameter of the small vessels the external particularly and encreasing the quantity of blood in them, have been supposed to act as stimulants. By encreasing the secretions they have been considered as [attenuants]. By diminishing inflamatn. they have been considered as sedatives Relaxants are powerfull remedies in fevers more so than any other class in counteracting & carrying off fever. Fever is always attended with [illegible] perhaps principally occasion’d by contraction of the small vessels, as these med: [counter???] this dispositn they become very efficacious in curing this disease [illegible] fever they are most usefull in the beginning may be [harmfull] in the end of fevers when the [patient] [is] become very weak 20 The addition of stimulants & opiates very much assists their operation in fevers Relaxants act very powerfully in carrying of the first symptoms of fever upon its attack & so preventing it farther encreased. Relaxants cannot be apply’d with propriety where there is a great degree of inflamatn untill it be taken off by evacuations also the heat occasion’d by their operat. encreases the inflammation. At the end of fevers when symptoms of weakness come on to a dangerous degree, they be encreasing the secretn. encrease the weakness be encreasing without any diminution of the fever. If relaxants are of use they generaly produce their good effects in [illegible] hours if they have no good effects or that time they should be discontinued. The first dose shd generally be given in quantity to prove emetic. In general inflamat. by relaxing the vessels they take off in some measure their pressure upon the blood and so are of use. Relaxants are also of very considerable use in intermittent fevers they tending to procure a perfect intermission & to remove the febrile symptoms that often remain after the terminat. of the paroxysm, also to prevent the attack of the cold fitt, are assisted by stimts & opiates. 21 Lect: 52nd May 8th 1772 Relaxants apply’d internally are more powerfull in carrying off internal than external inflamations, as they throw the blood upon the external parts & this is from whether the inflamation be of the phlegomonous kind or of some of the internal mucous membranes, the presence of general inflammation however forbids their use in this, as well as in all other cases, have been considered as particularly usefull in inflamations of the thorax. Relaxants are of very great use in all encreased glandular secretions particularly the internal as they, by throwing the circulation principally upon the [skin] and external parts cause less blood to be convey’d to the glands & greatly encreased the cutaneous [secretion] Rheumatisms are attended with general inflamation they tend immediately to carry off the contraction that takes place in the part affected with disease. but if general inflamation be present they should not be employ’d until it be got rid of They are also of use in carrying off spasmodic contractions when they take place. 22 23 Relaxants are of use in rheumatism but if the general inflamatn. is very great their operation is attended with danger. In spasmodic affections of the ureters urethra gall bladder and even intestinal canal. they are of great use when externally apply’d, and also when thrown into the rectum & colon. In muscular constitutions they are not so efficacious, but have been used sometimes even in these success In cutaneous eruptions depending upon dryness of the [sear] of skin they may often be used with success; so as to cure the disease Lect: 53d May 9th 1772 Action of particular relaxants I Neutral salts They have in general some degree of relaxant power, some more aft to act upon the stomachs, whilst others pass into the intestines & purge, [nitrus] digestiva salt of sylvius sal ammoniac & vitriol: tartar act more particularly upon the stomach. these have seen more [illegible] than the others as relaxants 24 No class of medicines has been more universally used than these salts, they were unknown to the ancients: from their ignorance in chemistry from the [illegible] or [illegible] [illegible] has got various names operatn by which it is procured. Surprising? that medicines of so little efficacy could be so much commended. there being hardly one case in which N:S: can be of any use & they in in case act as powerfull remedies, not withstandg the general use of these medicines in the present practice perfect intermissions of fevers are hot they are sometimes of used in [illegible] sufficiently powerfull to produce any bad effects. Dr. Fordyce attributes the use of N:S: to their disagreeable taste from which the patient supposes they must be efficacious. Some very powerfull applications require a considerable time to operate before they produce any sensible effects. hence inflamatory disorders after bleeding the patient largely, & exhibiting nitre afterward, the cure is attributed to the nitre, which in reality belongs to the operation of bleeding. Dr. F. wishes to make strong preparations on his pupils of the inefficacy of these Medicines, in order that they may not be depended upon, where active medicines may be used with advantage. 25 Neutral salts tho’ not powerfull relaxts sedatives, no [alterants] are yet very usefull purgatives, stimulating the glands of the intestines solely & producing an encreased secretion from these parts. Ipecacuanha Is the part of an America plant brought over dry, and may be preserved so, for a very considerable length of time like [illegible] depend upon a juice soluble in water or in spt of wine & water is [illegible] however (in most cases) used in [illegible] Has been principally used as an emetic, has a specific stimulus to the stomach, so much that, if its juice be injected into the blood vessels, or absorpt. it acts upon the stomach & proves emetic, hence it is more certain in its operatn as an emetic than any other. If given in smaller doses than to prove emetic it acts powerfully as a relaxant most stomachs will bear gr i some gr ii but few others cannot bear more than gr. fs with out producing sickness has been exhibited in dysenteric purgings often [alongst] with opium in which case it becomes powerfully sudorific & the stomach will bear a larger part of both med: when combin’d than when given alone has been successfully used in chronic rheumatism with [illegible] 26 Scilla with root of a plant is of the natural class called [lilliana] acts only as a partial stimulus Besides their power of encreasing the glandular secretions they have also a relaxant power this most being bulbous & acting cannot be well used in [subst.] unless dried in which case it loses somewhat of its efficacy shd be cut in thin transverse slices & slowly dried [illegible] shd begin with small doses. Aconitum has been consider’d as poisonous not lately employ’d in med: its virtues depend upon a juice not volatile & soluble in water it may be used then in form of an extract. Has been considered as a poison but introduced by [illegible] stork seems to act pretty powerfully as a relaxants [illegible] dose of it extremely small, we shd begin with 1/8 part of a grain which may be gradually encreased till it produces sickness has sometimes been used with success in obstinate rheumatism Lect: 54th May 11th 1772 Seneka the root of an American plant [illegible] from being knotted was suppos’d to resemble the tail of a rattle-snake, & to be usefull in the bit of that animal, the juice upon which its virtues depend is soluble in water & has thence commonly been used in [illegible] very disagreeable taste, occasions a heat in which the act. has been sometimes used in diseases of the lungs, in rheumatisms & cutaneous eruptions with success. 27 Cold water was employ’d in fever as a relaxant by the ancients & sometimes with considerable effect, but has not been used of late, it seems to be of no great consequence whether cold or hot water be drank in acute diseases. when cold water has acted as a relaxant it has been used in very large doses two or three quarts of this fluid having been thrown into the stomach acts sometimes both as a purgative & emetic & sometimes as a relaxant, & so has carried off the fever according to the accounts. Antimony No medicine has been subjected to more operations than this metal & yet the preperations of it in use are very few Regulus of antimony is found combined with sulphur & sometimes also the regulus of arsenic each however are very rare & easily discoverable by the redness of their colour. Regulus of antimony is very easy of fusion & may therefore be seperated by exposure to a small heat from the [stony] impurities with which it is mixt the metal 28 when melted is thrown into conical moulds inverted & the qy of [illegible] sulphur being greater than what united chemically with the regulus the later being heaver than the former subsides hence the apex of the cone is a purer regulus containing less sulphur than the base of the cake does. If we apply about 3 or 4 times the qy of [illegible] alkali it unites with the sulphur forming a hepar sulphuris which dissolves the regulus of the metal from which it may be precipitated or iron may be used it [affecting] the sulphur more powerfully than the antimony & no part of it making [illegible] the pure regulus Filings of iron [then] as to be mixt with antimony & the whole expos’d to fire. or a part of the sulphur may be destroy’d by deflagration with nitre if we add equal parts of nitre & any fixt alkali Another method of procuring the regulus for medl purposes is by uniting it [illegible] kali so as to make a hepar s. Regulus of antimony has been exhibited as a purgative in form of a pill called the [perpate] pill has seldom been given in powder in a [??gative] form except sulphur [illegible] antim: & [illegible] mineral Two of its calces have been used by exposure to the air & [illegible] only it thus forms a white powder this operatn is assisted by [illegible] between shavings or [illegible] or by deflagratn which nitre as 3 parts of [illegible] to 1 of [sul.] thrown into a red hot crucible 29 it has been used nitrified it has been combined with vit: & nit: acid but is [uncertain] been [illegible] by water. it has been combin’d with mur. acid [illegible] butter of antimony & [marmurius] [vita] has been combin’d with [illegible] tartar emetic the most certain in [illegible] Lect: 55th May 12th 1772 Preparations of antimony may be considered under 2 heads 1. such salts as are soluble in the watry juices of the stomach these are always certain in their operation therefore preferable to [them] 2. class whose action depend upon their solution in certain salts in the stomach which may vary according to the quantity of these salts [illegible] are therefore uncertain in their operation. There are none of the preperations of antimony so perfect as we could wish all metallic preperations soluble in watry fluids stimulate the stomach strongly & are more apt to act as simple stimulants than to produce their peculiar effects antomonls are also subject to this inconvenience. Antimonials are by much the most powerfull relaxants, & may properly be used in fevers & every other case where this class of medicines is proper & usefull the class of relaxants upon which we can must depend. Crude antimony & its calces are mostly inactive the [green] metallarum & glass of antimony are very uncertain in their [illegible] [illegible] [tartar] & [tincture] of antimony a combinat. of the regulus & hepar sulphuris [are] the only preparats [of] salts which are [active] 30 Relaxants are very usefull in internal inflamations & rheumatisms, such cases excepted when there is a great degree of general inflamation in which cases the genl inflamatn must be first be got rid of before we [illegible] to use them. In inflam: of the mucus membranes as catarrh, erysipelat. sore throat, diarrhoea & dysentery they ay be successfully employ’d, also [illegible] for encreased secretions & [catarcous] eruptions they are used with success. In internal haemorrhages they have often been exhibited successfully May have [illegible] been used in increas’d secretons from the urinary passages Strengtheners such remedies as [given] [contracting] [illegible] render them capable of [illegible] with a greater force differ from stimulants the [illegible] putting this power into action [illegible] also from astringts The strength & weakness of the system do not consist in the action, but in the capacity or incapacity to exert a great degree of power, although the power of the body be finite yet we might suppose the exertion of this power to be definite in some manner as a magnet will lift & suspend a certain piece of iron for any length of time. this is not the case, for the body after exerting its power for a certain length of time looses the capacity of continuing such exertion but has it restored again by rest of the parts. 31 We may say then that there is a flow of living power into the body which may be accumulated so as to act more strongly or by the exertion of this power it may be wasted & exhausted. Tho’ we don’t suppose there is any fluid running out, or into the body yet we may compare the accumulation of the living power to a dam of water gradually collected from a small rivulet which although incapable of turning a mill of itself yet when gather’d and collected in a body is capable for a length of time of producing this effect but the water which was collected being in time exhausted the mill can be no longer driven round till a quantity is re collected The body may be strengthen’d 2 ways 1 by preventing the waste of the living power (to carry on the simile) as by stopping up the dam, to prevent the water running out, or 2d By encreasing the flow of this living power into the body [illegible] by encreasing the stream of water into the dam. The flow of living power may be principally exerted in one part or another thus a dancing masters legs grow strong whilst the arms of a blacksmith grow strong also by exercise of these particular parts. 32 Strengthening remedies then are such as prevent the exertion of the living power or such as encrease the flow of it into the general system. they differ then in their action from stimulants etc. Lect: 56th May 15th 1772. The first action of the living power is to contract the blood vessels so as to adapt them to their contents if there be only a small quantity of blood in the vessels the greater exertion of the living power is requisite to produce this effect, hence nourishing foods, by filling the vessels with blood become strengthening remedies. It is not [suffict] though that food be thrown into the stomach but its quantity & quality must be adapted to the powers of injection & other circumstances. Food easy of digestion does not afford so much nourishment to a strong as to a weak stomach it being too soon thrown out of the former. 33 When the blood vessels have no great disposition to contract, but are forced to contract powerfully form the small quants of blood they contain in these cases the stomach digests well & the appetite is keen on the contrary when the vessels have a vary great disposition to contract not from this small quantity of blood contain’d in them. as inn the case in hectic fever in this case the stomach looses its powers & then appetite is lost. Nature then seems to adapt the appetite & digestive powers to the particular circumstances of the patient’s health & food is loath’d and rejected in cases where it would be unnecessary & hurtfull. Second method of strengthening the system is by applying cold to the body or living in a cold atmosphere In a cold climate the external vessels are contracted & the blood kept in the large vessels about the precordia upon which circumstance the strength of the body seems in a great measure to depend for when the circulatn is principally carried on in the external & not internal parts of the body the strength is diminished as is the case in warm climates. hence change from a warm to a colder climate 34 powerfully strengthens the system we shd only observe that the transition shd not be too sudden else the blood by being suddenly forced into the internal larger vessels it stimulates the body too powerfully & produces disease the [illegible] of the [illegible] jointly consider’d is always nearly the same & variety of [illegible] [the] [body] being subject to is extremely little In temperate climates the habit is greatly debilitated during the summer season whilst it is strengthened by the winter hence in the spring the diseases are mostly of the inflammatory kind whilst the autumnal are attended with weakness & depression of strength. Cold suddenly apply’d as in the cold bath has a very difft effect in this case the blood is suddenly thrown from the external to the internal blood vessels. the cold being removed the contractn of the external vessels does not continue but the large vessels acting powerfully, force the blood upon the external surface of the body hence that [glow] & heat that suddenly take place after using the cold bath. This sudden distribution of the blood through the small’ vessels of the external parts is very powerfull in removing obstructions of the external capillaries 35 Living in a pure atmosphere is another powerfull means of strengthening the system this seems to be affected by the living power being prevented from being exhausted. If the [illegible] of an animal be tied up he becomes gradually weak untill he dies if only a small quantity of air be allowed him he gradually becomes weaker & weaker the very same bakes place in the air of large towns a sense of [oppressn] & weight is felt about the precordia which is immedtly removed by the country air. Running water takes up fixible air, & other putrid effluvia hence an air saturated near running water is pure & wholesome whilst that in the situatn of stagnating water is the contrary from the putrefaction of the water etc. Exposure to continental as the [illegible] & N:E: winds renders the situation unhealthy in some measure, although the air is [denser] in these winds than any others yet if there be the smallest disposition to disease they are the means of producing them 36 Astringents given in small quantities strengthen in large quantities may weaken the system, they act more powerfully [upon the] small than great vessels & differ much from strengtheners Lect: 57th May 12th 1772 2d class act by increasing the flow of living power into the system Exercise having a tendency to draw the action of the living power from the vessels to the muscles has a very good effect in strengthening the habit in order to render exercise efficacious in strengthening the system it should be moderate according to the strength of the patient the exercise should be such as employs all the muscles of the body Riding on horse back, in a carriage, rowing, fencing etc. are of great use, riding in a carriage upon rough roads is disagreeble to the mind producing sensations of fear is therefore hurtfull Exercise should be agreeable and there should always if possible be some object in view besides the health the great use of mineral waters depends more upon the exercise and amusement 37 enjoy’d at those bublick places than any particular quality the waters possess The exercise should allways be in a pure air, if the air be impure the exercise encreases the weakness in place of strengthening hence exercise in close rooms do mischief Certain remedies as bitter vegetables substances tend to encrease the flow of living power into the body vegetable bitters differ considerably however in their properties the pure bitter is very probably the same in all of them The syngenesia of Linneus or those plants with double flowers as the lettuce, dandelion, endive etc. contain a white bitter juice which flows out like milk and resembles opium in its properties, others as the [abrotenum] mas, et [illegible] [tanecetum] etc. have a stimulating essential oil mixt with their bitter, whilst the chamomile contains a purgative as well as a bitter juice 38 The same bitter juice is contained in the peel of the lemon, orange etc. in qy Root of the gentian & tops of the [lesser] centaury This juice is purest in the bark of a certain American plant called Peruvian bark & by many other names Preperations of iron & copper are possess’d of nearly the same effects they have al la power of diminishing the irritability of the system, as well as of strengthening it, the weaker the habit them ore irritable it is and vice versa, but these medicines have in many instances a greater power of diminishing the irritability of the habit than of strengthening it. Cinquena cohina cohave cordex jesuitaves cortex [detrum] erc. The medical juice of the bark is contain’d in little cells or upon being broke & exposed to the sun the [illegible] juice glitters. The root of the small branches contain more of the medl juice than those of the trunk & larger ones you may subject to adulteration [illegible] therefore never be purchased in powder 39 Lect: 58th May 15th 1772 Bark & [bitters] besides their strengthening power, have a power also of diminishg the irritability of the system Bitters approach the bark nearer in their strengthening, than in their power of diminishing the irritability of the habit they may be properly be substituted then to it in the first case When the intestines are weaken’d & in consequence there are want of opposite indigestion, costiveness from want of the peristaltic motion or purging from too great irritability flatulency of the intestine etc. in all these cases the bark may be exhibited with the greatest success. Bitters in these cases are also of great use Bark should be employ’d in solution in cases where the intestines are so very irritable that it produces purging when exhibited in substance extract: [illegible] gives about 3 times as strong as the bark in substance in alcohol dissolves it more perfectly than watry fluids Bark sometimes it inflates the intestines producing purging in this case we may exhibit that with it a very small quantity of opium. 40 Bark sometimes disagrees with the stomach in the cases of spices may be join’d to it [even] as cinnamon clover etc. By diminishing the irritability of the intestines it sometimes produces costiveness this we should carefully prevent from taking place by the exhibition of rhubarb, or does so as to procure an evacuation every day. It is better to exhibit the purgative alone, than with the bark also we will give it either in too large, or too small Doses If it is exhibited with every dose of the bark in qy suffict to [procure] evacuatn it will purge too much if on the [illegible] it is not exhibited in this [illegible] it will produce no effect. Bark has been frequently employed in fevers, sometimes to diminish the irritability & sometimes it strengthens. 1st It may be employ’d in cases where people are exposed to circumstances, in which there is a probability of disease being produced. It is [illegible] by rendering the body insensible to the causes of disease. Bark by long continued use looses its effect upon the body rendering it in [time] insensible to its own, as well as to the action of other stimuli. Bath is of very great use in [illegible] that arise from the weakness & irritability of 41 As it can only be used there for a certain length of time with advantage, it should be exhibited only on certain occasions. [illegible] such as circumstances as the body is most subject to the causes of disease as a preventative zii-ziii in the 24 hours are sufficient the larger the doses exhibited the sooner it looses its efficacy & vice versa. If a man has been exposed to the cause of disease and languor, nausea, debility etc. have taken place it is then too late to exhibit the bark and we must use relaxants in its place Bark was first brought into [illegible] by its use in intermitting fevers it was for a time out of practising was again introduced & continue to be used. [Practitioners] differ very much respecting the propriety & particular time & mode of exhibiting it. It is generally agreed that the intermission of the fever is the most proper time for using it. 42 Some have thought it might properly be exhibited during the whole time of the intermission, others only in the first part & others again in the later part of the intermission [illegible] in a very large dose, before the attack of the paroxysm There has been as much disputes whether it might be exhibited in intermissions of fevers which were not perfect, some asserting that it might be exhibited in imperfect as well as perf. [illegible] The mode of its operating upon the body so as to produce its effects has been much disputed some have [suppos’d] it acted as a stimulus, others that it has some specific quality of destroying Fever independt of its other action upon the body We suppose that as it prevents the causes of disease from (originally taking place by diminishing this irritability of the body, so we suppose that it acts in the same manner in preventing the return of the paroxysm i.e. by rendering the body for the time are susceptible to the causes of the fever. Bark shd not be exhibited but in perfect intermissions [illegible] may sometimes render an intermittt a contg fever, if improperly used 43 Lect: 59th May 16th 1772 Bark has no tendency to carry of a fever which is present, if exhibited on a continual fever it never will cure it, but in most fevers will encrease; in place of diminishing the symptoms. Bark has the same good effects upon almost all intermitting disorders as upon fevers if properly exhibited in the intervals. The cause of a disease may be prevented from taking place in 2 ways [illegible] either by avoiding exposure to the cause producing the disease, or by counteracting that cause when it has taken place (i.e:) producing an effect that is opposite to it. That bark produces its effects by diminishing the irritability of the body appears from its similar effects in other diseases, it prevents the 5 salts of the urine from stimulating the excoriated passages in venereal disease not by destroying the venl matter but by diminishing the [practicability] & rendering the parts insusceptible to the [illegible] 44 The cases where the bark ought to be employed are those cases in which the disease is perfectly absent, or some symptoms of the paroxysm continue through the intermission from the great irritability of the habit and weakness by the long continuance of the disease If exhibited during the paroxysm or where the intermission is imperfect it does mischief & often converts the intermittent into a continual fever. If the disease has continued a length of time & some symptoms of the disease continue from weakness etc. in these cases the bark may be exhibited in the most perfect intermissions it can be found. As the bark is employed to diminish the irritability of the habit is should be given in large quantity & in substance if possible zi or zifs should be exhibited during the intermission & we should not stop its use, as soon as we prevent a paroxysm, but should continue it over a very considerable time afterwards if it can be too soon left off and the disease 45 reproduced the bark looses in a great measure its efficacy & will never after care the disease with such a degree of certainty as at first. Bark frequently produce a tightness about the thorax, & difficulty of respiration and also affection of the brain with all two symptoms attended with more danger than any other in fevers if in continued Fevers than any of them & symptomatic place at the patient be ever so weak & exhausted, by the disease we cannot employ the bark to encrease strength but if the symptoms above mentioned be absent the skin moist [illegible] the pulse quick we may exhibit the bark with advantage zifs or zii in 24 hours is suffict. in these cases. Bark is of great use to prevent the relapse of fevers after a crisis has taken place. If the crisis takes place before the 13th or 14th day the patient is particularly [illegible] to returns of the disorder & we shd use the bark to prevent this danger. 46 If a crisis takes place about or before the 7th day of the disease then the bark shold be administered in substance, & in as large quantity as if to prevent the return of an intermitting fever also there is very great danger of relapse. If a [cerisis] takes place after the disease has continued for more than 14 days there is much less danger of relapse & it holds general in fevers that the longer the disease has continued before a crisis takes place the patient is less subject to relapse & vice versa the sooner the crisis the greater it is danger. Lect: 60th May 18th 1772 When intermitting fevers run through their natural course they weaken the patient so much as at times to prove fatal to prevent this great weakness from taking place bark, & the bitters have been exhibited a small qy of bark, zi or zii in 24 hours is suffict. Chamomile etc. have been more frequently used it is better however to stop the course of the disease by large quantity of the bark. 47 Bark in general encreases phlegmonous & diminishes erysipelatous inflamation these two diseases are often combined, if the pulse be hard, fall, and strong the bark should not be exhibited if the pulse be quick, weak etc., and symptoms of irritability take place in such cases bark may be exhibited to advantage. it encreases suppuration & the format. of good [illegible] and prevents absorption. in particular spasmodic affections as of the intestines etc. in such cases they often depend upon weakness, hence the irregularity of the muscular motions the bark by strengthening the general habit restores the equality of the muscular powers & so cures the disease The matter as secreted by ulcers is not [pus] but a thin watry fluid at first and is gradually converted into [illegible], that this is the case appears from observing any small abscess as a pustule of the small, or chicken pox, the fluid it contains is at first clear and transparent but is gradually converted into thick yellow [illegible]. 48 Erysipelatous inflamation of an abscess or ulcer is the great or principal cause of the absorption of [illegible] into the system, hence the great use of the bark in converting the erysipelatous, into phlegmonous inflamation & these both dispose the ulcer to secrete a thicker & better [illegible] and to prevent the disposition of absorption. In all wounds, and ulcers where we want to produce good [illegible] bark is the most powerfull medicine in promoting it. If an ulcer be recent bark is very powerfull in producing good suppuration, & granulation, but if the ulcer be of a long standing the case is very different in the first case the system may be considered as affected in general, in the later case the disease is topical & the system not affected. In the later case mercury is particularly usefull. Bark much preferable to all the other bitter & strengthening medicines in the above [situations]. 49 inflamations of the mucous membranes are often attended with encreased secretions from the mucous glands. Bark stops this secretion by taking off from the irritability of these glands. Encreased secretions of the intestines and better treated by opiates & other astringents than the bark unless the disease has been long continued In gangrene the mortification bark the most powerfull remedy yet discovered A dead part is seperated from the living part of the body by a suppuratn which takes place between them & bark from its disposition to destroy erysipelatous inflamation, & convert it [into] phlegmonous inflamatn powerfully promotes the suppuration. The effect of the gangrened part upon the surrounding parts is such as not only to prevent this suppuration from taking place, but also to change the living parts into the same [illegible] with itself 50 Bark by its power of diminishing the irritability of the parts prevents the sound parts from being acted upon by the parts. Lect: 61st May 19th 72 In rheumatism bark does not at all tend to carry off the disease, but as in other disorders it prevents the return of it. It often happens in acute rheumatism after the disease has continued for some time if the pain goes off entirely in the day time, but returns at the natural evening paroxysm & continues through the night disappearing in the morning with sweating the continuance of which disease greatly weakens & wastes the patient. Bark in this case may be exhibited during the day in qy of from zfs to zi with the greatest success its use generally carrying off the disease. Rheumatism often returns at irregular periods like a spasmodic disease, or upon the least exposure to cold in these cases the bark 51 When great weakness takes place suddenly from any cause the strength may be restored in a short time by the exhibition of the bark in considerable quantities. If the weakness has been a long time in being produced we cannot expect to get rid of it so soon. Bitters in these cases are of use but the bark is preferable in most cases excepting where the habit is very lax in [illegible] case preparat. of iron have the preference. In these cases it should be exhibited in solution & its use intermitted after 1, or 3 weeks for some time, & returned to again, the strengthening medicines should be varied as one medicine will be efficacious when another by use has lost its effects. This advantage is lost if we use mixt preparations of them. In hysteric cases there is a great degree of irritability in the system. Bark may be properly exhibited, by taking off the irritability of the habit it often cures the disease. In chlorine strengthening remedies have often been recommended but the vessels and is [illegible] strongly in some cases it may be questioned whether a [illegible] [illegible] should be [illegible] evacuatn takes [illegible] actn of the arteries etc. 52 When the hysteric disease takes place in plethoric habits, bark cannot be exhibited, untill the plethora be remov’d When it proceeds from weakness the bark may be employ’d from the beginning with the greatest advantage most effectl [illegible] Disease has come on suddenly & vice versa. Preparations of iron unless when plethora is present are next to bark in efficacy in this disease In other spasmodic diseases this class of medicines and of some use if the body be weak & eventually they are most efficacious [illegible] if iron & [illegible] are often preferable to the bark & bitters in such cases. In epileptic fitts etc. where the habit is not plethoric, but weak those medicines may be used advantageously and are of use in all diseases that return at regular periods Tetanus & risus sardonicus can scarcely be [considered] as spasmodic & are little benefited by [illegible] symptoms of sickness of [illegible] place. In chorea st. Viti when it can be relieved by medicines the bark is the best they are only efficacious at the beginning of weak disease. Bark and other bitters may be used to carry out the [gout] but they are apt to induce a melancholic temperament and apoplexy palsy etc. have frequently been produced from their [illegible] use in this disease bitters & strengtheners are of use in weakness of the intestines attended with [illegible] as they [illegible] poison which [illegible] & strengthens the stomach 53 When the disease is regular & the patient strong bitters whd not be used. But if the disease returns irregularly is apt to infect the internal parts and the patient is weak the bark & bitters may be used to remove it but they in all these cases tend to encrease the melancholic temperament & their use is often attended with bad consequences [illegible] the Scotland, London Lect: 62d May 20th 1772 In such cases of gout where the disease has exhausted the patient the bark may be exhibited in small quantities from zis to ziii in 24 hours are mostly sufficient When the menstrua are obstructed from weakness, bark & bitters may be exhibited advantageously. Both species of [abrotonum] and absinthium contain a stimulating essential oil, they cannot be employ’d to take off the irritability of the habit, but to strengthen it. Wormwood, santonicum and sanacetum have been particularly employ’d to destroy worms in the intestines [illegible] poison these animalcula and at the same 54 time strengthen the intestines and enable them to digest and evacuate them. [Carduus] peridictus and cardina have been employ’d not only as strengtheners but as composers of the stomach in violent reaching infusion of chamomile has been used at the same intention these medicines when exhibited in large quantities excite vomiting. Chamomile has many of the same properties with the bark but has more of a purging power. The [illegible] of oranges lemons, [carass] apples etc. have an essential oil which renders them very agreeable to the stomach they have also a degree of astringency are often exhibited its other [illegible] on act. of their agreeable flavour. The lesser centaury & gentian are the purest bitters but they have no power of destroying the irritability of the [illegible] [wall] [that] [the] stomach & [strengthen] Hops are used only to preserve malt liquors but may deserve a place in the pharmacopia [Chamypotys] marebium chamedra [dictammus] albus, salvia & several others of the sedomamia contain besides their bitter & stimulating [illegible] 55 have been particularly employd in gout [where] we want to strengthen the stomach & prevent flatulency the astringent juice of these plants resemble that of the bark [illegible] has been particularly employ’d in the jaundice Preparations of iron besides their strengthening power have a considerable stimulus, they are next to the bark in their power of diminishing the irritability of the habit, but their stimulat renders them in many cases improper their calces shd be used, or else their salts in very weak solutions they stimulate the stomach also too powerfully Preparations of copper can be employ’d only to diminish the irritability, if not to strengthen the habit, have been particularly used to prevent the return of spasmodic diseases a calx of zinc has of late been employed at the same intention [illegible] & the flores zinci 56 57 Lect: 63d May 21st 1772 Remedies which weaken the system. Sedatives in as far as they act upon the system in general during the time of their action prevent the flow of the living power but they leave the parts as strong, or stronger after, than before their action. We have no medicine that will permanently diminish the flow of living power without it the same time diminishing the irritability of the system The only means we have of weakening the system is by exhausting the living power which we never wish to do permanently, but only with a view to cure some prevent disease which is worse & when this effect is produced & the habit freed of the disease it may soon be restored to its usual strength. If a patient be affected with pleurisy use bleeding & so weaken the system [while] taking off the strong action of the vessels of the pleura cures the disease but a small degree of weakness is left produced by the evacuation mode this however is not to be set in comparison with the danger the patient was subjected to from the original disease. 58 Weakness alone if free from other disease is generally soon got the better of therefore we do not hesitate weakening the system when we are to produce any good effect from it but if we weaken the system & any other disease to prevent we never can get rid of that weakness till the other disease be first removed such [illegible] then require much considerat. for all cases sedatives would be preferable to weakening remedies if they acted sufficiently powerfull. but as they are not we are oblidged in some cases to weaken it & the only method we know of producing the effect is by exhausting it. The first action of the living power is making the blood vessels contract, so as to adept themselves to the quantity of fluids they contain, the [illegible] empty the vessels then the more of the living power is spent in their contraction so that there is a smaller quantity of it to expend upon muscular power & the other functions of the body the system is therefore in some degree weakened by the extra quantity of living power of fluid so the action of the blood vessels for [illegible] is [illegible] as soon as the blood vessels [illegible] [illegible] [contract] upon their contents. 59 all evacuations tend to weaken emptying the blood vessels in whatever way but the effects of evacuations produced different ways are in some manner different When we evacuate by stimulating or relaxing any particular glands so as to make them secrete a larger quantity of fluids than usual the uniformity of the circulation is lost a particular quantity of it being drawn to the part, from which the evacuat. is made it becomes therefore languid in other parts When we make an immediate evacuation from the blood vessels it leaves the circulation uniform as before its use upon which account this evacuation is in general preferable to those made from particular glands The force that propells the blood out of a vessel when opened is exactly equal to the power with which the sides of the vessels contract & this may in every case be allowed because the force of the heart 60 This force is very considerable hence the blood flows out of an artery with very considerable rapidity. If a vein be open’d its ordinary force is not more than 1/16 of the arterial power, hence there must be an additional power [illegible] that of the heart & arteries when the vein is stopt IF the capillaries are opened the power with which blood is thrown into them is suffict. to make the blood flow out of them. The pressure of the weight of the atmosphere pressing upon other parts of the body forces the blood out of the capillaries where cupping glasses are apply’d By the general circulation of the vluids the blood is completely mixt hence the very same blood is taken away from particular part of the body & from whatever [order] of vessels the evacuation is made 61 The effects of quick & slow evacuation by bleeding are very different, because 1, 3, or 4 times the usual quantity of blood may sometimes be contained in the capillary vessels as in plain from examining the state of the [cornea] when natural & when inflamed when you take away a qy of blood suddenly you do not give time to the capillaries to contract but if the same quantity of blood be taken away slowly the capillaries have time to contract in the first case then the great vessels are principally evacuated. If blood be taken away suddenly the same quantity weakens much more than when taken away slowly. In most cases it has been recommended to make a large opening & from a large vein & this is generally the best [illegible] altho the reason was not well understood. If we wish to affect any particular part of the body we ought to evacuate from a particular part 62 Bleeding from a particular part seems to evacuate such part more than we should expect from any principles yet explained. The weakness communicated to the parts in the neighbourhood of those immediately evacuated does not depend upon any nervous or vascular communicat. betwixt the parts for parts supply’d by the same Trunks of nerves or vessels (if at a distance) are not affected which [illegible] qy neighboring parts to where the evacn is made are [the] [not] [illegible] the same nerves or blood vessels. Arteristomy dangerous & troublesome from the difficulty of stopping the bleeding hence never used in general but sometimes in [topical] bleeding has advantages as it cuts off the conveyance of blood to the part affected with the inflammation openings from large veins & those of the [illegible] are principally [pitched] upon when we want to make topical bleedings if there be any large vein running on the part it may be opened if not cupping or leeches may be apply’d to the part. Scarification is sometimes of particular use on account of [those] themselves occasion’d by two wounds as well as the evacuation made. 63 Leeches sometimes tho’ rarely contn a poisonous juice which occasions an inflammation of the erysipelatous kind but generally goes & is inoffensive. Lect: 64th May 22nd 1772 The quantity of blood that may be taken out of the body without destroying it has been much disputed by practitioners. Dr Hahls followers amongst the moderns & all the ancient physicians bled but in small Quantity others & in particular Boerhaave’s followers bled frequently in large quantities & in almost ever disease If we want to produce any effects upon the general system [&] [illegible] ounces of blood is in an adult that can be taken away, in very young children we more commonly employ leeches from the difficy of finding a vein for the lancet zi in very young children will produce a considerable effect in adults greatly emaciated as by hectic fever ziii will produce a considerable effect but it is but rarely that so small qy is of any service in adults. 64 A strong man will bear to loose 16 or 20 ounces of blood & it is better to take this away at once. some have thought qy a patient cannot bear to loose blood more than 3 or 4 times but Dr. Fordyce instances one case where 112 ounces were taken away in 3 days time with advantage the suddener the evacuat. the better as it produces a greater temporary weakness In bleeding regard ought to be had to the size of the patient to the disposition of his vessels to contract & to the quantity of blood they contain. The evacuat. may be made [fitt] the patient faints in many case there being no instances where the patient has died from loosing this quantity. In inflamat. there is an encreased actn of the arteries in the part inflamed which propelling the fluids the more force into the capillaries distend them beyond their tone & this distension of [illegible] stimulates the arteries & so keeps up the inflamation. In some inflamation sit is the distensn of the small vessels [purely] that keeps up the action of the arteries this is the case in phlegmonous inflamation. Another species of inflamation is when the small vessels are so very irritable that a moderate distension of the vessels will stimulate them and keep up the action of two arteries this we call erysipelatous inflamation 65 Inflamatn sometimes kept up by the stimulus apply’d to irritable surfaces as do sometimes of the internal parts that are subject to inflamtn from the stimulus of the salts contained in the fluids secreted upon them or the surfaces of ulcers that are inflamed from the same cause. When the habit is weak there is a disposition in some particular part to have its vessels act more strongly than natural which disposition bleeding encreases by further weakening the system Hardness of the pulse is the most certain symptoms [illegible] general & phlegmonous inflamatn frequency & smallness of [illegible] Bleeding is usefull in phlegmonous inflamatn only in erysipelas it increases the irritability of the part, in inflamat. from the mucous membrane being irritated by secretions it also tends to encrease the tendency of such membrane to be affected by the stimulus if the inflamatn be mixt of the phlegmonous & erysipelatous kind of bleeding be [and] [it] opens not only relieves [illegible] but the symptoms of irritat. also depending upon the erysipelas. Bleeding a very powerfull means of removg phlegmonous inflamatn to be remembered that its good effects may be instantaneous, but this seldom happens & we by bleeding only make the inflamatn begin to give way & it of itself continues to go off. In phlegmonous inflamatn the more the general system is affected, the more certain is the effects of this operatn & the greater & more suddenly [illegible] weakness of the system is produced the more it benefits. 66 If the system be but little affected evacuat. from the part is more usefull than general Evacuatn [illegible] are thus, more immediately evacuate the part affected Bleeding from the part affected was much practised by the antients, untill the circulat. of the blood was discovered when it fell into disrepute, but in many cases is of the greatest use when your evacuat. is of no service we could hardly expect this a [illegible] but experience conforms the propriety of the practice. In general inflamatn the sooner the evacuatn is made & in the larger quantity the more effectual it is in taking off the encreased actions of the vessels this depends partly upon the effect of habit when the vessels have been used to act strongly for any considerable time they acquire a disposition of continuing this encreas’d action, even after the cause that first produced it is removed The sooner then we empty the vessels the less danger there is of their beginning this habit. Our anxiety in carrying off inflammation by bleeding should be more or less according to the consequence that may arise, from suppuratn of the part affected the natural [cure] should also be considered if the part affected has a natural [cure] which is going on we shd be less anxious about bleeding. 67 Lect: 65th May 23d 1772. When the heart & arteries are acting strongly when the pulse is hard, strong & frequent, bleeding is the most effectual way of carrying off this inflamatn & is equally so from whatever cause it may arise provided it be the only disease in fevers in rheumatism an encreas’d action of the heart & arteries tend to carry off the disease but in fever it is not the only disease [illegible] arterial action & used shd be cautious of diminishing the quantity of blood as we may take away the strength which is necessary to carry him through the disease, in rheumatism the natural cure is worse than the disease it should always be prevented there from taking place by diminishing the arterial action by bleeding In the small pox we shd be cautious of bleeding during maturation (least the pustules sink) unless the symptoms of inflamtn runs extremely high so as greatly to endanger the patient life this evacuation should not be made. In chronic general inflamatn where the arteries only act strongly without strong action of the heart & the pulse is hard, small & contracted & not full, and strong in this case bleeding is not nigh so [illegible] & if we do bleed it should be made in small quantities & often repeated [singular] [illegible] tending to diminish the genl strength but not the encreas’d arterl action 68 One case in which copious bleeding is usefull when the pulse is small & contracted with great depression of strength which is when an irritable surface is affected with general inflamatn so the diaphragm or intestines in these cases the depression [illegible] strength & symptoms of irritation are very great yet the pulse is still to be felt hard & bleeding is the only thing we can depend upon for the cure. IN all cases of spontaneous haemorrage with symptoms of plethora & inflamation. Bleeding may be used advantageously & is the only [best] way of putting a stop to & curing the disease. If haemorrhage takes place in weak habit from relaxation, bleeding is in such cases always hurtfull & bark with strengtheners should be used for to cure the disease. If [illegible] arises from encreased arterial action bleeding is of great use in stopping it. Bleeding is often employ’d in the cure of fevers but it has not the least tendency to cure a fever only takes off the strong action of the vessels should never be used unless there by symptoms of general inflamation, as it will most certainly hurt if the disease does not soon terminate the crisis It may be used as the beginning of fever before symptoms of inflamatn take place when from too great quantity of blood the vessel cannot act sufficiently upon it in consequence the secretions & functions of the body are imperfectly performed & the disease prevented from [illegible] its regular type by bleeding in such [case] [are] often change a continued into an intermitting fever [69] In young women spasmodic & hysteric diseases sometimes proceed from plethora in which case we should evacuate before the use of antispasmodic & remedies diminishing the irritability of the system. In [plethoria] & robust habits we should never exhibit the bark till evacuations be [premised] as this medium in such cases at the same time that it diminishes the irritability of the system encreases the action of the heart & arteries [illegible] producing general inflamatn etc. The gout has all the appearance of an inflamaty disease when it arises in a man of a sanguineous melancholic temperament in such a habit when the symptoms of inflamatn run very high we may bleed with advantage, but in general we should be very cautious of bleeding in this disease as it often makes the gout seize the internal parts as the stomach [illegible] and so may render it suddenly fatal when it otherwise would not be attended with any great danger. Lect: 66th May 25th 1772 The classes of [illegible] already treated of we might suppose to exist a [illegible] [illegible] stimulants, astringts relaxts strengts etc but the [illegible] [illegible] we could not imagine to [illegible] [illegible] from [Expuriema[ [illegible] antispasmodics & narcotics. Antispasmodics are medicines tending to remove all preternatural contractions & actions of the moving parts. 70 There are some preternatl actions which antispamodic remedies have not a power or removing. Diseases were distinguished into such as arose from some particular matter in the system & such as arose from preternatl action of the difft parts only the latter were call spasmodic diseases, but many of the former do not depend upon any matter at least that is sensible to us we therefore deny its existence & yet in these diseases antispasmodic remedies are not usefull, but often improper. Diseases have been called spasmodic when they went through their course irregularly, all involuntary & irregular muscular contractions are called spasms All antispasmodic medicines are stimulants and when they do not exert their antispasmodic they exert their stimulant power, are therefore very uncertain in their operations although they cannot always take of diseases that are more fixt yet they tend in many cases to remove it. Vol: alkali has been employed in inflamat. of the thorax, where by its antispasmodic power it has sometimes been of use but much oftener hurtfull & should never be employed [71] in phlegmonous inflamatn of any kind if exhibited in peripneumony attended with inflamatn of the lungs they are hurtfull but in coughs arising in winter merely from the contind applicatn of cold without any particular inflamt taking place they are of service. Antisp are [sometime] apply’d externally are much more usefull & in deep seated inflamtn they are the most proper & efficacious stimulants, externally apply’d they are very properly apply’d with fomentations & poultices which we wish to act as emollients if joined with these they greatly assist their efficacy. They have a tendency to cure fevers & will sometimes carry off fever entirely but they are much oftener ineffectual & almost always do mischief when they are not serviceable we do not employ them in the beginning, but towards the end of continued fevers camphor in particular has been employ’d but without any great efficacy. Antispamodics have been used in intermitt. during the intermission to prevent the return of the paroxysm Much in particular has been thus employ’d & sometimes with success, they shd be exhibited in pretty large quantities & may be properly joined with narcotics as we cannot depend much upon them alone. In Rheumatism where stimulants cannot be advantageously used by antisp: are improper also but where stimulants are proper, those of the antispasmodic class s [72] should always be preferred guaiacum and volatile alkali are the best and have often been used with considerable success Antisp: have sometimes been employed with success to [procure] sleep when opium could not [illegible] exhibited [illegible] [illegible] liquor in part In spasmodic complaints they are often very powerfull in removing the disease when present, but have very little tendency to remove the disposition of falling into the disease but by encreasing the irritability of the habit often render it more susceptible of the disease & therefore encrease it rendering the paroxysms more frequent are most efficacious when externally apply’d. In other cases they have a tendency if exhibited in the interval of the paroxysms of spasmodic diseases to carry it off entirely & cure the disease whilst if exhibited in their case curing the presence or immediately before the attack of the paroxysm they have very little or no good effects. The effects seemingly so contradictory depend upon the particular habit of the patient if the patient be of a weak & irritable habit they by encreasing this dispositn do mischief but are more immedy efficaceous if exhibited during the paroxysm [illegible] be of a plethoria & [illegible] habit their effects are not so sudden but more usefull. In Hysteric complaints the habit is always weak & irritable antispasmodics then have almost always a tendency to carry off the paroxysm if exhibited during its attack, but if they are exhibited in the present case during the intermissions of the paroxysms by encreasing the irritability they encrease the [tendency] to the disease and so do mischief. The effects of antispasmodics in hysteric diseases are more uncertain than any other medicines if exhibited at the attack or during a paroxysm they sometimes instantly carry it off whilst at other times in circumstances exactly similar they produce no good effects. In perfect epilepsy & convulsion fitts they have very little efficacy if exhibited internally but are more frequently usefull externally apply’d particularly in convulsions & in spasmodic diseases having sometimes a tendency to curing them [illegible] particularly or return periodically shd be [illegible] internally & during the intermission of the paroxysms. No medicine is always successful in epilepsy the convulsive fitts and their similar diseases often baffling our utmost efforts antispasmodics however seem to be as efficaceous more as than any others.’ In the tetanus antispasmodics have neither been employ’d internally n or externally with any very general success altho’ the disease has bone off during the exhibition of opiates & antispasmodics in some instances as musk, opium etc yet the disease in such cases seems to have gone through its natural course rather than to have been cured by the medicines exhibited In the risus sardonicus, hiccup & others of the same kind antispasmodics have been sometimes exhibited with great success, and at other times with none their effects as in hysterical disorders being very uncertain. In cathartics in place of the proper pain & muscular & contraction necessary for expelling the fetus, unnatural pain sometimes take place in such cases antispasmodics have often been exhibited with good success they tending to take off the unnatural & tending to restore the natural muscular contractions & labour pains that are necessary for the expulsion of the child. 70 Fever, inflamation, & rheumatism are preternatural actions of the vessels which do not depend upon any matter in the habit, yet we do not call these spasmodic diseases. Spasmodic diseases are principally known by their coming on without any apparent cause and having no natural cure that we know of Animal [illegible] have generally an effect to produce spasms in difft parts of the body and these medicines seem to be of more general are in such cases than in any other complaints in which they have yet been used. Containing the lectures from No 45, to No 66. Materia Medica by Dr Fordyce No 4. Materia Medica Index Page No Particular sedatives 1 Effects of astringents 4 Action of particular [illegible] 8 general effects of relaxants 19 Particular relaxants [23] Strengtheners 30 Effects of the bark bitters etc. 39 Means of weakening the system 57 Effects of evacuation by bleeding 61 general effects of antispasmodics 69 1 Lect. 45th Sedatives Acids eternally apply’d are powerfully sedative. seem to be equally so, whatever once we use provided they be of the same strength If [so] concentrated they act as stimts Out taste is perhaps the best criterion of judging, the vinegar shd be the standard for diluting them. Acids are usefull as sedatives in all cases of deep seated inflams as in those accompanying fractures dislocations strains In erysipelatous the inflam of the skin [&] integuments they are improper They are very usefull as gargles in infl. of the mouth & throat Neutral salts are somewhat sedative externally employ’d Alcohol a powerfull sedative somewhat astringt but not stimulant is very usefull in erysipelatous inflam as those arising from burns, the bites of poisonous insects etc. provided it can 2 be apply’d before a blister is raised if pure it acts too powerfully as an astringt it shd be diluted then 2, 3, 4, or 5 times its quantity of water It has been disputed whether sedative or relaxing oily medicines were most usefull in burns, sedatives seem most proper in slight cases. All metallic salts are sedative when diluted with water & particularly usefull in inflam of the eyes the chief of these are white, blue vitriol & sacchar. saturni these are more proper in chronic, than in acute [illegible] of the eyes. Preparations of lead are seldom usefull in phlegm: inflam: they sometimes [illegible] or [illegible] & mortifict. [illegible] hazardous in [illegible] attended with great pain they have not this disposition. In excoriations preparats of lead are apply’d with propriety, particularly 3 [cerasse], as also lapis caluminaris & alum. this last is particularly usefull in inflam of the eyes, mouth, & throat. Prep of alum when apply’d to the eye have a disposit. to coagulate its humours [illegible] renders it necessary to be changed frequently. Alum [illegible] made with the white of an egg shd be changed every ¼ of an hour. All the vegetable astringents have been apply’d as sedatives, particularly the [certicosa] of Lineus. Some of the farinaceous seeds as [illegible] have been apply d as sedatives particularly in erysip. inflam. Lastly, opium & poppies are [illegible] sedatives and may be apply’d externally in all inflam. with success particularly of the [???table] parts 4 5 the contract. produced in animal fibre by astringts differ from that produced by the living power in that the water [illegible] combined is in the former seperated & cannot be recombined. The blood vessels are allways full of blood, an astringt. then can only make the vessels press more strongly upon their contain’d fluids, but can’t make them diminish in diameter but in proport. as they are emptied of blood, by larger [illegible] Astringents do not act equally upon all the blood vessels but act more powerfully upon the small & accumulate the blood of course in the great vessels Astringents may act more partict. upon the external, or internal vessels in which case the opposite set are dilated The actn of astringents upon the muscular fibres is permanent, whilst that of its acting upon the living power is temporary. 6 Astringents differ, in some of their acting parts or solely upon the part to which they are apply’d whilst others more universally upon the whole system these later have their actn of shorter continuance than the former they act upon partr parts. Astringts are strengtheners in consequence of their power of accumulate the blood in the greater & internal vesls the strength of the patient being always in proport. to the [qy] of blood contained in the greater vessels It is [illegible] holds good only a certain length, as astringts may be used so as to produce weakness when used to excess They may be used with advantage in restoring the tone to muscular fibres that have been relaxed or weaken’d by over act. hence they are usefull in strains [illegible] after the inflam: is gone When any of the glandr secretions are increased they stop or diminish them in quantity. they also diminish the natl secretn but we never use them so 7 Precautions on the use of astringts in increased secretions If there is inflamatn [illegible] secret. is the natural cure in place of stoppg. such secret rather promote it, to carry off the phlegmonous inflamat. of [illegible] part is increas’d secret. may be in conseq. of a stimulus applied. if we stop the increased secret. whilst the stimuli remains inflammatn is produced. The immedt. cause of secretion is a quantity of blood in the glands of the [part] in conseq. of the contract. of some distant part. was there not to be increased secret. inflamatn would be produced. before we cure such secret. by astringts we must take away a qy of blood from the part by relaxants. in watry secretns. where there appears to be no phlegm inflam. we may use astringt properly if there shd be sympt of plegm: inflam we shd avoid astringents untill the 8 increased secret. has carried off the inflamatn. [illegible] as to the use of astringents we shd evacuate the feces contain’d in the intestines. In secretions from the urethra produced by the applict. of [illegible] matter it is questioned whether astringents are proper. In increas’d secretns from the bladder we use remedies to take off the [illegible] of the habit, as the use of astringts wd be of little use there being a const. stimulus from the urine In haemorages we used sedative asts: In hamorages from the gums astrts are of great use. Of particular astringents [Fossils] astringents act on the system Vegtle astringts act for a longer time, [boles] are compds of calx of iron & clay their activity depends upon the iron. 9 Calcaresur earth has some slight astringency & may be exhibited in diarrhea with out any danger of increasing inflamat. Boles have become employ’d in bruises when the inflamatn has been previously removed they have been used in purgings but have no great efficacy. Alum is a powerfull astringent but we shd give it in such a form as to be certain of the dose. Lect: 48th May 4th 1772. Boles acquire difft colours as red, blue etc. from the calces of iron particularly with which it is mixt hence the [illegible], common bole & they have been advantageously externally employ’d in form of plaisters to restore the tone to relaxed muscular fibres. some of them as the lapis hibernicus contain a considerable portion of alum in their composition, but alum is exhibited alone with much greater propriety & certainty in the dose. 10 Alum is formed naturally by clay being mixt with pyrites which being decomposed the v: acid unites with the clay forming this earthy salt alum as thus formed generally contains a superfluous quantity of acid which may be [separated] from it together with a quantity of water contained in its crystals by exposure to heat the burnt alum is thus prepared differing from common alum only in being more active from the quantity of water evaporated The best mode of exhibiting alum seems to be by forming a whey of sweet milk which may be drunk the sugar & mucilage contained in the milk in some measure covers its taste, and renders it less disagreeable Iron has been employ’d with the vitriolic acid forming green vitriol, with the muriatic acid forming [illegible] [illegible] in spt salis and with sal ammoniae sublimed forming the flores martiales 11 The calces of iron and the flores martiales have greater astringency, and less stimulus than the neutral preperations with the acids Iron has sometimes been used as an astringent in diarrhoeas [its] calces particularly, as already noticed, in the different boles 12 Iron has astringency, but its power as an astring. is mixt with a strengthening & irritat power hence its uses in the chlorosis, fluor albus [illegible] Iron is always dissolved in the acids of the stomach so that it may be used in its metallic form with propriety. it is filed down. if the filings are of a large size they do not act powerfully [qty] if fine, will be as effectual as [qy x] [illegible] it may be rendered still more active by restoring it from its calcin’d state by exposing it to heat in a crucible with [flower] we then obtain it in a very fine powder mixt with the charcoal of the flower, all its difft calces are active It is employ’d externally in boles and 13 When combin’d with acids it is more active we use 3. [illegible] with vitl acid green vitriol & mur. acid The mart. in spt solis, [illegible] tartar by digestn in wine. Iron has been exhibited mixt with alkalis as in the flor. martiales. It has been exhibited combined with sulphur but is unactive the sulphur rendering a mild & inefficacious Lect 49th May 5th 1772 Lead seldom used as an astringt. generally as a sedative, can seldom be used, to stop internal increas’d secretions from its dispositn to [illegible] in paralytic weakness of the intestines. Zinc has been seldom used internally & then not as an astringt has been used externaly as such, never used in its metallic form, found in the earth calcined [illegible] lapis calaminas found in the earth exceedingly hard must be reduced to a fine powder by exposure to a red heat for some [time] & then powder it. It has been internally employ’d as an emetic its ore has been much in use externally for [illegible] as an [astgt] 14 when zinc is exposed to a red heat it puts on the appearance of burning and emits a very fine white powder a form of fumes, this called flowers of zinc. [illegible] or cadmia another calx formed from its combination with copper. all these calces are the same qy [cadonia] is procured in the soap manufactories, is more soluble in water than [illegible] White vit. formed by exposing [pyrites] mixt with calamine to the air. the vitc acid contain’d in the pyrites unites with the zinc the salt is seldom pure, but have a little vitriol of the iron or copper mixt. shd be dissolved in water, & crystalised then called [illegible] of vitriol preparation of zinc have an astringency that renders them very usefull, particularly for making the skin grow upon excoriatn & ulcers. Astringt. juice contained in a variety of vegetables, and it seems to be nearly the same in what ever one we find it. Agrimony etc. have been very properly used in fomentations of erysip. inflamt. act here as sedatives. [illegible] have been used for the eyes not very powerfull their flavour part recommends them Radix tormintilla has been used as an astrin: in dysenteries 15 Rhubarb has a [illegible] of astringency, but small, when compared with its purgative qy the purgative power may be extracted by infusion in water & the astringency aft. The husks of all red fruit contain more or less of an astringent juice. The [Viscus] [Queronas] contains the astringency of the tree, upon which it grows Uva ursi has been lately employ’d in cases of the stone in the bladder inefficacious [illegible] Japonica & sanguis draconis two resinous bodies, mixt with an astringt. juice of a red colour, obtained from trees unknown operate quickly & universally principally usefull in hemorages, may be properly combin’d with alum in this [illegible] & under its effects more lasting may be used in substance advantageously. Lect: 50th May 6th 1772. Narcotics act also as astringents, Acids and salts as astringents & sedatives. 16 17 The action of the relaxants is not so obvious to the senses as that of astringents, hence some have thought that the effects produced by them were produced in some manner difft. In inflamat. of the intestines when the rectum in contracted so that no stools can be procured nor glysters injected by the applic. of the [semicup???] or warm baths we can remove these contractions so that injections can be easily thrown in. when the urethra is contracted so that a suppression of urine is produced & the catheter cannot be introduced by fomentg the parts affected we take off these strictures hence we see that certain substances properly come under this class. Lect: 50th May 7th 1772 The terra japonica sang: draconis are sometimes used in dysenteries, the bark of the wild ash employ’d rather to take off the irritability of the system. The cortex granatorum does not act so quickly, but is more permanent in its action. 18 Oak bark contains a pretty powerfull astringt juice, is employ’d advantageously in fomentations of weak & [relax’d] [illegible] The semirabia has a difft kind of astringency from most others seems to act solely on the part to which it is apply’d [illegible] that astringt taste chiefly used in dysenteries & gleets where the system is greatly relaxed. The logwood is pretty powerfully astringt employ’d mostly in dysenteric cases its astringency similar to that of the other vegetable astringents acts universally ¬ like the semirabia The most powerfully veget: astringent is the juice of the oak collected by certain insects as the galls are employ’d advantageously in gleets, flour albus, & [illegibles] of every kind may be externally used in relaxation of the ligaments & cannot be employed in substance may be extracted by spts or water shd be used in decoctions, or infusion 19 Lect: 51st May 7th 1772 Relaxants are medicines that diminish contractions of the moving parts. As astringents do not decrease so relaxants do not increase the diameter of all the blood vessels their action is not equal but ore determined to the small than the great vessels Relaxants by encreasing the diameter of the small vessels the external particularly and encreasing the quantity of blood in them, have been supposed to act as stimulants. By encreasing the secretions they have been considered as [attenuants]. By diminishing inflamatn. they have been considered as sedatives Relaxants are powerfull remedies in fevers more so than any other class in counteracting & carrying off fever. Fever is always attended with [illegible] perhaps principally occasion’d by contraction of the small vessels, as these med: [counter???] this dispositn they become very efficacious in curing this disease [illegible] fever they are most usefull in the beginning may be [harmfull] in the end of fevers when the [patient] [is] become very weak 20 The addition of stimulants & opiates very much assists their operation in fevers Relaxants act very powerfully in carrying of the first symptoms of fever upon its attack & so preventing it farther encreased. Relaxants cannot be apply’d with propriety where there is a great degree of inflamatn untill it be taken off by evacuations also the heat occasion’d by their operat. encreases the inflammation. At the end of fevers when symptoms of weakness come on to a dangerous degree, they be encreasing the secretn. encrease the weakness be encreasing without any diminution of the fever. If relaxants are of use they generaly produce their good effects in [illegible] hours if they have no good effects or that time they should be discontinued. The first dose shd generally be given in quantity to prove emetic. In general inflamat. by relaxing the vessels they take off in some measure their pressure upon the blood and so are of use. Relaxants are also of very considerable use in intermittent fevers they tending to procure a perfect intermission & to remove the febrile symptoms that often remain after the terminat. of the paroxysm, also to prevent the attack of the cold fitt, are assisted by stimts & opiates. 21 Lect: 52nd May 8th 1772 Relaxants apply’d internally are more powerfull in carrying off internal than external inflamations, as they throw the blood upon the external parts & this is from whether the inflamation be of the phlegomonous kind or of some of the internal mucous membranes, the presence of general inflammation however forbids their use in this, as well as in all other cases, have been considered as particularly usefull in inflamations of the thorax. Relaxants are of very great use in all encreased glandular secretions particularly the internal as they, by throwing the circulation principally upon the [skin] and external parts cause less blood to be convey’d to the glands & greatly encreased the cutaneous [secretion] Rheumatisms are attended with general inflamation they tend immediately to carry off the contraction that takes place in the part affected with disease. but if general inflamation be present they should not be employ’d until it be got rid of They are also of use in carrying off spasmodic contractions when they take place. 22 23 Relaxants are of use in rheumatism but if the general inflamatn. is very great their operation is attended with danger. In spasmodic affections of the ureters urethra gall bladder and even intestinal canal. they are of great use when externally apply’d, and also when thrown into the rectum & colon. In muscular constitutions they are not so efficacious, but have been used sometimes even in these success In cutaneous eruptions depending upon dryness of the [sear] of skin they may often be used with success; so as to cure the disease Lect: 53d May 9th 1772 Action of particular relaxants I Neutral salts They have in general some degree of relaxant power, some more aft to act upon the stomachs, whilst others pass into the intestines & purge, [nitrus] digestiva salt of sylvius sal ammoniac & vitriol: tartar act more particularly upon the stomach. these have seen more [illegible] than the others as relaxants 24 No class of medicines has been more universally used than these salts, they were unknown to the ancients: from their ignorance in chemistry from the [illegible] or [illegible] [illegible] has got various names operatn by which it is procured. Surprising? that medicines of so little efficacy could be so much commended. there being hardly one case in which N:S: can be of any use & they in in case act as powerfull remedies, not withstandg the general use of these medicines in the present practice perfect intermissions of fevers are hot they are sometimes of used in [illegible] sufficiently powerfull to produce any bad effects. Dr. Fordyce attributes the use of N:S: to their disagreeable taste from which the patient supposes they must be efficacious. Some very powerfull applications require a considerable time to operate before they produce any sensible effects. hence inflamatory disorders after bleeding the patient largely, & exhibiting nitre afterward, the cure is attributed to the nitre, which in reality belongs to the operation of bleeding. Dr. F. wishes to make strong preparations on his pupils of the inefficacy of these Medicines, in order that they may not be depended upon, where active medicines may be used with advantage. 25 Neutral salts tho’ not powerfull relaxts sedatives, no [alterants] are yet very usefull purgatives, stimulating the glands of the intestines solely & producing an encreased secretion from these parts. Ipecacuanha Is the part of an America plant brought over dry, and may be preserved so, for a very considerable length of time like [illegible] depend upon a juice soluble in water or in spt of wine & water is [illegible] however (in most cases) used in [illegible] Has been principally used as an emetic, has a specific stimulus to the stomach, so much that, if its juice be injected into the blood vessels, or absorpt. it acts upon the stomach & proves emetic, hence it is more certain in its operatn as an emetic than any other. If given in smaller doses than to prove emetic it acts powerfully as a relaxant most stomachs will bear gr i some gr ii but few others cannot bear more than gr. fs with out producing sickness has been exhibited in dysenteric purgings often [alongst] with opium in which case it becomes powerfully sudorific & the stomach will bear a larger part of both med: when combin’d than when given alone has been successfully used in chronic rheumatism with [illegible] 26 Scilla with root of a plant is of the natural class called [lilliana] acts only as a partial stimulus Besides their power of encreasing the glandular secretions they have also a relaxant power this most being bulbous & acting cannot be well used in [subst.] unless dried in which case it loses somewhat of its efficacy shd be cut in thin transverse slices & slowly dried [illegible] shd begin with small doses. Aconitum has been consider’d as poisonous not lately employ’d in med: its virtues depend upon a juice not volatile & soluble in water it may be used then in form of an extract. Has been considered as a poison but introduced by [illegible] stork seems to act pretty powerfully as a relaxants [illegible] dose of it extremely small, we shd begin with 1/8 part of a grain which may be gradually encreased till it produces sickness has sometimes been used with success in obstinate rheumatism Lect: 54th May 11th 1772 Seneka the root of an American plant [illegible] from being knotted was suppos’d to resemble the tail of a rattle-snake, & to be usefull in the bit of that animal, the juice upon which its virtues depend is soluble in water & has thence commonly been used in [illegible] very disagreeable taste, occasions a heat in which the act. has been sometimes used in diseases of the lungs, in rheumatisms & cutaneous eruptions with success. 27 Cold water was employ’d in fever as a relaxant by the ancients & sometimes with considerable effect, but has not been used of late, it seems to be of no great consequence whether cold or hot water be drank in acute diseases. when cold water has acted as a relaxant it has been used in very large doses two or three quarts of this fluid having been thrown into the stomach acts sometimes both as a purgative & emetic & sometimes as a relaxant, & so has carried off the fever according to the accounts. Antimony No medicine has been subjected to more operations than this metal & yet the preperations of it in use are very few Regulus of antimony is found combined with sulphur & sometimes also the regulus of arsenic each however are very rare & easily discoverable by the redness of their colour. Regulus of antimony is very easy of fusion & may therefore be seperated by exposure to a small heat from the [stony] impurities with which it is mixt the metal 28 when melted is thrown into conical moulds inverted & the qy of [illegible] sulphur being greater than what united chemically with the regulus the later being heaver than the former subsides hence the apex of the cone is a purer regulus containing less sulphur than the base of the cake does. If we apply about 3 or 4 times the qy of [illegible] alkali it unites with the sulphur forming a hepar sulphuris which dissolves the regulus of the metal from which it may be precipitated or iron may be used it [affecting] the sulphur more powerfully than the antimony & no part of it making [illegible] the pure regulus Filings of iron [then] as to be mixt with antimony & the whole expos’d to fire. or a part of the sulphur may be destroy’d by deflagration with nitre if we add equal parts of nitre & any fixt alkali Another method of procuring the regulus for medl purposes is by uniting it [illegible] kali so as to make a hepar s. Regulus of antimony has been exhibited as a purgative in form of a pill called the [perpate] pill has seldom been given in powder in a [??gative] form except sulphur [illegible] antim: & [illegible] mineral Two of its calces have been used by exposure to the air & [illegible] only it thus forms a white powder this operatn is assisted by [illegible] between shavings or [illegible] or by deflagratn which nitre as 3 parts of [illegible] to 1 of [sul.] thrown into a red hot crucible 29 it has been used nitrified it has been combined with vit: & nit: acid but is [uncertain] been [illegible] by water. it has been combin’d with mur. acid [illegible] butter of antimony & [marmurius] [vita] has been combin’d with [illegible] tartar emetic the most certain in [illegible] Lect: 55th May 12th 1772 Preparations of antimony may be considered under 2 heads 1. such salts as are soluble in the watry juices of the stomach these are always certain in their operation therefore preferable to [them] 2. class whose action depend upon their solution in certain salts in the stomach which may vary according to the quantity of these salts [illegible] are therefore uncertain in their operation. There are none of the preperations of antimony so perfect as we could wish all metallic preperations soluble in watry fluids stimulate the stomach strongly & are more apt to act as simple stimulants than to produce their peculiar effects antomonls are also subject to this inconvenience. Antimonials are by much the most powerfull relaxants, & may properly be used in fevers & every other case where this class of medicines is proper & usefull the class of relaxants upon which we can must depend. Crude antimony & its calces are mostly inactive the [green] metallarum & glass of antimony are very uncertain in their [illegible] [illegible] [tartar] & [tincture] of antimony a combinat. of the regulus & hepar sulphuris [are] the only preparats [of] salts which are [active] 30 Relaxants are very usefull in internal inflamations & rheumatisms, such cases excepted when there is a great degree of general inflamation in which cases the genl inflamatn must be first be got rid of before we [illegible] to use them. In inflam: of the mucus membranes as catarrh, erysipelat. sore throat, diarrhoea & dysentery they ay be successfully employ’d, also [illegible] for encreased secretions & [catarcous] eruptions they are used with success. In internal haemorrhages they have often been exhibited successfully May have [illegible] been used in increas’d secretons from the urinary passages Strengtheners such remedies as [given] [contracting] [illegible] render them capable of [illegible] with a greater force differ from stimulants the [illegible] putting this power into action [illegible] also from astringts The strength & weakness of the system do not consist in the action, but in the capacity or incapacity to exert a great degree of power, although the power of the body be finite yet we might suppose the exertion of this power to be definite in some manner as a magnet will lift & suspend a certain piece of iron for any length of time. this is not the case, for the body after exerting its power for a certain length of time looses the capacity of continuing such exertion but has it restored again by rest of the parts. 31 We may say then that there is a flow of living power into the body which may be accumulated so as to act more strongly or by the exertion of this power it may be wasted & exhausted. Tho’ we don’t suppose there is any fluid running out, or into the body yet we may compare the accumulation of the living power to a dam of water gradually collected from a small rivulet which although incapable of turning a mill of itself yet when gather’d and collected in a body is capable for a length of time of producing this effect but the water which was collected being in time exhausted the mill can be no longer driven round till a quantity is re collected The body may be strengthen’d 2 ways 1 by preventing the waste of the living power (to carry on the simile) as by stopping up the dam, to prevent the water running out, or 2d By encreasing the flow of this living power into the body [illegible] by encreasing the stream of water into the dam. The flow of living power may be principally exerted in one part or another thus a dancing masters legs grow strong whilst the arms of a blacksmith grow strong also by exercise of these particular parts. 32 Strengthening remedies then are such as prevent the exertion of the living power or such as encrease the flow of it into the general system. they differ then in their action from stimulants etc. Lect: 56th May 15th 1772. The first action of the living power is to contract the blood vessels so as to adapt them to their contents if there be only a small quantity of blood in the vessels the greater exertion of the living power is requisite to produce this effect, hence nourishing foods, by filling the vessels with blood become strengthening remedies. It is not [suffict] though that food be thrown into the stomach but its quantity & quality must be adapted to the powers of injection & other circumstances. Food easy of digestion does not afford so much nourishment to a strong as to a weak stomach it being too soon thrown out of the former. 33 When the blood vessels have no great disposition to contract, but are forced to contract powerfully form the small quants of blood they contain in these cases the stomach digests well & the appetite is keen on the contrary when the vessels have a vary great disposition to contract not from this small quantity of blood contain’d in them. as inn the case in hectic fever in this case the stomach looses its powers & then appetite is lost. Nature then seems to adapt the appetite & digestive powers to the particular circumstances of the patient’s health & food is loath’d and rejected in cases where it would be unnecessary & hurtfull. Second method of strengthening the system is by applying cold to the body or living in a cold atmosphere In a cold climate the external vessels are contracted & the blood kept in the large vessels about the precordia upon which circumstance the strength of the body seems in a great measure to depend for when the circulatn is principally carried on in the external & not internal parts of the body the strength is diminished as is the case in warm climates. hence change from a warm to a colder climate 34 powerfully strengthens the system we shd only observe that the transition shd not be too sudden else the blood by being suddenly forced into the internal larger vessels it stimulates the body too powerfully & produces disease the [illegible] of the [illegible] jointly consider’d is always nearly the same & variety of [illegible] [the] [body] being subject to is extremely little In temperate climates the habit is greatly debilitated during the summer season whilst it is strengthened by the winter hence in the spring the diseases are mostly of the inflammatory kind whilst the autumnal are attended with weakness & depression of strength. Cold suddenly apply’d as in the cold bath has a very difft effect in this case the blood is suddenly thrown from the external to the internal blood vessels. the cold being removed the contractn of the external vessels does not continue but the large vessels acting powerfully, force the blood upon the external surface of the body hence that [glow] & heat that suddenly take place after using the cold bath. This sudden distribution of the blood through the small’ vessels of the external parts is very powerfull in removing obstructions of the external capillaries 35 Living in a pure atmosphere is another powerfull means of strengthening the system this seems to be affected by the living power being prevented from being exhausted. If the [illegible] of an animal be tied up he becomes gradually weak untill he dies if only a small quantity of air be allowed him he gradually becomes weaker & weaker the very same bakes place in the air of large towns a sense of [oppressn] & weight is felt about the precordia which is immedtly removed by the country air. Running water takes up fixible air, & other putrid effluvia hence an air saturated near running water is pure & wholesome whilst that in the situatn of stagnating water is the contrary from the putrefaction of the water etc. Exposure to continental as the [illegible] & N:E: winds renders the situation unhealthy in some measure, although the air is [denser] in these winds than any others yet if there be the smallest disposition to disease they are the means of producing them 36 Astringents given in small quantities strengthen in large quantities may weaken the system, they act more powerfully [upon the] small than great vessels & differ much from strengtheners Lect: 57th May 12th 1772 2d class act by increasing the flow of living power into the system Exercise having a tendency to draw the action of the living power from the vessels to the muscles has a very good effect in strengthening the habit in order to render exercise efficacious in strengthening the system it should be moderate according to the strength of the patient the exercise should be such as employs all the muscles of the body Riding on horse back, in a carriage, rowing, fencing etc. are of great use, riding in a carriage upon rough roads is disagreeble to the mind producing sensations of fear is therefore hurtfull Exercise should be agreeable and there should always if possible be some object in view besides the health the great use of mineral waters depends more upon the exercise and amusement 37 enjoy’d at those bublick places than any particular quality the waters possess The exercise should allways be in a pure air, if the air be impure the exercise encreases the weakness in place of strengthening hence exercise in close rooms do mischief Certain remedies as bitter vegetables substances tend to encrease the flow of living power into the body vegetable bitters differ considerably however in their properties the pure bitter is very probably the same in all of them The syngenesia of Linneus or those plants with double flowers as the lettuce, dandelion, endive etc. contain a white bitter juice which flows out like milk and resembles opium in its properties, others as the [abrotenum] mas, et [illegible] [tanecetum] etc. have a stimulating essential oil mixt with their bitter, whilst the chamomile contains a purgative as well as a bitter juice 38 The same bitter juice is contained in the peel of the lemon, orange etc. in qy Root of the gentian & tops of the [lesser] centaury This juice is purest in the bark of a certain American plant called Peruvian bark & by many other names Preperations of iron & copper are possess’d of nearly the same effects they have al la power of diminishing the irritability of the system, as well as of strengthening it, the weaker the habit them ore irritable it is and vice versa, but these medicines have in many instances a greater power of diminishing the irritability of the habit than of strengthening it. Cinquena cohina cohave cordex jesuitaves cortex [detrum] erc. The medical juice of the bark is contain’d in little cells or upon being broke & exposed to the sun the [illegible] juice glitters. The root of the small branches contain more of the medl juice than those of the trunk & larger ones you may subject to adulteration [illegible] therefore never be purchased in powder 39 Lect: 58th May 15th 1772 Bark & [bitters] besides their strengthening power, have a power also of diminishg the irritability of the system Bitters approach the bark nearer in their strengthening, than in their power of diminishing the irritability of the habit they may be properly be substituted then to it in the first case When the intestines are weaken’d & in consequence there are want of opposite indigestion, costiveness from want of the peristaltic motion or purging from too great irritability flatulency of the intestine etc. in all these cases the bark may be exhibited with the greatest success. Bitters in these cases are also of great use Bark should be employ’d in solution in cases where the intestines are so very irritable that it produces purging when exhibited in substance extract: [illegible] gives about 3 times as strong as the bark in substance in alcohol dissolves it more perfectly than watry fluids Bark sometimes it inflates the intestines producing purging in this case we may exhibit that with it a very small quantity of opium. 40 Bark sometimes disagrees with the stomach in the cases of spices may be join’d to it [even] as cinnamon clover etc. By diminishing the irritability of the intestines it sometimes produces costiveness this we should carefully prevent from taking place by the exhibition of rhubarb, or does so as to procure an evacuation every day. It is better to exhibit the purgative alone, than with the bark also we will give it either in too large, or too small Doses If it is exhibited with every dose of the bark in qy suffict to [procure] evacuatn it will purge too much if on the [illegible] it is not exhibited in this [illegible] it will produce no effect. Bark has been frequently employed in fevers, sometimes to diminish the irritability & sometimes it strengthens. 1st It may be employ’d in cases where people are exposed to circumstances, in which there is a probability of disease being produced. It is [illegible] by rendering the body insensible to the causes of disease. Bark by long continued use looses its effect upon the body rendering it in [time] insensible to its own, as well as to the action of other stimuli. Bath is of very great use in [illegible] that arise from the weakness & irritability of 41 As it can only be used there for a certain length of time with advantage, it should be exhibited only on certain occasions. [illegible] such as circumstances as the body is most subject to the causes of disease as a preventative zii-ziii in the 24 hours are sufficient the larger the doses exhibited the sooner it looses its efficacy & vice versa. If a man has been exposed to the cause of disease and languor, nausea, debility etc. have taken place it is then too late to exhibit the bark and we must use relaxants in its place Bark was first brought into [illegible] by its use in intermitting fevers it was for a time out of practising was again introduced & continue to be used. [Practitioners] differ very much respecting the propriety & particular time & mode of exhibiting it. It is generally agreed that the intermission of the fever is the most proper time for using it. 42 Some have thought it might properly be exhibited during the whole time of the intermission, others only in the first part & others again in the later part of the intermission [illegible] in a very large dose, before the attack of the paroxysm There has been as much disputes whether it might be exhibited in intermissions of fevers which were not perfect, some asserting that it might be exhibited in imperfect as well as perf. [illegible] The mode of its operating upon the body so as to produce its effects has been much disputed some have [suppos’d] it acted as a stimulus, others that it has some specific quality of destroying Fever independt of its other action upon the body We suppose that as it prevents the causes of disease from (originally taking place by diminishing this irritability of the body, so we suppose that it acts in the same manner in preventing the return of the paroxysm i.e. by rendering the body for the time are susceptible to the causes of the fever. Bark shd not be exhibited but in perfect intermissions [illegible] may sometimes render an intermittt a contg fever, if improperly used 43 Lect: 59th May 16th 1772 Bark has no tendency to carry of a fever which is present, if exhibited on a continual fever it never will cure it, but in most fevers will encrease; in place of diminishing the symptoms. Bark has the same good effects upon almost all intermitting disorders as upon fevers if properly exhibited in the intervals. The cause of a disease may be prevented from taking place in 2 ways [illegible] either by avoiding exposure to the cause producing the disease, or by counteracting that cause when it has taken place (i.e:) producing an effect that is opposite to it. That bark produces its effects by diminishing the irritability of the body appears from its similar effects in other diseases, it prevents the 5 salts of the urine from stimulating the excoriated passages in venereal disease not by destroying the venl matter but by diminishing the [practicability] & rendering the parts insusceptible to the [illegible] 44 The cases where the bark ought to be employed are those cases in which the disease is perfectly absent, or some symptoms of the paroxysm continue through the intermission from the great irritability of the habit and weakness by the long continuance of the disease If exhibited during the paroxysm or where the intermission is imperfect it does mischief & often converts the intermittent into a continual fever. If the disease has continued a length of time & some symptoms of the disease continue from weakness etc. in these cases the bark may be exhibited in the most perfect intermissions it can be found. As the bark is employed to diminish the irritability of the habit is should be given in large quantity & in substance if possible zi or zifs should be exhibited during the intermission & we should not stop its use, as soon as we prevent a paroxysm, but should continue it over a very considerable time afterwards if it can be too soon left off and the disease 45 reproduced the bark looses in a great measure its efficacy & will never after care the disease with such a degree of certainty as at first. Bark frequently produce a tightness about the thorax, & difficulty of respiration and also affection of the brain with all two symptoms attended with more danger than any other in fevers if in continued Fevers than any of them & symptomatic place at the patient be ever so weak & exhausted, by the disease we cannot employ the bark to encrease strength but if the symptoms above mentioned be absent the skin moist [illegible] the pulse quick we may exhibit the bark with advantage zifs or zii in 24 hours is suffict. in these cases. Bark is of great use to prevent the relapse of fevers after a crisis has taken place. If the crisis takes place before the 13th or 14th day the patient is particularly [illegible] to returns of the disorder & we shd use the bark to prevent this danger. 46 If a crisis takes place about or before the 7th day of the disease then the bark shold be administered in substance, & in as large quantity as if to prevent the return of an intermitting fever also there is very great danger of relapse. If a [cerisis] takes place after the disease has continued for more than 14 days there is much less danger of relapse & it holds general in fevers that the longer the disease has continued before a crisis takes place the patient is less subject to relapse & vice versa the sooner the crisis the greater it is danger. Lect: 60th May 18th 1772 When intermitting fevers run through their natural course they weaken the patient so much as at times to prove fatal to prevent this great weakness from taking place bark, & the bitters have been exhibited a small qy of bark, zi or zii in 24 hours is suffict. Chamomile etc. have been more frequently used it is better however to stop the course of the disease by large quantity of the bark. 47 Bark in general encreases phlegmonous & diminishes erysipelatous inflamation these two diseases are often combined, if the pulse be hard, fall, and strong the bark should not be exhibited if the pulse be quick, weak etc., and symptoms of irritability take place in such cases bark may be exhibited to advantage. it encreases suppuration & the format. of good [illegible] and prevents absorption. in particular spasmodic affections as of the intestines etc. in such cases they often depend upon weakness, hence the irregularity of the muscular motions the bark by strengthening the general habit restores the equality of the muscular powers & so cures the disease The matter as secreted by ulcers is not [pus] but a thin watry fluid at first and is gradually converted into [illegible], that this is the case appears from observing any small abscess as a pustule of the small, or chicken pox, the fluid it contains is at first clear and transparent but is gradually converted into thick yellow [illegible]. 48 Erysipelatous inflamation of an abscess or ulcer is the great or principal cause of the absorption of [illegible] into the system, hence the great use of the bark in converting the erysipelatous, into phlegmonous inflamation & these both dispose the ulcer to secrete a thicker & better [illegible] and to prevent the disposition of absorption. In all wounds, and ulcers where we want to produce good [illegible] bark is the most powerfull medicine in promoting it. If an ulcer be recent bark is very powerfull in producing good suppuration, & granulation, but if the ulcer be of a long standing the case is very different in the first case the system may be considered as affected in general, in the later case the disease is topical & the system not affected. In the later case mercury is particularly usefull. Bark much preferable to all the other bitter & strengthening medicines in the above [situations]. 49 inflamations of the mucous membranes are often attended with encreased secretions from the mucous glands. Bark stops this secretion by taking off from the irritability of these glands. Encreased secretions of the intestines and better treated by opiates & other astringents than the bark unless the disease has been long continued In gangrene the mortification bark the most powerfull remedy yet discovered A dead part is seperated from the living part of the body by a suppuratn which takes place between them & bark from its disposition to destroy erysipelatous inflamation, & convert it [into] phlegmonous inflamatn powerfully promotes the suppuration. The effect of the gangrened part upon the surrounding parts is such as not only to prevent this suppuration from taking place, but also to change the living parts into the same [illegible] with itself 50 Bark by its power of diminishing the irritability of the parts prevents the sound parts from being acted upon by the parts. Lect: 61st May 19th 72 In rheumatism bark does not at all tend to carry off the disease, but as in other disorders it prevents the return of it. It often happens in acute rheumatism after the disease has continued for some time if the pain goes off entirely in the day time, but returns at the natural evening paroxysm & continues through the night disappearing in the morning with sweating the continuance of which disease greatly weakens & wastes the patient. Bark in this case may be exhibited during the day in qy of from zfs to zi with the greatest success its use generally carrying off the disease. Rheumatism often returns at irregular periods like a spasmodic disease, or upon the least exposure to cold in these cases the bark 51 When great weakness takes place suddenly from any cause the strength may be restored in a short time by the exhibition of the bark in considerable quantities. If the weakness has been a long time in being produced we cannot expect to get rid of it so soon. Bitters in these cases are of use but the bark is preferable in most cases excepting where the habit is very lax in [illegible] case preparat. of iron have the preference. In these cases it should be exhibited in solution & its use intermitted after 1, or 3 weeks for some time, & returned to again, the strengthening medicines should be varied as one medicine will be efficacious when another by use has lost its effects. This advantage is lost if we use mixt preparations of them. In hysteric cases there is a great degree of irritability in the system. Bark may be properly exhibited, by taking off the irritability of the habit it often cures the disease. In chlorine strengthening remedies have often been recommended but the vessels and is [illegible] strongly in some cases it may be questioned whether a [illegible] [illegible] should be [illegible] evacuatn takes [illegible] actn of the arteries etc. 52 When the hysteric disease takes place in plethoric habits, bark cannot be exhibited, untill the plethora be remov’d When it proceeds from weakness the bark may be employ’d from the beginning with the greatest advantage most effectl [illegible] Disease has come on suddenly & vice versa. Preparations of iron unless when plethora is present are next to bark in efficacy in this disease In other spasmodic diseases this class of medicines and of some use if the body be weak & eventually they are most efficacious [illegible] if iron & [illegible] are often preferable to the bark & bitters in such cases. In epileptic fitts etc. where the habit is not plethoric, but weak those medicines may be used advantageously and are of use in all diseases that return at regular periods Tetanus & risus sardonicus can scarcely be [considered] as spasmodic & are little benefited by [illegible] symptoms of sickness of [illegible] place. In chorea st. Viti when it can be relieved by medicines the bark is the best they are only efficacious at the beginning of weak disease. Bark and other bitters may be used to carry out the [gout] but they are apt to induce a melancholic temperament and apoplexy palsy etc. have frequently been produced from their [illegible] use in this disease bitters & strengtheners are of use in weakness of the intestines attended with [illegible] as they [illegible] poison which [illegible] & strengthens the stomach 53 When the disease is regular & the patient strong bitters whd not be used. But if the disease returns irregularly is apt to infect the internal parts and the patient is weak the bark & bitters may be used to remove it but they in all these cases tend to encrease the melancholic temperament & their use is often attended with bad consequences [illegible] the Scotland, London Lect: 62d May 20th 1772 In such cases of gout where the disease has exhausted the patient the bark may be exhibited in small quantities from zis to ziii in 24 hours are mostly sufficient When the menstrua are obstructed from weakness, bark & bitters may be exhibited advantageously. Both species of [abrotonum] and absinthium contain a stimulating essential oil, they cannot be employ’d to take off the irritability of the habit, but to strengthen it. Wormwood, santonicum and sanacetum have been particularly employ’d to destroy worms in the intestines [illegible] poison these animalcula and at the same 54 time strengthen the intestines and enable them to digest and evacuate them. [Carduus] peridictus and cardina have been employ’d not only as strengtheners but as composers of the stomach in violent reaching infusion of chamomile has been used at the same intention these medicines when exhibited in large quantities excite vomiting. Chamomile has many of the same properties with the bark but has more of a purging power. The [illegible] of oranges lemons, [carass] apples etc. have an essential oil which renders them very agreeable to the stomach they have also a degree of astringency are often exhibited its other [illegible] on act. of their agreeable flavour. The lesser centaury & gentian are the purest bitters but they have no power of destroying the irritability of the [illegible] [wall] [that] [the] stomach & [strengthen] Hops are used only to preserve malt liquors but may deserve a place in the pharmacopia [Chamypotys] marebium chamedra [dictammus] albus, salvia & several others of the sedomamia contain besides their bitter & stimulating [illegible] 55 have been particularly employd in gout [where] we want to strengthen the stomach & prevent flatulency the astringent juice of these plants resemble that of the bark [illegible] has been particularly employ’d in the jaundice Preparations of iron besides their strengthening power have a considerable stimulus, they are next to the bark in their power of diminishing the irritability of the habit, but their stimulat renders them in many cases improper their calces shd be used, or else their salts in very weak solutions they stimulate the stomach also too powerfully Preparations of copper can be employ’d only to diminish the irritability, if not to strengthen the habit, have been particularly used to prevent the return of spasmodic diseases a calx of zinc has of late been employed at the same intention [illegible] & the flores zinci 56 57 Lect: 63d May 21st 1772 Remedies which weaken the system. Sedatives in as far as they act upon the system in general during the time of their action prevent the flow of the living power but they leave the parts as strong, or stronger after, than before their action. We have no medicine that will permanently diminish the flow of living power without it the same time diminishing the irritability of the system The only means we have of weakening the system is by exhausting the living power which we never wish to do permanently, but only with a view to cure some prevent disease which is worse & when this effect is produced & the habit freed of the disease it may soon be restored to its usual strength. If a patient be affected with pleurisy use bleeding & so weaken the system [while] taking off the strong action of the vessels of the pleura cures the disease but a small degree of weakness is left produced by the evacuation mode this however is not to be set in comparison with the danger the patient was subjected to from the original disease. 58 Weakness alone if free from other disease is generally soon got the better of therefore we do not hesitate weakening the system when we are to produce any good effect from it but if we weaken the system & any other disease to prevent we never can get rid of that weakness till the other disease be first removed such [illegible] then require much considerat. for all cases sedatives would be preferable to weakening remedies if they acted sufficiently powerfull. but as they are not we are oblidged in some cases to weaken it & the only method we know of producing the effect is by exhausting it. The first action of the living power is making the blood vessels contract, so as to adept themselves to the quantity of fluids they contain, the [illegible] empty the vessels then the more of the living power is spent in their contraction so that there is a smaller quantity of it to expend upon muscular power & the other functions of the body the system is therefore in some degree weakened by the extra quantity of living power of fluid so the action of the blood vessels for [illegible] is [illegible] as soon as the blood vessels [illegible] [illegible] [contract] upon their contents. 59 all evacuations tend to weaken emptying the blood vessels in whatever way but the effects of evacuations produced different ways are in some manner different When we evacuate by stimulating or relaxing any particular glands so as to make them secrete a larger quantity of fluids than usual the uniformity of the circulation is lost a particular quantity of it being drawn to the part, from which the evacuat. is made it becomes therefore languid in other parts When we make an immediate evacuation from the blood vessels it leaves the circulation uniform as before its use upon which account this evacuation is in general preferable to those made from particular glands The force that propells the blood out of a vessel when opened is exactly equal to the power with which the sides of the vessels contract & this may in every case be allowed because the force of the heart 60 This force is very considerable hence the blood flows out of an artery with very considerable rapidity. If a vein be open’d its ordinary force is not more than 1/16 of the arterial power, hence there must be an additional power [illegible] that of the heart & arteries when the vein is stopt IF the capillaries are opened the power with which blood is thrown into them is suffict. to make the blood flow out of them. The pressure of the weight of the atmosphere pressing upon other parts of the body forces the blood out of the capillaries where cupping glasses are apply’d By the general circulation of the vluids the blood is completely mixt hence the very same blood is taken away from particular part of the body & from whatever [order] of vessels the evacuation is made 61 The effects of quick & slow evacuation by bleeding are very different, because 1, 3, or 4 times the usual quantity of blood may sometimes be contained in the capillary vessels as in plain from examining the state of the [cornea] when natural & when inflamed when you take away a qy of blood suddenly you do not give time to the capillaries to contract but if the same quantity of blood be taken away slowly the capillaries have time to contract in the first case then the great vessels are principally evacuated. If blood be taken away suddenly the same quantity weakens much more than when taken away slowly. In most cases it has been recommended to make a large opening & from a large vein & this is generally the best [illegible] altho the reason was not well understood. If we wish to affect any particular part of the body we ought to evacuate from a particular part 62 Bleeding from a particular part seems to evacuate such part more than we should expect from any principles yet explained. The weakness communicated to the parts in the neighbourhood of those immediately evacuated does not depend upon any nervous or vascular communicat. betwixt the parts for parts supply’d by the same Trunks of nerves or vessels (if at a distance) are not affected which [illegible] qy neighboring parts to where the evacn is made are [the] [not] [illegible] the same nerves or blood vessels. Arteristomy dangerous & troublesome from the difficulty of stopping the bleeding hence never used in general but sometimes in [topical] bleeding has advantages as it cuts off the conveyance of blood to the part affected with the inflammation openings from large veins & those of the [illegible] are principally [pitched] upon when we want to make topical bleedings if there be any large vein running on the part it may be opened if not cupping or leeches may be apply’d to the part. Scarification is sometimes of particular use on account of [those] themselves occasion’d by two wounds as well as the evacuation made. 63 Leeches sometimes tho’ rarely contn a poisonous juice which occasions an inflammation of the erysipelatous kind but generally goes & is inoffensive. Lect: 64th May 22nd 1772 The quantity of blood that may be taken out of the body without destroying it has been much disputed by practitioners. Dr Hahls followers amongst the moderns & all the ancient physicians bled but in small Quantity others & in particular Boerhaave’s followers bled frequently in large quantities & in almost ever disease If we want to produce any effects upon the general system [&] [illegible] ounces of blood is in an adult that can be taken away, in very young children we more commonly employ leeches from the difficy of finding a vein for the lancet zi in very young children will produce a considerable effect in adults greatly emaciated as by hectic fever ziii will produce a considerable effect but it is but rarely that so small qy is of any service in adults. 64 A strong man will bear to loose 16 or 20 ounces of blood & it is better to take this away at once. some have thought qy a patient cannot bear to loose blood more than 3 or 4 times but Dr. Fordyce instances one case where 112 ounces were taken away in 3 days time with advantage the suddener the evacuat. the better as it produces a greater temporary weakness In bleeding regard ought to be had to the size of the patient to the disposition of his vessels to contract & to the quantity of blood they contain. The evacuat. may be made [fitt] the patient faints in many case there being no instances where the patient has died from loosing this quantity. In inflamat. there is an encreased actn of the arteries in the part inflamed which propelling the fluids the more force into the capillaries distend them beyond their tone & this distension of [illegible] stimulates the arteries & so keeps up the inflamation. In some inflamation sit is the distensn of the small vessels [purely] that keeps up the action of the arteries this is the case in phlegmonous inflamation. Another species of inflamation is when the small vessels are so very irritable that a moderate distension of the vessels will stimulate them and keep up the action of two arteries this we call erysipelatous inflamation 65 Inflamatn sometimes kept up by the stimulus apply’d to irritable surfaces as do sometimes of the internal parts that are subject to inflamtn from the stimulus of the salts contained in the fluids secreted upon them or the surfaces of ulcers that are inflamed from the same cause. When the habit is weak there is a disposition in some particular part to have its vessels act more strongly than natural which disposition bleeding encreases by further weakening the system Hardness of the pulse is the most certain symptoms [illegible] general & phlegmonous inflamatn frequency & smallness of [illegible] Bleeding is usefull in phlegmonous inflamatn only in erysipelas it increases the irritability of the part, in inflamat. from the mucous membrane being irritated by secretions it also tends to encrease the tendency of such membrane to be affected by the stimulus if the inflamatn be mixt of the phlegmonous & erysipelatous kind of bleeding be [and] [it] opens not only relieves [illegible] but the symptoms of irritat. also depending upon the erysipelas. Bleeding a very powerfull means of removg phlegmonous inflamatn to be remembered that its good effects may be instantaneous, but this seldom happens & we by bleeding only make the inflamatn begin to give way & it of itself continues to go off. In phlegmonous inflamatn the more the general system is affected, the more certain is the effects of this operatn & the greater & more suddenly [illegible] weakness of the system is produced the more it benefits. 66 If the system be but little affected evacuat. from the part is more usefull than general Evacuatn [illegible] are thus, more immediately evacuate the part affected Bleeding from the part affected was much practised by the antients, untill the circulat. of the blood was discovered when it fell into disrepute, but in many cases is of the greatest use when your evacuat. is of no service we could hardly expect this a [illegible] but experience conforms the propriety of the practice. In general inflamatn the sooner the evacuatn is made & in the larger quantity the more effectual it is in taking off the encreased actions of the vessels this depends partly upon the effect of habit when the vessels have been used to act strongly for any considerable time they acquire a disposition of continuing this encreas’d action, even after the cause that first produced it is removed The sooner then we empty the vessels the less danger there is of their beginning this habit. Our anxiety in carrying off inflammation by bleeding should be more or less according to the consequence that may arise, from suppuratn of the part affected the natural [cure] should also be considered if the part affected has a natural [cure] which is going on we shd be less anxious about bleeding. 67 Lect: 65th May 23d 1772. When the heart & arteries are acting strongly when the pulse is hard, strong & frequent, bleeding is the most effectual way of carrying off this inflamatn & is equally so from whatever cause it may arise provided it be the only disease in fevers in rheumatism an encreas’d action of the heart & arteries tend to carry off the disease but in fever it is not the only disease [illegible] arterial action & used shd be cautious of diminishing the quantity of blood as we may take away the strength which is necessary to carry him through the disease, in rheumatism the natural cure is worse than the disease it should always be prevented there from taking place by diminishing the arterial action by bleeding In the small pox we shd be cautious of bleeding during maturation (least the pustules sink) unless the symptoms of inflamtn runs extremely high so as greatly to endanger the patient life this evacuation should not be made. In chronic general inflamatn where the arteries only act strongly without strong action of the heart & the pulse is hard, small & contracted & not full, and strong in this case bleeding is not nigh so [illegible] & if we do bleed it should be made in small quantities & often repeated [singular] [illegible] tending to diminish the genl strength but not the encreas’d arterl action 68 One case in which copious bleeding is usefull when the pulse is small & contracted with great depression of strength which is when an irritable surface is affected with general inflamatn so the diaphragm or intestines in these cases the depression [illegible] strength & symptoms of irritation are very great yet the pulse is still to be felt hard & bleeding is the only thing we can depend upon for the cure. IN all cases of spontaneous haemorrage with symptoms of plethora & inflamation. Bleeding may be used advantageously & is the only [best] way of putting a stop to & curing the disease. If haemorrhage takes place in weak habit from relaxation, bleeding is in such cases always hurtfull & bark with strengtheners should be used for to cure the disease. If [illegible] arises from encreased arterial action bleeding is of great use in stopping it. Bleeding is often employ’d in the cure of fevers but it has not the least tendency to cure a fever only takes off the strong action of the vessels should never be used unless there by symptoms of general inflamation, as it will most certainly hurt if the disease does not soon terminate the crisis It may be used as the beginning of fever before symptoms of inflamatn take place when from too great quantity of blood the vessel cannot act sufficiently upon it in consequence the secretions & functions of the body are imperfectly performed & the disease prevented from [illegible] its regular type by bleeding in such [case] [are] often change a continued into an intermitting fever [69] In young women spasmodic & hysteric diseases sometimes proceed from plethora in which case we should evacuate before the use of antispasmodic & remedies diminishing the irritability of the system. In [plethoria] & robust habits we should never exhibit the bark till evacuations be [premised] as this medium in such cases at the same time that it diminishes the irritability of the system encreases the action of the heart & arteries [illegible] producing general inflamatn etc. The gout has all the appearance of an inflamaty disease when it arises in a man of a sanguineous melancholic temperament in such a habit when the symptoms of inflamatn run very high we may bleed with advantage, but in general we should be very cautious of bleeding in this disease as it often makes the gout seize the internal parts as the stomach [illegible] and so may render it suddenly fatal when it otherwise would not be attended with any great danger. Lect: 66th May 25th 1772 The classes of [illegible] already treated of we might suppose to exist a [illegible] [illegible] stimulants, astringts relaxts strengts etc but the [illegible] [illegible] we could not imagine to [illegible] [illegible] from [Expuriema[ [illegible] antispasmodics & narcotics. Antispasmodics are medicines tending to remove all preternatural contractions & actions of the moving parts. 70 There are some preternatl actions which antispamodic remedies have not a power or removing. Diseases were distinguished into such as arose from some particular matter in the system & such as arose from preternatl action of the difft parts only the latter were call spasmodic diseases, but many of the former do not depend upon any matter at least that is sensible to us we therefore deny its existence & yet in these diseases antispasmodic remedies are not usefull, but often improper. Diseases have been called spasmodic when they went through their course irregularly, all involuntary & irregular muscular contractions are called spasms All antispasmodic medicines are stimulants and when they do not exert their antispasmodic they exert their stimulant power, are therefore very uncertain in their operations although they cannot always take of diseases that are more fixt yet they tend in many cases to remove it. Vol: alkali has been employed in inflamat. of the thorax, where by its antispasmodic power it has sometimes been of use but much oftener hurtfull & should never be employed [71] in phlegmonous inflamatn of any kind if exhibited in peripneumony attended with inflamatn of the lungs they are hurtfull but in coughs arising in winter merely from the contind applicatn of cold without any particular inflamt taking place they are of service. Antisp are [sometime] apply’d externally are much more usefull & in deep seated inflamtn they are the most proper & efficacious stimulants, externally apply’d they are very properly apply’d with fomentations & poultices which we wish to act as emollients if joined with these they greatly assist their efficacy. They have a tendency to cure fevers & will sometimes carry off fever entirely but they are much oftener ineffectual & almost always do mischief when they are not serviceable we do not employ them in the beginning, but towards the end of continued fevers camphor in particular has been employ’d but without any great efficacy. Antispamodics have been used in intermitt. during the intermission to prevent the return of the paroxysm Much in particular has been thus employ’d & sometimes with success, they shd be exhibited in pretty large quantities & may be properly joined with narcotics as we cannot depend much upon them alone. In Rheumatism where stimulants cannot be advantageously used by antisp: are improper also but where stimulants are proper, those of the antispasmodic class s [72] should always be preferred guaiacum and volatile alkali are the best and have often been used with considerable success Antisp: have sometimes been employed with success to [procure] sleep when opium could not [illegible] exhibited [illegible] [illegible] liquor in part In spasmodic complaints they are often very powerfull in removing the disease when present, but have very little tendency to remove the disposition of falling into the disease but by encreasing the irritability of the habit often render it more susceptible of the disease & therefore encrease it rendering the paroxysms more frequent are most efficacious when externally apply’d. In other cases they have a tendency if exhibited in the interval of the paroxysms of spasmodic diseases to carry it off entirely & cure the disease whilst if exhibited in their case curing the presence or immediately before the attack of the paroxysm they have very little or no good effects. The effects seemingly so contradictory depend upon the particular habit of the patient if the patient be of a weak & irritable habit they by encreasing this dispositn do mischief but are more immedy efficaceous if exhibited during the paroxysm [illegible] be of a plethoria & [illegible] habit their effects are not so sudden but more usefull. In Hysteric complaints the habit is always weak & irritable antispasmodics then have almost always a tendency to carry off the paroxysm if exhibited during its attack, but if they are exhibited in the present case during the intermissions of the paroxysms by encreasing the irritability they encrease the [tendency] to the disease and so do mischief. The effects of antispasmodics in hysteric diseases are more uncertain than any other medicines if exhibited at the attack or during a paroxysm they sometimes instantly carry it off whilst at other times in circumstances exactly similar they produce no good effects. In perfect epilepsy & convulsion fitts they have very little efficacy if exhibited internally but are more frequently usefull externally apply’d particularly in convulsions & in spasmodic diseases having sometimes a tendency to curing them [illegible] particularly or return periodically shd be [illegible] internally & during the intermission of the paroxysms. No medicine is always successful in epilepsy the convulsive fitts and their similar diseases often baffling our utmost efforts antispasmodics however seem to be as efficaceous more as than any others.’ In the tetanus antispasmodics have neither been employ’d internally n or externally with any very general success altho’ the disease has bone off during the exhibition of opiates & antispasmodics in some instances as musk, opium etc yet the disease in such cases seems to have gone through its natural course rather than to have been cured by the medicines exhibited In the risus sardonicus, hiccup & others of the same kind antispasmodics have been sometimes exhibited with great success, and at other times with none their effects as in hysterical disorders being very uncertain. In cathartics in place of the proper pain & muscular & contraction necessary for expelling the fetus, unnatural pain sometimes take place in such cases antispasmodics have often been exhibited with good success they tending to take off the unnatural & tending to restore the natural muscular contractions & labour pains that are necessary for the expulsion of the child. 70 Fever, inflamation, & rheumatism are preternatural actions of the vessels which do not depend upon any matter in the habit, yet we do not call these spasmodic diseases. Spasmodic diseases are principally known by their coming on without any apparent cause and having no natural cure that we know of Animal [illegible] have generally an effect to produce spasms in difft parts of the body and these medicines seem to be of more general are in such cases than in any other complaints in which they have yet been used. Containing the lectures from No 45, to No 66. Materia Medica by Dr Fordyce No 4. Materia Medica Index Page No Particular sedatives 1 Effects of astringents 4 Action of particular [illegible] 8 general effects of relaxants 19 Particular relaxants [23] Strengtheners 30 Effects of the bark bitters etc. 39 Means of weakening the system 57 Effects of evacuation by bleeding 61 general effects of antispasmodics 69 1 Lect. 45th Sedatives Acids eternally apply’d are powerfully sedative. seem to be equally so, whatever once we use provided they be of the same strength If [so] concentrated they act as stimts Out taste is perhaps the best criterion of judging, the vinegar shd be the standard for diluting them. Acids are usefull as sedatives in all cases of deep seated inflams as in those accompanying fractures dislocations strains In erysipelatous the inflam of the skin [&] integuments they are improper They are very usefull as gargles in infl. of the mouth & throat Neutral salts are somewhat sedative externally employ’d Alcohol a powerfull sedative somewhat astringt but not stimulant is very usefull in erysipelatous inflam as those arising from burns, the bites of poisonous insects etc. provided it can 2 be apply’d before a blister is raised if pure it acts too powerfully as an astringt it shd be diluted then 2, 3, 4, or 5 times its quantity of water It has been disputed whether sedative or relaxing oily medicines were most usefull in burns, sedatives seem most proper in slight cases. All metallic salts are sedative when diluted with water & particularly usefull in inflam of the eyes the chief of these are white, blue vitriol & sacchar. saturni these are more proper in chronic, than in acute [illegible] of the eyes. Preparations of lead are seldom usefull in phlegm: inflam: they sometimes [illegible] or [illegible] & mortifict. [illegible] hazardous in [illegible] attended with great pain they have not this disposition. In excoriations preparats of lead are apply’d with propriety, particularly 3 [cerasse], as also lapis caluminaris & alum. this last is particularly usefull in inflam of the eyes, mouth, & throat. Prep of alum when apply’d to the eye have a disposit. to coagulate its humours [illegible] renders it necessary to be changed frequently. Alum [illegible] made with the white of an egg shd be changed every ¼ of an hour. All the vegetable astringents have been apply’d as sedatives, particularly the [certicosa] of Lineus. Some of the farinaceous seeds as [illegible] have been apply d as sedatives particularly in erysip. inflam. Lastly, opium & poppies are [illegible] sedatives and may be apply’d externally in all inflam. with success particularly of the [???table] parts 4 5 the contract. produced in animal fibre by astringts differ from that produced by the living power in that the water [illegible] combined is in the former seperated & cannot be recombined. The blood vessels are allways full of blood, an astringt. then can only make the vessels press more strongly upon their contain’d fluids, but can’t make them diminish in diameter but in proport. as they are emptied of blood, by larger [illegible] Astringents do not act equally upon all the blood vessels but act more powerfully upon the small & accumulate the blood of course in the great vessels Astringents may act more partict. upon the external, or internal vessels in which case the opposite set are dilated The actn of astringents upon the muscular fibres is permanent, whilst that of its acting upon the living power is temporary. 6 Astringents differ, in some of their acting parts or solely upon the part to which they are apply’d whilst others more universally upon the whole system these later have their actn of shorter continuance than the former they act upon partr parts. Astringts are strengtheners in consequence of their power of accumulate the blood in the greater & internal vesls the strength of the patient being always in proport. to the [qy] of blood contained in the greater vessels It is [illegible] holds good only a certain length, as astringts may be used so as to produce weakness when used to excess They may be used with advantage in restoring the tone to muscular fibres that have been relaxed or weaken’d by over act. hence they are usefull in strains [illegible] after the inflam: is gone When any of the glandr secretions are increased they stop or diminish them in quantity. they also diminish the natl secretn but we never use them so 7 Precautions on the use of astringts in increased secretions If there is inflamatn [illegible] secret. is the natural cure in place of stoppg. such secret rather promote it, to carry off the phlegmonous inflamat. of [illegible] part is increas’d secret. may be in conseq. of a stimulus applied. if we stop the increased secret. whilst the stimuli remains inflammatn is produced. The immedt. cause of secretion is a quantity of blood in the glands of the [part] in conseq. of the contract. of some distant part. was there not to be increased secret. inflamatn would be produced. before we cure such secret. by astringts we must take away a qy of blood from the part by relaxants. in watry secretns. where there appears to be no phlegm inflam. we may use astringt properly if there shd be sympt of plegm: inflam we shd avoid astringents untill the 8 increased secret. has carried off the inflamatn. [illegible] as to the use of astringents we shd evacuate the feces contain’d in the intestines. In secretions from the urethra produced by the applict. of [illegible] matter it is questioned whether astringents are proper. In increas’d secretns from the bladder we use remedies to take off the [illegible] of the habit, as the use of astringts wd be of little use there being a const. stimulus from the urine In haemorages we used sedative asts: In hamorages from the gums astrts are of great use. Of particular astringents [Fossils] astringents act on the system Vegtle astringts act for a longer time, [boles] are compds of calx of iron & clay their activity depends upon the iron. 9 Calcaresur earth has some slight astringency & may be exhibited in diarrhea with out any danger of increasing inflamat. Boles have become employ’d in bruises when the inflamatn has been previously removed they have been used in purgings but have no great efficacy. Alum is a powerfull astringent but we shd give it in such a form as to be certain of the dose. Lect: 48th May 4th 1772. Boles acquire difft colours as red, blue etc. from the calces of iron particularly with which it is mixt hence the [illegible], common bole & they have been advantageously externally employ’d in form of plaisters to restore the tone to relaxed muscular fibres. some of them as the lapis hibernicus contain a considerable portion of alum in their composition, but alum is exhibited alone with much greater propriety & certainty in the dose. 10 Alum is formed naturally by clay being mixt with pyrites which being decomposed the v: acid unites with the clay forming this earthy salt alum as thus formed generally contains a superfluous quantity of acid which may be [separated] from it together with a quantity of water contained in its crystals by exposure to heat the burnt alum is thus prepared differing from common alum only in being more active from the quantity of water evaporated The best mode of exhibiting alum seems to be by forming a whey of sweet milk which may be drunk the sugar & mucilage contained in the milk in some measure covers its taste, and renders it less disagreeable Iron has been employ’d with the vitriolic acid forming green vitriol, with the muriatic acid forming [illegible] [illegible] in spt salis and with sal ammoniae sublimed forming the flores martiales 11 The calces of iron and the flores martiales have greater astringency, and less stimulus than the neutral preperations with the acids Iron has sometimes been used as an astringent in diarrhoeas [its] calces particularly, as already noticed, in the different boles 12 Iron has astringency, but its power as an astring. is mixt with a strengthening & irritat power hence its uses in the chlorosis, fluor albus [illegible] Iron is always dissolved in the acids of the stomach so that it may be used in its metallic form with propriety. it is filed down. if the filings are of a large size they do not act powerfully [qty] if fine, will be as effectual as [qy x] [illegible] it may be rendered still more active by restoring it from its calcin’d state by exposing it to heat in a crucible with [flower] we then obtain it in a very fine powder mixt with the charcoal of the flower, all its difft calces are active It is employ’d externally in boles and 13 When combin’d with acids it is more active we use 3. [illegible] with vitl acid green vitriol & mur. acid The mart. in spt solis, [illegible] tartar by digestn in wine. Iron has been exhibited mixt with alkalis as in the flor. martiales. It has been exhibited combined with sulphur but is unactive the sulphur rendering a mild & inefficacious Lect 49th May 5th 1772 Lead seldom used as an astringt. generally as a sedative, can seldom be used, to stop internal increas’d secretions from its dispositn to [illegible] in paralytic weakness of the intestines. Zinc has been seldom used internally & then not as an astringt has been used externaly as such, never used in its metallic form, found in the earth calcined [illegible] lapis calaminas found in the earth exceedingly hard must be reduced to a fine powder by exposure to a red heat for some [time] & then powder it. It has been internally employ’d as an emetic its ore has been much in use externally for [illegible] as an [astgt] 14 when zinc is exposed to a red heat it puts on the appearance of burning and emits a very fine white powder a form of fumes, this called flowers of zinc. [illegible] or cadmia another calx formed from its combination with copper. all these calces are the same qy [cadonia] is procured in the soap manufactories, is more soluble in water than [illegible] White vit. formed by exposing [pyrites] mixt with calamine to the air. the vitc acid contain’d in the pyrites unites with the zinc the salt is seldom pure, but have a little vitriol of the iron or copper mixt. shd be dissolved in water, & crystalised then called [illegible] of vitriol preparation of zinc have an astringency that renders them very usefull, particularly for making the skin grow upon excoriatn & ulcers. Astringt. juice contained in a variety of vegetables, and it seems to be nearly the same in what ever one we find it. Agrimony etc. have been very properly used in fomentations of erysip. inflamt. act here as sedatives. [illegible] have been used for the eyes not very powerfull their flavour part recommends them Radix tormintilla has been used as an astrin: in dysenteries 15 Rhubarb has a [illegible] of astringency, but small, when compared with its purgative qy the purgative power may be extracted by infusion in water & the astringency aft. The husks of all red fruit contain more or less of an astringent juice. The [Viscus] [Queronas] contains the astringency of the tree, upon which it grows Uva ursi has been lately employ’d in cases of the stone in the bladder inefficacious [illegible] Japonica & sanguis draconis two resinous bodies, mixt with an astringt. juice of a red colour, obtained from trees unknown operate quickly & universally principally usefull in hemorages, may be properly combin’d with alum in this [illegible] & under its effects more lasting may be used in substance advantageously. Lect: 50th May 6th 1772. Narcotics act also as astringents, Acids and salts as astringents & sedatives. 16 17 The action of the relaxants is not so obvious to the senses as that of astringents, hence some have thought that the effects produced by them were produced in some manner difft. In inflamat. of the intestines when the rectum in contracted so that no stools can be procured nor glysters injected by the applic. of the [semicup???] or warm baths we can remove these contractions so that injections can be easily thrown in. when the urethra is contracted so that a suppression of urine is produced & the catheter cannot be introduced by fomentg the parts affected we take off these strictures hence we see that certain substances properly come under this class. Lect: 50th May 7th 1772 The terra japonica sang: draconis are sometimes used in dysenteries, the bark of the wild ash employ’d rather to take off the irritability of the system. The cortex granatorum does not act so quickly, but is more permanent in its action. 18 Oak bark contains a pretty powerfull astringt juice, is employ’d advantageously in fomentations of weak & [relax’d] [illegible] The semirabia has a difft kind of astringency from most others seems to act solely on the part to which it is apply’d [illegible] that astringt taste chiefly used in dysenteries & gleets where the system is greatly relaxed. The logwood is pretty powerfully astringt employ’d mostly in dysenteric cases its astringency similar to that of the other vegetable astringents acts universally ¬ like the semirabia The most powerfully veget: astringent is the juice of the oak collected by certain insects as the galls are employ’d advantageously in gleets, flour albus, & [illegibles] of every kind may be externally used in relaxation of the ligaments & cannot be employed in substance may be extracted by spts or water shd be used in decoctions, or infusion 19 Lect: 51st May 7th 1772 Relaxants are medicines that diminish contractions of the moving parts. As astringents do not decrease so relaxants do not increase the diameter of all the blood vessels their action is not equal but ore determined to the small than the great vessels Relaxants by encreasing the diameter of the small vessels the external particularly and encreasing the quantity of blood in them, have been supposed to act as stimulants. By encreasing the secretions they have been considered as [attenuants]. By diminishing inflamatn. they have been considered as sedatives Relaxants are powerfull remedies in fevers more so than any other class in counteracting & carrying off fever. Fever is always attended with [illegible] perhaps principally occasion’d by contraction of the small vessels, as these med: [counter???] this dispositn they become very efficacious in curing this disease [illegible] fever they are most usefull in the beginning may be [harmfull] in the end of fevers when the [patient] [is] become very weak 20 The addition of stimulants & opiates very much assists their operation in fevers Relaxants act very powerfully in carrying of the first symptoms of fever upon its attack & so preventing it farther encreased. Relaxants cannot be apply’d with propriety where there is a great degree of inflamatn untill it be taken off by evacuations also the heat occasion’d by their operat. encreases the inflammation. At the end of fevers when symptoms of weakness come on to a dangerous degree, they be encreasing the secretn. encrease the weakness be encreasing without any diminution of the fever. If relaxants are of use they generaly produce their good effects in [illegible] hours if they have no good effects or that time they should be discontinued. The first dose shd generally be given in quantity to prove emetic. In general inflamat. by relaxing the vessels they take off in some measure their pressure upon the blood and so are of use. Relaxants are also of very considerable use in intermittent fevers they tending to procure a perfect intermission & to remove the febrile symptoms that often remain after the terminat. of the paroxysm, also to prevent the attack of the cold fitt, are assisted by stimts & opiates. 21 Lect: 52nd May 8th 1772 Relaxants apply’d internally are more powerfull in carrying off internal than external inflamations, as they throw the blood upon the external parts & this is from whether the inflamation be of the phlegomonous kind or of some of the internal mucous membranes, the presence of general inflammation however forbids their use in this, as well as in all other cases, have been considered as particularly usefull in inflamations of the thorax. Relaxants are of very great use in all encreased glandular secretions particularly the internal as they, by throwing the circulation principally upon the [skin] and external parts cause less blood to be convey’d to the glands & greatly encreased the cutaneous [secretion] Rheumatisms are attended with general inflamation they tend immediately to carry off the contraction that takes place in the part affected with disease. but if general inflamation be present they should not be employ’d until it be got rid of They are also of use in carrying off spasmodic contractions when they take place. 22 23 Relaxants are of use in rheumatism but if the general inflamatn. is very great their operation is attended with danger. In spasmodic affections of the ureters urethra gall bladder and even intestinal canal. they are of great use when externally apply’d, and also when thrown into the rectum & colon. In muscular constitutions they are not so efficacious, but have been used sometimes even in these success In cutaneous eruptions depending upon dryness of the [sear] of skin they may often be used with success; so as to cure the disease Lect: 53d May 9th 1772 Action of particular relaxants I Neutral salts They have in general some degree of relaxant power, some more aft to act upon the stomachs, whilst others pass into the intestines & purge, [nitrus] digestiva salt of sylvius sal ammoniac & vitriol: tartar act more particularly upon the stomach. these have seen more [illegible] than the others as relaxants 24 No class of medicines has been more universally used than these salts, they were unknown to the ancients: from their ignorance in chemistry from the [illegible] or [illegible] [illegible] has got various names operatn by which it is procured. Surprising? that medicines of so little efficacy could be so much commended. there being hardly one case in which N:S: can be of any use & they in in case act as powerfull remedies, not withstandg the general use of these medicines in the present practice perfect intermissions of fevers are hot they are sometimes of used in [illegible] sufficiently powerfull to produce any bad effects. Dr. Fordyce attributes the use of N:S: to their disagreeable taste from which the patient supposes they must be efficacious. Some very powerfull applications require a considerable time to operate before they produce any sensible effects. hence inflamatory disorders after bleeding the patient largely, & exhibiting nitre afterward, the cure is attributed to the nitre, which in reality belongs to the operation of bleeding. Dr. F. wishes to make strong preparations on his pupils of the inefficacy of these Medicines, in order that they may not be depended upon, where active medicines may be used with advantage. 25 Neutral salts tho’ not powerfull relaxts sedatives, no [alterants] are yet very usefull purgatives, stimulating the glands of the intestines solely & producing an encreased secretion from these parts. Ipecacuanha Is the part of an America plant brought over dry, and may be preserved so, for a very considerable length of time like [illegible] depend upon a juice soluble in water or in spt of wine & water is [illegible] however (in most cases) used in [illegible] Has been principally used as an emetic, has a specific stimulus to the stomach, so much that, if its juice be injected into the blood vessels, or absorpt. it acts upon the stomach & proves emetic, hence it is more certain in its operatn as an emetic than any other. If given in smaller doses than to prove emetic it acts powerfully as a relaxant most stomachs will bear gr i some gr ii but few others cannot bear more than gr. fs with out producing sickness has been exhibited in dysenteric purgings often [alongst] with opium in which case it becomes powerfully sudorific & the stomach will bear a larger part of both med: when combin’d than when given alone has been successfully used in chronic rheumatism with [illegible] 26 Scilla with root of a plant is of the natural class called [lilliana] acts only as a partial stimulus Besides their power of encreasing the glandular secretions they have also a relaxant power this most being bulbous & acting cannot be well used in [subst.] unless dried in which case it loses somewhat of its efficacy shd be cut in thin transverse slices & slowly dried [illegible] shd begin with small doses. Aconitum has been consider’d as poisonous not lately employ’d in med: its virtues depend upon a juice not volatile & soluble in water it may be used then in form of an extract. Has been considered as a poison but introduced by [illegible] stork seems to act pretty powerfully as a relaxants [illegible] dose of it extremely small, we shd begin with 1/8 part of a grain which may be gradually encreased till it produces sickness has sometimes been used with success in obstinate rheumatism Lect: 54th May 11th 1772 Seneka the root of an American plant [illegible] from being knotted was suppos’d to resemble the tail of a rattle-snake, & to be usefull in the bit of that animal, the juice upon which its virtues depend is soluble in water & has thence commonly been used in [illegible] very disagreeable taste, occasions a heat in which the act. has been sometimes used in diseases of the lungs, in rheumatisms & cutaneous eruptions with success. 27 Cold water was employ’d in fever as a relaxant by the ancients & sometimes with considerable effect, but has not been used of late, it seems to be of no great consequence whether cold or hot water be drank in acute diseases. when cold water has acted as a relaxant it has been used in very large doses two or three quarts of this fluid having been thrown into the stomach acts sometimes both as a purgative & emetic & sometimes as a relaxant, & so has carried off the fever according to the accounts. Antimony No medicine has been subjected to more operations than this metal & yet the preperations of it in use are very few Regulus of antimony is found combined with sulphur & sometimes also the regulus of arsenic each however are very rare & easily discoverable by the redness of their colour. Regulus of antimony is very easy of fusion & may therefore be seperated by exposure to a small heat from the [stony] impurities with which it is mixt the metal 28 when melted is thrown into conical moulds inverted & the qy of [illegible] sulphur being greater than what united chemically with the regulus the later being heaver than the former subsides hence the apex of the cone is a purer regulus containing less sulphur than the base of the cake does. If we apply about 3 or 4 times the qy of [illegible] alkali it unites with the sulphur forming a hepar sulphuris which dissolves the regulus of the metal from which it may be precipitated or iron may be used it [affecting] the sulphur more powerfully than the antimony & no part of it making [illegible] the pure regulus Filings of iron [then] as to be mixt with antimony & the whole expos’d to fire. or a part of the sulphur may be destroy’d by deflagration with nitre if we add equal parts of nitre & any fixt alkali Another method of procuring the regulus for medl purposes is by uniting it [illegible] kali so as to make a hepar s. Regulus of antimony has been exhibited as a purgative in form of a pill called the [perpate] pill has seldom been given in powder in a [??gative] form except sulphur [illegible] antim: & [illegible] mineral Two of its calces have been used by exposure to the air & [illegible] only it thus forms a white powder this operatn is assisted by [illegible] between shavings or [illegible] or by deflagratn which nitre as 3 parts of [illegible] to 1 of [sul.] thrown into a red hot crucible 29 it has been used nitrified it has been combined with vit: & nit: acid but is [uncertain] been [illegible] by water. it has been combin’d with mur. acid [illegible] butter of antimony & [marmurius] [vita] has been combin’d with [illegible] tartar emetic the most certain in [illegible] Lect: 55th May 12th 1772 Preparations of antimony may be considered under 2 heads 1. such salts as are soluble in the watry juices of the stomach these are always certain in their operation therefore preferable to [them] 2. class whose action depend upon their solution in certain salts in the stomach which may vary according to the quantity of these salts [illegible] are therefore uncertain in their operation. There are none of the preperations of antimony so perfect as we could wish all metallic preperations soluble in watry fluids stimulate the stomach strongly & are more apt to act as simple stimulants than to produce their peculiar effects antomonls are also subject to this inconvenience. Antimonials are by much the most powerfull relaxants, & may properly be used in fevers & every other case where this class of medicines is proper & usefull the class of relaxants upon which we can must depend. Crude antimony & its calces are mostly inactive the [green] metallarum & glass of antimony are very uncertain in their [illegible] [illegible] [tartar] & [tincture] of antimony a combinat. of the regulus & hepar sulphuris [are] the only preparats [of] salts which are [active] 30 Relaxants are very usefull in internal inflamations & rheumatisms, such cases excepted when there is a great degree of general inflamation in which cases the genl inflamatn must be first be got rid of before we [illegible] to use them. In inflam: of the mucus membranes as catarrh, erysipelat. sore throat, diarrhoea & dysentery they ay be successfully employ’d, also [illegible] for encreased secretions & [catarcous] eruptions they are used with success. In internal haemorrhages they have often been exhibited successfully May have [illegible] been used in increas’d secretons from the urinary passages Strengtheners such remedies as [given] [contracting] [illegible] render them capable of [illegible] with a greater force differ from stimulants the [illegible] putting this power into action [illegible] also from astringts The strength & weakness of the system do not consist in the action, but in the capacity or incapacity to exert a great degree of power, although the power of the body be finite yet we might suppose the exertion of this power to be definite in some manner as a magnet will lift & suspend a certain piece of iron for any length of time. this is not the case, for the body after exerting its power for a certain length of time looses the capacity of continuing such exertion but has it restored again by rest of the parts. 31 We may say then that there is a flow of living power into the body which may be accumulated so as to act more strongly or by the exertion of this power it may be wasted & exhausted. Tho’ we don’t suppose there is any fluid running out, or into the body yet we may compare the accumulation of the living power to a dam of water gradually collected from a small rivulet which although incapable of turning a mill of itself yet when gather’d and collected in a body is capable for a length of time of producing this effect but the water which was collected being in time exhausted the mill can be no longer driven round till a quantity is re collected The body may be strengthen’d 2 ways 1 by preventing the waste of the living power (to carry on the simile) as by stopping up the dam, to prevent the water running out, or 2d By encreasing the flow of this living power into the body [illegible] by encreasing the stream of water into the dam. The flow of living power may be principally exerted in one part or another thus a dancing masters legs grow strong whilst the arms of a blacksmith grow strong also by exercise of these particular parts. 32 Strengthening remedies then are such as prevent the exertion of the living power or such as encrease the flow of it into the general system. they differ then in their action from stimulants etc. Lect: 56th May 15th 1772. The first action of the living power is to contract the blood vessels so as to adapt them to their contents if there be only a small quantity of blood in the vessels the greater exertion of the living power is requisite to produce this effect, hence nourishing foods, by filling the vessels with blood become strengthening remedies. It is not [suffict] though that food be thrown into the stomach but its quantity & quality must be adapted to the powers of injection & other circumstances. Food easy of digestion does not afford so much nourishment to a strong as to a weak stomach it being too soon thrown out of the former. 33 When the blood vessels have no great disposition to contract, but are forced to contract powerfully form the small quants of blood they contain in these cases the stomach digests well & the appetite is keen on the contrary when the vessels have a vary great disposition to contract not from this small quantity of blood contain’d in them. as inn the case in hectic fever in this case the stomach looses its powers & then appetite is lost. Nature then seems to adapt the appetite & digestive powers to the particular circumstances of the patient’s health & food is loath’d and rejected in cases where it would be unnecessary & hurtfull. Second method of strengthening the system is by applying cold to the body or living in a cold atmosphere In a cold climate the external vessels are contracted & the blood kept in the large vessels about the precordia upon which circumstance the strength of the body seems in a great measure to depend for when the circulatn is principally carried on in the external & not internal parts of the body the strength is diminished as is the case in warm climates. hence change from a warm to a colder climate 34 powerfully strengthens the system we shd only observe that the transition shd not be too sudden else the blood by being suddenly forced into the internal larger vessels it stimulates the body too powerfully & produces disease the [illegible] of the [illegible] jointly consider’d is always nearly the same & variety of [illegible] [the] [body] being subject to is extremely little In temperate climates the habit is greatly debilitated during the summer season whilst it is strengthened by the winter hence in the spring the diseases are mostly of the inflammatory kind whilst the autumnal are attended with weakness & depression of strength. Cold suddenly apply’d as in the cold bath has a very difft effect in this case the blood is suddenly thrown from the external to the internal blood vessels. the cold being removed the contractn of the external vessels does not continue but the large vessels acting powerfully, force the blood upon the external surface of the body hence that [glow] & heat that suddenly take place after using the cold bath. This sudden distribution of the blood through the small’ vessels of the external parts is very powerfull in removing obstructions of the external capillaries 35 Living in a pure atmosphere is another powerfull means of strengthening the system this seems to be affected by the living power being prevented from being exhausted. If the [illegible] of an animal be tied up he becomes gradually weak untill he dies if only a small quantity of air be allowed him he gradually becomes weaker & weaker the very same bakes place in the air of large towns a sense of [oppressn] & weight is felt about the precordia which is immedtly removed by the country air. Running water takes up fixible air, & other putrid effluvia hence an air saturated near running water is pure & wholesome whilst that in the situatn of stagnating water is the contrary from the putrefaction of the water etc. Exposure to continental as the [illegible] & N:E: winds renders the situation unhealthy in some measure, although the air is [denser] in these winds than any others yet if there be the smallest disposition to disease they are the means of producing them 36 Astringents given in small quantities strengthen in large quantities may weaken the system, they act more powerfully [upon the] small than great vessels & differ much from strengtheners Lect: 57th May 12th 1772 2d class act by increasing the flow of living power into the system Exercise having a tendency to draw the action of the living power from the vessels to the muscles has a very good effect in strengthening the habit in order to render exercise efficacious in strengthening the system it should be moderate according to the strength of the patient the exercise should be such as employs all the muscles of the body Riding on horse back, in a carriage, rowing, fencing etc. are of great use, riding in a carriage upon rough roads is disagreeble to the mind producing sensations of fear is therefore hurtfull Exercise should be agreeable and there should always if possible be some object in view besides the health the great use of mineral waters depends more upon the exercise and amusement 37 enjoy’d at those bublick places than any particular quality the waters possess The exercise should allways be in a pure air, if the air be impure the exercise encreases the weakness in place of strengthening hence exercise in close rooms do mischief Certain remedies as bitter vegetables substances tend to encrease the flow of living power into the body vegetable bitters differ considerably however in their properties the pure bitter is very probably the same in all of them The syngenesia of Linneus or those plants with double flowers as the lettuce, dandelion, endive etc. contain a white bitter juice which flows out like milk and resembles opium in its properties, others as the [abrotenum] mas, et [illegible] [tanecetum] etc. have a stimulating essential oil mixt with their bitter, whilst the chamomile contains a purgative as well as a bitter juice 38 The same bitter juice is contained in the peel of the lemon, orange etc. in qy Root of the gentian & tops of the [lesser] centaury This juice is purest in the bark of a certain American plant called Peruvian bark & by many other names Preperations of iron & copper are possess’d of nearly the same effects they have al la power of diminishing the irritability of the system, as well as of strengthening it, the weaker the habit them ore irritable it is and vice versa, but these medicines have in many instances a greater power of diminishing the irritability of the habit than of strengthening it. Cinquena cohina cohave cordex jesuitaves cortex [detrum] erc. The medical juice of the bark is contain’d in little cells or upon being broke & exposed to the sun the [illegible] juice glitters. The root of the small branches contain more of the medl juice than those of the trunk & larger ones you may subject to adulteration [illegible] therefore never be purchased in powder 39 Lect: 58th May 15th 1772 Bark & [bitters] besides their strengthening power, have a power also of diminishg the irritability of the system Bitters approach the bark nearer in their strengthening, than in their power of diminishing the irritability of the habit they may be properly be substituted then to it in the first case When the intestines are weaken’d & in consequence there are want of opposite indigestion, costiveness from want of the peristaltic motion or purging from too great irritability flatulency of the intestine etc. in all these cases the bark may be exhibited with the greatest success. Bitters in these cases are also of great use Bark should be employ’d in solution in cases where the intestines are so very irritable that it produces purging when exhibited in substance extract: [illegible] gives about 3 times as strong as the bark in substance in alcohol dissolves it more perfectly than watry fluids Bark sometimes it inflates the intestines producing purging in this case we may exhibit that with it a very small quantity of opium. 40 Bark sometimes disagrees with the stomach in the cases of spices may be join’d to it [even] as cinnamon clover etc. By diminishing the irritability of the intestines it sometimes produces costiveness this we should carefully prevent from taking place by the exhibition of rhubarb, or does so as to procure an evacuation every day. It is better to exhibit the purgative alone, than with the bark also we will give it either in too large, or too small Doses If it is exhibited with every dose of the bark in qy suffict to [procure] evacuatn it will purge too much if on the [illegible] it is not exhibited in this [illegible] it will produce no effect. Bark has been frequently employed in fevers, sometimes to diminish the irritability & sometimes it strengthens. 1st It may be employ’d in cases where people are exposed to circumstances, in which there is a probability of disease being produced. It is [illegible] by rendering the body insensible to the causes of disease. Bark by long continued use looses its effect upon the body rendering it in [time] insensible to its own, as well as to the action of other stimuli. Bath is of very great use in [illegible] that arise from the weakness & irritability of 41 As it can only be used there for a certain length of time with advantage, it should be exhibited only on certain occasions. [illegible] such as circumstances as the body is most subject to the causes of disease as a preventative zii-ziii in the 24 hours are sufficient the larger the doses exhibited the sooner it looses its efficacy & vice versa. If a man has been exposed to the cause of disease and languor, nausea, debility etc. have taken place it is then too late to exhibit the bark and we must use relaxants in its place Bark was first brought into [illegible] by its use in intermitting fevers it was for a time out of practising was again introduced & continue to be used. [Practitioners] differ very much respecting the propriety & particular time & mode of exhibiting it. It is generally agreed that the intermission of the fever is the most proper time for using it. 42 Some have thought it might properly be exhibited during the whole time of the intermission, others only in the first part & others again in the later part of the intermission [illegible] in a very large dose, before the attack of the paroxysm There has been as much disputes whether it might be exhibited in intermissions of fevers which were not perfect, some asserting that it might be exhibited in imperfect as well as perf. [illegible] The mode of its operating upon the body so as to produce its effects has been much disputed some have [suppos’d] it acted as a stimulus, others that it has some specific quality of destroying Fever independt of its other action upon the body We suppose that as it prevents the causes of disease from (originally taking place by diminishing this irritability of the body, so we suppose that it acts in the same manner in preventing the return of the paroxysm i.e. by rendering the body for the time are susceptible to the causes of the fever. Bark shd not be exhibited but in perfect intermissions [illegible] may sometimes render an intermittt a contg fever, if improperly used 43 Lect: 59th May 16th 1772 Bark has no tendency to carry of a fever which is present, if exhibited on a continual fever it never will cure it, but in most fevers will encrease; in place of diminishing the symptoms. Bark has the same good effects upon almost all intermitting disorders as upon fevers if properly exhibited in the intervals. The cause of a disease may be prevented from taking place in 2 ways [illegible] either by avoiding exposure to the cause producing the disease, or by counteracting that cause when it has taken place (i.e:) producing an effect that is opposite to it. That bark produces its effects by diminishing the irritability of the body appears from its similar effects in other diseases, it prevents the 5 salts of the urine from stimulating the excoriated passages in venereal disease not by destroying the venl matter but by diminishing the [practicability] & rendering the parts insusceptible to the [illegible] 44 The cases where the bark ought to be employed are those cases in which the disease is perfectly absent, or some symptoms of the paroxysm continue through the intermission from the great irritability of the habit and weakness by the long continuance of the disease If exhibited during the paroxysm or where the intermission is imperfect it does mischief & often converts the intermittent into a continual fever. If the disease has continued a length of time & some symptoms of the disease continue from weakness etc. in these cases the bark may be exhibited in the most perfect intermissions it can be found. As the bark is employed to diminish the irritability of the habit is should be given in large quantity & in substance if possible zi or zifs should be exhibited during the intermission & we should not stop its use, as soon as we prevent a paroxysm, but should continue it over a very considerable time afterwards if it can be too soon left off and the disease 45 reproduced the bark looses in a great measure its efficacy & will never after care the disease with such a degree of certainty as at first. Bark frequently produce a tightness about the thorax, & difficulty of respiration and also affection of the brain with all two symptoms attended with more danger than any other in fevers if in continued Fevers than any of them & symptomatic place at the patient be ever so weak & exhausted, by the disease we cannot employ the bark to encrease strength but if the symptoms above mentioned be absent the skin moist [illegible] the pulse quick we may exhibit the bark with advantage zifs or zii in 24 hours is suffict. in these cases. Bark is of great use to prevent the relapse of fevers after a crisis has taken place. If the crisis takes place before the 13th or 14th day the patient is particularly [illegible] to returns of the disorder & we shd use the bark to prevent this danger. 46 If a crisis takes place about or before the 7th day of the disease then the bark shold be administered in substance, & in as large quantity as if to prevent the return of an intermitting fever also there is very great danger of relapse. If a [cerisis] takes place after the disease has continued for more than 14 days there is much less danger of relapse & it holds general in fevers that the longer the disease has continued before a crisis takes place the patient is less subject to relapse & vice versa the sooner the crisis the greater it is danger. Lect: 60th May 18th 1772 When intermitting fevers run through their natural course they weaken the patient so much as at times to prove fatal to prevent this great weakness from taking place bark, & the bitters have been exhibited a small qy of bark, zi or zii in 24 hours is suffict. Chamomile etc. have been more frequently used it is better however to stop the course of the disease by large quantity of the bark. 47 Bark in general encreases phlegmonous & diminishes erysipelatous inflamation these two diseases are often combined, if the pulse be hard, fall, and strong the bark should not be exhibited if the pulse be quick, weak etc., and symptoms of irritability take place in such cases bark may be exhibited to advantage. it encreases suppuration & the format. of good [illegible] and prevents absorption. in particular spasmodic affections as of the intestines etc. in such cases they often depend upon weakness, hence the irregularity of the muscular motions the bark by strengthening the general habit restores the equality of the muscular powers & so cures the disease The matter as secreted by ulcers is not [pus] but a thin watry fluid at first and is gradually converted into [illegible], that this is the case appears from observing any small abscess as a pustule of the small, or chicken pox, the fluid it contains is at first clear and transparent but is gradually converted into thick yellow [illegible]. 48 Erysipelatous inflamation of an abscess or ulcer is the great or principal cause of the absorption of [illegible] into the system, hence the great use of the bark in converting the erysipelatous, into phlegmonous inflamation & these both dispose the ulcer to secrete a thicker & better [illegible] and to prevent the disposition of absorption. In all wounds, and ulcers where we want to produce good [illegible] bark is the most powerfull medicine in promoting it. If an ulcer be recent bark is very powerfull in producing good suppuration, & granulation, but if the ulcer be of a long standing the case is very different in the first case the system may be considered as affected in general, in the later case the disease is topical & the system not affected. In the later case mercury is particularly usefull. Bark much preferable to all the other bitter & strengthening medicines in the above [situations]. 49 inflamations of the mucous membranes are often attended with encreased secretions from the mucous glands. Bark stops this secretion by taking off from the irritability of these glands. Encreased secretions of the intestines and better treated by opiates & other astringents than the bark unless the disease has been long continued In gangrene the mortification bark the most powerfull remedy yet discovered A dead part is seperated from the living part of the body by a suppuratn which takes place between them & bark from its disposition to destroy erysipelatous inflamation, & convert it [into] phlegmonous inflamatn powerfully promotes the suppuration. The effect of the gangrened part upon the surrounding parts is such as not only to prevent this suppuration from taking place, but also to change the living parts into the same [illegible] with itself 50 Bark by its power of diminishing the irritability of the parts prevents the sound parts from being acted upon by the parts. Lect: 61st May 19th 72 In rheumatism bark does not at all tend to carry off the disease, but as in other disorders it prevents the return of it. It often happens in acute rheumatism after the disease has continued for some time if the pain goes off entirely in the day time, but returns at the natural evening paroxysm & continues through the night disappearing in the morning with sweating the continuance of which disease greatly weakens & wastes the patient. Bark in this case may be exhibited during the day in qy of from zfs to zi with the greatest success its use generally carrying off the disease. Rheumatism often returns at irregular periods like a spasmodic disease, or upon the least exposure to cold in these cases the bark 51 When great weakness takes place suddenly from any cause the strength may be restored in a short time by the exhibition of the bark in considerable quantities. If the weakness has been a long time in being produced we cannot expect to get rid of it so soon. Bitters in these cases are of use but the bark is preferable in most cases excepting where the habit is very lax in [illegible] case preparat. of iron have the preference. In these cases it should be exhibited in solution & its use intermitted after 1, or 3 weeks for some time, & returned to again, the strengthening medicines should be varied as one medicine will be efficacious when another by use has lost its effects. This advantage is lost if we use mixt preparations of them. In hysteric cases there is a great degree of irritability in the system. Bark may be properly exhibited, by taking off the irritability of the habit it often cures the disease. In chlorine strengthening remedies have often been recommended but the vessels and is [illegible] strongly in some cases it may be questioned whether a [illegible] [illegible] should be [illegible] evacuatn takes [illegible] actn of the arteries etc. 52 When the hysteric disease takes place in plethoric habits, bark cannot be exhibited, untill the plethora be remov’d When it proceeds from weakness the bark may be employ’d from the beginning with the greatest advantage most effectl [illegible] Disease has come on suddenly & vice versa. Preparations of iron unless when plethora is present are next to bark in efficacy in this disease In other spasmodic diseases this class of medicines and of some use if the body be weak & eventually they are most efficacious [illegible] if iron & [illegible] are often preferable to the bark & bitters in such cases. In epileptic fitts etc. where the habit is not plethoric, but weak those medicines may be used advantageously and are of use in all diseases that return at regular periods Tetanus & risus sardonicus can scarcely be [considered] as spasmodic & are little benefited by [illegible] symptoms of sickness of [illegible] place. In chorea st. Viti when it can be relieved by medicines the bark is the best they are only efficacious at the beginning of weak disease. Bark and other bitters may be used to carry out the [gout] but they are apt to induce a melancholic temperament and apoplexy palsy etc. have frequently been produced from their [illegible] use in this disease bitters & strengtheners are of use in weakness of the intestines attended with [illegible] as they [illegible] poison which [illegible] & strengthens the stomach 53 When the disease is regular & the patient strong bitters whd not be used. But if the disease returns irregularly is apt to infect the internal parts and the patient is weak the bark & bitters may be used to remove it but they in all these cases tend to encrease the melancholic temperament & their use is often attended with bad consequences [illegible] the Scotland, London Lect: 62d May 20th 1772 In such cases of gout where the disease has exhausted the patient the bark may be exhibited in small quantities from zis to ziii in 24 hours are mostly sufficient When the menstrua are obstructed from weakness, bark & bitters may be exhibited advantageously. Both species of [abrotonum] and absinthium contain a stimulating essential oil, they cannot be employ’d to take off the irritability of the habit, but to strengthen it. Wormwood, santonicum and sanacetum have been particularly employ’d to destroy worms in the intestines [illegible] poison these animalcula and at the same 54 time strengthen the intestines and enable them to digest and evacuate them. [Carduus] peridictus and cardina have been employ’d not only as strengtheners but as composers of the stomach in violent reaching infusion of chamomile has been used at the same intention these medicines when exhibited in large quantities excite vomiting. Chamomile has many of the same properties with the bark but has more of a purging power. The [illegible] of oranges lemons, [carass] apples etc. have an essential oil which renders them very agreeable to the stomach they have also a degree of astringency are often exhibited its other [illegible] on act. of their agreeable flavour. The lesser centaury & gentian are the purest bitters but they have no power of destroying the irritability of the [illegible] [wall] [that] [the] stomach & [strengthen] Hops are used only to preserve malt liquors but may deserve a place in the pharmacopia [Chamypotys] marebium chamedra [dictammus] albus, salvia & several others of the sedomamia contain besides their bitter & stimulating [illegible] 55 have been particularly employd in gout [where] we want to strengthen the stomach & prevent flatulency the astringent juice of these plants resemble that of the bark [illegible] has been particularly employ’d in the jaundice Preparations of iron besides their strengthening power have a considerable stimulus, they are next to the bark in their power of diminishing the irritability of the habit, but their stimulat renders them in many cases improper their calces shd be used, or else their salts in very weak solutions they stimulate the stomach also too powerfully Preparations of copper can be employ’d only to diminish the irritability, if not to strengthen the habit, have been particularly used to prevent the return of spasmodic diseases a calx of zinc has of late been employed at the same intention [illegible] & the flores zinci 56 57 Lect: 63d May 21st 1772 Remedies which weaken the system. Sedatives in as far as they act upon the system in general during the time of their action prevent the flow of the living power but they leave the parts as strong, or stronger after, than before their action. We have no medicine that will permanently diminish the flow of living power without it the same time diminishing the irritability of the system The only means we have of weakening the system is by exhausting the living power which we never wish to do permanently, but only with a view to cure some prevent disease which is worse & when this effect is produced & the habit freed of the disease it may soon be restored to its usual strength. If a patient be affected with pleurisy use bleeding & so weaken the system [while] taking off the strong action of the vessels of the pleura cures the disease but a small degree of weakness is left produced by the evacuation mode this however is not to be set in comparison with the danger the patient was subjected to from the original disease. 58 Weakness alone if free from other disease is generally soon got the better of therefore we do not hesitate weakening the system when we are to produce any good effect from it but if we weaken the system & any other disease to prevent we never can get rid of that weakness till the other disease be first removed such [illegible] then require much considerat. for all cases sedatives would be preferable to weakening remedies if they acted sufficiently powerfull. but as they are not we are oblidged in some cases to weaken it & the only method we know of producing the effect is by exhausting it. The first action of the living power is making the blood vessels contract, so as to adept themselves to the quantity of fluids they contain, the [illegible] empty the vessels then the more of the living power is spent in their contraction so that there is a smaller quantity of it to expend upon muscular power & the other functions of the body the system is therefore in some degree weakened by the extra quantity of living power of fluid so the action of the blood vessels for [illegible] is [illegible] as soon as the blood vessels [illegible] [illegible] [contract] upon their contents. 59 all evacuations tend to weaken emptying the blood vessels in whatever way but the effects of evacuations produced different ways are in some manner different When we evacuate by stimulating or relaxing any particular glands so as to make them secrete a larger quantity of fluids than usual the uniformity of the circulation is lost a particular quantity of it being drawn to the part, from which the evacuat. is made it becomes therefore languid in other parts When we make an immediate evacuation from the blood vessels it leaves the circulation uniform as before its use upon which account this evacuation is in general preferable to those made from particular glands The force that propells the blood out of a vessel when opened is exactly equal to the power with which the sides of the vessels contract & this may in every case be allowed because the force of the heart 60 This force is very considerable hence the blood flows out of an artery with very considerable rapidity. If a vein be open’d its ordinary force is not more than 1/16 of the arterial power, hence there must be an additional power [illegible] that of the heart & arteries when the vein is stopt IF the capillaries are opened the power with which blood is thrown into them is suffict. to make the blood flow out of them. The pressure of the weight of the atmosphere pressing upon other parts of the body forces the blood out of the capillaries where cupping glasses are apply’d By the general circulation of the vluids the blood is completely mixt hence the very same blood is taken away from particular part of the body & from whatever [order] of vessels the evacuation is made 61 The effects of quick & slow evacuation by bleeding are very different, because 1, 3, or 4 times the usual quantity of blood may sometimes be contained in the capillary vessels as in plain from examining the state of the [cornea] when natural & when inflamed when you take away a qy of blood suddenly you do not give time to the capillaries to contract but if the same quantity of blood be taken away slowly the capillaries have time to contract in the first case then the great vessels are principally evacuated. If blood be taken away suddenly the same quantity weakens much more than when taken away slowly. In most cases it has been recommended to make a large opening & from a large vein & this is generally the best [illegible] altho the reason was not well understood. If we wish to affect any particular part of the body we ought to evacuate from a particular part 62 Bleeding from a particular part seems to evacuate such part more than we should expect from any principles yet explained. The weakness communicated to the parts in the neighbourhood of those immediately evacuated does not depend upon any nervous or vascular communicat. betwixt the parts for parts supply’d by the same Trunks of nerves or vessels (if at a distance) are not affected which [illegible] qy neighboring parts to where the evacn is made are [the] [not] [illegible] the same nerves or blood vessels. Arteristomy dangerous & troublesome from the difficulty of stopping the bleeding hence never used in general but sometimes in [topical] bleeding has advantages as it cuts off the conveyance of blood to the part affected with the inflammation openings from large veins & those of the [illegible] are principally [pitched] upon when we want to make topical bleedings if there be any large vein running on the part it may be opened if not cupping or leeches may be apply’d to the part. Scarification is sometimes of particular use on account of [those] themselves occasion’d by two wounds as well as the evacuation made. 63 Leeches sometimes tho’ rarely contn a poisonous juice which occasions an inflammation of the erysipelatous kind but generally goes & is inoffensive. Lect: 64th May 22nd 1772 The quantity of blood that may be taken out of the body without destroying it has been much disputed by practitioners. Dr Hahls followers amongst the moderns & all the ancient physicians bled but in small Quantity others & in particular Boerhaave’s followers bled frequently in large quantities & in almost ever disease If we want to produce any effects upon the general system [&] [illegible] ounces of blood is in an adult that can be taken away, in very young children we more commonly employ leeches from the difficy of finding a vein for the lancet zi in very young children will produce a considerable effect in adults greatly emaciated as by hectic fever ziii will produce a considerable effect but it is but rarely that so small qy is of any service in adults. 64 A strong man will bear to loose 16 or 20 ounces of blood & it is better to take this away at once. some have thought qy a patient cannot bear to loose blood more than 3 or 4 times but Dr. Fordyce instances one case where 112 ounces were taken away in 3 days time with advantage the suddener the evacuat. the better as it produces a greater temporary weakness In bleeding regard ought to be had to the size of the patient to the disposition of his vessels to contract & to the quantity of blood they contain. The evacuat. may be made [fitt] the patient faints in many case there being no instances where the patient has died from loosing this quantity. In inflamat. there is an encreased actn of the arteries in the part inflamed which propelling the fluids the more force into the capillaries distend them beyond their tone & this distension of [illegible] stimulates the arteries & so keeps up the inflamation. In some inflamation sit is the distensn of the small vessels [purely] that keeps up the action of the arteries this is the case in phlegmonous inflamation. Another species of inflamation is when the small vessels are so very irritable that a moderate distension of the vessels will stimulate them and keep up the action of two arteries this we call erysipelatous inflamation 65 Inflamatn sometimes kept up by the stimulus apply’d to irritable surfaces as do sometimes of the internal parts that are subject to inflamtn from the stimulus of the salts contained in the fluids secreted upon them or the surfaces of ulcers that are inflamed from the same cause. When the habit is weak there is a disposition in some particular part to have its vessels act more strongly than natural which disposition bleeding encreases by further weakening the system Hardness of the pulse is the most certain symptoms [illegible] general & phlegmonous inflamatn frequency & smallness of [illegible] Bleeding is usefull in phlegmonous inflamatn only in erysipelas it increases the irritability of the part, in inflamat. from the mucous membrane being irritated by secretions it also tends to encrease the tendency of such membrane to be affected by the stimulus if the inflamatn be mixt of the phlegmonous & erysipelatous kind of bleeding be [and] [it] opens not only relieves [illegible] but the symptoms of irritat. also depending upon the erysipelas. Bleeding a very powerfull means of removg phlegmonous inflamatn to be remembered that its good effects may be instantaneous, but this seldom happens & we by bleeding only make the inflamatn begin to give way & it of itself continues to go off. In phlegmonous inflamatn the more the general system is affected, the more certain is the effects of this operatn & the greater & more suddenly [illegible] weakness of the system is produced the more it benefits. 66 If the system be but little affected evacuat. from the part is more usefull than general Evacuatn [illegible] are thus, more immediately evacuate the part affected Bleeding from the part affected was much practised by the antients, untill the circulat. of the blood was discovered when it fell into disrepute, but in many cases is of the greatest use when your evacuat. is of no service we could hardly expect this a [illegible] but experience conforms the propriety of the practice. In general inflamatn the sooner the evacuatn is made & in the larger quantity the more effectual it is in taking off the encreased actions of the vessels this depends partly upon the effect of habit when the vessels have been used to act strongly for any considerable time they acquire a disposition of continuing this encreas’d action, even after the cause that first produced it is removed The sooner then we empty the vessels the less danger there is of their beginning this habit. Our anxiety in carrying off inflammation by bleeding should be more or less according to the consequence that may arise, from suppuratn of the part affected the natural [cure] should also be considered if the part affected has a natural [cure] which is going on we shd be less anxious about bleeding. 67 Lect: 65th May 23d 1772. When the heart & arteries are acting strongly when the pulse is hard, strong & frequent, bleeding is the most effectual way of carrying off this inflamatn & is equally so from whatever cause it may arise provided it be the only disease in fevers in rheumatism an encreas’d action of the heart & arteries tend to carry off the disease but in fever it is not the only disease [illegible] arterial action & used shd be cautious of diminishing the quantity of blood as we may take away the strength which is necessary to carry him through the disease, in rheumatism the natural cure is worse than the disease it should always be prevented there from taking place by diminishing the arterial action by bleeding In the small pox we shd be cautious of bleeding during maturation (least the pustules sink) unless the symptoms of inflamtn runs extremely high so as greatly to endanger the patient life this evacuation should not be made. In chronic general inflamatn where the arteries only act strongly without strong action of the heart & the pulse is hard, small & contracted & not full, and strong in this case bleeding is not nigh so [illegible] & if we do bleed it should be made in small quantities & often repeated [singular] [illegible] tending to diminish the genl strength but not the encreas’d arterl action 68 One case in which copious bleeding is usefull when the pulse is small & contracted with great depression of strength which is when an irritable surface is affected with general inflamatn so the diaphragm or intestines in these cases the depression [illegible] strength & symptoms of irritation are very great yet the pulse is still to be felt hard & bleeding is the only thing we can depend upon for the cure. IN all cases of spontaneous haemorrage with symptoms of plethora & inflamation. Bleeding may be used advantageously & is the only [best] way of putting a stop to & curing the disease. If haemorrhage takes place in weak habit from relaxation, bleeding is in such cases always hurtfull & bark with strengtheners should be used for to cure the disease. If [illegible] arises from encreased arterial action bleeding is of great use in stopping it. Bleeding is often employ’d in the cure of fevers but it has not the least tendency to cure a fever only takes off the strong action of the vessels should never be used unless there by symptoms of general inflamation, as it will most certainly hurt if the disease does not soon terminate the crisis It may be used as the beginning of fever before symptoms of inflamatn take place when from too great quantity of blood the vessel cannot act sufficiently upon it in consequence the secretions & functions of the body are imperfectly performed & the disease prevented from [illegible] its regular type by bleeding in such [case] [are] often change a continued into an intermitting fever [69] In young women spasmodic & hysteric diseases sometimes proceed from plethora in which case we should evacuate before the use of antispasmodic & remedies diminishing the irritability of the system. In [plethoria] & robust habits we should never exhibit the bark till evacuations be [premised] as this medium in such cases at the same time that it diminishes the irritability of the system encreases the action of the heart & arteries [illegible] producing general inflamatn etc. The gout has all the appearance of an inflamaty disease when it arises in a man of a sanguineous melancholic temperament in such a habit when the symptoms of inflamatn run very high we may bleed with advantage, but in general we should be very cautious of bleeding in this disease as it often makes the gout seize the internal parts as the stomach [illegible] and so may render it suddenly fatal when it otherwise would not be attended with any great danger. Lect: 66th May 25th 1772 The classes of [illegible] already treated of we might suppose to exist a [illegible] [illegible] stimulants, astringts relaxts strengts etc but the [illegible] [illegible] we could not imagine to [illegible] [illegible] from [Expuriema[ [illegible] antispasmodics & narcotics. Antispasmodics are medicines tending to remove all preternatural contractions & actions of the moving parts. 70 There are some preternatl actions which antispamodic remedies have not a power or removing. Diseases were distinguished into such as arose from some particular matter in the system & such as arose from preternatl action of the difft parts only the latter were call spasmodic diseases, but many of the former do not depend upon any matter at least that is sensible to us we therefore deny its existence & yet in these diseases antispasmodic remedies are not usefull, but often improper. Diseases have been called spasmodic when they went through their course irregularly, all involuntary & irregular muscular contractions are called spasms All antispasmodic medicines are stimulants and when they do not exert their antispasmodic they exert their stimulant power, are therefore very uncertain in their operations although they cannot always take of diseases that are more fixt yet they tend in many cases to remove it. Vol: alkali has been employed in inflamat. of the thorax, where by its antispasmodic power it has sometimes been of use but much oftener hurtfull & should never be employed [71] in phlegmonous inflamatn of any kind if exhibited in peripneumony attended with inflamatn of the lungs they are hurtfull but in coughs arising in winter merely from the contind applicatn of cold without any particular inflamt taking place they are of service. Antisp are [sometime] apply’d externally are much more usefull & in deep seated inflamtn they are the most proper & efficacious stimulants, externally apply’d they are very properly apply’d with fomentations & poultices which we wish to act as emollients if joined with these they greatly assist their efficacy. They have a tendency to cure fevers & will sometimes carry off fever entirely but they are much oftener ineffectual & almost always do mischief when they are not serviceable we do not employ them in the beginning, but towards the end of continued fevers camphor in particular has been employ’d but without any great efficacy. Antispamodics have been used in intermitt. during the intermission to prevent the return of the paroxysm Much in particular has been thus employ’d & sometimes with success, they shd be exhibited in pretty large quantities & may be properly joined with narcotics as we cannot depend much upon them alone. In Rheumatism where stimulants cannot be advantageously used by antisp: are improper also but where stimulants are proper, those of the antispasmodic class s [72] should always be preferred guaiacum and volatile alkali are the best and have often been used with considerable success Antisp: have sometimes been employed with success to [procure] sleep when opium could not [illegible] exhibited [illegible] [illegible] liquor in part In spasmodic complaints they are often very powerfull in removing the disease when present, but have very little tendency to remove the disposition of falling into the disease but by encreasing the irritability of the habit often render it more susceptible of the disease & therefore encrease it rendering the paroxysms more frequent are most efficacious when externally apply’d. In other cases they have a tendency if exhibited in the interval of the paroxysms of spasmodic diseases to carry it off entirely & cure the disease whilst if exhibited in their case curing the presence or immediately before the attack of the paroxysm they have very little or no good effects. The effects seemingly so contradictory depend upon the particular habit of the patient if the patient be of a weak & irritable habit they by encreasing this dispositn do mischief but are more immedy efficaceous if exhibited during the paroxysm [illegible] be of a plethoria & [illegible] habit their effects are not so sudden but more usefull. In Hysteric complaints the habit is always weak & irritable antispasmodics then have almost always a tendency to carry off the paroxysm if exhibited during its attack, but if they are exhibited in the present case during the intermissions of the paroxysms by encreasing the irritability they encrease the [tendency] to the disease and so do mischief. The effects of antispasmodics in hysteric diseases are more uncertain than any other medicines if exhibited at the attack or during a paroxysm they sometimes instantly carry it off whilst at other times in circumstances exactly similar they produce no good effects. In perfect epilepsy & convulsion fitts they have very little efficacy if exhibited internally but are more frequently usefull externally apply’d particularly in convulsions & in spasmodic diseases having sometimes a tendency to curing them [illegible] particularly or return periodically shd be [illegible] internally & during the intermission of the paroxysms. No medicine is always successful in epilepsy the convulsive fitts and their similar diseases often baffling our utmost efforts antispasmodics however seem to be as efficaceous more as than any others.’ In the tetanus antispasmodics have neither been employ’d internally n or externally with any very general success altho’ the disease has bone off during the exhibition of opiates & antispasmodics in some instances as musk, opium etc yet the disease in such cases seems to have gone through its natural course rather than to have been cured by the medicines exhibited In the risus sardonicus, hiccup & others of the same kind antispasmodics have been sometimes exhibited with great success, and at other times with none their effects as in hysterical disorders being very uncertain. In cathartics in place of the proper pain & muscular & contraction necessary for expelling the fetus, unnatural pain sometimes take place in such cases antispasmodics have often been exhibited with good success they tending to take off the unnatural & tending to restore the natural muscular contractions & labour pains that are necessary for the expulsion of the child. 70 Fever, inflamation, & rheumatism are preternatural actions of the vessels which do not depend upon any matter in the habit, yet we do not call these spasmodic diseases. Spasmodic diseases are principally known by their coming on without any apparent cause and having no natural cure that we know of Animal [illegible] have generally an effect to produce spasms in difft parts of the body and these medicines seem to be of more general are in such cases than in any other complaints in which they have yet been used. Containing the lectures from No 45, to No 66. Materia Medica by Dr Fordyce No 4. Materia Medica Index Page No Particular sedatives 1 Effects of astringents 4 Action of particular [illegible] 8 general effects of relaxants 19 Particular relaxants [23] Strengtheners 30 Effects of the bark bitters etc. 39 Means of weakening the system 57 Effects of evacuation by bleeding 61 general effects of antispasmodics 69 1 Lect. 45th Sedatives Acids eternally apply’d are powerfully sedative. seem to be equally so, whatever once we use provided they be of the same strength If [so] concentrated they act as stimts Out taste is perhaps the best criterion of judging, the vinegar shd be the standard for diluting them. Acids are usefull as sedatives in all cases of deep seated inflams as in those accompanying fractures dislocations strains In erysipelatous the inflam of the skin [&] integuments they are improper They are very usefull as gargles in infl. of the mouth & throat Neutral salts are somewhat sedative externally employ’d Alcohol a powerfull sedative somewhat astringt but not stimulant is very usefull in erysipelatous inflam as those arising from burns, the bites of poisonous insects etc. provided it can 2 be apply’d before a blister is raised if pure it acts too powerfully as an astringt it shd be diluted then 2, 3, 4, or 5 times its quantity of water It has been disputed whether sedative or relaxing oily medicines were most usefull in burns, sedatives seem most proper in slight cases. All metallic salts are sedative when diluted with water & particularly usefull in inflam of the eyes the chief of these are white, blue vitriol & sacchar. saturni these are more proper in chronic, than in acute [illegible] of the eyes. Preparations of lead are seldom usefull in phlegm: inflam: they sometimes [illegible] or [illegible] & mortifict. [illegible] hazardous in [illegible] attended with great pain they have not this disposition. In excoriations preparats of lead are apply’d with propriety, particularly 3 [cerasse], as also lapis caluminaris & alum. this last is particularly usefull in inflam of the eyes, mouth, & throat. Prep of alum when apply’d to the eye have a disposit. to coagulate its humours [illegible] renders it necessary to be changed frequently. Alum [illegible] made with the white of an egg shd be changed every ¼ of an hour. All the vegetable astringents have been apply’d as sedatives, particularly the [certicosa] of Lineus. Some of the farinaceous seeds as [illegible] have been apply d as sedatives particularly in erysip. inflam. Lastly, opium & poppies are [illegible] sedatives and may be apply’d externally in all inflam. with success particularly of the [???table] parts 4 5 the contract. produced in animal fibre by astringts differ from that produced by the living power in that the water [illegible] combined is in the former seperated & cannot be recombined. The blood vessels are allways full of blood, an astringt. then can only make the vessels press more strongly upon their contain’d fluids, but can’t make them diminish in diameter but in proport. as they are emptied of blood, by larger [illegible] Astringents do not act equally upon all the blood vessels but act more powerfully upon the small & accumulate the blood of course in the great vessels Astringents may act more partict. upon the external, or internal vessels in which case the opposite set are dilated The actn of astringents upon the muscular fibres is permanent, whilst that of its acting upon the living power is temporary. 6 Astringents differ, in some of their acting parts or solely upon the part to which they are apply’d whilst others more universally upon the whole system these later have their actn of shorter continuance than the former they act upon partr parts. Astringts are strengtheners in consequence of their power of accumulate the blood in the greater & internal vesls the strength of the patient being always in proport. to the [qy] of blood contained in the greater vessels It is [illegible] holds good only a certain length, as astringts may be used so as to produce weakness when used to excess They may be used with advantage in restoring the tone to muscular fibres that have been relaxed or weaken’d by over act. hence they are usefull in strains [illegible] after the inflam: is gone When any of the glandr secretions are increased they stop or diminish them in quantity. they also diminish the natl secretn but we never use them so 7 Precautions on the use of astringts in increased secretions If there is inflamatn [illegible] secret. is the natural cure in place of stoppg. such secret rather promote it, to carry off the phlegmonous inflamat. of [illegible] part is increas’d secret. may be in conseq. of a stimulus applied. if we stop the increased secret. whilst the stimuli remains inflammatn is produced. The immedt. cause of secretion is a quantity of blood in the glands of the [part] in conseq. of the contract. of some distant part. was there not to be increased secret. inflamatn would be produced. before we cure such secret. by astringts we must take away a qy of blood from the part by relaxants. in watry secretns. where there appears to be no phlegm inflam. we may use astringt properly if there shd be sympt of plegm: inflam we shd avoid astringents untill the 8 increased secret. has carried off the inflamatn. [illegible] as to the use of astringents we shd evacuate the feces contain’d in the intestines. In secretions from the urethra produced by the applict. of [illegible] matter it is questioned whether astringents are proper. In increas’d secretns from the bladder we use remedies to take off the [illegible] of the habit, as the use of astringts wd be of little use there being a const. stimulus from the urine In haemorages we used sedative asts: In hamorages from the gums astrts are of great use. Of particular astringents [Fossils] astringents act on the system Vegtle astringts act for a longer time, [boles] are compds of calx of iron & clay their activity depends upon the iron. 9 Calcaresur earth has some slight astringency & may be exhibited in diarrhea with out any danger of increasing inflamat. Boles have become employ’d in bruises when the inflamatn has been previously removed they have been used in purgings but have no great efficacy. Alum is a powerfull astringent but we shd give it in such a form as to be certain of the dose. Lect: 48th May 4th 1772. Boles acquire difft colours as red, blue etc. from the calces of iron particularly with which it is mixt hence the [illegible], common bole & they have been advantageously externally employ’d in form of plaisters to restore the tone to relaxed muscular fibres. some of them as the lapis hibernicus contain a considerable portion of alum in their composition, but alum is exhibited alone with much greater propriety & certainty in the dose. 10 Alum is formed naturally by clay being mixt with pyrites which being decomposed the v: acid unites with the clay forming this earthy salt alum as thus formed generally contains a superfluous quantity of acid which may be [separated] from it together with a quantity of water contained in its crystals by exposure to heat the burnt alum is thus prepared differing from common alum only in being more active from the quantity of water evaporated The best mode of exhibiting alum seems to be by forming a whey of sweet milk which may be drunk the sugar & mucilage contained in the milk in some measure covers its taste, and renders it less disagreeable Iron has been employ’d with the vitriolic acid forming green vitriol, with the muriatic acid forming [illegible] [illegible] in spt salis and with sal ammoniae sublimed forming the flores martiales 11 The calces of iron and the flores martiales have greater astringency, and less stimulus than the neutral preperations with the acids Iron has sometimes been used as an astringent in diarrhoeas [its] calces particularly, as already noticed, in the different boles 12 Iron has astringency, but its power as an astring. is mixt with a strengthening & irritat power hence its uses in the chlorosis, fluor albus [illegible] Iron is always dissolved in the acids of the stomach so that it may be used in its metallic form with propriety. it is filed down. if the filings are of a large size they do not act powerfully [qty] if fine, will be as effectual as [qy x] [illegible] it may be rendered still more active by restoring it from its calcin’d state by exposing it to heat in a crucible with [flower] we then obtain it in a very fine powder mixt with the charcoal of the flower, all its difft calces are active It is employ’d externally in boles and 13 When combin’d with acids it is more active we use 3. [illegible] with vitl acid green vitriol & mur. acid The mart. in spt solis, [illegible] tartar by digestn in wine. Iron has been exhibited mixt with alkalis as in the flor. martiales. It has been exhibited combined with sulphur but is unactive the sulphur rendering a mild & inefficacious Lect 49th May 5th 1772 Lead seldom used as an astringt. generally as a sedative, can seldom be used, to stop internal increas’d secretions from its dispositn to [illegible] in paralytic weakness of the intestines. Zinc has been seldom used internally & then not as an astringt has been used externaly as such, never used in its metallic form, found in the earth calcined [illegible] lapis calaminas found in the earth exceedingly hard must be reduced to a fine powder by exposure to a red heat for some [time] & then powder it. It has been internally employ’d as an emetic its ore has been much in use externally for [illegible] as an [astgt] 14 when zinc is exposed to a red heat it puts on the appearance of burning and emits a very fine white powder a form of fumes, this called flowers of zinc. [illegible] or cadmia another calx formed from its combination with copper. all these calces are the same qy [cadonia] is procured in the soap manufactories, is more soluble in water than [illegible] White vit. formed by exposing [pyrites] mixt with calamine to the air. the vitc acid contain’d in the pyrites unites with the zinc the salt is seldom pure, but have a little vitriol of the iron or copper mixt. shd be dissolved in water, & crystalised then called [illegible] of vitriol preparation of zinc have an astringency that renders them very usefull, particularly for making the skin grow upon excoriatn & ulcers. Astringt. juice contained in a variety of vegetables, and it seems to be nearly the same in what ever one we find it. Agrimony etc. have been very properly used in fomentations of erysip. inflamt. act here as sedatives. [illegible] have been used for the eyes not very powerfull their flavour part recommends them Radix tormintilla has been used as an astrin: in dysenteries 15 Rhubarb has a [illegible] of astringency, but small, when compared with its purgative qy the purgative power may be extracted by infusion in water & the astringency aft. The husks of all red fruit contain more or less of an astringent juice. The [Viscus] [Queronas] contains the astringency of the tree, upon which it grows Uva ursi has been lately employ’d in cases of the stone in the bladder inefficacious [illegible] Japonica & sanguis draconis two resinous bodies, mixt with an astringt. juice of a red colour, obtained from trees unknown operate quickly & universally principally usefull in hemorages, may be properly combin’d with alum in this [illegible] & under its effects more lasting may be used in substance advantageously. Lect: 50th May 6th 1772. Narcotics act also as astringents, Acids and salts as astringents & sedatives. 16 17 The action of the relaxants is not so obvious to the senses as that of astringents, hence some have thought that the effects produced by them were produced in some manner difft. In inflamat. of the intestines when the rectum in contracted so that no stools can be procured nor glysters injected by the applic. of the [semicup???] or warm baths we can remove these contractions so that injections can be easily thrown in. when the urethra is contracted so that a suppression of urine is produced & the catheter cannot be introduced by fomentg the parts affected we take off these strictures hence we see that certain substances properly come under this class. Lect: 50th May 7th 1772 The terra japonica sang: draconis are sometimes used in dysenteries, the bark of the wild ash employ’d rather to take off the irritability of the system. The cortex granatorum does not act so quickly, but is more permanent in its action. 18 Oak bark contains a pretty powerfull astringt juice, is employ’d advantageously in fomentations of weak & [relax’d] [illegible] The semirabia has a difft kind of astringency from most others seems to act solely on the part to which it is apply’d [illegible] that astringt taste chiefly used in dysenteries & gleets where the system is greatly relaxed. The logwood is pretty powerfully astringt employ’d mostly in dysenteric cases its astringency similar to that of the other vegetable astringents acts universally ¬ like the semirabia The most powerfully veget: astringent is the juice of the oak collected by certain insects as the galls are employ’d advantageously in gleets, flour albus, & [illegibles] of every kind may be externally used in relaxation of the ligaments & cannot be employed in substance may be extracted by spts or water shd be used in decoctions, or infusion 19 Lect: 51st May 7th 1772 Relaxants are medicines that diminish contractions of the moving parts. As astringents do not decrease so relaxants do not increase the diameter of all the blood vessels their action is not equal but ore determined to the small than the great vessels Relaxants by encreasing the diameter of the small vessels the external particularly and encreasing the quantity of blood in them, have been supposed to act as stimulants. By encreasing the secretions they have been considered as [attenuants]. By diminishing inflamatn. they have been considered as sedatives Relaxants are powerfull remedies in fevers more so than any other class in counteracting & carrying off fever. Fever is always attended with [illegible] perhaps principally occasion’d by contraction of the small vessels, as these med: [counter???] this dispositn they become very efficacious in curing this disease [illegible] fever they are most usefull in the beginning may be [harmfull] in the end of fevers when the [patient] [is] become very weak 20 The addition of stimulants & opiates very much assists their operation in fevers Relaxants act very powerfully in carrying of the first symptoms of fever upon its attack & so preventing it farther encreased. Relaxants cannot be apply’d with propriety where there is a great degree of inflamatn untill it be taken off by evacuations also the heat occasion’d by their operat. encreases the inflammation. At the end of fevers when symptoms of weakness come on to a dangerous degree, they be encreasing the secretn. encrease the weakness be encreasing without any diminution of the fever. If relaxants are of use they generaly produce their good effects in [illegible] hours if they have no good effects or that time they should be discontinued. The first dose shd generally be given in quantity to prove emetic. In general inflamat. by relaxing the vessels they take off in some measure their pressure upon the blood and so are of use. Relaxants are also of very considerable use in intermittent fevers they tending to procure a perfect intermission & to remove the febrile symptoms that often remain after the terminat. of the paroxysm, also to prevent the attack of the cold fitt, are assisted by stimts & opiates. 21 Lect: 52nd May 8th 1772 Relaxants apply’d internally are more powerfull in carrying off internal than external inflamations, as they throw the blood upon the external parts & this is from whether the inflamation be of the phlegomonous kind or of some of the internal mucous membranes, the presence of general inflammation however forbids their use in this, as well as in all other cases, have been considered as particularly usefull in inflamations of the thorax. Relaxants are of very great use in all encreased glandular secretions particularly the internal as they, by throwing the circulation principally upon the [skin] and external parts cause less blood to be convey’d to the glands & greatly encreased the cutaneous [secretion] Rheumatisms are attended with general inflamation they tend immediately to carry off the contraction that takes place in the part affected with disease. but if general inflamation be present they should not be employ’d until it be got rid of They are also of use in carrying off spasmodic contractions when they take place. 22 23 Relaxants are of use in rheumatism but if the general inflamatn. is very great their operation is attended with danger. In spasmodic affections of the ureters urethra gall bladder and even intestinal canal. they are of great use when externally apply’d, and also when thrown into the rectum & colon. In muscular constitutions they are not so efficacious, but have been used sometimes even in these success In cutaneous eruptions depending upon dryness of the [sear] of skin they may often be used with success; so as to cure the disease Lect: 53d May 9th 1772 Action of particular relaxants I Neutral salts They have in general some degree of relaxant power, some more aft to act upon the stomachs, whilst others pass into the intestines & purge, [nitrus] digestiva salt of sylvius sal ammoniac & vitriol: tartar act more particularly upon the stomach. these have seen more [illegible] than the others as relaxants 24 No class of medicines has been more universally used than these salts, they were unknown to the ancients: from their ignorance in chemistry from the [illegible] or [illegible] [illegible] has got various names operatn by which it is procured. Surprising? that medicines of so little efficacy could be so much commended. there being hardly one case in which N:S: can be of any use & they in in case act as powerfull remedies, not withstandg the general use of these medicines in the present practice perfect intermissions of fevers are hot they are sometimes of used in [illegible] sufficiently powerfull to produce any bad effects. Dr. Fordyce attributes the use of N:S: to their disagreeable taste from which the patient supposes they must be efficacious. Some very powerfull applications require a considerable time to operate before they produce any sensible effects. hence inflamatory disorders after bleeding the patient largely, & exhibiting nitre afterward, the cure is attributed to the nitre, which in reality belongs to the operation of bleeding. Dr. F. wishes to make strong preparations on his pupils of the inefficacy of these Medicines, in order that they may not be depended upon, where active medicines may be used with advantage. 25 Neutral salts tho’ not powerfull relaxts sedatives, no [alterants] are yet very usefull purgatives, stimulating the glands of the intestines solely & producing an encreased secretion from these parts. Ipecacuanha Is the part of an America plant brought over dry, and may be preserved so, for a very considerable length of time like [illegible] depend upon a juice soluble in water or in spt of wine & water is [illegible] however (in most cases) used in [illegible] Has been principally used as an emetic, has a specific stimulus to the stomach, so much that, if its juice be injected into the blood vessels, or absorpt. it acts upon the stomach & proves emetic, hence it is more certain in its operatn as an emetic than any other. If given in smaller doses than to prove emetic it acts powerfully as a relaxant most stomachs will bear gr i some gr ii but few others cannot bear more than gr. fs with out producing sickness has been exhibited in dysenteric purgings often [alongst] with opium in which case it becomes powerfully sudorific & the stomach will bear a larger part of both med: when combin’d than when given alone has been successfully used in chronic rheumatism with [illegible] 26 Scilla with root of a plant is of the natural class called [lilliana] acts only as a partial stimulus Besides their power of encreasing the glandular secretions they have also a relaxant power this most being bulbous & acting cannot be well used in [subst.] unless dried in which case it loses somewhat of its efficacy shd be cut in thin transverse slices & slowly dried [illegible] shd begin with small doses. Aconitum has been consider’d as poisonous not lately employ’d in med: its virtues depend upon a juice not volatile & soluble in water it may be used then in form of an extract. Has been considered as a poison but introduced by [illegible] stork seems to act pretty powerfully as a relaxants [illegible] dose of it extremely small, we shd begin with 1/8 part of a grain which may be gradually encreased till it produces sickness has sometimes been used with success in obstinate rheumatism Lect: 54th May 11th 1772 Seneka the root of an American plant [illegible] from being knotted was suppos’d to resemble the tail of a rattle-snake, & to be usefull in the bit of that animal, the juice upon which its virtues depend is soluble in water & has thence commonly been used in [illegible] very disagreeable taste, occasions a heat in which the act. has been sometimes used in diseases of the lungs, in rheumatisms & cutaneous eruptions with success. 27 Cold water was employ’d in fever as a relaxant by the ancients & sometimes with considerable effect, but has not been used of late, it seems to be of no great consequence whether cold or hot water be drank in acute diseases. when cold water has acted as a relaxant it has been used in very large doses two or three quarts of this fluid having been thrown into the stomach acts sometimes both as a purgative & emetic & sometimes as a relaxant, & so has carried off the fever according to the accounts. Antimony No medicine has been subjected to more operations than this metal & yet the preperations of it in use are very few Regulus of antimony is found combined with sulphur & sometimes also the regulus of arsenic each however are very rare & easily discoverable by the redness of their colour. Regulus of antimony is very easy of fusion & may therefore be seperated by exposure to a small heat from the [stony] impurities with which it is mixt the metal 28 when melted is thrown into conical moulds inverted & the qy of [illegible] sulphur being greater than what united chemically with the regulus the later being heaver than the former subsides hence the apex of the cone is a purer regulus containing less sulphur than the base of the cake does. If we apply about 3 or 4 times the qy of [illegible] alkali it unites with the sulphur forming a hepar sulphuris which dissolves the regulus of the metal from which it may be precipitated or iron may be used it [affecting] the sulphur more powerfully than the antimony & no part of it making [illegible] the pure regulus Filings of iron [then] as to be mixt with antimony & the whole expos’d to fire. or a part of the sulphur may be destroy’d by deflagration with nitre if we add equal parts of nitre & any fixt alkali Another method of procuring the regulus for medl purposes is by uniting it [illegible] kali so as to make a hepar s. Regulus of antimony has been exhibited as a purgative in form of a pill called the [perpate] pill has seldom been given in powder in a [??gative] form except sulphur [illegible] antim: & [illegible] mineral Two of its calces have been used by exposure to the air & [illegible] only it thus forms a white powder this operatn is assisted by [illegible] between shavings or [illegible] or by deflagratn which nitre as 3 parts of [illegible] to 1 of [sul.] thrown into a red hot crucible 29 it has been used nitrified it has been combined with vit: & nit: acid but is [uncertain] been [illegible] by water. it has been combin’d with mur. acid [illegible] butter of antimony & [marmurius] [vita] has been combin’d with [illegible] tartar emetic the most certain in [illegible] Lect: 55th May 12th 1772 Preparations of antimony may be considered under 2 heads 1. such salts as are soluble in the watry juices of the stomach these are always certain in their operation therefore preferable to [them] 2. class whose action depend upon their solution in certain salts in the stomach which may vary according to the quantity of these salts [illegible] are therefore uncertain in their operation. There are none of the preperations of antimony so perfect as we could wish all metallic preperations soluble in watry fluids stimulate the stomach strongly & are more apt to act as simple stimulants than to produce their peculiar effects antomonls are also subject to this inconvenience. Antimonials are by much the most powerfull relaxants, & may properly be used in fevers & every other case where this class of medicines is proper & usefull the class of relaxants upon which we can must depend. Crude antimony & its calces are mostly inactive the [green] metallarum & glass of antimony are very uncertain in their [illegible] [illegible] [tartar] & [tincture] of antimony a combinat. of the regulus & hepar sulphuris [are] the only preparats [of] salts which are [active] 30 Relaxants are very usefull in internal inflamations & rheumatisms, such cases excepted when there is a great degree of general inflamation in which cases the genl inflamatn must be first be got rid of before we [illegible] to use them. In inflam: of the mucus membranes as catarrh, erysipelat. sore throat, diarrhoea & dysentery they ay be successfully employ’d, also [illegible] for encreased secretions & [catarcous] eruptions they are used with success. In internal haemorrhages they have often been exhibited successfully May have [illegible] been used in increas’d secretons from the urinary passages Strengtheners such remedies as [given] [contracting] [illegible] render them capable of [illegible] with a greater force differ from stimulants the [illegible] putting this power into action [illegible] also from astringts The strength & weakness of the system do not consist in the action, but in the capacity or incapacity to exert a great degree of power, although the power of the body be finite yet we might suppose the exertion of this power to be definite in some manner as a magnet will lift & suspend a certain piece of iron for any length of time. this is not the case, for the body after exerting its power for a certain length of time looses the capacity of continuing such exertion but has it restored again by rest of the parts. 31 We may say then that there is a flow of living power into the body which may be accumulated so as to act more strongly or by the exertion of this power it may be wasted & exhausted. Tho’ we don’t suppose there is any fluid running out, or into the body yet we may compare the accumulation of the living power to a dam of water gradually collected from a small rivulet which although incapable of turning a mill of itself yet when gather’d and collected in a body is capable for a length of time of producing this effect but the water which was collected being in time exhausted the mill can be no longer driven round till a quantity is re collected The body may be strengthen’d 2 ways 1 by preventing the waste of the living power (to carry on the simile) as by stopping up the dam, to prevent the water running out, or 2d By encreasing the flow of this living power into the body [illegible] by encreasing the stream of water into the dam. The flow of living power may be principally exerted in one part or another thus a dancing masters legs grow strong whilst the arms of a blacksmith grow strong also by exercise of these particular parts. 32 Strengthening remedies then are such as prevent the exertion of the living power or such as encrease the flow of it into the general system. they differ then in their action from stimulants etc. Lect: 56th May 15th 1772. The first action of the living power is to contract the blood vessels so as to adapt them to their contents if there be only a small quantity of blood in the vessels the greater exertion of the living power is requisite to produce this effect, hence nourishing foods, by filling the vessels with blood become strengthening remedies. It is not [suffict] though that food be thrown into the stomach but its quantity & quality must be adapted to the powers of injection & other circumstances. Food easy of digestion does not afford so much nourishment to a strong as to a weak stomach it being too soon thrown out of the former. 33 When the blood vessels have no great disposition to contract, but are forced to contract powerfully form the small quants of blood they contain in these cases the stomach digests well & the appetite is keen on the contrary when the vessels have a vary great disposition to contract not from this small quantity of blood contain’d in them. as inn the case in hectic fever in this case the stomach looses its powers & then appetite is lost. Nature then seems to adapt the appetite & digestive powers to the particular circumstances of the patient’s health & food is loath’d and rejected in cases where it would be unnecessary & hurtfull. Second method of strengthening the system is by applying cold to the body or living in a cold atmosphere In a cold climate the external vessels are contracted & the blood kept in the large vessels about the precordia upon which circumstance the strength of the body seems in a great measure to depend for when the circulatn is principally carried on in the external & not internal parts of the body the strength is diminished as is the case in warm climates. hence change from a warm to a colder climate 34 powerfully strengthens the system we shd only observe that the transition shd not be too sudden else the blood by being suddenly forced into the internal larger vessels it stimulates the body too powerfully & produces disease the [illegible] of the [illegible] jointly consider’d is always nearly the same & variety of [illegible] [the] [body] being subject to is extremely little In temperate climates the habit is greatly debilitated during the summer season whilst it is strengthened by the winter hence in the spring the diseases are mostly of the inflammatory kind whilst the autumnal are attended with weakness & depression of strength. Cold suddenly apply’d as in the cold bath has a very difft effect in this case the blood is suddenly thrown from the external to the internal blood vessels. the cold being removed the contractn of the external vessels does not continue but the large vessels acting powerfully, force the blood upon the external surface of the body hence that [glow] & heat that suddenly take place after using the cold bath. This sudden distribution of the blood through the small’ vessels of the external parts is very powerfull in removing obstructions of the external capillaries 35 Living in a pure atmosphere is another powerfull means of strengthening the system this seems to be affected by the living power being prevented from being exhausted. If the [illegible] of an animal be tied up he becomes gradually weak untill he dies if only a small quantity of air be allowed him he gradually becomes weaker & weaker the very same bakes place in the air of large towns a sense of [oppressn] & weight is felt about the precordia which is immedtly removed by the country air. Running water takes up fixible air, & other putrid effluvia hence an air saturated near running water is pure & wholesome whilst that in the situatn of stagnating water is the contrary from the putrefaction of the water etc. Exposure to continental as the [illegible] & N:E: winds renders the situation unhealthy in some measure, although the air is [denser] in these winds than any others yet if there be the smallest disposition to disease they are the means of producing them 36 Astringents given in small quantities strengthen in large quantities may weaken the system, they act more powerfully [upon the] small than great vessels & differ much from strengtheners Lect: 57th May 12th 1772 2d class act by increasing the flow of living power into the system Exercise having a tendency to draw the action of the living power from the vessels to the muscles has a very good effect in strengthening the habit in order to render exercise efficacious in strengthening the system it should be moderate according to the strength of the patient the exercise should be such as employs all the muscles of the body Riding on horse back, in a carriage, rowing, fencing etc. are of great use, riding in a carriage upon rough roads is disagreeble to the mind producing sensations of fear is therefore hurtfull Exercise should be agreeable and there should always if possible be some object in view besides the health the great use of mineral waters depends more upon the exercise and amusement 37 enjoy’d at those bublick places than any particular quality the waters possess The exercise should allways be in a pure air, if the air be impure the exercise encreases the weakness in place of strengthening hence exercise in close rooms do mischief Certain remedies as bitter vegetables substances tend to encrease the flow of living power into the body vegetable bitters differ considerably however in their properties the pure bitter is very probably the same in all of them The syngenesia of Linneus or those plants with double flowers as the lettuce, dandelion, endive etc. contain a white bitter juice which flows out like milk and resembles opium in its properties, others as the [abrotenum] mas, et [illegible] [tanecetum] etc. have a stimulating essential oil mixt with their bitter, whilst the chamomile contains a purgative as well as a bitter juice 38 The same bitter juice is contained in the peel of the lemon, orange etc. in qy Root of the gentian & tops of the [lesser] centaury This juice is purest in the bark of a certain American plant called Peruvian bark & by many other names Preperations of iron & copper are possess’d of nearly the same effects they have al la power of diminishing the irritability of the system, as well as of strengthening it, the weaker the habit them ore irritable it is and vice versa, but these medicines have in many instances a greater power of diminishing the irritability of the habit than of strengthening it. Cinquena cohina cohave cordex jesuitaves cortex [detrum] erc. The medical juice of the bark is contain’d in little cells or upon being broke & exposed to the sun the [illegible] juice glitters. The root of the small branches contain more of the medl juice than those of the trunk & larger ones you may subject to adulteration [illegible] therefore never be purchased in powder 39 Lect: 58th May 15th 1772 Bark & [bitters] besides their strengthening power, have a power also of diminishg the irritability of the system Bitters approach the bark nearer in their strengthening, than in their power of diminishing the irritability of the habit they may be properly be substituted then to it in the first case When the intestines are weaken’d & in consequence there are want of opposite indigestion, costiveness from want of the peristaltic motion or purging from too great irritability flatulency of the intestine etc. in all these cases the bark may be exhibited with the greatest success. Bitters in these cases are also of great use Bark should be employ’d in solution in cases where the intestines are so very irritable that it produces purging when exhibited in substance extract: [illegible] gives about 3 times as strong as the bark in substance in alcohol dissolves it more perfectly than watry fluids Bark sometimes it inflates the intestines producing purging in this case we may exhibit that with it a very small quantity of opium. 40 Bark sometimes disagrees with the stomach in the cases of spices may be join’d to it [even] as cinnamon clover etc. By diminishing the irritability of the intestines it sometimes produces costiveness this we should carefully prevent from taking place by the exhibition of rhubarb, or does so as to procure an evacuation every day. It is better to exhibit the purgative alone, than with the bark also we will give it either in too large, or too small Doses If it is exhibited with every dose of the bark in qy suffict to [procure] evacuatn it will purge too much if on the [illegible] it is not exhibited in this [illegible] it will produce no effect. Bark has been frequently employed in fevers, sometimes to diminish the irritability & sometimes it strengthens. 1st It may be employ’d in cases where people are exposed to circumstances, in which there is a probability of disease being produced. It is [illegible] by rendering the body insensible to the causes of disease. Bark by long continued use looses its effect upon the body rendering it in [time] insensible to its own, as well as to the action of other stimuli. Bath is of very great use in [illegible] that arise from the weakness & irritability of 41 As it can only be used there for a certain length of time with advantage, it should be exhibited only on certain occasions. [illegible] such as circumstances as the body is most subject to the causes of disease as a preventative zii-ziii in the 24 hours are sufficient the larger the doses exhibited the sooner it looses its efficacy & vice versa. If a man has been exposed to the cause of disease and languor, nausea, debility etc. have taken place it is then too late to exhibit the bark and we must use relaxants in its place Bark was first brought into [illegible] by its use in intermitting fevers it was for a time out of practising was again introduced & continue to be used. [Practitioners] differ very much respecting the propriety & particular time & mode of exhibiting it. It is generally agreed that the intermission of the fever is the most proper time for using it. 42 Some have thought it might properly be exhibited during the whole time of the intermission, others only in the first part & others again in the later part of the intermission [illegible] in a very large dose, before the attack of the paroxysm There has been as much disputes whether it might be exhibited in intermissions of fevers which were not perfect, some asserting that it might be exhibited in imperfect as well as perf. [illegible] The mode of its operating upon the body so as to produce its effects has been much disputed some have [suppos’d] it acted as a stimulus, others that it has some specific quality of destroying Fever independt of its other action upon the body We suppose that as it prevents the causes of disease from (originally taking place by diminishing this irritability of the body, so we suppose that it acts in the same manner in preventing the return of the paroxysm i.e. by rendering the body for the time are susceptible to the causes of the fever. Bark shd not be exhibited but in perfect intermissions [illegible] may sometimes render an intermittt a contg fever, if improperly used 43 Lect: 59th May 16th 1772 Bark has no tendency to carry of a fever which is present, if exhibited on a continual fever it never will cure it, but in most fevers will encrease; in place of diminishing the symptoms. Bark has the same good effects upon almost all intermitting disorders as upon fevers if properly exhibited in the intervals. The cause of a disease may be prevented from taking place in 2 ways [illegible] either by avoiding exposure to the cause producing the disease, or by counteracting that cause when it has taken place (i.e:) producing an effect that is opposite to it. That bark produces its effects by diminishing the irritability of the body appears from its similar effects in other diseases, it prevents the 5 salts of the urine from stimulating the excoriated passages in venereal disease not by destroying the venl matter but by diminishing the [practicability] & rendering the parts insusceptible to the [illegible] 44 The cases where the bark ought to be employed are those cases in which the disease is perfectly absent, or some symptoms of the paroxysm continue through the intermission from the great irritability of the habit and weakness by the long continuance of the disease If exhibited during the paroxysm or where the intermission is imperfect it does mischief & often converts the intermittent into a continual fever. If the disease has continued a length of time & some symptoms of the disease continue from weakness etc. in these cases the bark may be exhibited in the most perfect intermissions it can be found. As the bark is employed to diminish the irritability of the habit is should be given in large quantity & in substance if possible zi or zifs should be exhibited during the intermission & we should not stop its use, as soon as we prevent a paroxysm, but should continue it over a very considerable time afterwards if it can be too soon left off and the disease 45 reproduced the bark looses in a great measure its efficacy & will never after care the disease with such a degree of certainty as at first. Bark frequently produce a tightness about the thorax, & difficulty of respiration and also affection of the brain with all two symptoms attended with more danger than any other in fevers if in continued Fevers than any of them & symptomatic place at the patient be ever so weak & exhausted, by the disease we cannot employ the bark to encrease strength but if the symptoms above mentioned be absent the skin moist [illegible] the pulse quick we may exhibit the bark with advantage zifs or zii in 24 hours is suffict. in these cases. Bark is of great use to prevent the relapse of fevers after a crisis has taken place. If the crisis takes place before the 13th or 14th day the patient is particularly [illegible] to returns of the disorder & we shd use the bark to prevent this danger. 46 If a crisis takes place about or before the 7th day of the disease then the bark shold be administered in substance, & in as large quantity as if to prevent the return of an intermitting fever also there is very great danger of relapse. If a [cerisis] takes place after the disease has continued for more than 14 days there is much less danger of relapse & it holds general in fevers that the longer the disease has continued before a crisis takes place the patient is less subject to relapse & vice versa the sooner the crisis the greater it is danger. Lect: 60th May 18th 1772 When intermitting fevers run through their natural course they weaken the patient so much as at times to prove fatal to prevent this great weakness from taking place bark, & the bitters have been exhibited a small qy of bark, zi or zii in 24 hours is suffict. Chamomile etc. have been more frequently used it is better however to stop the course of the disease by large quantity of the bark. 47 Bark in general encreases phlegmonous & diminishes erysipelatous inflamation these two diseases are often combined, if the pulse be hard, fall, and strong the bark should not be exhibited if the pulse be quick, weak etc., and symptoms of irritability take place in such cases bark may be exhibited to advantage. it encreases suppuration & the format. of good [illegible] and prevents absorption. in particular spasmodic affections as of the intestines etc. in such cases they often depend upon weakness, hence the irregularity of the muscular motions the bark by strengthening the general habit restores the equality of the muscular powers & so cures the disease The matter as secreted by ulcers is not [pus] but a thin watry fluid at first and is gradually converted into [illegible], that this is the case appears from observing any small abscess as a pustule of the small, or chicken pox, the fluid it contains is at first clear and transparent but is gradually converted into thick yellow [illegible]. 48 Erysipelatous inflamation of an abscess or ulcer is the great or principal cause of the absorption of [illegible] into the system, hence the great use of the bark in converting the erysipelatous, into phlegmonous inflamation & these both dispose the ulcer to secrete a thicker & better [illegible] and to prevent the disposition of absorption. In all wounds, and ulcers where we want to produce good [illegible] bark is the most powerfull medicine in promoting it. If an ulcer be recent bark is very powerfull in producing good suppuration, & granulation, but if the ulcer be of a long standing the case is very different in the first case the system may be considered as affected in general, in the later case the disease is topical & the system not affected. In the later case mercury is particularly usefull. Bark much preferable to all the other bitter & strengthening medicines in the above [situations]. 49 inflamations of the mucous membranes are often attended with encreased secretions from the mucous glands. Bark stops this secretion by taking off from the irritability of these glands. Encreased secretions of the intestines and better treated by opiates & other astringents than the bark unless the disease has been long continued In gangrene the mortification bark the most powerfull remedy yet discovered A dead part is seperated from the living part of the body by a suppuratn which takes place between them & bark from its disposition to destroy erysipelatous inflamation, & convert it [into] phlegmonous inflamatn powerfully promotes the suppuration. The effect of the gangrened part upon the surrounding parts is such as not only to prevent this suppuration from taking place, but also to change the living parts into the same [illegible] with itself 50 Bark by its power of diminishing the irritability of the parts prevents the sound parts from being acted upon by the parts. Lect: 61st May 19th 72 In rheumatism bark does not at all tend to carry off the disease, but as in other disorders it prevents the return of it. It often happens in acute rheumatism after the disease has continued for some time if the pain goes off entirely in the day time, but returns at the natural evening paroxysm & continues through the night disappearing in the morning with sweating the continuance of which disease greatly weakens & wastes the patient. Bark in this case may be exhibited during the day in qy of from zfs to zi with the greatest success its use generally carrying off the disease. Rheumatism often returns at irregular periods like a spasmodic disease, or upon the least exposure to cold in these cases the bark 51 When great weakness takes place suddenly from any cause the strength may be restored in a short time by the exhibition of the bark in considerable quantities. If the weakness has been a long time in being produced we cannot expect to get rid of it so soon. Bitters in these cases are of use but the bark is preferable in most cases excepting where the habit is very lax in [illegible] case preparat. of iron have the preference. In these cases it should be exhibited in solution & its use intermitted after 1, or 3 weeks for some time, & returned to again, the strengthening medicines should be varied as one medicine will be efficacious when another by use has lost its effects. This advantage is lost if we use mixt preparations of them. In hysteric cases there is a great degree of irritability in the system. Bark may be properly exhibited, by taking off the irritability of the habit it often cures the disease. In chlorine strengthening remedies have often been recommended but the vessels and is [illegible] strongly in some cases it may be questioned whether a [illegible] [illegible] should be [illegible] evacuatn takes [illegible] actn of the arteries etc. 52 When the hysteric disease takes place in plethoric habits, bark cannot be exhibited, untill the plethora be remov’d When it proceeds from weakness the bark may be employ’d from the beginning with the greatest advantage most effectl [illegible] Disease has come on suddenly & vice versa. Preparations of iron unless when plethora is present are next to bark in efficacy in this disease In other spasmodic diseases this class of medicines and of some use if the body be weak & eventually they are most efficacious [illegible] if iron & [illegible] are often preferable to the bark & bitters in such cases. In epileptic fitts etc. where the habit is not plethoric, but weak those medicines may be used advantageously and are of use in all diseases that return at regular periods Tetanus & risus sardonicus can scarcely be [considered] as spasmodic & are little benefited by [illegible] symptoms of sickness of [illegible] place. In chorea st. Viti when it can be relieved by medicines the bark is the best they are only efficacious at the beginning of weak disease. Bark and other bitters may be used to carry out the [gout] but they are apt to induce a melancholic temperament and apoplexy palsy etc. have frequently been produced from their [illegible] use in this disease bitters & strengtheners are of use in weakness of the intestines attended with [illegible] as they [illegible] poison which [illegible] & strengthens the stomach 53 When the disease is regular & the patient strong bitters whd not be used. But if the disease returns irregularly is apt to infect the internal parts and the patient is weak the bark & bitters may be used to remove it but they in all these cases tend to encrease the melancholic temperament & their use is often attended with bad consequences [illegible] the Scotland, London Lect: 62d May 20th 1772 In such cases of gout where the disease has exhausted the patient the bark may be exhibited in small quantities from zis to ziii in 24 hours are mostly sufficient When the menstrua are obstructed from weakness, bark & bitters may be exhibited advantageously. Both species of [abrotonum] and absinthium contain a stimulating essential oil, they cannot be employ’d to take off the irritability of the habit, but to strengthen it. Wormwood, santonicum and sanacetum have been particularly employ’d to destroy worms in the intestines [illegible] poison these animalcula and at the same 54 time strengthen the intestines and enable them to digest and evacuate them. [Carduus] peridictus and cardina have been employ’d not only as strengtheners but as composers of the stomach in violent reaching infusion of chamomile has been used at the same intention these medicines when exhibited in large quantities excite vomiting. Chamomile has many of the same properties with the bark but has more of a purging power. The [illegible] of oranges lemons, [carass] apples etc. have an essential oil which renders them very agreeable to the stomach they have also a degree of astringency are often exhibited its other [illegible] on act. of their agreeable flavour. The lesser centaury & gentian are the purest bitters but they have no power of destroying the irritability of the [illegible] [wall] [that] [the] stomach & [strengthen] Hops are used only to preserve malt liquors but may deserve a place in the pharmacopia [Chamypotys] marebium chamedra [dictammus] albus, salvia & several others of the sedomamia contain besides their bitter & stimulating [illegible] 55 have been particularly employd in gout [where] we want to strengthen the stomach & prevent flatulency the astringent juice of these plants resemble that of the bark [illegible] has been particularly employ’d in the jaundice Preparations of iron besides their strengthening power have a considerable stimulus, they are next to the bark in their power of diminishing the irritability of the habit, but their stimulat renders them in many cases improper their calces shd be used, or else their salts in very weak solutions they stimulate the stomach also too powerfully Preparations of copper can be employ’d only to diminish the irritability, if not to strengthen the habit, have been particularly used to prevent the return of spasmodic diseases a calx of zinc has of late been employed at the same intention [illegible] & the flores zinci 56 57 Lect: 63d May 21st 1772 Remedies which weaken the system. Sedatives in as far as they act upon the system in general during the time of their action prevent the flow of the living power but they leave the parts as strong, or stronger after, than before their action. We have no medicine that will permanently diminish the flow of living power without it the same time diminishing the irritability of the system The only means we have of weakening the system is by exhausting the living power which we never wish to do permanently, but only with a view to cure some prevent disease which is worse & when this effect is produced & the habit freed of the disease it may soon be restored to its usual strength. If a patient be affected with pleurisy use bleeding & so weaken the system [while] taking off the strong action of the vessels of the pleura cures the disease but a small degree of weakness is left produced by the evacuation mode this however is not to be set in comparison with the danger the patient was subjected to from the original disease. 58 Weakness alone if free from other disease is generally soon got the better of therefore we do not hesitate weakening the system when we are to produce any good effect from it but if we weaken the system & any other disease to prevent we never can get rid of that weakness till the other disease be first removed such [illegible] then require much considerat. for all cases sedatives would be preferable to weakening remedies if they acted sufficiently powerfull. but as they are not we are oblidged in some cases to weaken it & the only method we know of producing the effect is by exhausting it. The first action of the living power is making the blood vessels contract, so as to adept themselves to the quantity of fluids they contain, the [illegible] empty the vessels then the more of the living power is spent in their contraction so that there is a smaller quantity of it to expend upon muscular power & the other functions of the body the system is therefore in some degree weakened by the extra quantity of living power of fluid so the action of the blood vessels for [illegible] is [illegible] as soon as the blood vessels [illegible] [illegible] [contract] upon their contents. 59 all evacuations tend to weaken emptying the blood vessels in whatever way but the effects of evacuations produced different ways are in some manner different When we evacuate by stimulating or relaxing any particular glands so as to make them secrete a larger quantity of fluids than usual the uniformity of the circulation is lost a particular quantity of it being drawn to the part, from which the evacuat. is made it becomes therefore languid in other parts When we make an immediate evacuation from the blood vessels it leaves the circulation uniform as before its use upon which account this evacuation is in general preferable to those made from particular glands The force that propells the blood out of a vessel when opened is exactly equal to the power with which the sides of the vessels contract & this may in every case be allowed because the force of the heart 60 This force is very considerable hence the blood flows out of an artery with very considerable rapidity. If a vein be open’d its ordinary force is not more than 1/16 of the arterial power, hence there must be an additional power [illegible] that of the heart & arteries when the vein is stopt IF the capillaries are opened the power with which blood is thrown into them is suffict. to make the blood flow out of them. The pressure of the weight of the atmosphere pressing upon other parts of the body forces the blood out of the capillaries where cupping glasses are apply’d By the general circulation of the vluids the blood is completely mixt hence the very same blood is taken away from particular part of the body & from whatever [order] of vessels the evacuation is made 61 The effects of quick & slow evacuation by bleeding are very different, because 1, 3, or 4 times the usual quantity of blood may sometimes be contained in the capillary vessels as in plain from examining the state of the [cornea] when natural & when inflamed when you take away a qy of blood suddenly you do not give time to the capillaries to contract but if the same quantity of blood be taken away slowly the capillaries have time to contract in the first case then the great vessels are principally evacuated. If blood be taken away suddenly the same quantity weakens much more than when taken away slowly. In most cases it has been recommended to make a large opening & from a large vein & this is generally the best [illegible] altho the reason was not well understood. If we wish to affect any particular part of the body we ought to evacuate from a particular part 62 Bleeding from a particular part seems to evacuate such part more than we should expect from any principles yet explained. The weakness communicated to the parts in the neighbourhood of those immediately evacuated does not depend upon any nervous or vascular communicat. betwixt the parts for parts supply’d by the same Trunks of nerves or vessels (if at a distance) are not affected which [illegible] qy neighboring parts to where the evacn is made are [the] [not] [illegible] the same nerves or blood vessels. Arteristomy dangerous & troublesome from the difficulty of stopping the bleeding hence never used in general but sometimes in [topical] bleeding has advantages as it cuts off the conveyance of blood to the part affected with the inflammation openings from large veins & those of the [illegible] are principally [pitched] upon when we want to make topical bleedings if there be any large vein running on the part it may be opened if not cupping or leeches may be apply’d to the part. Scarification is sometimes of particular use on account of [those] themselves occasion’d by two wounds as well as the evacuation made. 63 Leeches sometimes tho’ rarely contn a poisonous juice which occasions an inflammation of the erysipelatous kind but generally goes & is inoffensive. Lect: 64th May 22nd 1772 The quantity of blood that may be taken out of the body without destroying it has been much disputed by practitioners. Dr Hahls followers amongst the moderns & all the ancient physicians bled but in small Quantity others & in particular Boerhaave’s followers bled frequently in large quantities & in almost ever disease If we want to produce any effects upon the general system [&] [illegible] ounces of blood is in an adult that can be taken away, in very young children we more commonly employ leeches from the difficy of finding a vein for the lancet zi in very young children will produce a considerable effect in adults greatly emaciated as by hectic fever ziii will produce a considerable effect but it is but rarely that so small qy is of any service in adults. 64 A strong man will bear to loose 16 or 20 ounces of blood & it is better to take this away at once. some have thought qy a patient cannot bear to loose blood more than 3 or 4 times but Dr. Fordyce instances one case where 112 ounces were taken away in 3 days time with advantage the suddener the evacuat. the better as it produces a greater temporary weakness In bleeding regard ought to be had to the size of the patient to the disposition of his vessels to contract & to the quantity of blood they contain. The evacuat. may be made [fitt] the patient faints in many case there being no instances where the patient has died from loosing this quantity. In inflamat. there is an encreased actn of the arteries in the part inflamed which propelling the fluids the more force into the capillaries distend them beyond their tone & this distension of [illegible] stimulates the arteries & so keeps up the inflamation. In some inflamation sit is the distensn of the small vessels [purely] that keeps up the action of the arteries this is the case in phlegmonous inflamation. Another species of inflamation is when the small vessels are so very irritable that a moderate distension of the vessels will stimulate them and keep up the action of two arteries this we call erysipelatous inflamation 65 Inflamatn sometimes kept up by the stimulus apply’d to irritable surfaces as do sometimes of the internal parts that are subject to inflamtn from the stimulus of the salts contained in the fluids secreted upon them or the surfaces of ulcers that are inflamed from the same cause. When the habit is weak there is a disposition in some particular part to have its vessels act more strongly than natural which disposition bleeding encreases by further weakening the system Hardness of the pulse is the most certain symptoms [illegible] general & phlegmonous inflamatn frequency & smallness of [illegible] Bleeding is usefull in phlegmonous inflamatn only in erysipelas it increases the irritability of the part, in inflamat. from the mucous membrane being irritated by secretions it also tends to encrease the tendency of such membrane to be affected by the stimulus if the inflamatn be mixt of the phlegmonous & erysipelatous kind of bleeding be [and] [it] opens not only relieves [illegible] but the symptoms of irritat. also depending upon the erysipelas. Bleeding a very powerfull means of removg phlegmonous inflamatn to be remembered that its good effects may be instantaneous, but this seldom happens & we by bleeding only make the inflamatn begin to give way & it of itself continues to go off. In phlegmonous inflamatn the more the general system is affected, the more certain is the effects of this operatn & the greater & more suddenly [illegible] weakness of the system is produced the more it benefits. 66 If the system be but little affected evacuat. from the part is more usefull than general Evacuatn [illegible] are thus, more immediately evacuate the part affected Bleeding from the part affected was much practised by the antients, untill the circulat. of the blood was discovered when it fell into disrepute, but in many cases is of the greatest use when your evacuat. is of no service we could hardly expect this a [illegible] but experience conforms the propriety of the practice. In general inflamatn the sooner the evacuatn is made & in the larger quantity the more effectual it is in taking off the encreased actions of the vessels this depends partly upon the effect of habit when the vessels have been used to act strongly for any considerable time they acquire a disposition of continuing this encreas’d action, even after the cause that first produced it is removed The sooner then we empty the vessels the less danger there is of their beginning this habit. Our anxiety in carrying off inflammation by bleeding should be more or less according to the consequence that may arise, from suppuratn of the part affected the natural [cure] should also be considered if the part affected has a natural [cure] which is going on we shd be less anxious about bleeding. 67 Lect: 65th May 23d 1772. When the heart & arteries are acting strongly when the pulse is hard, strong & frequent, bleeding is the most effectual way of carrying off this inflamatn & is equally so from whatever cause it may arise provided it be the only disease in fevers in rheumatism an encreas’d action of the heart & arteries tend to carry off the disease but in fever it is not the only disease [illegible] arterial action & used shd be cautious of diminishing the quantity of blood as we may take away the strength which is necessary to carry him through the disease, in rheumatism the natural cure is worse than the disease it should always be prevented there from taking place by diminishing the arterial action by bleeding In the small pox we shd be cautious of bleeding during maturation (least the pustules sink) unless the symptoms of inflamtn runs extremely high so as greatly to endanger the patient life this evacuation should not be made. In chronic general inflamatn where the arteries only act strongly without strong action of the heart & the pulse is hard, small & contracted & not full, and strong in this case bleeding is not nigh so [illegible] & if we do bleed it should be made in small quantities & often repeated [singular] [illegible] tending to diminish the genl strength but not the encreas’d arterl action 68 One case in which copious bleeding is usefull when the pulse is small & contracted with great depression of strength which is when an irritable surface is affected with general inflamatn so the diaphragm or intestines in these cases the depression [illegible] strength & symptoms of irritation are very great yet the pulse is still to be felt hard & bleeding is the only thing we can depend upon for the cure. IN all cases of spontaneous haemorrage with symptoms of plethora & inflamation. Bleeding may be used advantageously & is the only [best] way of putting a stop to & curing the disease. If haemorrhage takes place in weak habit from relaxation, bleeding is in such cases always hurtfull & bark with strengtheners should be used for to cure the disease. If [illegible] arises from encreased arterial action bleeding is of great use in stopping it. Bleeding is often employ’d in the cure of fevers but it has not the least tendency to cure a fever only takes off the strong action of the vessels should never be used unless there by symptoms of general inflamation, as it will most certainly hurt if the disease does not soon terminate the crisis It may be used as the beginning of fever before symptoms of inflamatn take place when from too great quantity of blood the vessel cannot act sufficiently upon it in consequence the secretions & functions of the body are imperfectly performed & the disease prevented from [illegible] its regular type by bleeding in such [case] [are] often change a continued into an intermitting fever [69] In young women spasmodic & hysteric diseases sometimes proceed from plethora in which case we should evacuate before the use of antispasmodic & remedies diminishing the irritability of the system. In [plethoria] & robust habits we should never exhibit the bark till evacuations be [premised] as this medium in such cases at the same time that it diminishes the irritability of the system encreases the action of the heart & arteries [illegible] producing general inflamatn etc. The gout has all the appearance of an inflamaty disease when it arises in a man of a sanguineous melancholic temperament in such a habit when the symptoms of inflamatn run very high we may bleed with advantage, but in general we should be very cautious of bleeding in this disease as it often makes the gout seize the internal parts as the stomach [illegible] and so may render it suddenly fatal when it otherwise would not be attended with any great danger. Lect: 66th May 25th 1772 The classes of [illegible] already treated of we might suppose to exist a [illegible] [illegible] stimulants, astringts relaxts strengts etc but the [illegible] [illegible] we could not imagine to [illegible] [illegible] from [Expuriema[ [illegible] antispasmodics & narcotics. Antispasmodics are medicines tending to remove all preternatural contractions & actions of the moving parts. 70 There are some preternatl actions which antispamodic remedies have not a power or removing. Diseases were distinguished into such as arose from some particular matter in the system & such as arose from preternatl action of the difft parts only the latter were call spasmodic diseases, but many of the former do not depend upon any matter at least that is sensible to us we therefore deny its existence & yet in these diseases antispasmodic remedies are not usefull, but often improper. Diseases have been called spasmodic when they went through their course irregularly, all involuntary & irregular muscular contractions are called spasms All antispasmodic medicines are stimulants and when they do not exert their antispasmodic they exert their stimulant power, are therefore very uncertain in their operations although they cannot always take of diseases that are more fixt yet they tend in many cases to remove it. Vol: alkali has been employed in inflamat. of the thorax, where by its antispasmodic power it has sometimes been of use but much oftener hurtfull & should never be employed [71] in phlegmonous inflamatn of any kind if exhibited in peripneumony attended with inflamatn of the lungs they are hurtfull but in coughs arising in winter merely from the contind applicatn of cold without any particular inflamt taking place they are of service. Antisp are [sometime] apply’d externally are much more usefull & in deep seated inflamtn they are the most proper & efficacious stimulants, externally apply’d they are very properly apply’d with fomentations & poultices which we wish to act as emollients if joined with these they greatly assist their efficacy. They have a tendency to cure fevers & will sometimes carry off fever entirely but they are much oftener ineffectual & almost always do mischief when they are not serviceable we do not employ them in the beginning, but towards the end of continued fevers camphor in particular has been employ’d but without any great efficacy. Antispamodics have been used in intermitt. during the intermission to prevent the return of the paroxysm Much in particular has been thus employ’d & sometimes with success, they shd be exhibited in pretty large quantities & may be properly joined with narcotics as we cannot depend much upon them alone. In Rheumatism where stimulants cannot be advantageously used by antisp: are improper also but where stimulants are proper, those of the antispasmodic class s [72] should always be preferred guaiacum and volatile alkali are the best and have often been used with considerable success Antisp: have sometimes been employed with success to [procure] sleep when opium could not [illegible] exhibited [illegible] [illegible] liquor in part In spasmodic complaints they are often very powerfull in removing the disease when present, but have very little tendency to remove the disposition of falling into the disease but by encreasing the irritability of the habit often render it more susceptible of the disease & therefore encrease it rendering the paroxysms more frequent are most efficacious when externally apply’d. In other cases they have a tendency if exhibited in the interval of the paroxysms of spasmodic diseases to carry it off entirely & cure the disease whilst if exhibited in their case curing the presence or immediately before the attack of the paroxysm they have very little or no good effects. The effects seemingly so contradictory depend upon the particular habit of the patient if the patient be of a weak & irritable habit they by encreasing this dispositn do mischief but are more immedy efficaceous if exhibited during the paroxysm [illegible] be of a plethoria & [illegible] habit their effects are not so sudden but more usefull. In Hysteric complaints the habit is always weak & irritable antispasmodics then have almost always a tendency to carry off the paroxysm if exhibited during its attack, but if they are exhibited in the present case during the intermissions of the paroxysms by encreasing the irritability they encrease the [tendency] to the disease and so do mischief. The effects of antispasmodics in hysteric diseases are more uncertain than any other medicines if exhibited at the attack or during a paroxysm they sometimes instantly carry it off whilst at other times in circumstances exactly similar they produce no good effects. In perfect epilepsy & convulsion fitts they have very little efficacy if exhibited internally but are more frequently usefull externally apply’d particularly in convulsions & in spasmodic diseases having sometimes a tendency to curing them [illegible] particularly or return periodically shd be [illegible] internally & during the intermission of the paroxysms. No medicine is always successful in epilepsy the convulsive fitts and their similar diseases often baffling our utmost efforts antispasmodics however seem to be as efficaceous more as than any others.’ In the tetanus antispasmodics have neither been employ’d internally n or externally with any very general success altho’ the disease has bone off during the exhibition of opiates & antispasmodics in some instances as musk, opium etc yet the disease in such cases seems to have gone through its natural course rather than to have been cured by the medicines exhibited In the risus sardonicus, hiccup & others of the same kind antispasmodics have been sometimes exhibited with great success, and at other times with none their effects as in hysterical disorders being very uncertain. In cathartics in place of the proper pain & muscular & contraction necessary for expelling the fetus, unnatural pain sometimes take place in such cases antispasmodics have often been exhibited with good success they tending to take off the unnatural & tending to restore the natural muscular contractions & labour pains that are necessary for the expulsion of the child. 70 Fever, inflamation, & rheumatism are preternatural actions of the vessels which do not depend upon any matter in the habit, yet we do not call these spasmodic diseases. Spasmodic diseases are principally known by their coming on without any apparent cause and having no natural cure that we know of Animal [illegible] have generally an effect to produce spasms in difft parts of the body and these medicines seem to be of more general are in such cases than in any other complaints in which they have yet been used. Containing the lectures from No 45, to No 66.