Charles Condit
College of Physicians & Surgeons
of the city of 
New York 1825-6



1818
Neuralgia 117
O
Ophthalmia Gonorrhael 36
P
Phymosis 4
Paraphymosis 5
Ptyalism profuse, treat, of 19
Process of the healing of bones 156
Polypus 121
methods of removing 122
Paracentesis 153
Ranula 201
S
Spine, injuries of 173
Strictures 26
Staphyloma 116
Stone, operation for 194
T
Testicles, diseases of 202
manner of extirpating 204
Trephine, application of 100
Tonsils, removal of 123
U
Ulcers, treatment of 68
fungous 70
callous 72
fistulous 73
Contagious 74
noli me tangere 78
Urine, retention & suppression of 18
V
Venereal disease 13
affection of throat 1
skin 1
nose 1
Varicocele 14



1
Lecture Nov 11th 1825 Dr Mott
On the Venereal disease-
The first appearance of this disease is in the form of 
chancres.- The chancrous matter has a peculiarity distinct
from the Gonorrhael as that of the latter may be applied
to different parts of the body & produce no effects whatever,
whereas the matter of chancres have been found producing
effects when applied to parts of the body - this was exampled
for the case of a surgeon having dressed a 
chancrous sore & the matter being applied to his 
fingers caused a bubo in the axilla -
The first effect produced by chancres is an 
itching about the part, & after increasing for a few 
days a small eminemco makes its appearance, which
breaking causes a discharge of matter leaving an excavation,
which excavation distinguishes a chancres from a
mere excoriation - The majority of cases however may 
be mere excoriations & notwithstanding they may be 
cured by local applications, yet it is advisable to 
have recourse to internal medicines which may 
act as antidotes to the poison, as if it was a systematic
disease -


2
The time of the appearance of chancres is generaly
from 7 to 10 days after exposure, tho' in some cases
a month may intervene before it developes itself -
Chancres make their appearance on different
parts of the body organ, the most frequently if that
of the corona glandis near the fraenum, which it 
speedily erodes. The next most common appearance
is on the prepuced itself in the orifice of the 
Urethra, & occasionally along the dorsum of the 
penis extending to the scrotum -
Treatment. The best is that which
exposes to the least inflamn. Some advise Escharotics
but excision is better if the chancre is in a situation
to be taken hold of with the forceps - applications -
Dr Mott advises to apply the black washs (made
by rubbing ʒi Sub. muria Hydrary, in ℥iiij lime water)
or other mild preparations of mercury, yellow wash
& S. these applications to be accompanied with the 
blue pill (made with 1 gr Cal 1/4 gr opium & a little
starch) or Corrosive Sublimate (1/8 gr pill) -


3
Little effect is made upon chancres until the 
system is affected by the mercury & unless its use 
is accompanied by the strictest antiphlogistic regimen
Bubo is always produced by harsh applications
inducing inflamn- Beware then of inflamn- & you 
will avoid Bubo. Treat mildly, & you will not have
bubo in one case out of twenty -
Chancre is apt to occasion Phymosis
this is generally accompanied with considerable
inflamn- on this stage, the Physician should pause
& reflect, tho' some recommend to continue the use 
of mercury at all hasards, Dr Mott reprobates this 
practice as detrimental to the safety of the paten
If its use is continued the invariable result is
sphacelation -
New York


4
Lecture Nov 12th 1825 Dr Mott
When phymosis exists, make use of such remedies
as well reduce the inflamn- viz leeches &
the application of warm poultices, the more 
emollient the better, at the same time make 
injections of black wash, & then cleanse with soap
& water - If harshness & ulceration appear about 
the corona glandis, the best practice is to lay it 
open by incision in order to expose it to the 
operation of the medicine, as the wound of necessarily
considerable, the inflamn- is also considerably
increased, hence of possible dipense with cutting 
Dr Motts manner of operating is with the Phymosis
Knife - Slit the penis on either side parrelel to 
the prepuce. The common manner is with the 
director & bestouri, introducing the disector under the
prepuced & cutting down upon it, after cutting apply
a thin layer of lint, & over this an emollient & poultices
In a few days inflamn having subsided you must
use such forms of mercury as least calculated to 
produce inflamn- as Blue pill. Plummers pill & 


5
Paraphymosis is an opposite state to phymosis, being
a retracted state of the prepuce. Most practitioners are 
too anxious in this state. In the greater number of cases
relief may be afforded by manual operation. Dr Mott's
practice is, if delay be admissible, first to attempt a reduction
by manual operations, which is performed as follows
Sit down before the patient & after winding a piece of 
rag around the penis, above the place of strangulation
(the object is to press the blood out of the glans, for
which much time & patience is necessary) Then take the 
penis, between the first & second fingers of each hand
push with the thumbs upon the glans & draw upon the 
prepuce, by this means relief is generally obtained. If we 
fail in effecting this operation must be resorted to -
After frequent general & local bleeding, apply
lead water poultices (made of bread & milk & lead water)
for a few days. Here too if there be much inflamn 
lay aside mercury - Operation. Turn up the penis &
seek out the place where the prepuce is most closely
bound downs. Take hold of the penis & in this place
with phymosis knife, cut the prepuces a little -


6
Sometimes the penis mortifies, occasioning much
soliatude on the part of the patient & Physicians
Generally the integuments only, tho' sometimes the whole
or greater part of the penis are destroyed -
On the first appearance of symptoms of mortification,
proceed to arrest it by poultices - a blister around
the penis on the healthy part prevents the mortification
from extending farther - To prevent factor &c on sloughing
use lotions of nitric acids gutta 30-40 pint of water -
another good application is Conserv, Rosar ℥s. Honey roses
Tinct opii aa ʒij - In this stage Opium should be 
freely used, for in almost all cases, there is great
irritability & opium judiciously given is of much
benefit. Dr Mott considers it a great antiphlogistic 
Remedy in this state - If the patient has been in the 
habit of using liquors, let him have such kinds, as 
he has previously used tho' not to the same excess
In many cases there is delirium tremens & here the 
above is particularly necessary, Restore now the tone of 
the system, after which you may recur to the use of 
mercury as the blue pill &c - Treat the ulcer as a 
simple ulcer - One of the most absurd practices in 

7
healthy granulation is to apply lotions &c - It is only
necessary to protect from airs -
When the penis is sloughing, two or three rather 
alarming circumstances sometimes occur, as Haemorrhage
which sometimes is so considerable as to demand immediate
attention. It may commonly be arrested by applying lint
& pressure. If these fail, apply with a probe but dipped
or Spts Terebinth, to the artery -
Another occurence is the union of the 
urethra. This is to prevented by inserting & wearing from 
the commencement of ulceration an elastic catheter an
inch or two in length. This is very important, for strictures
of an ordinary nature, are nothing compared with strictures
from cicitrization -
Females are occasionally subject
to chancres, one fact should be noticed, that in females
there is much more danger than in males. Chancres
commonly occur just within & in the lower part of 
the labia majora & sometimes on the mons veneris
Same Treatment - as in males -

8
Warts are appearance found in both sexes. There
are two kinds venereal & nonvenereal warts. They generaly
arise from the want of Cleanliness, as they frequently
occur when there is no venereal disease. They appear
in two forms, soft & hard. The soft nonvenereal
the hard venereal -
Though warts are cured by mercury
this is no evidence of their venereal nature - mercury
operates upon the system & as it is of use in fevers
so is this. Dr Mott in treating warts depends entirely
upon local applications as Sulp Tinc, Sulp Cupri.
Tinct Uron, or extirpation by knife, also by oxide
of arsenic applied in powder or ointment - antimony
lunar caustic &c -

9
Lecture Nov 14th 1825 Dr Mott - 
Bubo, tho' a frequent is not always a certain product 
of chancre. Dr Mott says he has seen the most 
terrible forms of bubo without chancre. Bubo in the 
groin is a state between constitutions & local diseases
or primary & secondary forms. When bubo is the 
consequence, of, or follows chancre, it generally appears
on the same side with regard to the penis as the 
chancre is. If chancre be on the penis it is seldom
or never followed by bubo. Bubo generally appears
in the upper range of glands. If the enlargement
be in the lower range of glands & particularly if 
there be many glands affected & depend upon it
these are independent of venereal affection, they may
be scrofulous & sympathetic - a venereal bubo has tho 
appearance of a simple ulcerated gland, it may always
be distinguished by nocturnal pain.
Treatment, if there be much inflam, 
mercury either generally or locally is improper- It has been
administered for the purpose as was said of removing
the obstruction below & about the parts - the effect
however is inflamn- Dr Mott reduces the inflamn 
by free, brisk purging & vomiting - He relates the case 


10
of a man going to sea affected with bubo, & in
consequence of 24 days sea sickness, the bubo was 
discussed & he returned well. Local applications
for the same purpose are Leeches. If in the country
where leeches are procured with difficulty, the 
best substitute is cupping - apply both of these
near the bubo. Then follow by emollient poultices
In many cases they are excellent for discussing 
tumors. If inconvenient for the patient to wear
poultices, substitute blister plaisters or stimulating
plaisters, as the different gum plaisters, ointment of 
Tart Emet. If matter be formed in bubo poultices
will increase that matter.
Bubo appears in three different
states. It may become indolent during the state
of suppuration. When this is the case promote inflammation
by mercury- or by brine poultice (made with 
brine or salt water & bread & milk) they are sometime
stationary during the process of suppuration. Besides
Mercury internally, apply ungt nitrat, argent, or 
yellow or blue wash, & if this be not sufficiently
powerful use caustic either in Solution or apply
to the part


11
When a bubo has suppurated, it is no insignifing
question, when is the proper time for opening it 
Dr Mott's opinion & practice is to open as soon as 
matter is fairly & distinctly formed. It is however
dangerous to open before matter is distinctly formed
after matter is completely evacuated, apply rum by
with prepuce. It is generally a matter of some 
importance to guard against an eschar. The best 
manner of opening is by seton, the next best is by
caustic, far though it takes out a piece of flesh, yet
the eschar is but small. The Escharotic compounded
with opium is less painful than a simple one.
Bubo sometimes forms sinuses. In this 
lay it open. It sometimes takes on a sloughing
nature & sloughing pains is not more alarming.
Treat it similar to a sloughing pains. In
both cases beware how you use mercury until its
has become a perfect granulated sore -

12
The first evidence, that the constitution it 
affected is its appearance in the throat. It is 
an interesting question, whether the matter is 
introduced into the system & breaks out in the 
throat, or whether it is produced by sympathy
This question will probably never be decided
When it does appear in the throat it is commonly
known by the peculiar pain in the throat
It is curious that it will appear then years after
it has been cured in the genitals. The patient
will commonly tell you that the throat feels
uncommonly dry & that in swallowing irritating
fluids, a smarting is felt. The venereal ulcer in 
the throat commonly appears in form of a slit
of a white appearance. The most favourable situation
for the occurrence of ulcer is the Tonsils
Sauces &c - venereal ulcer in the throat is generaly
very rapid in its progress, destroying not only the 
soft parts, but also producing caries of the 
bones of the palate &c -


13
Lecture Nov 15th 1825 - Dr Mott - 
On the Venereal Disease -
It is frequently found affecting the larynx at its upper part
Its being a venereal affection is known by an expectoration
of bloody mucus - loss of voice - haemorrhage from the laryngeal
arteries, & not being connected with any pain in the chest
Treatment- Mauriate of mercury is the most proper
preparation of mercury as it acts upon the system sooner -
nauseates sooner & owing to that connection between the 
stomach & blood vessels serves to excite its action upon the 
system sooner than any other preparation It may be used
either on the form of solution or pill. Dr Mott gives it in 
solution as its quantity may be better determined. It may 
be dissolved in Spts & 1/8 gr be taken twice or thrice a day.
It may be sooner cured in warm than cold climates
as the effect of the medicines tend more to open the sluices
as decoctions, syrups, teas &c. Continues the mercury until you
find Some impression is made upon the system - frequently
recourse must be had to Tonics & a judicious course of 
regimen. Where he affection about the throat is visible
it may be touched with a pencil previously cupped in a 
solution of muriate of mercury 1 gr water ℥i, or a solution
of acetate of copper, morning & evening, or muriatic acid 

14
20 drops to ℥8 water or the caustic in its solid state
argent, nitrat, Sometimes you will be obliged to stop &
institute a tonic plan & afterwards continue the first
mentioned -
It next attacks the skin & is very strongly
marked - assumes a variety of farms, but has peculiar
characteristics, generally a brownish sort of Scale appears
& underneath that scale or scab there is an oozing of 
blood fluid, & there is visible a lived sort of inflamn-
Sometimes it appears in the form of blotches - one
singular circumstance of these sores is that they are 
attended with very little pain but there comes on an 
itching towards night which continuing until three oclars
in the morning, an interval takes place. Sometimes
these sores assume a larger surface & take the name
of sphagedenics sores, appearing first about the Lead
breast & upper extremities. The most speedy & efficacious
mode of treatment if the Muriate of mercury & the 
sores dressed with mercurial ointment or black wash 
never remove the scab for the application of the 
ointments. Tonics & syrups are likewise necessary - you 
may use ℥i 

15
This disease next attack the nose, Known by the patient
telling you that while blowing or picking his nose, hard
scabs have come out, and on these scabs a bloody fluid
appears, it commences with an inflamn of the membrane
of the nose - when the bones of the nose become affected
it will give a most foetid smell, sometimes they can
be removed by taking hold of them from time to time
with the forceps -
Lecture Nov 16th 1825 Dr Mott
The venereal affection of the nose requires the same 
treatment as the foregoing forms - Bring the system
immediately under the influence of mercury - use muriate
of mercury - correct the foetus, which happens when the 
bones of the nose become affected by using nitric or muriatic 
acid Dr Mott recommends the muriatic - take 
25 drops to 83 water, let the patient put some in 
his hand & snuff it up his nose, this is also calculated
to forward the separation of the bones -


16
Nodes appear upon certain parts of the body,
always upon the hard bones viz tibia, ulna, metacarpal
bones sometimes tho' rarely upon the sternum -
It is an inflamn- on the bone, & the pus discharged 
in a smooth elevation with an effusion of fluid underneath, 
the fluid is not purulent, but serous. When 
there is no inflamn the fluid may be absorbed as 
then there is an evidence of no pus - The fluid remaining,
recourses must be had to the antidote mercury
apply blisters & tart anty ointiment - inflamn- coming 
on suspend the mercury, use emollient poultices
antiphlogistic lotions, alteratives & tonics. When 
inflamn- subsides, resume the mercury. When nodes
appear upon the head, and inflamn comes on, let
them remain until they break - sometimes the external
table of the bones of the cranium comes away
leaving the internal table & diploe enter, & sometimes
they are removed, exposing the dura mater. The 
foregoing are the most common appearance of the 
venereal disease -
Tumours are sometimes found in 
the cellular membrane - cured by mercury


17
Testicles are often affected, the diseases of these are intricate 
& various -
The Venereal pains on the bones, are
to be distinguished from Rheumatic pains, persons
under the influence of mercury being exposed to cold
will be affected with what is called Venereal Rheumatism,
which may be distinguished from acute or chronic
Rheumatism, by the venereal pains having an exacerbation
every 24 hrs - these pains come on towards evening
& increase in violence until towards morning, when
an internal takes place -
The venereal disease attacks
certain parts only .viz the Skin, bones & membranous
parts but never the vital parts, neither the viscera
of the Thorax, abdomen, or brain -
It is divided into primary & secondary
forms. The primary are chancres & buboes. The
secondary are affections of the throat, skin, and 
bones -

18
As it regards the history of the venereal disease
Dr Mott thinks it has existed from times
immemorial, tho' called by different names 
The modus operandi of mercury upon the 
system is by its producing a superior effect to 
that of the venereal virus, by operating upon
the salivary glands, kidneys, skin &c, thus opening what
are called the sluices of the body, which carry off
the disease. It is the long continued action of 
mercury upon the system that cures the disease
and not profuse ptyalism. For the cure of 
chancres continue mercury for 2 weeks at least
after the chancre is healed for the cure of bubo
4 weeks, and in secondary disease no definite
time can be assigned -

19
Lecture Nov 17th 1825 Dr Mott
The susceptibility of receiving the venereal poison is 
diminished by the frequent applications of it - this poison
is unlike others of a contagious nature, for being once
affected with it is no security against a second attack
upon exposure, as it the case in some others -
The first attack of this disease is always the most
violent, & more difficult of cure than subsequent ones
When you give a patient mercury, you will find 
that small doses sometime produce great Heats,
and at other times large doses no very evident effect
Dr Mott says he scarcely ever uses mercury except 
internally, though he says cases have occurred where
where the disease was very violent & rapid & he 
was obliged to have recourse to mercurial ointment
When Ptyalism comes on most profusely, keep the 
bowels laxative, the mouth clean by borax & honey
blisters applied over the parotid glands - the neck &
face covered with flannel, or you may use nitric
acids 20 drops to ℥8 water increasing it if necessary -
or angent, nitral, - acetate of lead is however the most 
efficacious for sore mouths ʒ4 to a quart of water
in consequence of long continued ptyalism the alveolar pockets

20
sometimes become loosened -
With regard to the treatment
of sucking children labouring this disease Dr Mott
gives muriate of mercury gr 1 to ℥i alcohol taking 
1 drop 3 times a day increasing it by 1 drop a day
A curious effect produced by the continued
use of mercury is a disease called Erythema Mercurical
an affection of the skin entirely - sometimes covering
a small extent of the body, at other times the 
whole body. It appears in the form of a brany
scale, & under that scale a bloody fluid, attended
with a peculiar odour, this is a most distressing
& alarming affection, when it extends over the 
whole body. It proves fatal on two different ways
1st By producing a diarrhaea & 2dy by bringing on 
a most awful dyspnoea (See Pearson on the venereal)
Watch it carefully in its tendency to the typhoid
state - in some cases bleeding may be necessary but 
you must not venture too far, when the breathing
is very difficult you may then bleed & apply blisters
When a diarrhaea comes on use soothing drinks &
anodyne injections, & applications to the skin of 
lime water & milk 

21
On Gonorrhaeus 
Gonorrhaea is a term made use of to convey an idea that 
there is an inflamn of the mucous membrane of the Urethra
of a specific sort, called Clap, from a French word signify
debauchea horses, because the disease was there contracted
Dr Mott thinks the best term for the disease is Urethritis
A Clap commonly comes on at first with a sensation
at the end of the penis as if a drop of water is as
there retained, attended with an itching which causes
the patient to rub it, & then there will exude a fluid
from the end of the penis, the next day or two upen
squiring a whitish fluid appears, in a few days more
a smarting will be felt in passing water called ardor
Urinae - The discharge afterwards assumes a greenish
appearance or yellow -
The disease generally appears in
in the course of a week after exposure, sometimes longer
& sometimes shorter. It generally is confined within 2 in.
of the end of the Urethra, but sometimes extends the 
whole course of it, even inflaming the bladder -


22
Lecture Nov 18th 1825 Dr Mott -
Gonorrhaea Continued -
We occasionally find that a person unacquainted with
Urethritis will be afraid of ulceration, there is no 
danger however of this. Gonorrhael inflamn- spreads
over the penis along the dorsum penis as far as the groin
there is no fear to be entertained with regard to 
buboes arising from Gonorr for they scarcely ever
suppurate, requiring merely local treatment for 
discussing them -
This disease is communicated by contagion,
it may be communicated by a catheter previously
used in a person affected with it -
The method of cure depends upon several circumstances.
If the patient has had the disease
before I attended with a swelled testicle, you must
beware of injections so likewise if he has had a 
stricture. If the system is scrofulous it will sometimes
require all the remedies, you can desire -
There is a great variety among practitioners
in treating this disease -

23
Dr Abernethy (whom Dr M says he has listened to with
admiration & delight) called this disease nothing but
a cold (as he expressed it) of the Urethra & being left to 
itself will run out in a short time - But Dr Mott does 
not coincide with this opinion, for he says instead of running
out, it will run up - On the very first appearance of 
this disease you may make use of a strong injection of 
of Sulp Tinc 5 gr to ℥i water & this will cause an 
inflamn which in most cases will cure the disease
But for the most part we do not see the patient
until there is a considerable degree of inflamn when
this method will not answer - you must then treat
it strictly antiphlogistic for a few days - Dr Mott gives
the following Recipe -
Rx. Sulp Mag. ʒiij { To be pulverised finely -
Nitrate Potats ℈i { & divided into 8 powders
Gum arabic ʒss { Give 1 every 3 or 4 hours
In addition to this it may be necessary to apply leeches
to the penis & even bleed from the arm, use warm bath
bring the penis to the abdomen-

24 
When the inflamn subsides, you may either use 
injections or not, if not Dr Mott give the following
prescription which he says is generally effectual 
R. Balsam Copaiva ℥i
Spts nitre ℥i
Sulphuric acid ʒi
Mucilage of gum arabic ℥6 (or simple syrup ʒi water ℥5
Tinct Lavend ʒi -
Mix in the following manner. Pour the water into a 
large Phial, then add the Sulphuric acid shaking it 
well, then add the balsam Copaiva, shaking it up again
then the Spts nitre & lastly the Tinct Lavend.
Let the patient take a table spoonful three
times a day - This seldom fails of effecting a cure -
But if disposed to treat by injection lead 
is not to be used, because it is apt to produce
strictures, you may use either the acetate of Tinct
or Sulp Tinc - 1 gr acetate to ℥i water - Sulp Tinc
gr iij to ℥i water - or Murias Hydrargyri gr i to
℥6 lime water, making the yellow wash 

25
If a person, who has the disease with a stricture, & it resists
the remedies used, you must then use the bougie, & if there 
is no stricture, & the disease does not yield, you must
take a bougie besmeared with balsam Copaiva & introduce
it. In the use of Balsam Copaiva it will sometimes
have such an affection that you must leave it off, producing
Urticaria. To be removed by active purging, and 
discontinuing the balsam -
Another remedy recommended by 
Dr Mott is the Cubebs. The first year that I introduced
it into my practice, I used 30 or 40 pounds. It operates
by its stimulating effect - Take it & let it be finely
pulverised - Give a spoonful 3 times a day in a cup of 
milk.

26
Lecture Nov 19th 1825 Dr Mott
On Strictures -
Strictures in the Urethra are sometimes a consequent
effect of Gonorrhaea. They are not only interesting &
to be particularly regarded by the Practitioner from
the effect of their stopping the passage of the water
but likewise from producing effects upon other parts
viz the bladder, perineum &c. An intimate knowledge
of the male organs of generation is absolutely necessary
to the surgeon in treating strictures, hence the necessity
of combining anatomy with Surgery. Strictures are 
divided into permanent. Spasmodic & inflammatory
The first evidence of a permanent stricture is a 
more frequent desire to pass water, then the water
passes in an unnatural stream, as the current is split
or spiral or flat. it also requires great effort to pass 
it. the bladder often becomes contracted and 
diminished in capacity, there is a continual dribbling
of water, there is also an inflamn above the stricture
The irritation sometimes extends to the kidneys
inflamn, suppuration & frequently terminating
fatally. One consequence of stricture is fistula in 
perineo



27
When you have reason to apprehend a stricture it
is important to know the proper & precise situation
of it in the Urethra. The Male Urethra is divided
into the prostrate, membranous & penis portions
The most common situation for strictures is in 
the membranous portion, the next is that near the 
bulb of the Urethra, sometimes they are within an
inch of the end of the penis, when in this situation
it is the hardest & most firm of any presenting a 
white appearance -
Inflamn- is the cause of stricture
a man may have a stricture without being produced
by gonorrhaea, as when violence is done to the parts
even by the use of Cantharides - They present themselves
in 2 or 3 different ways, the 1st as if a narrow cord
was drawn around the Urethra, the next as if a broad
cord was drawn tightly around it & 3dly like small
thread passing across the Urethra. There is another
stricture called the Elastic Stricture which will
suffer a large bougie to pass up the Urethra, but 
being withdrawn, the Urethra returns to its former
state, but a stricture resulting from cicatrix is the 
most tedious to overcome, they are to be overcome 



28
if possible by the frequent introduction of bougies
Prudence & delicacy is particularly to be observed
in the introduction of bougies for ascertaining the 
state of the Urethra, very little force is requisite
when there is no impediment, & when imprudently
managed in the hands of the unskilful, it may be 
resisted by the folds of the Urethra inducing him
to suppose it to be the stricture -
A variety of instruments are in use for 
this purpose, such as the Gum Elastic bougies
the wax & the catgut bougie, but the best boug
is the inflexible metal bougie, as by its inflexibility
you can manage it according to the situation
of the Urethra -
If upon an attempt to introduce
the instrument for the purpose of ascertaining the 
state of the Urethra, it should be stopped, use 
no violence, but withdraw, & make several trials
for several days & not have immediate recourse to 
Caustics - 

29
Lecture Nov 21st 1825 Dr Mott -
Whenever a stricture exists in the Urethra pass an instrument
to ascertain first a large one then a smaller one. It is very
rare for me to use any thing else but common bougie. In
Hospital practice I never use the caustic bougie but 3 times
& in private practice, but once, it requires a long time for the 
purpose of overcoming it -
Caustic Bougies are useful in the hands 
of the experienced. Sometimes they cause an inflamn 
in the perineum, swelling of the Urethra, causing inability to 
to pass water, if so put the patient in warm bath, give 
anodynes - if sloughing comes on, apply a common bougie - The
Caustic Bougies, are the lunar Caustic, lapis infernalis
Caustic Sol. - In the use of Caustic Bougies, it is better
first to take a common wax bougie, & bent it a little, then 
introduce it as far as the stricture, & withdraw it, marking
the length on the caustic bougie that requires to reach the 
stric, then introduces the Caustic, & withdraw as soon
as it reaches the stricture, then wait until 24 hrs, then
the common bougie, & a sloughing will appear on the end 
of it - Under several circumstances, from the Sensation
caused by the passage of the instrument, either, fainting or
rigors well come on. Give anodynes before the introduction of 
bougies

30
It is often enough to make use of them every 2 or 3 days, until
the patient becomes inured to it. Sometimes 2 or 3 applications
will be attended with remarkable success, at other
times it is very tedious to overcome - Haemorrhages sometimes
succeed the use of Caustic Bougies. I think the 
Argent, Nitrat, the best caustic, another kind is the 
Caustic Solution. You may make a caustic bougie in 
the following manner. Take an indefinite wanting of muriate of 
Ammonia & Muriate mercury equal parts, put it into a 
quart of rain water, shake it until it dissolves. Then
take a catgut Bougie & dip it in the solution, it will
chrystalis on the end of the bougie, thus then it is armed
Persons using bougies should have a great variety of 
them -
The Spasmodic Stricture is consequent upon
permanent Stric, it is that which gives the irritation
causing a spasm -
It comes on upon sudden exposure to 
cold air, after drinking - Use warm bath & pass a 
catheter, if the water does not pass, give a large anodyne
& let the patient go to bed. If this does not succeed
give an active enema which by relaxing the parts will
sometimes cause the water to pass freely -


31
If this fails, give an anodyne injection (a wine glass of 
starch & a teaspoonful of Laud) - If this does not succeed
give Muriated Tinct of drow for the purpose of producing
nausea - 10 drops every 10 minutes until it nauseates on
Tartranting
Lecture Nov 22nd - 1825 Dr Mott -
Remedies for Spasmodic Stric, cold bath, where 
nothing can be introduced into the Urethra -
In inflamny Stric, there is more or less of spasm
inflammation may take place in the Urethra as in other 
parts of the body - the urethra being more or less irritable
in persons of full living as a predisposing cause -
Treatment, Apply sinapisms to the perineum
they are better than blisters, as strangury often follows blisters,
they also produce the rubefacient effect sooner than
blisters. Mustard poultices will have an effect in 1/2 hour - it
will often relieve the spasm the urine follows -

32
In cases of inflamn of the urinary organs, give liquor 
potassar, or aquae Kali puras, a teaspoonful in milk.
The oesophagus is sometimes affected with stric,
that part opposite the cricoid cartilage of the larynx -
here it is where substance are generally lodged, it is 
known by its gradual advanced -
Sometimes it occurs low down in the 
oesophagus, the patient complains of inability to 
pass his food in the stomach - uneasiness - soon the 
contents of the oesophagus are thrown up caused by
an inverted action of the tube. When a stric, exists
in this part, the patient becomes emaciated, unable
to take solid food, & liquid with difficulty -
Treatment, under these circumstances
nothing but manual assistance can be afforded- 
in order to do this, Take a large bougie 18-24 Inches
long, as large as your fore finger, give it a little cure
let the head be drawn backward, oil the bougie the 
common wax one & pass it down the oesophagus, the 
case with which it passes into the stomach, will 
determine that it has passed the obstruction -

33.
For E Home has recommended caustic bougies to be used
here, but I have never used them in the oesophagus -
the vicinity of the parts to the stric as the diaphra
would partake of the inflamn- & probably prove fatal
Stric in Rectum. The rectum being a muscular
organ is liable to contraction, by far the most of them
end in Schirrosity & this carcinomas - The sphincter
muscle becomes so contracted as scarcely to admit a 
quill, vomiting comes, externally there will be piles -
Treatment - It has been proposed to cut the
rectum, more benefit however is attendant upon bougies
beginning with Small ones & increasing in size, until
they become as large as the rectum
The next consequence of strictures is fistula
in perineo, it is an opening formed for the passage of the 
urine in perineo, a hard tumor is formed. Pass the
instrument to as to let the urine pass through
& interrupt its passage in the sac. Where no bougie
will pass, you must use caustic, so as to prevent the 
fistula from suppurating - Open the urethra by passing
an instrument down the penis & cut upon in perineo- 
substituting an articial urethra -

34
Lecture Nov 23rd 1825 Dr Mott -
There is danger of keeping the instrument in too long
10 or 12 days is sufficient at the longest - a metallic
instrument is objectionable on account of being 
inflexible. Flexible gum elastic instruments are 
the best -
An effect of Gonorrhaea is an irritability 
of the mucous membrane of the bladder
known by pain in regio pubis, desire to make water
urine of a white colour -
Treatment, the patient must live 
abstemiously - use an injection of 13 opium dissolved in
water, injecting the bladder - not always produced
by gonorrhaea, sometimes happens in children, use lime
water & milk. Palsy of the bladder sometimes succeeds
inability to contract. Cured by applications of blisters
to the back & loins, or which is better to the regio
pubis
Buboe from Gonorrhaea are called Sympathetic
because they rarely suppurate, apply a soap plaister
to the part - 

35
There are sometimes Haemorrhages from the Urethra
in Gonorrhaea of an alarming nature, when profuse they
often cure the disease. they may be stayed by a cold
injection - apply a compress with T bandage -
External Gonorrhaea, when the small glands behind
the Corona glandis are affected, allayed by lead water,
or black wash. Treat antiphlogistically -
Another effect of Gonorr, is an inflamn- of the testicles
commonly only one is affected - comes on at first with pain
in perineum, then pain in the back & long [cross out]
then in the groin, shooting down to the testicle, beginning
at the Epidydimis the inflamn produces sickness at 
the stomach. If the patient goes about, apply a suspensory
bandages - bleed, purge, apply lotions of Spts min duri
& lead water, alter general bleeding, use local bleeding
by leeches, or of leeches cannot be procured, foment the 
serotum with flannel wrung out of warm water, this 
determines the blood to the being of the scrotum, so that 
you may open them with a lancet - then apply a common 
warm poultice - Consult your patient's feelings with regard
to a warm or cold poultice. In some cases, warm application
will increase instead of alleviating the pains 


36
Some apprehend suppuration in case of inflamed
testicle, but this is very rare indeed -
Sometimes the testicle remains in a 
state of enlargement & hardness for a length of 
time - sometimes like a knot upon the Epydidimis
apply a soap plaster with a suspensory bandage
or wear a piece of oiled silk for weeks or months
it relaxes the skin & frequently reduces the enlargement
Beware of injection in inflamn of the testicles
pay strict attention to the scrotum, regardless in a 
measure of the Urethra, if the running returns
treat internally & not by injections -
Another effect of gonorrahea is what is called 
Gonorrhael Ophthalmia & Gonorrhael Rheumatism
Under these circumstances I have bled & purged pretty
freely - the following is very good to administer.
Equal parts of balsam Copaiva & Spts Turpentin
Take 20-40 drops 2 or 3 times a day - drink freely
of some diluents such as teas of Sassafras of Sarsaparilla


37 
Lecture Nov 25th 1825 Dr Mott -
The last consequent effect of gonorrhae which I shall mention
is impotence, implying loss of virile powers. This is frequently
attributable to some defect in the testicles, & tho' one testicle
may be removed yet the power of procreation is not suspended.
We have examples of persons losing one of their testicles & yet have
had a large family, & even after both testicles have been removed
still the process of secretion will continue for some time 
whether from the vesicular Seninales or vasa deferentia
is not accurately known - Under circumstances of enlargement
of the testicles, it is an alarming fact, that when 
the inflamn- subsides the testicles are sometimes wholly
absorbed. I knew a gentleman who had an inflamn- of 
the testicles & after that inflamn- had subsided the testicles
where completely absorbed leaving a sort of ligament -
the secretion continued for some months, & was then suspended
also the power of erection was lost -
A common cause of impotence is an inability to
to retain the Semens owing to the peculiar irritability
of the parts. Under these circumstances, the least excitement
will cause the discharged even the slightest indulgence
on lascivious ideas - 


38 
Treatment for impotence, address the mind & invigorate
the body - use [cross out] cold bath - give a large dose
of opium on going to beds - recommend exercise -
take a journey internally give the following -
R ℈i Gum olibanum
℈ij Gum Myrrh
gr X Carb, Iron
Balsam Copaiva sufficient to mak up
divide into 20 pills, give one morning, noon &
evening, & increase the quantity of iron as the 
Stomach will bear it - you may also use an
instrument called the jugum penis, which is 
serviceable by preventing the extension of the penis
it is to be applied near the scrotum -
It happens now & then that person are 
impotent from the state of the mind, believing
that, they are inadequate to the performance
When this is the case, it is useful to call up that 
engemous stratagem of Jno Hunter - he was applied
to by a gentleman who was about to join in matrim
but said he was unable to perform the act of sexual
intercourse, he attributed it to his mind & therefore
prescribed some gentle medicine, assuring him that 


39 
if he would promise to lay so long a time with his 
wife, without embracing her, he would be cured,
he therefore made the promise, but did not fulfil
it, for within a few days, he engaged in the act & did 
well.
On Inflammation
Inflammation is a term which implies, that the 
part is hotter, redder, more swelled & more painful
than naturally, the ancient division was into 
acute & chronic, another division is into active &
passive, the division made by Jno Hunter was 
that of Healthy & Unhealthy - When inflamn-
attacks certain parts it obscures certain forms, or the same characters
in every constitution, tho' in different degrees -
Healthy inflamn- is always apt to terminate
more favourably when seated near the source 
of circulation - 

40 
Healthy inflamn- is generally of a pale red, and 
Unhealthy of a dark red colour -
Parts highly organized & sensitive resist
inflamn- best - vz inflamn- of the skin & muscles
terminate more favourably than of the harder &
less sensitive parts as tendons & bones -
It has been said that the vital parts are
highly organized & should resist inflamn- best,
here a qualification is necessary - tho' it does not 
follow, that because vital therefore highly organized,
wounds of these parts are dangerous, because they 
are so essential to life -
Inflamn- is apt to be most violent
on that side nearest the surface of the body 
gum boils are illustration of this, making their
appearance generally on the outside, instead of 
inside of the jaw -

41 
Lecture Nov 26th 1825 Dr Mott
In farther illustrating the law which inflamn- deserve
of being most violent on that part nearest the surface
of the body fistula in ano is an example, when it 
exists it shews itself on the inside of the gut & instead
of going through the gut & will it makes its way down
the side of the gut to the anus. Sometimes it appears
high up & the matter passes out thro' the rectum
so likewise in diseases of the antrum maxillure
it forces itself externally - another example is that 
of gun shot wounds, for instances if a bale pass laterely
into the thigh, nature will discharge it either 
upwards or downwards according to circumstances
instead of either side - 
All newly formed parts are more easily
destroyed than original, because they are less highly
organized take for example any form of tumor
that will be found more fragile more easily destroyed
Hence the success which quack often have by apps
their poultice, lotions &c, which by stimulating the parts
induce inflamn- & sloughing, & thus the tumor disappears  

42 
In observing the process of inflamn- we find
three stages of it - 1st Adhesion. 2nd Suppuration
3rd Ulceration -
There is a law to be observed with 
regard to these different stages of inflamn-
Adhesive inflamn- takes place in certain parts
of the body, as in membranes, those attached
to important viscera - as the Pleura, Peritoneum
so also in the cellular membrane -
On other surfaces, we have another state of 
inflamn- called Suppuration, this take place
on mucous surfaces, as the Urethra, Trachea
&c. if in these cases adhesion took place, it would
be attended with serious consequences -
Ulceration, this is more likely to take place 
on mucous surfaces than adhesion is. When 
ulceration exists it generally spreads considerably 
& the vessels throw into such a state, as to 
be absorbed by the Lymphatics 

43
Healthy Inflamn- or Phlegmon - Characteristics are 
Redness, Tumefaction, Pain & Heat -
1 Redness in inflamn- is to be accounted far by 
the red blood getting into the vessels, which are not 
naturally destined to carry it, & by its rushing into 
these vessels reddens the part -
2 Tumefaction is owing to several causes -
1st To the quantity of blood - 2d To the coagulable
lymph or adhesive materials - 3dy To diminished
absorption 4ths Extravasated blood -
3 Increased sensibility or pain is explained
differently by different persons, it is greater when
the artery is dilating - hence the cause probably
is the pressure made upon the nerves by the 
diastoli of the arteries - 

44 
Lecture Nov 28th 1825 Dr Mott -
4th Heat - Soon after the discovery of the circulation
of the blood, it was supposed to be owing 
to the friction of the red globules passing thro'
the vessels, called arteries, but this is disproved
by the fact, than any fluid passing through
a tube with the greatest velocity is incapable of 
generating heat, the vessels of an inflamed
part, having more blood in them, become distended
the circulation retarded, & in consequence of this 
more time is given for the evolution of heat -
If you apply a blister to any part of the body
& when the cuticle is denuded, place a sensitive
thermometer, to the part, & it will be found
to rise from 4 to 7 degrees higher, than at any
other part -
Inflammation terminates in five
different ways, 1st Resolution, 2d Adhesion
3d Suppuration, 4th Ulceration, 5th Mortification
When it terminates in Resolution, the 
swelling subsides, the heat goes off & leaves the 
part in a natural state -

45 
When adhesion takes place, the redness will not 
gradually subside, the part will be altered in its 
structure, & the tumefaction will not entirely
disappear - When the part becomes shining among
elastic, the pain subsiding, but tumefaction increases 
& a fluctuation is felt, it will then terminate
in Suppuration. When the lymphatics remove the 
parts inflamed, it is said to terminate in Ulcerating 
The last & happily the least frequent termination
is in Mortification, it may terminate in this way
when the part has been destroyed of its vitality
by severe injuries tho' it is very surely we see a healthy
inflamn- to terminate in mortification, when it 
does however, instead of the florid red, the part will
assume a livid hue, and blisters will be observed
on the part, there is also dimination of heat -
Another termination is Schirrus. this 
is chiefly on glandular parts -
The pulse in inflamn- is generally
hard, it depends upon the situation of the [cross out] inflamn-
whether it be full, or small.

46
Lecture Nov 29th 1825 Dr Mott
With regard to inflamn- arising when fracture exists
it is observed that if the muscles become inflamed
there is generally spasm, it is an objection to operation,
where there is inflamn-, for if you cut into
a part inflamed, instead of uniting by adhesion
suppuration will be the consequence -
Predisposing & Exciting Causes of Inflamn-
It is untrue that the debility is not prone to 
inflamn-, on the contrary there is less aptitude
to inflamn- in healthy habits. Take for example
a tumor on the breast, the irritability caused by 
an operation on it will sometimes prove fotus -
Never therefore perform an operation of much 
consequence, where the system is debilitated, & where
there has been an action of mercury upon the system 


47 
Exciting Causes are divide into two great
classes. Mechanical & Chemical - as violences from 
blows &c. Irregular action - Cold operates in promoting 
inflamn- by debilitating the part & subduing
the heat of the part -
The Proximate Cause of Inflamn- 
is difficulty assigned - Boorhave entertained
an opinion that it was an obstruction of the blood
& it thereby became thicker, & getting into vessels
not destined to carry it hence the error loci 
Cullen's opinion was, that there was a 
spasm of the extreme vessels & called this the 
proximate causes of Inflamn-. But if it were 
owing to a spasms of the extreme vessels, the blood
probably would not get into the vessels, giving
the general characters of inflamn- viz tumefaction
redness &c 
Jno Hunter considers inflamn- a 
disturbed state of the parts & requires a new action
to be instituted or to counteract that disturbances
He says that vessels are dilated, & if he had said 
that they at the same time were diminished in action 

48
he would have anticipated my opinion -
There are two opening on this subject one 
that there is an increased action, the other
that the vessels are dilated & the action diminished.
When we reflect upon the anatomy
of the part, & consider that the vessels of the 
human body are hollow muscles, it must be 
admitted that when the red globules are admitted
into vessels not destined to carry them, the 
vessels become stimulated, & sometimes carry off
these red globules. But if a few moments
elapse & they are not propelled, the vigour 
of the vessels is lost, they become distended, their 
muscularity impaired, & hence inflamn- is induced
at the same time the vessels about the part are 
excited, to keep up the distension -
This is illustrated by a frequent examples
viz over distension of the bladder, & the consequence
is, that the water passes with difficulty, because
the over distension destroys its power of contracting -
The same may be said of the stomach, which 
is a hollow muscle, when over distended, its functions
are impaired, inducing a train of ayspeptic sysmptom 

49
a case is related by Dr Mott of a lady in this city
whom he attended affected with Tympanitis Intestine
when recourse was had to antispasmodics &c. until
the disease [cross out] attacked the Tranverse arch of the colon
more particularly, producing a swelling across the 
abdomen as large as mans arm, when on a sudden
the wind rushed out & she recovered. 
Lecture Nov 30th 1825 Dr Mott -
Treatment of Inflamn- If the opinion be correct -
that inflammation consists in a distended state of the 
vessels, the nature conclusion is that the treatment
consists in taking off that distention -
The first thing which should engage the attention
is, to remove the remote & exciting causes, which advances
the cure of the inflamn- & thus removing the distension
This is to be effected by three different methods
the first grand mean is V.S. this takes off the currents
of blood generally, in some cases if inflamn- it is necessy
to bleed freely, e.g in inflamn- of the eyes, in others 


50
cases, circumspection is very necessary with regard
to bleeding, e.g inflamn- of the abdominal viscera -
Perhaps there is no condition of the system
that will bear profuse bleeding than that accompand
with a hard pulse, together with the white crust
which the blood assumes.
Practitioners differ as to the 
manner of drawing blood, some in a large stream
& very suddenly, others upon a small orifice & in 
a small stream. I am decidedly of the opinion 
that drawing blood suddenly & in large quantity has the best effect -
There is only one objection to this manner viz.
that the patient sinks under it & syncope success
but it makes the desired impression on the system 
Bleeding is attended with the best effects
when it is performed near the part inflamed
as for instance in affections of the head it is 
preferable to bleed from the temporal artery -
Open the artery high up, so as it may be more 
easily compressed, being situated near the bone 


51 
Local Bleeding is likewise necessary, as with Leeches
& by cupping, scarifications, these are to be employed
according to circumstances, after a leech is applied
falls off, you can generally take away as much 
blood as you choose by fomenting the part with 
flannels wrung out of warm water, & they will even
bleed so profusely often as to give anxiety on the part
of the patient, & also to the practitioner - it may 
generally be stopped however.
Under many circumstances scarifications
may be employed with great advantage as on 
the eyelids. Scrotum & S. - But you are never to 
make use of scarifications on the eyelids when the 
inflamn- is at its highest stage, because it will 
only increase it -
Purging is the next proper mean for 
removing inflamn- it takes off the irritation,
it diminishes the action of the system, & sometimes
the strength is diminished - Salts are frequently give 
in the dose of ℥i. If you give salts, & would recommend
to give a little Tarts antimo, with, as for instance
take ℥iss of Sulphus magnesia 1 gr Tarty antimony

52 
and dissolve in ℥8 of the infusion of Rose leaves, &
to this a few drops of Elix. vit, -
But this is not sufficient to produce 
a powerful impression upon the system. I am 
of opinion that Rhubarb & magnesia is better -
The best purgative of Cal & Jal -
Johnson's practice was to give a dose of Cal at 
bed time, & then the morning a dose of salts -
If calomel does not agree with the patient
& he is averse to taking it, you may give him
ʒss Jal & ʒss Sup. Tart. Potat - another remedy
which I use for Children is the Croton oil,
mixed it with mucilage of gum arabic. & giving 
it in doses of 1/4 or 1/2 drop at a time -
Another mean of removing inflamn- is by Perspiration.
It is common & we are desirous to have
recourse to this immediately after bleeding, purging
&c. 

53
Lecture Dec 1st 1825 Dr Mott -
Whenever the skin is acted upon by perspiration, the 
action of the heart & arteries is diminished, the exhalant
vessels are also relaxed, when this is brought about 
it will prove a powerful auxiliary towards removing
inflamn- for this use Tarty antimony - The Pulvis
antimonialis is less effectual & not so certain of 
producing an effect as the Tarty antimy. It is 
best plan to give it on solutions, as you may better
command the quantity. Whatever lowers the action
of the heart & arteries is production of good effects
& this The Tarty antimo, does by its nauseating effect
and if you have none, nor any proper vegetable
substances, you may uses Tobacco on small quantities,
either in Solution, Powder or Decoctions &
it will produce the same nauseating effect
When perspiration is brought on, it may
easily be kept up, by diluent drinks, make 
use of an infusion of any the warm vegetable
substances, beware of using those of a stimulating
nature - Catnup & mint teas are very good 

54 
If there be great pain & irritation, accompanied
with inflamn-, after bleeding & purging, you 
may with great propriety use Dovers Powder -
the only objection to this is the opium which it 
contains, but in pure inflamn- unattended with 
pain it does injury - You may use bottles of 
warm water applied to the arm pit, soles
of the feet & sides of the body -
With regard to the use of opium, most 
Surgeons entertain an idea that it is pernicious
in inflamn-, but there are cases where it 
may be used with great propriety, & prove a 
valuable remedy - Dr Mott relates the case of 
a lady attacked with Pleuritis, accompanied
with violent pain, after bleeding, purging &
applying a blister, he gave opium in large
doses, & with great success
After performing an operation, as 
Amputation. If the patient shall complain
of severe pains, & is of a full habit, did not 
lose much blood during the operation, After bleeding give
opium in large quantities -

55 
After any considerably operation 80 drops of Laud
is a proper doses -
Local means for treating inflamn-
Cold. when properly applied, is an important remedy
by subducting the heat of the part -
If cold be applied irregularly or for too long
& time, it will augment the inflamn-
The common cold application is lead water 
& it is better to put little alcohol with it, or
you may put it into a bladder & apply to the part
Another excellent applications is Spts Mendery,
it is useful as a Collyrium, & it may be applied
to any inflamed part -
Blisters also come in as important
& and particularly beneficial if the inflamn- be 
near the surface, as in buboes they act by the 
evacuating the serum -
When inflamn- is deep seated,
[cross out] about its joints, you may use Tarty antimy ointment
or you may use it in Solution by washing the part,
I have used it in this way, & with great success 

56 
in a case of Lock jaws, the objects is to produce an 
eruption on the skins -
If you use the ointment, Take 
from ʒij - ʒiiij of Tart/Antimos & ℥i Lard
rub the part morning & evening, & in two days
that state of the skin will appear, which you
desire -
Plaisters are also beneficial in deep seated
inflamn- among the best is the Gum ammoniacs
with a little mercurial ointment. you may use 
those that are less stimulating as Soap plaisters
For instance in an enlarged testicle, by applying a 
soap plaister & over this a suspensory bandage will be 
attended with beneficial effects. Upon the same 
principle you may apply a piece of oiled silk over an
enlarged joint 
Poultices are eminently useful in relieving 
inflamn- by diminishing the distention of the vessels
& evacuating the lymph of the blood - Some entertain
an opinion that poultices tend to forward suppuration
this is incorrect, for in pure inflamn- they will relieve
it, but if the process of suppuration has commenced 
poultices there will increases it -


57
In chronic inflamn- where the acute stages has passed
by, there is a medicine to be used internally of great services
There is an inflamn- of the eyes of infants which will
resist all the antiphlogistics remedies that can be 
devised, but may be cured by Muriate of Mercury- 
in proportion to the age of the child either in Solution
with Tinct, Bark or Alcohol, it acts upon the 
bowels & thus probably diverts it from the eyes -
In making poultices use Linseed meal or bread &
milk. Let the infusion of the different herbs be 
mixed with it, they are useful from their relaxing
effects. Stale bread with a little oil makes the 
best poultice -
Position has an influence in relieving
in inflamn- If a person has a Whittow on his finger 
he will naturally carry his hand in a sling, for if
he carries it by the Side of his body it would be 
attended with great pain - In every Base of inflam
therefore give all the advantages of position -
Bandages are also to be particularly attended
to -

58 
Lecture Dec 2d 1825 Dr Mott -
Adhesive inflamn-. The benefits resulting from 
union by adhesion are not only remarkable in the 
operation of amputation but in several other cases
& if this did not take places, the inflamn- would
extend much farther, a certain degree of inflamn-
is necessary for adhesion, Take for example the 
operation of Paracentesis of the part did not 
unite by adhesion, it would attended with 
dangerous consequences by extending to the Peritoneum.
In a common abscess there is great
advantage in adhesion, for it will limit the 
extent of the abscess, by invigorating the constitution
(of debilitated) So as to give vigour to the part,
that it may adhere - Another remarkable
advantage of parts uniting by adhesion is exemplified
is in the division of arteries for if they did not
adhere it would be attended with awful consequences
Here I would remark with regard to tying artery
that there is no necessity of drawing the ligature 
as firmly & tightly as some are in the habit 
of doing -

59 
On Ligatures
The Haemorrhage from the largest vessels of the 
body may sometimes be stopped by pressure & styptic
application, as was the case where the thigh was 
amputated, & the femoral artery compressed in this 
way.
A variety of ligatures have been in use. viz -
Ligatures made of the raw silk, which are very good.
The Common flax & thread ligatures are also used
with success - another kind is that made of Buck
skin called the animal ligature. The Catgut ligature
- The common silk of the shops is the kind of 
ligatures which I use altogether, let it be twisted
& doubled & waxed a little, the advantage of waxing
then is that they may not yield when tying the knot -
More lately a method has been recommended with 
regard to ligatures, that is take a very small delicate 
ligature of silk, & after tying the artery, cut off
both ends of the ligatures, this practice is not to be 
recommended, because I have tried it & did not succeed
as well, as to cut one end of the ligature off, & let the 
others, be without the wound, & by gently drawing upon
it from time to time, it will come away, & the part heal up 


60 
Lecture Dec 3d 1825 Dr Mott -
Adhesive inflamn-. How long a time is required 
for adhesion? The shortest time that we have
any knowledge of is 16 & 19 hours, We see it taking
sooner in some parts than others, as in a laceration
of the intestines, this generally proves fatal -
The appearance which a part exhibits in a state
of adhesion after cutting into it is a gelatinous 
substance & upon it elongations & vessels -
Suppurative inflamn-. Suppuration is 
a term implying that the vessels take on a peculiar
action, which pour out a fluid called pus 
In all those surfaces of the body called mucous
we expect to see this taking place
Characters evidencing a state of suppuration
are, a prickling sensation, an eminence of the part,
diminution or remission of pain & redness, fluctuation
this is to be learnt from experience -
Here is a concurring circumstance which will
generally determine whether there is matter formed or not 
viz an oedematous state of the part, leaning on 
indentation, when pressed upon by the finger. 


61 
There may be chills sometimes, if they recur, it is 
a pretty sure sign that matter is formed.
In some parts of the body, the matter discharged is 
very foetid as ulcers about the nates, as likewise the 
female organs, labia.
There are exceptions, as to matter forming
on all mucous surfaces, as the Bronchia, Trachea,
Larynx on these surfaces, an adhesive materials
are thrown out -
Much has been said with regard
to the evidences of pus. I am inclined to think
that there is no difficulty in discriminating between
pus & mucus. Pus is heavier than mucus, as it 
will sink in water, it has a sweetish & Sometimes
a saltish taste. it has a peculiar smell, as in
Gonorrhaeus.
Suppuration is useful in the human 
body. It serves two important purposes, first for 
the removal of extraneous bodies, & sometimes it is 
necessary to institute suppuration for this purpose
another important purpose is to defend the surface
of granulations. In a healthy ulcer, nature institutes

2 
a scab for the defence of the sore, & the scale
should not be removed.
Matter differs in appearance, being
thick, white, yellow, brown or bloody, it is not 
originally so, but has a limped appearance -
When a person has been long subject to a 
discharge from the part, by Seton, draws &c
it is never safe to heal it suddenly, as there may 
be a determination to some other part -
Matter will sometimes form very soon, the 
shortest period is that of 5 hrs -

63 
Lecture Dec 5th 1825 Dr Mott -
There is a form of matter when applied to any part
of the body, under any circumstances, will not produce
any effect, but is perfectly innocent, as in a healthy
Phlegmen. But there is another kind, when applied 
to parts will produce a specific effect, as that 
of Small pox &c -
An Abscess is a collection of matter
in any part of the body, which is circumscribed
by a hard margin, in consequence of adhesive inflamn-
Abscess are dangerous on proportion to their
size, also to their situation, as in the lungs.
Trachea &c, a very interesting cases Sometimes occur 
as when situation on the prostrate gland, this causes
a retention of urine -
Every abscess when opened, has a 
shaggy appearance, from which there are a great
points arising & from these points, arise absorbents -
they often make their way to the surface very
circuitously, travelling for some distance, before 
they appear -

64
Treatment, Poultices of the emollient or stimulating
kind. If there be matter, these will
hasten its formation, & if not, they will tend
to remove the abscess -
When matter is formed it is a 
question whether to open it immediately or not -
you are not prematurely to open an abscess -
But you are to open an abscess, when if left it 
would necessary injury contiguous & important 
parts - When under a fascial expansion it is 
necessary to open it rather prematurely -
The manner of opening depends upon the nature 
of it - If you have a large abscess & open it by 
a large orifice so as to evacuates the matter
suddenly, you will bring on an inflamn- by a rush
of blood to this part
When you are desirous of preventing 
any accumulation of matter, & wish to keep the 
orifice open introduce a piece of catheter or 
a piece of quill -  

65
When large abscess are opened, Hectic fever is 
sometimes the consequence. This peculiar state of 
the constitution arises from the abscess being situated
on certain parts of the body. The general opinion
with regard to Hectic fever is that it arises
from the absorption of matter. Another & opposite
opinion has arisen - If it was owing to absorption,
we should expect to see it follow where there 
is the greatest quantity of matter formed, but 
this is not always the case, it is often produced
from a small abscess in the lungs, where it is not 
owing to absorption, but arising from irritation.
When it succeeds the opening of large abscesses -
an inflamn- extends from the part, & consequently
an effort of the constitution which is Hectic fever -
Some say that when an abscess is opened,
the admission of air to it is prejudicial, but I 
believe this to be an error -
Air has been thrown into the abdomen of a 
dog where it was absorbed, two dangerous consequences
ensued - 

66
Ulceration, is a process, by which the 
parts are thrown into a state favourable
to their removal.
There are two great causes of 
Ulceration. Inflamn- & Pressure, when one 
only exists, it will be more tardy, where 
both exist, it will be rapid -


67
Lecture Dec 6th 1825 Dr Mott -
Granulation or Healing by second intention -
Whenever a part does not unite by adhesive process,
it will often Lenite by granulation, which is by second
intention. After an abscess is opened, around the 
sides & edges will be observed small granulations
arising - These small glandules are very vascular &
organized, & appear in small number at first, but 
arise crop after crop until they reach the surface
of the body. When this granulating process is going 
on, you may avail yourselves of the opportunity of 
uniting it by the first intention, by bringing them 
together. Hence this great advantage of adhesive
plaisters - oblong & longitudinal ulcers will heal 
more readily than circular ones -
You are as much as possible to favour the 
process of cicatrization, which is a granulating process  
of the skins. In order to heal an ulcer when 
granulating, apply lint upon the surface of the
ulcer, let it come within the cicatrising edge
lay a compress over this, then apply a moderately
tight bandages - 


68
Parts which will be reproduced -
Bones & cellular Membrane will be reproduced
So also Nerves, a case is related by Dr Mott
where the sciatic nerve was divided & regenerated
Tendons will be reproduced. Artery & vein
will not be reproduced, for if an artery is 
divided, it is then completely obliterated
with regard to Lymphatics the general presumption
is that they are not regenerated -
Cartilages will not be reproduced, tho' bone
sometimes takes their place. The Rete mucosum
will be regenerated -
Treatment of Ulcers, an ulcer has 
a secretory & absorbing surfaces, there is always 
a secretion of matter in a healthy ulcer - When
the granulations are luxuriant & show a deposition
to increase, on order that cicatrization 
may be produced, we may keep them down
by a piece of sheet lead of a little less sire than
the ulcer - Once a day is often enough to dress
an ulcer -

69
Sometimes instead of healthy granulations
an ulcer will present itself an inch below the
surface of the body of a shining & glassy appearances,
showing no disposition to granulate. To the 
surface of this applications are necessary -
At first for a day or two you must use Poultices
to the part, this will invite more blood to 
the surface, take off that hardness, & render it 
more favourable for granulation. Then apply
stimulating applications as yellow wash, wetting
a little lint with it & filling up the sore, if 
applied in the morning. you may in the evening
wet the lint again & apply a piece of oiled silk
this will keep the parts moist & soft & favour
the easy removal of dressings - Another wash 
is the Sulphas Cupri gr iiij to ℥i water -
In the coarse of a few days the ulcer will
become florid & new granulations arise, then it is 
in a condition to be treated as a simple ulcer 
 

70
There is another kind of ulcer called this 
fungous, which does not readily heal, which 
generally bleeds, & is the consequence of some 
extraneous body getting into the flesh -
There is an affection of the fingers & toes
which exhibit this sort of ulcer - sometimes
[cross out] sprouting out from the root of the toe, & at others
from the nail growing in the flesh & a fungus 
shooting out from the side of the toe -
It becomes necessary to extract the nail of the
toe - 

71
Lecture Dec 7 1825 Dr Mott -
After extracting the toe nail, bring on suppuration,
by applying a poultice, & sometimes it is necessary
to give an opiate -
Ulcers present sometimes a sloughing
appearance, a dark coloured surface, and a foetid
smell, these generally occur in Hospitals -
Whenever an ulcer has such an appearance
apply a yeast poultice, from its stimulating action
it will clear the ulcer, make it of bread, flour
or linseed & yeast - Sometimes a table spoonful or 
two is enough to mix with the farinaceous substances,
putting yeast on the surface of the 
poultice -
Ulcers frequently put on this sloughing 
nature, under a vitiated state of constitution
it becomes as to look to the general habit & 
treat as condition requires - Correct the foetor
by nitric acid 50 drops to a pint of water, or 
ʒi to quart of water, wet lint with this, apply
to the part & over this a compress, removing it 
3 or 4 times a day, by this means the ulcer will
become cleansed -


72
Carrot poultice is a good application, if 
painful when used raw, you must boil it -
or you may take the expressed juice of Carrots
& mix it with Bark, Charcoal, yeast &
other farinaceous substances -
Spts Turpentine is a good application
in sloughing ulcers, in order to produce an
impression upon the sound parts & prevent
the progress of Sphacelation, hence the utility
of blisters to the living part, in order to arrest
the progress of Sphacelation - 
Callous Ulcer, having an extreme hardness
& no disposition to heal cuticle very hard &
thick. Treatment. your attention must first be directed
to the hard edges, in order to alter the condition
of that callosity, by applying poultices or some form
of plaisters or blisters around it to promote absorption
and thus thin the edges, but a more efficacious
treatment is by an incision with the lancet, making
little notches, inducing inflan & there by favouring the 
process of granulation - In obstinate cases I have
had recourse to Mercury -

73
There is a peculiar ulceration appearing in the 
bottom of the foot, or ball of the great toe, remarkably
hard & generally circular & very deep, I call it 
the circular callous ulcer of the foot, it comes on 
without any known cause, there is an exudation from 
it of a fluid substances, extending to the tendons, and 
eventually to the bones - I have cured it by the 
acetate of copper filling the ulcer with it.
Fistulous Ulcer is when there is a canal
or sinus extending into the parts, very difficult to
be managed, when it extends under parts difficult
to be cut. The best Treatment is incision, when 
it can be practiced. If the fistula is deep & cannot
be cut, the best treatment, by stimulating the parts
bring on inflamn- & thus a granulatory process -
This is effected by injections of Sulphas Cupri
beginning with 5 gr to ℥i water, increasing it to 
ʒi If injections do not succeed use Setons -
Caustic Bougies may be used passing them through
the sinus 

74
Ulcers sometimes occur on the extremeties
of females, who have borne children on the Vena
Saphena, this cutaneous ulceration is best treated
by yellow wash, once a day, & oiled silk, &
compress. Ulcers also occur upon females
who have not menstruated, assuming a vitiated
appearance, your practice must here be guided
by reference to the state of menstruation, Give
Tonics &c
Another kind of ulcer is that which 
menstruates is bleeds periodically, of a healthy
appearance, but obstinate to heal, generally
referable to some state of the constitution
which must be counteracted, according to 
circumstances -
Contagious ulcer, occuring in 
foul vitiated air, it will spread with great
fury, for a description of it see Kellen's military 
surgery - Those affected should be immediately
removed - Give an emetic, following it by Cathartics
anodynes, antiseptics &c -


75
Lecture Dec 8th 1825 Dr Mott -
The Contagious ulcer is rarely seen in the walks
of private life, one peculiar character about is that 
is assumes a circular form, particularly in its commencement. 
it is called the Hospital ulcer, or 
Sphagedena Gangrenosa, it is very prominent, hard
rigged edges with a cup like cavity -
Treatment, Emetics, antiseptic poultices
yeast or Porter, Nitric acid, lastly actual Cautery
An ulcer sometimes occurs, with its edges
livid, skin hanging over the edges, & no disposition to 
heal, this occurs for the most part in Scrofulous
constitutions -
Treat, Caustic applications, nitrate of 
Silver ʒi rain water ℥i, with this solution, pencil the 
edges & dress the bottom of the ulcer with Black
wash, put over the whole a piece of oiled silk
Repeat it once a day. If the bottom does not 
readily heal, you may pencil that also with the 
Caustic Sol. then the Black wash & oiled Silks


76
Ulcers, are sometimes quite insensible, at other
times remarkably pain, so that the application of 
the most emollient ointment will produce acute 
pain, in such cases take ℥iiij Black wash to 
ʒi Laud -
Ulcers occurring on the calf of the 
leg are apt to become unhealthy & foul, between
the Tendo Achillis & the ham, owing to the action
of the Gastrocnemius muscle. When ulcer happens
on the lower extremities, the patient should be 
keep in a recumbent posture, or if he sits up.
the leg must be supported either on a chair or 
some other way - Sometimes they are remarkably
obstinate which cannot be accounted for from 
the appearance of the Sore, frequently they are 
as large as the palm of the hand, presenting insolated
portions of the integuments, this is an ulcer
of a specific sort, & you may rest assured that 
it is generally a venereal Sore -
Treat, Whenever this obstinacy exists
you must have recourse of mercury, as the muriate
of mercury, together with the decoction of the wood
If the system is debilitated, you must use 

77
the blue pill or Plumner's pill -
Conium maculatum is sometimes a remedy
in ulcers, particularly that irritable condition
of ulcers, connected with Scrofula, you may take 
the extract & uniting it with Lard making an 
ointment, but you must be careful how you
apply strong ointments of this nature to extensive
ulcerations particularly in children -
Arsenic, may be used in some cases
with advantages. In a peculiar kind of ulcer
called the fungoid I have used it with success
a great deal of care is necessary in using this, some 
times it occasion Paralysis. I have known it 
to occasion a most dreadful diarrhoea ʒi to ℥i
Lard is sufficiently strong -
There is an affection appearing upon the 
face of children & even adults, commencing with a 
red pimple, this may be taken hold of with the 
forceps & cut out, or you  may touch it with the 
oxide of arsenic, which will destroy it -


78
There is another ulcer occurring in the 
nose called, Noli me tangere, it comes on in 
the form of pimples, destroying the integuments -
In its incipient stage it may be cured by the 
application of the Caustic Solution. When 
ulceration takes place, the cartilages are eroded
& sometimes the bones destroyed. In this stage
I have used arsenic internally. Local application
Phos, Iron or Carb Iron in Powder -

79
Lecture Dec 9th 1825 Dr Mott -
Ulceration of the lower extremities connected
with enlargements of the Venæ Saphena
It has been a practice to take up the trunk
of this vein, & this has been considered as safe &
efficacious, the question arises whether it will really
benefit the patient - I have known it to prove
fatal & I have known it to prove a cure -
The practice of E Hume was to lay bare the 
vein, pass the ligature & leave it to come away
the consequence of this in many cases was eripsipelatous 
inflamn- Another & more modern practice
is to divide the vein by a curved instrument, & by 
bring together the sides of the vein, by applying
bandages immediately - These operations will only
relieve & not cure the disease as the patient will
be obliged ever after to wear bandage -
my opinion is that the veins should be 
tied nearer the heart & that the branches & not 
the trunk of the vein should be tied -

80
Mortification, being the most disastrous consequence
of inflamn- it becomes us to pay particular
regard it. It is the local death of any part of 
the body generally resulting from Erysiplatous
inflamn- When a part is mortified is loses its 
warmth & sensibility, its colour is changed to a 
darkest brown & vesications appear on the surface
If any doubt exist as to mortified parts, break
one of the vesicles & apply your finger, if mortified
it will feel cold & cause no pain upon pressure -
When the colour is changed, & warmth & sensibility
is not destroyed is it called gangrene, when these 
are destroyed it is called Sphacelus -
Hiccups is a frequent attendant upon Mortification -
You are not always to infer from vesications
that mortification exists, In cases of sprains
dislocation & fractures we frequently meet with
vesications arising from inflamn- & effusion, which
by apply any lotions & adhering to antiphlogistic
treatment soon disappears  


81
Mortification arises from various causes - as
Alternations of temperature, When exposed to cold
& immediately afterwards to a great degree of heat,
which the parts is unable to sustain, the vitality of 
of the part is subducted -
The Chilblain is an instance of this 
resulting from the alternations of Temperature -
An obstruction to the return of venous blood
is another cause of mortification, as exemplied in 
hernia, the stricture prevents its return, the veins become
gorged, & mortification ensues -
An interruption to the circulation
of the arteries is another cause, & when a large artery
going to a lint is tied & circulation does not goon
the part dies - In very old persons the inozculating
circulation is less complete, & it may take place
when an artery is not tied, but merely by pressure
thus, interrupting the circulation - 

82
Great General Debility is another cause
of Mortification, In this way we may often
account for its occurring on the extremities not 
referible to any external causes, it may arise
from ossification of the vessels - Incidental 
circumstance, will aggravate this general debility
as want of cleanliness, pure air &c -
Mortification sometimes happen from 
violent blows, when the part is severly bruised
the vital principle is almost destroyed, & inflamn-
succeeding, wholly extinguishes it -
When a part mortifies, if there be 
be vigour of constitution, the dead part is separated
from the living. When it causes to spread
the first evidence is an elevation of the cuticle
immediately between the dead & living part, then 
a depression of the cuticle, by a new action being 
instituted, the fluid thrown out & the absorbents 
removing it, hence the line of demarkation
first the cuticle separates, then the muscles, down
to the bone

83
In amputating a limb near the sphacelation
little or no haemorrhage will take place the arteries 
being plugged up - 
Mortification is divided into 
Spontaneous & Traumatic -
Treatment differs according 
to the causes producing it, when arising from
external injuries, antiphlogistic treatment, by depletion
&c -
Second Indication, Tonics & Stimulants,
among these none is better than Cinchona -

84
Lecture Dec. 10th 1825 Dr Mott -
Treatment of Mortification, When arising from 
a traumatic cause, the system is debilitated &.
the phlogistic diathesis completely subdued,
Bark is an excellent remedy - It should 
be administered in substance, when the stomach
can bear it. The Pale bark is the best kind
being more agreeable to the stomach, & if finely
powdered will be still more efficacious & grateful
If the stomach rejects it, join it with some 
aromatic, making a confection - 
The wafer form of administering it 
is a good method, mix together flour & water into 
a paste, then form the wafers by putting the paste
between two irons, then take wafers putting in 
a glass of wine & the bark around it, let the 
patient swallow it 
The Decoction of bark is recommended
by some, but I believe the infusion to be better
by pouring hot water upon the bark -
Sometimes Bark purges, Give Laud if it 
purges violently -
At other times it produces costiveness
In such cases add little Rhubarb to it - 

85
Quinines is a valuable medicine, but rendered
more so by adding dilated sulphuric acid to the 
Sulphate making Super Sulphate of Quinine -
Take 16 grs sulp quinin ʒij Elix vit, 8oz water -
put the Elix vit with the Quinine, & by shaking it, it 
will soon dissolve, then add the water, Give a table
spoonful every hour or two -
When it is important to invigorate
the constitution after the use of bark, give food of 
a nutritious kind & stimulating drinks, as Porter,
generous wines &c.- 
Another Indications is to remove all
sources of irritation, & it often becomes necessary to give 
opium in large doses, when opium is disagreeable to 
the stomach, mingle camphor with it -
Black drop is a good remedy, Give it doses
of 20 drops, which is equal to 80 drops Laud -
Local Treat. If mortification arises from 
external injury, unconnected with any constitutional
affections, pay all your attention to the circumference
of the living part. Tepid applications & saturnine
poultices applied over the dead & living parts - 

86
When inflamn- is subdued, make use of yeast poultices -
For arresting this progress of Mortification
the attention of Surgeons has been directed to 
Blisters, they are eminently useful on erysipelatous
inflamn-. They may be applied & with 
great Success in mortification of the toes -
Lecture Dec. 12th 1825 Dr Mott -
Besides Blisters, other topical applications
are to be used as Poultices, they may be applied
over blisters, In cases of erysipelatous inflamn-
occurring on the body & making progress upwards
it may often be arrested by the application of 
a narrow blister passed around the body -
At what period of time is amputation to 
be performed in cases & mortification {In order
to answer this question the division of the causes
of mortification into Spontaneous & Traumatic
is always to be kept in view -

87
If mortification stops, you are not always
to amputate immediately, if the system is debilitated
as a collapse is induced by the loss of blood, which 
may never be regained, but it is necessary to invigorate
the constitution first -
When the constitution is affected
amputation is not to be performed until the 
mortification, causes, but arising from an external
cause, & the system unaffected, you may amputate
immediately -
Hunter says that amputation
should never be performed until mortification
ceases, but Dr Mott does not agree with 
this opinion in all cases, (See Guthrie, & Kellen)


88
Lecture Dec. 13th 1825 Dr Mott -
Spontaneous Mortification, This is of rare
occurrence. The mortification of the toes described
by Pott is of this kind. It is unconnected
with any peculiar condition of constitution
appears generally in one of the small toes
patient complains of pain through the foot
soon swelling takes place, inflamn- on the top 
of the foot supervenes, continuing for 2 or 3 weeks 
more durable than Plegmon, & unlike Erysipelas
a blue spot will be observed on one of the 
toes, cuticle little elevated, skin under it 
of a livid colour, & the mortification progress
very slowly. It occurs generally in advanced
life. In two instances where I have seen it,
both were corpulent persons of advanced age
& had lived freely through life -
It has been ascribed by some, as 
arising from an ossification of the extreme
arteries, this is Pott's opinion, Others have 
ascribed it to the extreme debility of the 
vessels -


89
This mortification of the toes generally proves
fatal, goes on uncontrolled, spreading up
the limb, & finally affecting the constitution,
Pott's great remedy was opium, The
black drop is preferable - Tonics & Antiseptics
Anodynes - Emollient & yeast poultices - Blisters
Bark administered internally constitute the 
remedies to be used in this disease -
It will sometimes prove fatal in 
one week, in other instances it will continue
for 2 or 3 years -
An important question here arises
whether amputation should be resorted to -
I know of but once case, where this operation
was performed while the mortification was 
going on & this was successful - 
There is another form of mortification 
arising, undoubtly from the use of ergot, (which
is a morbid growth of rye or wheat). This 
has attracted the attention of practitioners of late
as having a specific action upon the uterus - 

90
Tisseau made experiments upon animals, proving
the specific action of ergot, as it caused the 
death of the animals.
What quantity is necessary for producing
such effects upon the Human system is not 
precisely known -
In the years of 1809, 10, 11, 12, 13, there 
was a prevalent disease in the Hlms House of 
this city, attributable to no particular cause,
but I was led to the opinion that it probably
was occasioned by ergot being in the bread when
they eat. It was denominated a Necrosis 
of the Under Jaw, It commenced with a tumefaction
of the gum, jaw became denuded,
lips & cheeks partaking of the disease, & the 
mortification extending down to the clavicle
Various kinds of treatment were pursued -
Tonics & Antiseptics were of no avail - The 
diluted state of nitric acid with carbon
succeeded better than any thing else, unless it 
was the extraction of the incisors, which was of 
more benefit - 

91
Lecture Dec. 14th 1825 Dr Mott
Carbuncles are of 3 sorts viz. Common, Pestilential
& Episure - Carbuncle derives its name from the 
peculiar burning sensation, which attends it, It 
most commonly occurs in vitiated habits, on the 
back for the most part, tho' sometimes on the 
head, neck, & extremities. When on the back it is 
less dangerous than on other parts, generally fatal
on the head & neck, by producing an affection of 
the membranes of the brain. It first appears in 
form of small pimples, with a vesicle on breaking
which, a sanious fluid is discharged, leaving a small
pit or depression. On pressing round this, small bubles
of air are perceived. It is evidently a mortification
of the cellular substance, very soon there are many
holes formed, giving the honey comb appearance
the inflamn- is of the erysipelatous kinds, I never
saw a case attended with phlegmonous inflamn-
or that admitted of depletion - 

92
Treatment of Carbuncle, In the early stage
before much disorder of the part, the application
of a small blister is peculiarly calculated
to arrest it, If this stage has passed by, an
application of yeast poultice with bark is 
beneficent. I have found benefit from the 
application of aqua ammonia, previous to the 
poultice, or aqua amm., & camphorated spts 
this followed by the poultice should be renewed
every 3 or 4 hrs, never allowing the poultice to 
become dry. Shall this treatment alone be
depended upon, or shall we make a free incision? 
In large carbuncles, I have made the 
crucial incision 8-10 In in length. afterward
filling the wound with turpentine & dressing with 
an emollient poultice - Either practice may be adopted.
The first evidence of its doing well is the change
of the sanious discharge into healthy pus, & in
proportion to the quantity of pus secreted, will 
the morbid part be removed & healthy granulation
arise. Cutting off large portions of the integuments
is a bad practice - 

93
Dr Mott relates a case of carbuncles, where the 
patient had laboured under mania for some 
time, on healing of the ulcer, he became sane
Hence the utility of setons & issues on similar
affections -
The Pestilential carbuncle is always 
symptomatic of malignant disorder of warm
climates of Plague &c (See Rupel on plague) -
The Epism, occurs on animals & is communicated
by contact to the human species -
Injuries of the Head
They are divided into 1st Those where the 
integuments only are concerned, 2dy Where the 
skull & brain are also affected - The Head
is an organ subject to a variety of affections from
external violence, & injuries of the scalp are more
serious than in other parts of the body - It is 
an uniform practice, never to remove any portion
of the scalp for any causes, however, much lacerated
it may be -
Wounds of the scalp never require
sutures, owing to the extreme vascularity, adhesion 


94
soon takes place. Bring together the parts &
support them in apposition by means of strip
of Adhesive plaister -
The scalp is liable to four
particular injury, & it is well to keep in mind
the anatomy of the parts, 1st Skin of the scalp
2d the cellular membrane filled with adipose
substance. Underneath this the tendinous
expansion of the Occipito Frontalis muscle & lastly
the pericranium -
The first affection arises most commonly
from a small puncture, inducing an extensive
erystpelatous inflamn- of the whole cellular membrane
It may occur from lacerated or incised wounds
or as a secondary affection, indicative of inflamn-
in the brain, Treatment, immediate & active
depletion & antiphlogistic treat, generaly - at
the same time cover the whole head with yeast
poultices frequently renewed, that it may be kept
moist, this is generally sufficient. It requires no
incision - 

95
2d Kind. Is a puffy tumor, coming on several
weeks after the injury is received, generally indicative 
of mischief on the brain, extreme restlessness flushed
faces &c. It discharges a thin watery fluid & there 
is an oedematous feel. It is always an indication
of inflamn- in the brain
Lecture Dec 15th 1825 Dr Mott -
3d Affection of the scalp accompanied with phlegmonous
inflamn- is that arising from wounds in the 
tendon of the Occipito Frontalis Muscle, does not 
have that puffiness which the last described does
the extreme pain denotes the place of inflammation 
& the only relief which can be obtained is by the
division of the aponeuroris, before the incision, and 
bent poultices will be proper, in order to relax
& soften the part -
4th form of Tumor, is denominated the 
bloody, & arises from blows received on the head -
sometimes it is of great size, when feeling it 
it gives a sensation as if a part of the bone was
depressed, requires no operation. If after treating the 
patient antiphlogistically & using discutients -


96
it still remains swelled it may proper to 
puncture it. If there are no symptoms indicative  
of injury done to the brain, never open it.
Apply to the part, camphorated spirits or 
Common rum & brandy.
Symptoms, indicating injury of 
the brain. 1st Sickness at stomach & vomiting
2d Loss of sense & voluntary motion 3d Bleeding
from noses & ears, accompanied perhaps with
vomiting of blood. If you wipe the blood from
the ears with a sponge, & still perseive it discharging
from the meatus auditorious externus, you 
may rest assured that there is a fracture
of the petrous portion of the temporal bone & 
this is generally fatal -
The two injuries of the brain are 
called Concussion & Compression, by concussion
we are to understand, that there has been a 
violent motion of the brain suspending its
functions, this may be brought on by injuries
recovered on parts of the body besides the head
there is a suspension of sense & voluntary motion
sickness at stomach &c -

97
Some have recommended emetics, but I believe
this to be a pernicious practice - The patient
lies in an easy state of respiration, the
pupil of the eye contracted at first, the 
pulse natural & easy, perhaps little less frequent
some degree of extravasation takes place in 
concussion, & here the symptoms will be more 
or less mingled with those of compression
& hence there is some difficult in discriminating
between concussion & compression - Suppose
for example, a person receives an injury of the 
brain & falls down in a state of insensibility 
& after a short time recovers, so as to walk
about, this would be called Concussion, but if 
after a short elapse of time, he should again
fall into a state of insensibility, stupor &c
this would be called Compression, arising
from extravasation -
From the imagined analogy
between the symptoms of concussion of the brain
& of the syncope, Stimulants have been restored
to, this is a bad practice -

98
I have seen instances, where the patient was 
bled immediately in this state of insensibility
& did not recover -
The best mode of Treatment
is to leave the patient, in the first stage, until
he recovers from that insensibility, then the 
reaction of the heart & arteries take place
which increased still more in the 3d stage
when the patient becomes very sensible -
Then bleeding is to be performed, to be 
regulated according to circumstances, There
is no disease perhaps in general which will
admit of more copious depletion than this 
seclude the patient from light, purge briskly &c 

99
Lecture Dec 16th 1825 Dr Mott -
Brisk purging is to be employed in concussion of 
the brain, with the view of producing a new irritation,
as well as to evacuate the contents of the 
bowels, by producing large evacuating from the
arteries & exhalents, causing a revulsion from the 
brain. One among the best of purgatives is Sulphus
Mag. & Tartrite Antimony, another & better one is 
Jalap ʒss Cal, 10 grs, or Jalap & Sup. Tart, Potate -
after this the head should be shaved & a blister
applied over it - great benefit is derived from -
blisters applied to the lower extremities, but
in this case they should be applied to the head
or nape of the neck. It is to be kept on for 
24 hrs. Watch the state of the pulse, for it 
may be necessary to bleed frequently -
Hemoplegia sometimes attends concussion of 
the brain. In order to prevent this, you must
have recourse to copious depletion, & when it 
supervenes, you are to deplete as far as the 
system will bear it & also by purges of Cal 
causing an absorption from the brain -  

100
Fatuity Sometimes follows a concussion of the 
brain & also sometimes remains as a constant
effect -
The bone, where the injury was recovered
may be depressed, causing that affection
of the nervous system called Epilepsy - Here
it would be necessary to Trephine -
Three causes of compression, 1st Extravasation
of blood. 2d Depression of bone 3d Formation of 
matter, The patient with a compression of the brain
falls immediately in a state of stupidity, [cross out]
attended with vomiting, eyes half closed, with 
the pupil dilated, breathing stertorous, hard &
laborious - pulse irregular, slow & intermittent.
Compress, arising from extravasated blood. When a 
person labours under compress, from this causes
the symptoms do not immediately appear,
The largest extravasations of blood are on 
the side of the head from the situation of the 
middle artery of the [cross out] dura mater which may be 
ruptured, likewise on the outer surface of 
the dura mater, 

101
If a person receives an injury of the head unattended
with symptoms of fracture, but merely
of compression, the rule is to perforate the 
skull at the anterior lower edge of the parietal
bone, if there be no extravasation here -
perforate the other side, If the symptoms
denote extravasation under the Dura mater, you
may open it, not by puncture, but by incisions
Blood extravasated, will sometimes coagulate,
remain there, & the patient recover -
Symptoms of extravasated blood, are no 
bleeding from the pericranium, & upon striking 
the bone, it sounds as tho' it was hollow -
Simple fracture requires no operation, but 
demand the strictest antiphlogistic Treat,

102
Lecture Dec 17th 1825 Dr Mott -
[cross out] Treat of simple Fracture of skull
Potts practice was to make numerous perforations
along the place of fracture, for fear of inflamn-
Here I think he erred for it would probably
increase inflamn- by injuring the membranes of 
the brain, The best modern practitioners reprobate
the practice In no case therefore are
you to apply a trephine, where there are no 
symptoms of compression, injuries recovered over
the frontal sinuses, occasioning a depression
of the external table, here apply a pair of 
forceps & extract it -
Under circumstances of 
Fracture attended with depression, but no 
symptoms of compression, no wound of integuments
a question arises whether it is necessary to 
immediately elevate the depressed bone -
As regard the practice there are a variety of 
opinions, my opinion is of the depression be
slight, you may leave it, If it be considerable 
remove its immediately -

103
When there is a wound of the membranes of 
the brain, causing a discharge from the brain,
you must take away all the loose portions
of bones, A person may be relieved from compression 
of brain, after recuring an injury for some
months - Dr M, relates the case of a person affected
with compression of brain for one year, & was
relieved -
3d Cause of compression is the formation
of matter. It forms within the skull at different 
& uncertain periods of times after the injury
after 3 or 4 weeks the patient is generally safe
if matter is not then formed -
Previous to the formation of 
matter, there is an inflamn- of the brains,
The patient is drowsy, eyes flushed - fever -
restlessness, comatose - pulse quick, tense &
corded - rigors - sensation of heat - stupidity -
loss of sense & voluntary motion 

104
Matter is commonly seated in the dura
mater, between it & the skull -
Perforate the skull at the situation
of the tumor, & if you find no matter here
you are not to open at any other part of 
the skull, but may open the dura mater
with the lancet - The greatest danger
of opening the dura mater is the formation
of a fungus, this in itself is not dangerous
if properly treated. It protrudes from the 
opening sometimes as large as an egg - 
it is formed of blood & coagulate lymph
Some have thought it was a portion of the 
brain, this is an error, It suffered to go on 
it may occasion Hemiplegia - Treat As soon
as there is any evidence of its coming on, apply
lint, then a compress, & over this a bandage,
the doubled headed roller, or stand the head
& apply strips of adhesive plaisters - 

105
Certain parts of the Head are objected to
for the application of Trephine -
Avoid the line running from the root 
of the nose over the vertex, called the sagittal
suture, it is more adherent here than in other 
parts, & besides having situated immediately
under it the great Longitudinal Sinus -
avoid the part where the spinal artery runs,
the lower anterior angle of the partial bone, 
Avoid the transverse ridges of the os occipitis.
where the lateral sinus is situated -
Altho, the sinus may be opened [cross out] till it will not
prove fatal, if the haemorrhage be immediately
stopped - 

106
Lecture Dec 19th 1825 Dr Mott -
In dividing the scalp for the application of the 
Trephine, the incision is to be made in the direction
of the vessels, it is unnecessary (as some recommend) to 
scrap off the pericranium, but apply the trephine
at once - Pin of the saw must invariably be applied
to a sound position of bone, frequently remove the 
instrument in order to find how near through
the bone, it has already pierced, after bone
is completely perforated with the Trephine,
remove all the fragments, extravasated blood,
& then dress it. Bring down the lips of the 
incision, & retain them by adhesive plaisters
then apply some lint, over this a compress & over the 
whole a night up. After dressing it, the 
patient is to be put to bed in a dark apartment,
commonly vomiting takes place -
Treat, It may be necessary to bleed the next
day after the operation, & each successive day for  
some time, I do not recommend purgatives, but 
I use Enemata for several days. If fever comes 
on, & the vomiting & sickness at stomach is suspended
you may give salts - If the patient lives for 
the space of 14 days, he is generally safe  

107
But if you do any thing to the brain, which 
will tend to excite, inflamn- will be brought on
& perhaps terminate in the death of the patient
Leave the head untouched until the 14th day
when you may apply a poultice & soften the dressing
so as they may be removed -

108
Lecture Decr 20th 1825 Dr Mott -
On Cataract
Cataract derives its name from a greek word
signifying to destroy - It is an opacity of the 
Chrystalline lens or of its capsule - When
seated in the lens called the true Cataract
when in the capsule the false Cataract -
Symptoms, The patient first peceives motes
floating before his eyes, this however does
not invariably denote cataract, for it may
arise from a preternatural determination
of blood to the head, & it may eventually
terminate in cataract - When he looks at 
an object, he will observe some permanent
spot, afterwards it will appear to him as 
tho' he was looking through gauzes, at 
this time no disorder can be perceived in the 
eye, soon after a cloudiness will appear -
The patient can see better at twilight or 
in cloudy weather than in sunshine, the 
pupil is dilated & the iris contracted -
This contraction & dilatation are not 
the strongest evidence of sensibility - 

109
The best evidence is, when the patient can
distinguish between light & darkness, & unless
this be the case, you are not to operate -
Cataracts produced by external violence
do not require an operation immediately, but 
when they have come on gradually for a long 
space of times, relief cannot be expected unless
from an operation, no internal remedies will be
of much benefit
Cataracts are presented in different
states viz 1st Hard - 2d Soft or Milky
3d partly Solid & partly fluid 4th Floating -
5th Dislocated, & sometimes a cataract will
be long -
It is important to distinguish between
true & false cataract - As the lens is situated
behind the iris, if an opake spot is there perceived
it is the true cataract, if false, it adheres to &
fills up the pupil. If the patient can distinguish
between light & darkness, has no 
chronic pain in head - iris moveable, it is then 
advisable to operate -

110
Lecture Dec 21st 1825 Dr Mott
The patient should be prepared for the operation
of cataract, by being kept on a low diet -
by venesection, purgative &c for a least two weeks
previous, the eye should also be frequently touched
with a probe, that it may be accustomed to the 
irritation - you are now to judge, whether it 
is best to extract or depress it - the rule
which I observe is if the eye be prominent & the 
anterior chamber large, it is fit for extraction
If this is not the case & the cataract is soft
it is then to be couched - We are to examine
whether the cataract be hard or soft, when 
opake & white they are hard, & those of long 
standing are generally hard, of recent formation
they are soft, when of this last form it is 
better to couch - It is called Couching
because the lens is removed from the axis of 
the eyes & depressed into the posterior chamber
of the eyes -

111
Saunders needle is the one which I use for 
couching - The patient is to be placed before 
the light - The French Surgeons perform this 
operation by candle light, the reason for which is 
that the pupil may be dilated or contracted at
pleasure - Previous to the operation you may
apply the extract of some narcotic as stramonium
to the eyes. The surgeon sets before the patient,
an assistant supports his head behind, & with 
his forefinger draws up the upper eyelid, the surgeon
now plunges the needle through the sclerotica
& carries it forward before the lens, lacerates
the capsule, & it be hard the lens disappears, if 
it be soft, scrape the lens 3 or 4 times & withdraw 
the needle - Close the eye immediately, & do not 
look at it for 8 or 10 days. Treat the patient 
antiphlogistically, by vs, Rhs, purges, Leeches & confine
in dark apartment - This operation may be 
repeated for several times - 

112
Lecture Decr 22nd 1825 Dr Mott -
Operation for the extraction of Cataract -
Prepare the patient for the operation in a more 
rigid manner than for couching - An incision
is to be made in the cornea, then let the 
eyelid fall immediately, remaining for a short 
time, then the upper eyelid is to be raised,
instrument to be passed up to the pupil & the 
lens to be scratched, by making pressure upon
the ball of the eye, it is now to be conducted
out with the instrument. The condition of the 
iris is now to be attended to, if it has fallen
down between the lips of the incision, this to 
be pushed back. The patient must now close
his eyes, a dry compress applied over the eye - to 
be put to bed, with his head a little elevated -
If great pain comes on, with great irritability
give Laud to allay it. Treat the patient
most strictly with the view of guarding against 
inflamn- viz by vs. purges, Blisters &c - his hands 
should be secured, lest he should raise them
to his eyes, & scratching them thereby destroy
them -


113
In 24 hrs. the eye will sometimes be full
& convex, the aqueous humor being regenerated
When looking at the eye, by a omitting gradually
a small degree of light to the apartment, there
sometimes will be seen a small tumor, called
prolapsus Iridis, Take an instrument & endeavour
to push it back to its places, if this does
not succeed, make use of some gentle Escharotus 
the effect of this stimulus will cause the iris
to retract - An opacity of the capsule of the 
lens is most generally anterior if this be the 
case, introduce a pair of forceps & draw it away -
if posterior, some advise to leave it, others to 
lacerate it, I would lacerate it, as a small
discharge of the vitreous humor is of no great
consequence, with regard to vision being disturbed
3d Operation termed the Capsular operation of 
Saunders, suited to the eyes of infants. It consists
in first dilating the pupil with some of 
the Narcotics as stramonium 1 or 2 hrs previous to the 
operation, then the patient is laid upon a table,
the eye confined, by a silver were passed under the 
upper eyelid securing the ball of the eye


114
Then the system takes a very delicate needle
introduces it through the corneas & through the
pupil, then a little rotatory motion lacerates
it, leave it to be dissolved, this operation is 
generally successful in children, very little 
inflamn- attends it, & it may if necessary be repeated -
4th Method of operating is by a curved knife 
introduced through the cornea & lacerating
the capsules - another method of operating
is by passing the needle behind the ciliary ligament,
to the top of the lens & depressing it
down in the vitreous humor - 

115
Lecture Decr 23rd 1825 Dr Mott -
It becomes necessary sometimes to make an opening
through the iris for the purpose of admitting light to 
the bottom of the eye, constituting an artificial pupil
Chesseldents operation was to pass the needle posterior
to the ciliary ligament as far as the iris, making an
opening, this operation does not often succeed, for 
opening closes up - Baron Wensel recommends that an 
incision be made through the cornea, to the iris, then
introduce a pair of scissors & cut out a triangular
piece of the iris, this operation is only applicable, where
the iris is completly closed & the cornea transparent.
Scarpers operation was to introduce the needle & tear 
it the iris from the ciliary ligament - This often
succeeds & continues to be practised -
The best operation is that recommended
by Gibson - Take a cataract knife & pass it through
the cornea where it is transparent, & by making an incision,
the aqueous humor will leak out, then the 
iris will bulge out immediately through the incision,
take a pair of scissors & cut a small piece out,
& the iris will retract with an opening. If the iris
does not protrude, introduce a small delicate instrument 


116
draw it out, then make the opening -
Staphyloma is an affection of the eyes where
the cornea is more prominent than natural, & in which 
the sight is generally lost, the projection is such that 
the eyelids will not close, resulting generally
from inflamn- When only one eye is affected, & the 
eyelids will close there is no hurry for the operation
It has been Suggested that pressure might 
restore it to its natural State -
Various methods have been suggested for 
removing a portion of the eye. Some recommend
Caustics, but this dangerous & painful. It is 
best to make an incision around the margin of 
the ciliary ligament & remove a portion of the cornea
Medical College of 
New York
1820.

117
Lecture Dec 29th 1825 Dr Mott
Neuralgia or Dolor Facia
This is a disease of an organic kind, tho' it leaves
no evidence of diseases. There is no redness swelling
or the like. I have one dissection, where the nerve
is enlarged. It occurs most commonly in the 
branches of 5th pair of nerves, as they spread up
on the face, tho' it occasionally is found in the 
extremities & other parts of the body. It occurs
generally as an Idiopathic, tho' it Sometimes
is symptomatic if allowing wounds &c -
The person is seized with an acute
darting pains, taking distinctly the course of 
the nerves & whilst it exists, the face (or part
affected) is spasmodically [crossed out] constricted.
At the Same time there is a gush of tears -
from the eye of that Side of the face. It goes
off without leaving any marks except perhaps
a little redness produced by the Spasm (For 
a peculiar description of symptoms see a letter
in Philo, Med Mun No XXVI from Dr Jones
to Dr Rush. This disease is liable to 
be confounded with others as Rheumatic 

118
affections of the face. In the latter the pain
is generally felt in the jaw bones & not so 
distinctly in the soft parts as Neuralgia -
A more distinct mark is that in neuralgia
the pain is excited by passing the hand over the
part, particularly if its temperature vary from 
that of the face. It generally occurs after 
middle age -
Treatment, Is either medical
or surgical, I always attempt relief by the 
former, before adopting the latter, Tonics or
Cinchona. Carb Iron in large quantities, but 
with little efficacy, Cathartics in large
[crossed out] doses have also been used. Cicuta
in large quantities has been given with beneficial 
effect as by Dr Jackson of Boston, who
gave to the extent of 300 grs in 6 hours
To be commenced in doses of 1-2 grs increasing
gradually or I prefer the datura Stramonium
to the Cicuta, dose in form of extract
48 gr every 3 or 4 hours, this continued 2-3 
days will produce its specific effects -
Its dose may be increased to 1-5 grs every hr,

119
A good remedy is arsenic. Its use should
be preceded by general depletion, as it is 
predjudicial, whenever there is a plethoric
state of the System, or instead of depletion
you may add digitalis, which diminishes
the action of the heart & arteries -
Strong injections into the rectum of Terebin,
or aloes exciting tenesmus & bloody stools have
removed it during their operation
but this remedy is not preferable to the 
disease - Opium, Camphor, Musk & Assafoetida 
have been used, the first of these 
in the form of black drop is best -
Medicines acting on the skin, as vol
Tinct, Guiac, in dose of teaspoonful repeated
thro, the day have been used with Success -
To also a small bay of murias Soda laid
in the mouth along the jaw has been found
beneficial. It doubtless acts by promoting
fill circulation &c -
Sinapisms. Blisters, Issues
operating on the vital properties of the 
nervous system are also used -


120
Electricity, Galvanism & magnetism
have palliated the disease. Dr Jones was 
relieved by putting a small magnet in 
his mouth. It soon lost its power &
on substituting a larger one the disease
became more violent -
Surgical Treatment. Where medicine
fail. Instruments may succeed. The 
operation consists in dividing the affected
nerve. It is best performed with a 
phymosis Knifes, or some instrument in 
a stiff handle. The Infra orbital nerve
is most frequently divided. Pass your knife
down to the bone on either side of the nerve
according to the side of the face which is 
affected. On depressing the handle the nerve
may be felt on the knife like a wiry
cord. On making a cutting motion the nerve
is divided producing for a moment excruciating 
pain. A more infallible test of the division
of the nerve is that loss of sensation or motion
in the part. The beneficial effects of this operation
are seldom procured until after several days 

121
Lecture Jany 3rd,, 1826 Dr Mott -
Symptomatic Neuralgia, following VS. attended
with acute pains in the arms. The operation consists
in taking out an elliptical portion including
the cicatrix completely, & removing a portion of nerves
then draw & retain together the integuments -
Polypus -
A polypus receives its name from its supposed
animal nature, but erroneously. It is of a fleshy 
nature unaccompanied with pain for the most 
part. I believe there are two distinct kinds of 
polypus occurring in the noses viz. Benign &
Malignant - The first form has an external
vascular covering & internally a gelatinous substance,
always attaches itself to the sides 
of the nose, to the inferior Turbinated bones,
a factor generally attends with a discharge
of matter, rarely attacks both nostrils at 
once 

122
Polypi can be removed in three ways
viz. by Forceps, Ligature & Caustic -
The Forceps should be curved a little, avoid
the inferior turbinated bones, & here you must 
distinguish between a polypus & a spongy state
of the Sneiderian membrane covering these
bones, a polypus is always softer -
The patient should be seated in a light 
take a probe & pass it up the nose to ascertain
the precise attachment of it, let 
the head be raised & thrown back, then 
introduce the forceps & after applying it at 
the root of the polypus, give a sudden jerk,
that it may be torn away by the root -
Great circumspection is necessary in the use 
of Caustics. If you use were for their
extraction, a canula is necessary, & iron wire
is preferable, pass the wire into the canula
making a loop, introduce it & pass the 
loop around the polypus & draw it very
tightly -
 

123
2d kind of Polypus is purely Hydated like a 
small bladder filled with fluid, unaccompanied 
with pain, occurs in young subjects, my plan is 
to draw them away as much as possible with 
the forceps, then applying Escharotics beginning
with ʒi oxide Arsenic ℥i Lard put on a dossil 
of lint & applied to the part -
3 Kind of Polypus, is Malignant, more 
fleshy than the first, remarkably prone to
bleed, great pain attending it, no operation
to be performed here. Use palliative medicines -
Excrescences about the mouth
uvula &c may be excised with a pair of 
scissors - 

123 
Lectures Jany 4th 1820 Dr Mott
Removal of the Tonsils, The Tonsils are 
occasionally so enlarged as to impede deglutition
& respiration. When of long standing
they should be removed, but they sometime
occur in Children, where they may be removed
by the application of Blister, Gargles, Caustics
Method of Removal is by wire ligatures
& a canula, seize the gland with 
a hook & draw it up that you may readily
apply the wire, secure the mouth of the 
patient by placing a piece of cork between
the Molars teeth, apply the wire very
firmly at first, after its removal a 
considerable joeter will attend, to be 
corrected by Spts & water - 


124
Bronchotomy -
This operation consists in making an opening
in the larynx or Trachea for the purpose
of admitting air into & out of the lungs. It is 
performed for suspended respiration arising
from various causes, as Suspended respiration
from Submersion. The first thing to be 
done in such a case is to inflate the 
lungs. this may be done by a pair of 
bellows, pass your handkerchief around
the bellows, & introduce them, while an assistant
holds the nose of the patient with 
one hand & with the other presses upon the 
thyroid cartilage, pressure upon the ribs is 
also necessary & Persevere in your efforts
for at least half an hour -

125
Lecture Jany 5th 1826 Dr Mott
A vulgar practice in case of Suspended 
respiration is immediate VS. This is improper
until respiration has commenced. vs. is then
proper from the right jugular vein -
Attention should also be given to the stomach.
Introduce something to arouse its 
energies, as warm toddy. This is injected into
the stomach & does not interfere with 
the process of respiration - Now it become 
important to apply friction, which is 
calculated to support the action of 
the heart & arteries - 
When Bronchotomy is performed
it had better be in the Trachea, below
the Cricoid cartilage rather than
between the cricoid & Thyroid, as you
may then have sufficient space to pass
your instrument -
Suspended respiration -
from hanging produces the same effects
on the brain as that of drowning - Some 
suppose that death from hanging is 


126
produced by dislocation of the second from 
the first vertebra of the neck. This however
is not the case
Extraneous substances may
get into the Larynx or Trachea & require
removal by Bronchotomy - Before proceeding
to operate it is important to examine 
the posterior fauces, as the substance
may be lodged there-

127
Lectures Jany 9th 1826 Dr Mott -
On Hernia -
Hernia is defined a protusion of any viscus from 
its proper Situation. Divided into Hernia of the 
Abdomen, Thorax & Brain. I shall confine my
attention to that of the Abdomen. There are
several species of this kind of hernia as femoral
hernia, inguinal. Ventral & Umbilical -
Anatomy of the groin, In dissecting off the integuments,
we observe the fascia superficialis of kamper
upon which are situated the inguinal glands, this
appears the external oblique muscle of the abdomen
pouparts ligament, called the crural arch arising
from the anterior superior spinous process of the ilium
inserted into the ligament of the pubis, the symphisis
of the pubis & the linea Ileo pectinalis. From the 
crural arch go off several processes, first the fascia
lata of tho thigh divided into two portions. the 
iliac portion on the outside of the vena saphena 
the Pupal portion on the inner Side, We observe
also the fascia transversalis going up under
the Transversalis Muscles, between it & the Peritoneum,
in this is situated the internal abdominal 

128
ring, another process is the fascia Iliaca, covering
the Iliacus muscle -
Lecture Jany 10th 1826 Dr Mott -
There are two species of inguinal hernia occurring
at the external abdominal ring viz the Oblique
& the direct, the first on the outside of the epigastric
artery - There are two abdominal rings.
viz the external & internal, the external is 
where the cord emerges, & wholly formed by 
the tendon of the external abdominal
muscle. The Internal is situated midway
between the anterior superior spinous process 
of the Ilium & the tuberosity of the pubis,
formed by the slit in the fascia transversalis
& is covered by the fibres of the transversalis muscle.
The space between the two rings is called
the Inguinal canal & is the passage of the cord
from 1-2 in. in length. the floor is formed by
the Transversalis Muscle - The relative
situation of the Epigastric artery to these two
holes is to be observed, It arises from the femoral
just above the crural arch, running up on the 

129
abdomen in an oblique direction between the 
two rings -
Operation for Indirect Inguinal Hernia
make an incision directly over the surface
& you will generally cut the Pudic artery which
is to be tied, after you come down to the 
hernial Sac, take a pair of forceps & raise the 
tumor gently that it may be cut with the 
Knife after the Sac is opened you are to feel
for the stricture, it is generally found in the 
inguinal canal, after feeling it, insinuates your
finger nail & introduce by the side of it the
Bistouri & cut it, always give the edge of the 
knife a direction straight upwards - 

130
Lecture Jany 11th 1826 Dr Mott -
In the Indirect Inguinal Hernia the protusions
generally takes place over the cord, this however is 
not always the case. The direct Inguinal Hernia
comes through the external abdominal ring, the 
neck of it is on the inside of the epigastric vessels
The Stricture is to be dilated straight upwards
The operation consists in making on incision through
the integuments, then through the fascia superficialy
then you come down to the hernial Sac. The stricture 
is now to be dilated -
Femoral or Crural Hernia -
This is a protrusion of some part under the crural 
arch. The tumor appears below the crural arch
& lies on the inside of the femoral view, upon the 
pubal portion of the fascia lata, emerging under
the crescentic edge, It comes down with the 
sheath of the vessels. The sheath of the vessels
is formed anteriorly by the reflection of the 
fascia transversalis & posteriorly by the fascia
Iliaca, the fascia propria is the sheath of 
the vessels pushed forwards - 

131
The Femoral is to be distinguished from
Inguinal Hernia. The femoral is never so 
large as the inguinal, it has its long axis
across the thigh in the direction of the crural
arch, it is always below pouparts Ligament
by feeling the crural arch above the tumor
you will be sure that it is Inguinal Hernia
This Hernia below the crural arch generally
tilts upwards, therefore in order to reduce 
it, put the patient in a situation which
will relax the parts, let him lay down,
& the leg being bent upon the thigh, you press
the tumor downwards with your thumb
which will generally reduce it -
Operation. Put the patient upon a 
table, make an incision in the direction of 
the long axis of the tumor along the crural
arch, and another incision in an opposite direction 
⟂, then dissect up the parts, after you come 
down to the fascia propria, raise it up with 
a pair of forceps & cut it flatwise -


132
The rule, which I have followed for removing it,
is to pass the bistouri flatwise on the finger &
press the intestine down, after coming to the stricture,
turn the edge of the Knife upwards & outwards
that you may go in a line with the Epigastric
artery - Relative situation of vessels to the 
femoral ring. The obturator artery sometimes arises
from the epigastric, & may be so situated with 
regard to the hernia as to endanger cutting it -
if the hernia comes down over the artery, there is 
no danger, if not, when introducing your finger
feel for the pulsation of the artery, that you 
may avoid cutting it. (on this subject see
Laurence & Anderson) -

133
Lecture Jany,, 12th,, 1826  Dr. Mott -
On Aneurisms -
Operation for popliteal aneurisms -
The lower part of the upper third of the 
thigh is the best situation. The artery is the 
most superficial & with few anastomosing
branches - 1st,, Make an incision on the 
inner edge of the Sartorius muscle about 
3 Inches in length, the leg being a little
flexed, then raise the inner edge of the 
Sartorius muscle, the sheath of the vessels is 
now exposed, this is to be cut into & the artery
laid bare, which is on the outside next the bone
A strong double ligature is to be passed round
the artery by means of a blunt needle, then the 
ligatures being divided from each other, they are 
to be firmly tied on the vessel about an inch from
each other & the artery divided between them.
The edges of the wound are to be drawn
together & secured by adhesive strips, the 
ligatures being left out at the angles - 


134
Jany 13th,, 1825-
The situation above mentioned for the operation
of popliteal aneurisms is not the only one
for it may be tied any where between the tumor
& crural arch, of cases where it has been
tied below the tumor within my knowledge
are unfavourable for the principle is to tie 
between the tumor & heart -
If the aneurism be situated in the 
posterior tibial artery, it would be better to tie 
it alone rather than at the ham; but if possible
or the tumor be situated low down, you may tie 
the artery between the tumor & ham -
In taking up the anterior tibial artery
there is more difficulty than in the posterior 
owing to the fascia covering it - 



135
Lecture Jany 15th,, 1826 Dr Mott -
Method of taking up the Subclavian artery
on the Scapular Side of the Scaleni Muscles -
Make an incision above the clavicle & going
down along the side of the amohyoideus muscle
after coming to the bundle of nerves which go 
to form the axillary plexus, you must go below 
these nerves & then you will feel for the pulsation
of the artery on the first rib -
Operation for aneurism on the Brachial artery
Feel for the pulsation of the artery, & cut along 
the inner edges of the Biceps muscle between it 
& the Coracobrachialis about the middle of the 
arm, avoid the median nerve, feel for the 
artery, cut down upon it & thus avoid the nerve
The only case, where the artery is to be taken up
at the elbow in where it is punctured from 
venesection -

136
Lecture Jan 17th 1826 Dr Mott
Operation for tying the Carotid artery -
It can be taken up any where above the sternum
to the angle of the lower jaw. Care is necessary here on account
of the internal jugular vein which lies immediately
above the artery & the par vagum lies also near 
these vessels. Make an incision along the inner
edge of the Sterno Cleido Mastoid Muscle of 4 in
in length, raise this up, the omo, hyoidcus is seen
crossing the sheath of the vessels, which has been
mistaken for the artery, removing this & the
internal jugular vein, you apply the ligature,
draw the sides of the wound together & retain
by adhesive strips. It generally unites by the 
first intention

137
Lecture Jany 19th 1826 Dr Mott -
On Amputation-
This is an operation, which we are obliged to have 
recourse to, for to save the trunk of the limb -
The great danger of amputation arises from its tendency
to produce lock jaw.
This operation is called for in several
& various instances, occasionally in compound
fractures, & sometimes in accidents which do not 
involve the bone, as in Severe & are adfully lacerated
wounds. In the walks of private life, most 
cases requiring amputation, arise from diseases in 
joints, connected with a scrofulous habit -
Fungus Haemotodes existing on the extremities
require amputation sometimes, Gunshot wounds
Carcinoma &c -
When amputation is to be performed it is an
interesting question whether to perform it before the 
mortification cases or not, In cases of spontaneous
mortification we should wait until it ceases,
but when arising from a traumatic cause
you may amputate before the mortification
ceases -

138

139
Lecture Jany 25th 1826 Dr Mott -
Symptoms of Inguinal Hernia
Inguinal Hernia may be defined to be a
tumor appearing midway between the spine of 
the Ilium & symphisis pubis, generally disappearing
upon lying down, dilated by coughing
& disappearing on pressure -
Diagnostic Symptoms. It is most apt 
to be confounded with Hydrocele. This may 
be known by the tumor commencing at the 
bottom of the scrotum - by its translucency
fluctuation, pyriform shape - absence of pain
except at the attachment of the Testicles
If Hydrocele extend up to the inguinal 
canal & passes out at the external abdominal
ring, it will be difficult to distinguish it 
except by the history of the Case -
A more difficult case is that Hydrocele
which communicates with the peritoneal
cavity. In this case upon lying down the 
tumor disappears, dilated by coughing &c
This generally occurs in children soon after
the descent of the Testicle, very translucent.  


140
Let the patient lie down - then elevate the 
scrotum & the water passes into the abdomen
place your finger on the external abdominal
ring if the tumor now appears it is Hydrocele
In cases of Hydrocele in children. It is best to 
apply a small seton -
Varicocele is also liable to be mistaken
for Hernia. This is an enlargement of the 
spermatic veins & generally occurs in the left
because the left spermatic empties into the 
emulgent, while the right empties into vena cava
It may be known by rolling the tumor
between the fingers, giving the feel of a bundle 
of worms - Lay the patient on his back
elevate the scrotum & the tumor disappears
apply pressure at the abdominal ring. If
the tumor returns while pressure is made it 
is Varicocele - 

141
Lecture Jany 26th 1826 Dr Mott -
Diagnosis between inflamed testicle & hernia
When this inflamn- exists, it has been mistaken
for Hernia. The symptoms are vomitings fever
constipation of the bowels, & therefore requires
attention to discriminate -
Abscesses take place here, & might
be mistaken for Hernia, attended with 
fever, vomiting, constipation of bowels &c
Predisposing Causes of Hernia are.
Relaxed state of the system acting
1st By enlarging the apertures, & 2nd by elongating
the mesentery allowing the intestine to come 
down when the exciting cause is applied -
Exciting Causes are Laborious employments
Strictures in the Urethra, Habitual Coughs
occurring generally in persons of advanced life
Reducible Hernia is a curable affection
in children & sometimes in middle life
by proper applications of instruments - 
Hull's Patent Hinge Trusses are the 
best that have been invented - 


142
Lecture Jany 27th 1826
Irreducible Hernia. The most common
cause of irreducible hernia is its quantity which 
is constantly liable to be increased. It is a great 
desideratum to render it reducible. This is 
sometimes affected (particularly of omental sort)
by promoting absorption. Confinement to bed
depleting & antiphlogistic means are necessary
When rendered irreducible by adhesion, it can 
only be reduced by an operation -
Strangulated Hernia, The symptoms of
this are similar to inflamn- of intestines viz
a pain across the upper part of the abdomen
in the course of the colon, with vomiting, costiveness,
a tumor which at first is not painful
on being handled, tho' it soon becomes extremely
tender & painful. The abdomen also becomes tense
& very tender to the touch. This last being an 
evidence of peritoneal inflamn- I should
then operate immediately -
 

143
Treatment, Bring about as much relaxation
as possible, diminish both vascular & muscular 
action, by bleeding &c. The first attempt at 
reduction may now be made. The patient being
properly placed, with one hand between his legs
grasp the tumor & with the other assist its
passages at the ring. In the early stages I
made use of a great deal of force for 15-20 min
after a faithful, but unsuccessful attempt. I 
would put the patient in a warm bath & bleeding
while in the bath & embrace the opportunity
during the relaxation to reduce it. This is sometimes
attended with success, if not I would attend
it on removing the patient to bed, if this fail 
try Tobacco injections (Nicotiana Tabocum ʒi
infused in [crossed out] water, inject half of this & if necessary
in 20 min. inject the rest - at same time
you may use cold in form of powdered
ice - Take care not to freeze the Scrotum - 

144
Lecture Jan 28th 1826
Before an intestine is returned, after dilating
the stricture, it should be pulled out a little
to ascertain if there be not a hole in it at the 
strictured part. If not, it is to be cautiously
returned in the same course, which it came
down. This being done, pass in your finger to see 
that all the contents of the sac are passed
into the peritoneal cavity -
Show dress the wound. It is to be brought
together by sutures & adhesive plaisters. The patient
is to be put to bed with his legs in an extended
position. In general vomiting ceases immediately
after operation. For 3-4 hrs give patient only
drinks, now an evacuation per ani becomes desirable
This is to be procured if the stomach be very
irritable by enema if not by Seidelitz Powder
Senna, Manna &c. It is not uncommon to 
obtain a very profuse discharges exhausting the 
patient very much in which case he is to be 
supported by proper nourishing diet - Avoid
inflamn- by antiphlogistic treat. If no discharge
occur, the dressings are not to be disturbed 

145
If on opening the sac, there is doubt, whether
the intestine be returnable or not, ascertain if 
the circulation is still going on in the part, if so 
it may be returned - If no veins are to be seen
apply an emollient poultice for an hour or two 
if circulation goes on it assumes a healthy aspect
& may be returned - If the intestine be sphacelated
after relieving the stricture procure an evacuation
The state of this is truly deplorable, the discharges
for the most being, [cross out]
from this artificial anus. If it be in the 
small intestines, the discharge of fluids is so 
rapid that the nutritious particles are not taken
up by the lacteals & the patient does of emaciation
Sometimes the opening heals & the patient recovers
at others it continues open for years, tho' in general
death is an early consequence.
If the omentum be in a state of sphacelation it 
may be cut off. In this case it becomes necessary
to tie 2 or 3 vessels. I would do this with fine silk
& cut off the ends at the knot - If the patient
recovers it will generally be in the course of 
10-12 days 


146
Lecture Jany,, 31st 1826 Dr Mott -
Diseases of the Breast
This part is subject to several diseases, some
only cured by by a removal of the whole breast
others by a removal of part, & others without any 
operation. Were it not for a continual tendency
for the disease to increase & the system to become
affected, we might employ more time for the 
application of remedies external & internal. 
Some forms of this disease do not require an
immediate operation as Hardness from mammary abscess
There are five diseases of the breast 
requiring Expiration. 1st The Hydatid. 2d Schirrhus
3d Medullary Carcinoma, 4th Steatoma - 5th
Fungus Haematodes- The Hydatid breast
is a rare affection independent of any other
diseases, by it we understand a tumor in the 
breast, containing a pellucid fluid ralying inside, 
the breast grows to a considerable sire, 
has an elastic feel soft with a degree of fluctuation
When these tumors are large, they may be punctured,
& injected treating the tame as Hydrocele,
but generally they are numerous, & therefore 


147
it is more safe to remove the whole breast -
2d Schirrus of the Breast is a peculiar
disease of the breast, females are first apprised
of by perceiving blood on the linen, or in consequence
of exerting the pectoral muscle an acute 
pain is felt in the breast & a tumor appears
The Schirrus tumor is remarkably hard
& circumscribed, sometimes irregular & knotting
females subject to it, have not pain at all
times, a few days previous to menstruation the 
pain is more considerable. When seated on 
the outside of the nipple by absorption it 
extends itself to the axilla. When on the 
inside it produces cough, dyspnore, as these
tumors grow, they contract adhesions around 
the Surrounding parts, nipple is drawn inward
when it become an open ulcer it is called
Carcinoma -
Carcinomatous ulcer never discharges
healthy pus, the edges are turned outwards
with remarkable callosity. Cancer proves
fatal in one of 3 ways. 1st by discharging large
& exhausting the patient 

148
2d By producing a peculiar affection of the side
affected in consequence of the swelling of the axillary
glands, impeding the return of venous blood & thus
producing Erysipelatous inflamn-
3dy By Absorption, producing a constitutional
affection - This disease occurs in persons between
the age of 30-50 tho' more frequently betwen 40 &
50, most frequently in unmarried women & in married
women, who have never given suck. When
schirrus becomes an open sore, the patient does
not generally live over a year, tho' sometimes
for several years. Diseases of the female breast
sometimes alternate with diseases of Uterus
3dy Soft Cancer or Medullary Carcinoma
appears for most parts in vitiated habits in 
form of a large tumor, after it ulcerates it 
appears like a fungus, progresses very rapidly
& requires a speedy extirpation


149
Lecture Feby 1st 1826 Dr Mott -
4th disease of the female breast is Steatoma
This does not involve the glandular part 
It is known by the freedom from pain, & to a 
certain degree tuberculated, liable to occur in 
any part of the body of an enormous size
5th Disease is Fungus Haematodes
This is accompanied with pain, it is soft,
elastic, pulpy, & becomes of a purplish colour
when it bursts, the fungus springs out, &
sometimes bleeds freely. This requires speedy
extirpation, & after it is removed the constitution
most generally partakes of it & the patient
sooner or later perishes - The operation for 
removing a part or all of the breast is dangerous
in proportion to the Size of the tumor
after its extirpation lay a napkin across the 
patient & let her remain 15-20 min. before
dressing the wounds, & she should be in a 
recumbent posture - Bring the integuments
together & retain them by adhesive plaisters,
over this lint & a compress, use a roller for first 
dressing afterwards the mammary bandage 


150
The axillary glands are sometimes so affected
as to require removal, & great attention is 
requisite in removing them lest the axillary
vein be cut -
The female breast at the age of puberty
is subject to an enlargement which gives
great anxiety, being a distinct tumor, painful
hard & more or less of an inflamnt nature
There is no necessity for an operation here -
Cover it with Soap plaister or oiled silk
Treat the patient antiphlogistically
if there be any interruption to the menstrual
discharge, it requires particular attention.

151
Lecture Feby 2nd 1826 Dr Mott -
Dropsy of the Abdomen
Peritoneal or Ascital & Cystical or Ovarial
Dropsy - In the peritoneal there is a larger quantity
than naturally of pellucid fluid exhaled & deposited
& tho' absorption goes on, yet an accumulation
takes place, the fluid is within the sac of the 
peritoneum -
The patient is first apprised of this 
disease, by his clothes being tighter than natural
then a sensation of a waving motion within 
the abdomen. In order to detect the presence 
of fluid within the cavity of the abdomen
we should endeavour to discover the fluctuation.
The proper method for this is to let the 
patient be seated in a chair, there by placing 
your hand at the upper part of the abdomen
on one side & striking the other side with 
the other hand, you may discover it -
Sometimes the fluctuation is very indistinct
thr' the collection of water be considerable, owing
to its being contained in cysts & also to the 
oedema of the integuments -


152
Dr. Fothergill says that the treatment of 
this disease would be more successful if the 
operation of paracentesis was sooner performed than 
is usually the case, & then using a judicious course
of Treatment by Tonics, Diuretics &c
Tapping sometimes cures encysted dropsy
by the inflamn- they induced by the operation -
Ovarial dropsy either arises between
the peritoneums & ovariums, or consists in an 
enlargement of the ovarium - Distinguished
from peritoneal dropsy by the history of the case 
commencing on the Side has not as distinct a
fluctuation - In all cases of Ovarial dropsy
there is no hurry for an operation, the object in 
delaying the operation is that cysts will
sometime burst into one cyst & then by 
tapping the water is all drawn off 
We know of no medicines which will control
this disease, Keep the patient in a comfortable
situation. Females hear the operation of ovarial
dropsy much better than the operation for 
peritoneal dropsy -


153
The fluid drawn off is of different colours
in different cases - The ordinary quantity of 
fluid contained & drawn off is from 20-30 pints
We should endeavour to discriminate between
dropsy & pregnancy as instances are known where 
the operation of Paracentesis was performed in 
consequence of an enlarged abdomen, which arise from 
pregnancy, & mistaken for dropsy - Distinguishing
by placing your hand on the abdomen & feeling
the movement of the child - Here Dr Mott
closed by relating some curious facts -
Lecture Feby 3d 1826 Dr Mott -
Previous to the operation of Paracentesis,
it is best to have the bladder emptied, as if
it be enormously distended, you might 
puncture the bladder -
Operation, Take a single headed roller
& pass around the patient, let him be in a 
recumbent position. Make the puncture
about an inch below the Umbilicus, as 
there then will be no danger from the Situation
of vessels, first make an incision through 


154
the integuments, then pass in the trocar
and as the water runs out, make pressure
upon the abdomen by the bandage if much 
cough comes on while the trocar is within it is 
best to withdraw it. Remove the Sheet, apply
a piece of adhesive plaister, then a bandage
A person will seldom survive many operations
of parecentesis, not generally more than 3 or 4
Besides tapping other attempt have been
made to cure dropsy, as in encysted dropsy
by excision, but this is a hazardous practice
Setons have introduced into these encysted
tumors, & it has been proposed to inject them
as in Hydrocele, in two cases this was 
done within my knowledge both were fatal - 

155
On Fractures
By a fracture is understood a solution of 
continuity in a bone produced by external
violence, or from violent muscular exertion
Fractures are divided into Simple &
Compound. The first is a fracture, without
any injury of the soft parts, the latter
where this is the case.
A simple fracture is generally known
by change in the position of the limb,
By mobility of parts: by crepitation, this 
last is not always present & when present is 
not to be always depended upon. In injury
of the joints there is sometimes an effusion
which gives on motion a sense of crepitation
The Bones of the body unite at different
periods. Those of the superior extremities
with but one exception unite sooner than 
those of the inferior. The bones of the fore arm
generally require 3 weeks the [cross out] os brachii
4 weeks - The Tibia 5 weeks. fibula 3 weeks
the femur 6-8 weeks - The Clavicle from the 
difficulty of keeping the parts in proper crepitation
requires generally 5 weeks - 


156
Lecture Feby 4th 1826 Dr Mott
Process of the healing of Bones -
Directly after a bone is broken there is a considerable
effusion of blood between the ends of 
the bones, which is absorbed in the course of 
3 or 4 days after the injury. Then inflamn- of 
the periosteum comes on, which throws out a 
material which forms a bond of union
this is thrown out in form of a ring. In a 
few days it becomes hard. This material then
becomes vascular & bony matter is secreted
from the arteries, until the whole becomes ossified,
as bony matter is secreted, the material
forming the nidus is absorbed -
In simple fracture, when by feeling you 
perceive a redundance of ossific matter, apply
a stuffed strap so as easily to compress & thereby
promote absorption.
There are two great points in the management 
of fractures with regard to the position of 
the leg. The French advocate the extended. The English
the Semi flex. judgment is to be exercised, & one or the 
other adopted according to circumstances -

157
Fractures of the leg, many of these are managed
with great comfort to the patient in the Semi
flex position on Potts plans. Fractures of the
bones of the leg require splints. These should 
always extend beyond two joints that the 
limb may be properly steadied -
In some cases, as in oblique fractures, it is necessy
to place the limb in an extended position
resting upon the heel & calf. In this position
the action of the Gastrocnemii muscles (which
is apt to distort the limb) is counteracted
On first seeing a fracture, a popular setting
(as I term it) is only requisite, tho, in children
or in very irritable nervous persons, splints lightly 
applied become necessary. In general it is only
necessary to place the limb straight -
In the course of a few days. when 
Swelling & inflamn- have subsided. the Surgical
Setting becomes necessary. This consists
in proper adaptation of parts & the application
of proper splints - 

158
Lecture Feby 6th 1826 Dr Mott -
It often becomes necessary to bleed the 
patient after a fracture, to prevent too great
inflamn- & also to make use of local application,
the best of which is lead water & laud, 
in the proportion of ʒij - iij acetas Plumb. pint
of water, to this add a cup full of vinegar -
Spts & water is a good application. If the 
pain swelling & inflamn be great, apply leeches
if blisters appear, make the lead wash stronger,
After this preparatory treatment, you are 
to apply permanent bandages, & for this purpose
the many tailed bandage is to be used
It is necessary to examine the fracture
daily, lest the limb become distorted 
Fractures of the Thigh. These are of more 
importance than those of the leg, as distortion
& shortness of the limb more frequently happen
The old English plan of Treating fractures of 
the thigh was that of the flexed. The fault
of that practice was submitting the patient
to great inconvenience by shortning the limb 

159
This practice consists in making use of three
splints, one applied on the outside, one on the inside
& one on the upper part of the thigh -
The next plan is that of the double inclined
plane, with a fracture box - I never knew an 
instance of a fracture of the thigh bone, where
the broken ends did not overlap each other
the lower portion of the fracture sliding under
the upper portion, owing to the strong action of 
the flexor muscles, & for counteracting this,
the Fracture box is admirably well adapted
the ball of the great toe must be in a 
line with the inside of the patella -
Another of treating fractures of the 
thigh bone is in the extended position -
Lecture Feby 7th,, 1826 Dr Mott -
In Fractures of the thigh bone, it becomes necessary
to ascertain whether the limb be of its proper length,
in order to determine this, measure from the 
anterior superior spinous process of the Ileum to 
the bottom of the foot - 


160
Fracture of the neck of the thigh bone
This accident more frequently occurs in old people
& often from slight causes -
Symptoms. 1st The limb is generally shortened
sometimes very little, & sometimes very considerably -
2dy- The foot is always turned outwards - 3dy-
Crepitation, this does not take place where the 
limb is much shortened - 4thly- Ready mobility
of the limb - Different opinions are entertained as 
to the union of a fracture at this place, some maintaining
that it never unites of the fracture be within the
capsular ligament, this is the opinion of H Cooper -
The French are of the contrary opinion -
My opinion is, that if the fracture be treated as 
ordinary fractures, & the extremities of the bone be 
brought into crepitation. they will unite - 
It is to be treated upon the plan of the double 
inclined plane or in the extended position -
 

161
Lecture Feby 8th 1826 Dr Mott -
Fracture of the Clavicle, From the 
situation of this bone it is liable to be broken
by falls on the Shoulder -
Symptoms. Pass your finger along the 
clavicle, & you will generally detect the fracture
the Sternal end remains fixed, & the Shoulder end,
is raised. When fractured near the Shoulder, it 
will not be much displaced, but the crepitation
may generally be felt -
Treatment. Bring the bones in 
crepitation, by elevating the shoulder by means of 
a sling carried around the forearm, & by passing 
a handkerchief around the arm to keep it close
to the body - In small children I have applied
a single headed roller making the figure 8
bandage across the Shoulder - apply camphorated
spirits for a few days - 

162
Fracture of the OS Brachii -
Symptoms are great mobility - alterations
in the position of the limb. Crepitation &c.
Treatment. Attention must be paid to the 
inflamn- in the beginning, by means of the antiphlogistic 
treat, tho' in some instances I apply the 
splints immediately, four splints are requisite 
the one on the inside must reach from the 
axilla, down below the elbow - In the first
place take a single headed roller, & begin at 
the point of fracture (which is generally at the centre
of the bone) & go down to the elbow, then up
to the axilla then down again, now apply
the splints, then with a similar roller, apply it
over the splints reversing the order, by first carrying it up -
Fracture of the lower part of the os
Brachii at the Epyphisis. This generally
happens in young subjects & requires attention
to distinguish it from dislocation at the 
elbow, Grasp the elbow firmly with one 
hand & the shaft of the os brachii with 
the other, & by turning it a little you will
perceive considerable mobility - 

163
Treatment, as considerable swelling & inflam
attends a fracture at this place, let the arm
be laid upon a pillow for some days until
the swelling & inflammation subsides -
Take a roller & apply it over the arm &
forearm, then take a piece of paste board 
of the length to reach from the axilla to 
the wrist, & of the width to surround the arm
moisten it in water, cut out a triangular
portion for the elbow, bend the arm, then
apply the paste board in the moistened state
which soon becomes hard so as to firmly
compress the limb, after the expiration of 
2 or 3 weeks, make use of passive motion to prevent
stiffness at the joint -
Fracture of the Condyles of the Os Humeri
requires the Same treatment as the preceding
Charles Condit 

164
Lecture Feby 9th 1826 Dr Mott -
Fractures of the Fore Arm, When only one  
bone is broken there is not much difficulty in 
ascertaining it or treating it, unless where it happens
that the radius is broken high up, it is necessary
to guard against its pressure upon the other bone,
Management of a fracture of one bone
If the inflamn- be considerable, leave it for a
few days until it subsides, then take two splints
of the length to reach nearly to the ends of the 
fingers & apply them along the sides of the bone
If both bones be broken three splints are 
necessary the third one to be applied along the 
edge of the Ulna -
Fracture of the radius low down
This happens just where the Quadratus Muscle
crosses the bone & this muscle draws down the 
[crossed out] fractured end to the Ulna - In this case
apply a splint just long enough to reach the 
wrist, so that the weight of the hand may 
counteract the action of the Quadratus muscle
& thereby keep the ends of the bone in good 
coaptation - 

165
Fracture of Olecranon, This is to 
be managed upon the extended plans. Upon examining
to ascertain the fracture, relax the arm as much
as possible, then take hold of the olecranon & it 
may be moved -
Treat, antiphlogistics in the 
commencement - Apply a roller, beginning at the 
wrist & carrying it to the axilla, then apply a 
splint along the inside of the arm -
after 3 weeks, remove the dressings & make use 
of passive motion in a very gradual manner at first
Fracture of the Patella, This is 
generally a simple transverse fracture -
Sometimes the ends of the bone are considerably
Seperated, after the inflammation is subdued -
it is best to relax the muscles arising from 
the pelvis & inserted into the Patella, which will
be obtained better by the patient being
bolstered up in bed instead of being in a recumbent
position 


166
Treatment of Fractured Patella -
Apply a splint reaching from the calf of the 
leg to the middle of the thigh. Then take a 
roller, pass it around the leg & thigh, describing
the figure 8 Bandage across the patella, observing
at the same time, that the ends of the bone are 
brought into good coaptation. Treat it on this
way for 6 or 7 weeks, after the expiration of 4 weeks
make use of passive motion - When these bones
are not brought into good coaptation the union
by ligament takes place, & the patient remains
lame for some time -
Laceration of the ligament going from the 
Patella to the Tuberosity of the Tibia -
This accident is known by the patient falling &
attended with a Sensation of something giving way
suddenly - Upon close examination you will feel a 
deficiency - Treatment. The same as in 
fracture of the Patella - 

167
Fracture of bones sometimes go beyond the 
usual time before union takes place, sometimes
they never unite - This is sometimes owing to the 
patient being confined to low diet, who had previously
been accustomed to full living -
Three circumstances prevent the union of 
bones. 1st The ends of the bones are not brought together -
2ndy- Where the bones are not kept in proper
coaptation 3dy- Deficiency of energy in the 
constitution - Various methods have been 
adopted in reference to the treatment of a 
bone in this situation - Supposing it to be 
the Tibia I would recommend to apply a
splint & let the patient walk about as much 
as possible - 2dy Blisters to the part -
If this does not succeed make use of Setons
leaving them in for several months & taking 
them away in a gradual manner -

168
Lecture Feby 10th 1826 Dr Mott -
Fracture of the Ribs, Symptoms are crepitation,
which if not distinguished readily, direct the 
patient to take a long breath, & then you will a
grating Sensation - Treat antiphlogistically
& apply a bandage around the chest, if it be
a simple fracture it will soon unite, if composed
Emphysema may come on attended with difficulty
of breathing &c. In this case cut down upon the 
upper edge of the rib & make an incision thro'
the pleura, that the air may have a free exit.
Fracture of the lower jaw, This may be known
by looking into the mouth & observing the irregu
of the teeth, also by crepitation -
Treatment, The greatest difficulty is to 
keep the patient from moving it, which only requires
to be kept still. If a tooth be involved in the 
fracture extract it, apply a bandage across it 
leaving a space for the chin or merely apply a 
handkerchief across the head & under the jaw -
I have sometimes found it necessary to wire
the teeth together -

169
On Compound Fractures.
By a compound fracture, we mean a fracture
of a bone complicated with a wound of 
the external Soft parts, thereby denuding the 
bones -
Treatment, The first thing which attracts
the attention of the Surgeon is the Haemorrhage
this is therefore to be arrested, & if possible by
pressure, avoiding ligatures - It is now desirable
to bring about an union of the wound, tho'
generally it does not unite by the first intention
My plan is to lay the limb in its proper
situations, either on the side or heel, governed
in this respect according to the situation of 
the wound. The wound is then to be dressed
apply a piece of lint wet with blood to the 
part, then an adhesive plaister, compress & the
many tailed bandages. In this way it may 
be reduced to the state of a simple fracture
I have sometimes made use of splints for the 
purpose of steadying the limb, at other times
only applying a pillow around the limb - 

170
If inflamn- comes on employ vs &c to subdue it,
If the part is about the Suppurate, make use 
of poultices - In applying the many tailed
bandage, leave the strips seperate, as it becomes
necessary to dress the wound often. Wash the 
limb frequently with spirits, lay pieces of sponges
along the sides of the wound, for the purpose of 
absorbing the discharges -
Other circumstances attend compound
fractures of a more serious nature. 1st Protrusion
of the bone. In this case return the protruded
end & if the wound is not large enough to return 
it, it is advisable to make it larger, by 
altering the position of the limb & managing it 
skilfully, it may returned without producing 
any laceration - If the bone is not denuded
of its periosteum you may leave it, but if denuded,
you may Saw it off - 


171
Compound Fracture of the Tibia, If the end 
of the bone be considerably protruded, sawed off &
returned, it will unite only by ligament -
A circumstance attending a compound fracture
of this bone is the laceration of the artery,
If it be the anterior tibial artery, you can tie
it any where in its course, & if the posterior
tibial artery be lacerated 4 or 5 inches above the 
ankle it may be tied also & the limb saved
But if it be lacerated at its situation in the 
calf of the leg & especially injured by the bones
it is very uncertain, whether it can be saved -
In this instance my opinion is that amputation
should be performed, But if the artery be 
lacerated by the cause which produced the 
fracture & not by the bone itself & if at the same 
there is no great laceration of parts. I would 
tie the artery & attempt to Save the limb -

172
Compound Fracture of the OS Brachii
If the brachial artery be lacerated, it is advisable
to tie it, because the vascularity of 
that part is so great that the anastomosing
branches may carry on the circulation, If you 
find however, that the circulation does not go 
on & the hand & arm has a cadaverous coldness
for 24 hrs, then amputation is to be performed
Compound Fracture of the Thigh - This 
is a dreadful accident owing to the great
laceration of muscles. I have known it to prove
fatal in 24 hrs, As it respects the position of 
the limb we are to be governed according to 
circumstances - If the femoral artery be lacerated.
I would advise you to secure it as 
in the Brachial, & at the place of the wound
if the circulation does not go on afterwards
amputation must be resorted to - 


173
Lecture Feby,, 11th,, 1826 Dr Mott -
On Injuries of the Spine -
No dislocation can take place on the spine
without a fracture except between the first &
second vertebra. The most common situation
for an injury of the spine is at the lumbar vertebra
produced by falls &c -
Symptoms, are loss of voluntary motion
retention of urine & faeces for 3 or 4 days then 
follows an involuntary evacuation of urine & faeces
a person receiving this injury does not in general
live over 3 months tho' Sometimes they will live 
a year or two - They die in consequence of immune
sloughing at the part -
If the injury occurs at the dorsal
vertebra, in addition to the symptoms already
mentioned, will be a disordered state of the 
Stomach, & if high up with difficulty of breathing
the patient generally dies on 3 or 4 Weeks 
When the injury is at the cervical vertebra
the patient loses all motion in the Superior
extremities, breathing difficult, the patient
does not live commonly over 24 hrs - 


174
When the first is dislocated from the second
vertebra, death is almost the immediate consequence
In relation to the injuries of the spend, my
opinion is that nothing has been done for the 
cure of these accidents - Some have recommended
an operation, by cutting down & removing the bones
which compress the spinal marrow. I would
not advise it - make the patient as comfortable
as possible by antiphlogistic treat. vs. Cathartic
Enema &c -
Dislocation of the Sternal end of 
the Clavicle. When this happens, the clavicle
rides upon the first bone of the Sternum
this is easily detected - This dislocation
cannot be remedied, for when it is reduced
by which is easily done by bringing the shoulder
back & retaining them by a bandage. It steps
out as soon as the body moves -
Dislocation of the Clavicle from the acromion
process- This is ascertained by the irregularity about
the shoulder, pass your finger along the spine of Scupula
& when you come to the articulation, the clavicle
appears raised - Treat. Elevate the 


175
shoulder & keep the arm to the body -
Dislocation of the OS Brachii -
This takes place in 3 different ways, the most
frequent is downwards in the axilla - 2dly
forwards under the great pectoral muscle
& 3dly Backwards on the dorsum of the Scapula
The Characters of a dislocation, are -
The arm is generally fixed & at a little 
distance from the body, & as soon as it is 
moved the patient experiences great pain,
upon examining the shoulder, instead of a round
it has a flattened appearance, & if the patient
is not very muscular, you may crowd your finger
under the acromion process, direct the patient
to raise his hand to the top of his head
& if he cannot, with the other symptoms we 
may be sure that it is a dislocation -
If there Still be doubt, search for the head
of the bone, whenever you find it, place your
finger on it, & grasp the elbow rotate the 
bone, & thus you may distinguish, whether
it be the head of the bone or not -


176
A Fracture of the neck of the Scapula
might be mistaken for a dislocation -
Characters, are more mobility than in dislocation -
the head of the bone is not felt in the 
axilla - crepitation may also be felt - Put
your hand over the shoulder with your thumb
in the axilla, then rotate - or Find the coracoid 
process, put your finger on it, then
rotate the arm & you will feel the crepitation
Lecture Feby 19th 1826 Dr Mott -
Treatment of a [cross out] fracture of the neck of the scupula
Elevate the Shoulder by placing it in a sling
& having brought the parts into coaptation, bind
the arm to the body. Perhaps it will be necessary
to put a bolster in the axilla - Leave it for 
4 weeks, when make a little passive motion
continue this for a week & leave off the dressings
Method of reducing a dislocation at the shoulder
joint - This is effected with but little difficulty 
in recent cases - The greatest difficulty occurs
in dislocation under the pectoral muscle 


177
Have a person to hold the body of the patient,
another to steady the Scapula, a third
to pull upon the arm (which should be flexed
& a little from the body) while the Surgeon
directs the head of the bone into its situatn
A great object is to divert the attention of the 
Surgeons. If this can by any means be effected
it is a very matter to reduce recent dislocation
We however sometimes see these cases hours,
weeks or months after the accident, in which
case it is difficult, sometimes impossible to reduce
it. A dislocation which has existed 6 months
is not hopeless. I have reduced them of 11 or 13 
weeks standing - Direct the patient to sit
in a chair which is to be supported against
a tree or pillar, a sheet properly folded is then
to be passed under the axilla & over the shoulder
& tied to the pillar or tree - Two silk
handkerchiefs are now to be affixed to the 
arm by a double hitch - Having all things
ready, an assistant must hold the scapula
& extension may now be made by two or more 
persons, while the surgeon directs the arm 

178
in such a manner as to relax the muscles,
the extension should be made gradually, and 
steadily - The relaxation may be aided by the adminstration
of nauseating doses of antimony &c
Fracture of the os Brachii at its neck, involving
the joint. In this case there is no displacement
of parts or loss of motion. It may be Known by 
grasping the head of the bone & rotating the arm
when crepitation will be perceived. The arm
should be kept still when union will take 
place
Fracture of the acromion process. In this 
case elevate the arm & bind in a sling to the 
body -
Injuries at the Elbow joint. 1st Dislocation
of the Ulna backward, the arm is in a state 
of partial flexion, and can be neither flexed or 
extended without great pain. It occurs from 
falls upon the hands & is attended probably
with a rupture of the ligaments -  

179
Plan of reducing the dislocation of the ulna
Place your knee on the inside of the arm
& pull upon the forearm, at the same time 
straightening it, a circumstance sometimes
attends this, which should be known which is 
that the coronoid process is sometimes broken
off. This may be known by the difficulty of keeping
the arm reduced it being redislocated on the 
slightest motion. In this case it is attended for 
a long time with a loss of all motion - a little
motion after a long time may be attained
Dislocation of the Radius forwards, so that 
it rides upon the Brachialis Internus muscle.
In this case if you attempt either to extend
or flex the arm excruciating pain is produced
by the pressure of the bone upon the muscle
In recent cases, it is easily reduced - Place
the elbow upon the knee, then take hold of the 
os brachii & place a finger so as to press upon
& follow the radius - with the other hand take 
hold of the forearm & make sudden extensions

180
3dy Dislocations of one or both bones backwards -
4thy. Dislocations laterally - These are easily detected
& reduced by extension & counter extension -
Dislocation of the Wrist - When this occurs, it is 
generally backwards upon the Carpus - Simple
extension & Counter extension is sufficient to reduce
this. After restoring a dislocated wrist, it is liable
to be left in a state of deformity, a tumor upon 
the anterior part of the wrist which by the vulgar
might be considered as an inward dislocation -
It must be removed by mercurial plaister, over 
this a piece of lead & bandage only Blisters &c
Dislocation of the Thumb, reduced by Extension -
Ganglions are enlargements about a tendon
It is known vulgarly as a bursted tumor. It occurs
frequently about the joint - They may be removed
by bursting them, by a blow by long continued
pressure - only cutting into them, which is attended
with danger, should inflamn- ensue -

181
Lecture Feby 14th 1826 Dr Mott -
Injuries of the Hip joint - 1st Contusion
This occurs from falls attended with excruciating
pain, the limb is shortened arising from the 
pelvis making a twist on the spine, the 
three points forming the equilateral triangle
preserve their relative Situation - 
Treat antiphlogistically - apply a blister &c
The Bursae mucosae lying under the tendon
of the great Gluteus muscle for sometime inflamed - Treat antiphlogisy
Dislocations of the Hip joint. These occur 
in 4 different situations, 1st & most frequently
on the Dorsum of the Ileum, Characters
The limb is 2 or 3 inches shorter, very much 
distorted, the foot turned inwards over the 
knee of the other leg -
2dy In the Foramen Thyroideum
Characters the limb is lengthened, & when the 
patient stands up, it is considerably advanced
beyond the other, considerable lateral motion
is allowed, foot turned outwards - 

182
3dy,, Dislocated into the Ischiatic notch 
In this case the limb is shortened, foot turned
inwards, but not so much as when it happens
on the dorsum of the Ilium -
4tly,, When the head of the bone is thrown on 
the pubis - The limb is shortened, foot turned
outwards. These symptoms are similar to those 
in a fracture of the neck of the bone - distinguished
from that accident by feeling the head of 
the bone above the crural arch -
Method of reducing dislocation of the hip
joint - Fix the pelvis, by passing straps
between the thighs & over the Ilium,
Then make extension according to the situation
of the head of the bone. If you do not
succeed, recourse must be had to means for 
favouring the relaxation of the muscles, viz. vs
warm bath, small doses of antimony, then make 
use of pullies for its reduction, continuing the 
extension for a 1/6 - 1/2 - or even an hour - 

183
Injuries of the Knee Joint, 1st Dislocation
of the Patella. This occurs either inwards or outwards
In order to reduce it, let the patient Set up in 
bed, take hold of the patella on one side, & tip
it up, by this means it will slip into its places
2dy Dislocation of the Tibia. This occurs either
inwards or outwards, Sometimes it is only partial
or it occurs backwards, pressing upon the popliteal
artery. These dislocations are to be reduced by 
simple extensions -
3dy An accident occurs at this 
joint, concerning the nature of which there is a 
variety of opinions - Characters of it, are an 
internal derangement producing by throwing the 
foot out suddenly in falling, so that it is impossible 
to Straighten the limb - Some suppose it 
to be caused by the thick part of one of the 
Semilunar cartilages getting between the ends of 
the bones, others have thought that one of the 
condyles rests upon it 
Treat. let the patient be placed
on a bed with the leg hanging over it. Take hold of 
it & throw it backwards 2 or 3 times suddenly -

184
The Knee joint is subject to the presence of loose
cartilages floating within the joint, cartilaginous at the 
margin & bony in the centre, occurring from inflammation
in the joint & deposits of this substances, the pain 
attending it is most excruciating, they can be discovered
on the outside of the bones -
Treat. When they can be felt on 
the outside of the bone confine them there by a small
concave truss & bandage -
The Knee joint is subject to a 
tumor occurring between the patella & tuberosity of 
the Tibia, of the size of an egg, which fluctuates
happens in persons who are frequently on their knees
Treat. Take a crooked needle with a waxed ligature
& pass through the tumor, & the fluid will run out -
after a time withdraw the Seton. inflamn- comes on &
consequent adhesion -
A collection of fluid sometimes takes
place in the joint, the fluctuation of which may be 
felt, occurring in persons subject to Rheumatism
Distinguished from white swelling by the softness
of the tumor its fluctuation, great mobility &
absence of pain - 
 

85
Treat by bandages & plaisters - apply the Gum ammoniac 
wit the mercurial plaister with the many
tailed bandage over it, then a roller -
Occasionaly a tumor appears above the patella
as large as the fist, being a collection of fluid in 
the bursae mucosae, in young subjects it has 
no communication with the joint -
Treat. Blisters, Bandages & stimulating Plaisters
Lecture Feby 15th,, 1826 Dr Mott -
Dislocation of the ankle joint. This occurs in 
3 ways, 1st Inwards in which case the tibia is thrown
inwards of the astragalus, & the fibula is broken
2dy on the outside - 3dy,, on the Tarsus -
Simple dislocation it not attended with much 
difficulty, simple extension only being required -
But a compound dislocation with fracture
is a dreadful accident, In this case my opinion
is that the foot should be amputated - 

186
Retention & Suppression of Urine
The bladder is liable to be so over distended is that 
the urine cannot be evacuated, hence called Retention.
Suppression denotes that there is no secretion
When the bladder is thus distended so as to contain 
3 pints a tumor can be felt in the Hypogastric region
ascertained by feeling it with the hand - after a 
time the bladder begins to leak, this dribbling from 
the bladder, will deceive you, unless you are aware
of the fact that the bladder still continue distended
If there be doubt as to its distension introduce the catheter
Suppression of urine rarely occurs & when it does
it is for a short time & symptomatic of some disease 
Common Causes of retention of urine - Paralysis of 
the bladder caused by over distension, it may arise from 
injuries of the spine -
Treat. Introduce the Catheter & 
draw off the water, at least 3 times in 24 hours -
this is my plan if there be no impediment -
If there be much impediment, after its introduction
leave it in the bladder for a day or two 


187
By drawing off the water frequently, the bladder
will sometimes recover its tone in a few days,
sometimes not until after some weeks, at other 
times never - It is a good plan to introduce the 
Catheter at night & leave it in the bladder, so 
that if the bladder becomes distended, it may be 
evacuated - one of the evidences that the bladder
is recovering its tone is that the water flows in 
a considerable stream, If the Catheter be left
in the bladder longer than 24 hrs, it should
be an elastic one - other means have been
used for restoring the tone of the bladder -
as Tinct. Cantharides, nux vomica. &c. I have
never seen any beneficial effects resulting from 
the administration of them, you may apply
a blister over the hypogastric region or on 
the Sacrum -

188
Lecture Feby 16th 1826 Dr Mott -
Another cause of retention of urine is inflammations
of the neck of the bladder, brought on by exposure to 
cold when there is any predisposition -
Symptoms, Inability to pass water, deep seated
pain in perineum - vomiting - When you introduce an 
instrument, it gives most excruciating pain at the 
neck of the bladder -
Treatment, VS. Cathartics -
Enemata - Warm Bath - Anodynes - Sinapisms
If these means do not afford relief, Introduce
the catheter, leaving it for sometime, then withdraw
suddenly -
Enlargement of the Prostate Gland
is another cause of retention - attack persons
in the advanced of life - Symptoms, Difficulty 
of passing water, naturally disposed to incline the 
body forwards - pain not acute - no tenderness upon
pressure - finally retention of urine -
Treatment, Examine the prostate gland by 
the touch, introducing the finger into the rectum
thus you may ascertain whether it be diseased
or not - 



189
It is to be recollected than an ordinary catheter
will not evacuate the bladder in persons affected
with an enlarged State of the Prostrate Gland
a longer one than ordinary must be used -
Keep the bowels open - use warm bath - Setons
in perinea - Blisters &c - When the bladder cannot
be evacuated by means of a catheter - the bladder
must be opened above the Pubis -
Extraneous Substance getting into the Urethra
Sometimes give rise to Retention such as Calculi
When situated at the lower part of the Urethra
employ vs. warm bath - anodyne - If not 
relieved by this treat, pass an instrument in down 
[illegible] the stone, leave it there for some time, then 
withdraw, the Gush of water will sometimes
bring along the Stone -
Blood will sometimes pass
in great quantities through the Urethra without
difficulty, at other times it collects & coagulates
in the bladder, by which inability to pass the 
water comes on -

190
Treatment. Cut off the end of a large catheter
make it smooth & introduce it - Sometimes it 
becomes necessary to draw it off with a Syringe
Faeces are sometimes a cause of retention
Ulceration coming on between the colon & fundus
of the bladder & thus passing in -
Another cause is Strictures - When 
this occurs, attempt to introduce the Cathartics carrying
it down to the Stricture. If this will not pass -
employ vs. warm bath - Enema - Anodynes -
Then make another attempt - If you cannot 
afford relief yet - Give muriated Tinct Iron
10-15 drops every 15 minutes or Tarty Antimony
Pass in a large instrument down to the stricture
leave it for some time, then withdraw it &
the water will sometimes flow out -
The operation for opening the bladder is 
very rarely to be performed - Whenever it is 
called for, it is performed in 3 different ways
1st Through the rectum - 2dy above the pubis
& 3dy Through the perineum - In enlarged prostrate 
gland of necessary it must be punctured above pubis


191
Stone in the Bladder. These cannot be 
dissolved after they are deposited or formed in the 
bladder. But by the administration of antilithics
their formation may be prevented - their prescription
is to be governed by the colour of the Sand, which 
the urine deposit, whether it be red or white.
The red deposit which denotes lithic or uric
acid calls for alkalies, the best is Calcd- Magnesium
Carb-Soda - The White is the Ammonia magnesi
Phosphate or triple phosphate & calls for acid such
as Citric, Malic or (which Dr Mott prefer) muriatic
acid -
Stones are formed in 5 parts of the Uropoietic 
organs of the male viz Kidneys, Ureters, Bladder,
prostrate Gland & Urethra - 
Stones are frequently met with 
on the kidneys, producing distressing symptoms -
sometimes death - Symptoms are Nausea
vomiting - pain in the lumbar region - bloody
urine & sometimes an enlargement of the kidney 


192
Lecture Feby 18th 1826 Dr Mott -
Calculi Sometimes obstruct the passage of the 
urine through the ureters & thereby produce distressing
symptoms - The symptoms are excruciating pain
along the course of the ureters, nausea & vomiting
retraction of the testicle, bloody urine, pain in the 
lumbar region, not unfrequently adhesions between
the ureters & colon or rectum occur, in which case
the discharge of calculi per ani takes place
Persons thus affected are said to have paroxysm
of gravel -
When a stone has reached the bladder a new 
set of symptoms arise, viz pain at the end of the 
penis which is most severe after making water
the urine is passed in fits - great pain is produced
in riding on horseback or by any violent exercise
specks of blood are passed in the urine particularly
after such exercise & in children prolapsus ani
is a common attendant - Distinguished from inflamn
of the bladder (Cystytis) by the pain in the latter
being most severe while in a state of distension
To be certain of the existence of stone in the 
bladder it should be sounded, this should 


193
be done with an instrument perfectly devoid of flaus
so that the presence of the smallest stone may 
be detected. If you sound a person in a 
recumbent position & do not discover the stone
you should try it with the patient in an erect
position a little inclined forwards so that the 
stone may change its position - The sounding should
not be continued too long at a time, but should
be repeated 2 or 3 times before operating. It should
be felt immediately previous to the operation
A child should not be operated on before the 
age of 3 yrs unless the symptoms are extremely
violent & rapidly destroying - & then the parents
should be apprised that the child is very liable
to sunk under the operation. In general it 
should not be performed before 6 or 8 years -
In advanced life patients do better than in 
middle life from the greater liability in the 
latter to inflamn- &c
The system previous to this operation
should be prepared for it by depleting
means - 

194
At the time of operation the rectum should
be unloaded by an enema & if possible the bladder
should be kept distended -
Operation - The patient being properly
fixed upon a table, the staff should be introduced
& the stone felt - now feel for the arch of the 
pubis, immediately under this make an incision
on the left side of the raphe of the perineum,
obliquely between the tubes Ischii & the anus - Having
cut through the integuments, seperate the accelerated
urinal muscle & erector penis muscle - push
aside the bulb of the urethra & pass the Knife
into the groove of the staff with a free incision
now take the staff previously held by an assistant
in your left hand & pull it towards you hold it 
firmly, pass the knife into the bladder & throw it 
off the staff - you now introduce the forceps
which should be larger or smaller according to 
the size of the stone. They should be passed in so
far that the joint is at the neck of the bladder
now upon them until you feel the stone, then
pass the lower blade under the stone having served
it previous to withdrawing it they should be 

195
turned completely around to ascertain whether
the bladder be not within the blades - The forceps
must now be withdrawn -
Put the patient to bed - laying a 
folded sheet under the notes - no dressing is necessary -
Stones are of various characters & are 
generally formed upon a nucleus - Stratum
Superstratum - This structure may be distinctly
perceived on sawing through the calculi -
These nuclei may be any extraneous substances
introduced into the bladder such as an ear
of wheat corn - a bullet - a dossel of lint &c -
There are 6 species of urinary calculi
1st The Uric or lithic acid, concreted & blended
with a quantity of animal matter - It is fusible
by the blow pipe - volatilizes & emits an animal
odour, leaving a carbonaceous residue -
It is reddish in its appearance. 2dy Phosphate
of lime or Bony Calculi - generally the centre of 
these is lithic acid & animal matter, which particularly
after exposure to the air takes on the appearance
of rotten wood - It is very hard - is readily
soluble in mineral acids - by strong heat 

196
the phosphoric acid may be driven off leaving the 
lime behind. 3dy Ammonia magnesia Phosphate
very hard & chrysalises, rough & gravelly -
4th is rarely Secu. oxalate of lime or mulberry
Calculis - 5th Urate of Ammonia 6th Cystic
oxyde recently described by Wollastong -
Feby 21ty,, 1826 Dr Mott -
Parts cut in the operation for Stone -
1st Skin & cellular Substance, acceleration urinary
muscle, the artery of the bulb is generally cut,
sometimes avoided by pushing the bulb by one side,
The levator ani muscle - one side of the Prostrate
gland, Parietes of the Bladder -
Difficulties met with in the operation -
1st Slipping of the gorget. 2dy The size of the 
Stone, one weighing more than 8 oz cannot be taken
from the bladder whole Stones may be broken by 
instruments made for that purpose. 3dy The Stone
being enclosed in a sac - 4th The Internal Pudi
artery is often cut when the gorget is used. when
the Knife is used there is no danger - Some 
have suggested that a ligature should be passed 
 

197
around it when it is cut, but this is attended
with considerable difficulty, 5th- Number of 
Stones. Known by their smoothness - 6th Diseased
state of the Bladder -
Lecture Feby 22nd,, 1826 Dr Mott -
On Hydrocele
Hydrocele is defined a collection of water, generally
confined to the Scrotum, either to the cellular substance
or Tunica vaginalis Testis, but I make a 
more extended definition as Hydrocele of the Scrotum
head & back -
Hydrocele of the Scrotum should 
be distinguished from other affections of this part
It begins at the bottom of the Scrotum, gradually
enlarging particularly on one side, of a pyriform
shape generally th" not always, translucent, this
last symptom will distinguish it from most of the 
other affections of this part - fluctuation, passing 
alternately from top to bottom, not much
pain except upon pressure - Distinguished from 
Hydatid by the fluctuation being from top to 
bottom. The history of the case will assist the diagnose 


198
Known from Hernia by its commencing at the 
bottom - From Haematocele by its translucency, generaly
Haematocele is the Sequel of Hydrocele -
Causes of Hydrocele. Inflamn- in the tunica
vaginalis testis, occurring from accidents - diseases in 
the urethra - warm climate &c. When the cord is affected
called Encysted Hydrocele -
Treat. divided into Palleative
& Radical. The first consists in tapping the 
Scrotum with a trocar, which sometimes proves a 
radical cure - All forms do not require an immediate
operation - There is a form termed acute, which 
is sometimes cured spontaneously -
Radical Treat, The best means for 
effecting this is by injection. When called to a 
case of Hydrocele if it be very large, Tap it at 
first, then leave it to accumulate, afterwards
injecting it - If you are not positive that it is a 
Hydrocele. Take a lancet & cautiously cut down
until you come to the water, then pass in the trocar
obliquely upwards, withdraw the stile & thrust the 
canula completely in the Tunica vaginalis testis
for the injection take ʒi Sulf Tinc to a pint water 

199
Inject it half full, leave it in 8 or 10 min -
It generally produces pain - sickness at stomach
fainting &c, if the pain be excruciating, give a
dose of Laud - Let the patient walk about 
until considerable inflamn- & oedema comes on 
keep the bowels open, in the course of 8 or 10 days
the inflamn- subsides, then apply a suspensory bandage
If the injection passes into the cellular substance,
known by its not flowing freely outwards -
sphacelation will be the consequence. In this 
case make a free incision immediately down 
to the Tunica vaginalis testis, along the place of 
puncture, apply poultices &c -
When it is an encysted Hydrocele of the 
cord, cut down to it cautiously, no injection
will be necessary - When it extends to the 
peritoneal cavity, apply a solution of muriate  
of ammonia & vinegar, which will promote
absorption - When occurring in children. If you 
cannot remove it by application, take a common
crooked needle, armed with a waxen ligature, pass
it through scrotum, leave it 8 or 10 days
Hydrocele in other parts may be treated
as before mentioned -
 

200
Hydrocele of the Back, called Spina Bifida -
This appears in different parts of the spine, most
commonly at the lumbar vertebra or Sacrum, there 
is a deficiency in the spinous process, a congenital deformity,
the tumor is Sometimes pellucid & fluctuating
Treat. Palliative & Radical, The first consists
in supporting the tumor by means of a truss, thereby
preventing it from growing, this requires to be worn
for several years - 2dy- This consists in puncturing
the part & evacuating the fluid, then making pressure
with a small instrument. When connected with 
Hydrocephalus I never knew it to be cured -
Lecture Feby 23d 1826 Dr Mott
On Hydrocephalus -
In hydrocephalus, the water for the most part is 
within the Lateral ventricles, it is however, sometimes
contained between the membrane of the brain
When it is thus situated without the brain, the 
fluctuation can sometimes be distinctly felt, & it 
is translucent - It has been thought that in 
such cases, the water might be drawn off -
For this purpose, a delicate trocar is necessary
puncturing at the place of fluctuation on either 

201
side of the longitudinal sinus, after it is 
punctured, & as the water runs out, immediately
apply a bandage around the head, either the 
double headed roller, or a night cap firmly
In this way children have been completely cured
Convulsions will sometimes ensue & destroy the child
It is a question whether to puncture the brain
if no water be found between the membranes
It maybe done, not without considerable danger
if it is pass the instrument in the lateral ventricle
Ranula -
This is a tumor situated on one side of the 
tongue of a pellucid appearance, containing
calcareous matter. sometimes it is perfectly
fleshy. consequent upon inflamn- -
Treat. Pass in a seton & leave it 
for several weeks. upon withdrawing all 
difficulty will be removed - 

 

202
Diseases of the Testicles -
There are four of these requiring expiration of 
this organ - 1. The Hydatid - 2d Schirrous -
3d Pulpy cancer - 4th Scrofulous Testicle
The Hydatid is characterized by great enlargement
of the Testicle, unattended with pain, preserving
the form of the Testicle, heavier than Hydrocele
fluctuating, tho, not from top to bottom -
It will remain for some time without affecting
the constitution - occurs in early life from 20-
30 years - In cutting into it. sacs are observed
containing a pellucid fluid -
2d Schirrous Testicle. This is 
very rare - occurs in advanced life - remarkably
hard - not very large - pain passes up the cord
of a pungent, burning nature, afterwards becomes
knotted - inguinal glands become affected,
When the glands become affected, it is doubtful
whether it can be cured by removing the 
Testicle



203
3th Is denominated the Pulpy cancer of the 
Testicle - Begins insidiously, considerable pain
vitiated habit - very rapid in it progress -
early removal may cure it -
4th This is an affection of the Testicle
attended upon a Scrofulous habit
Lecture Feby 24th 1826 Dr Mott
Another disease of the Testicle is called Schirrocele
formerly denominated Sarcocele. This arises from
diseases of the Urethra. It is a hard swelling
It may be Idiopathic, but for the most part,
they are Symptomatic of Stricture or a morbid
sensibility of the Urethra & therefore when this is 
removed, the enlargement of the testicle will be 
removed, sometimes it is accompanied with an 
inflamn- of the Tunica vaginalis -
I have met with this disease where it 
was purely Idiopathic, & cured it by directing my 
attention to the constitution & to the Testicle.
Treat, apply a piece of oiled silk over the 
testicle, & over this a suspensory bandage - Gives 
internally small quantities of Digitalis, Calomel 

204
& opium in the proportion of 1/2 gr Digitalis 1/2 gr opium
& 1/4 gr Calomel - This I have found very beneficial
Operation for Extirpation of the Testicle
Make an incision from the external abdominal
ring to the bottom of the Scrotum, through the 
Tunica Vaginalis Testis, lay bare the cord, seperate
the vas deferens. then tie the cord. an assistant now 
takes hold of the cord just above the ligature
while the Surgeon cuts the cord, the vessels are 
now to be tied, leave the ligature for a short time
The parts are now to be dressed. Two or three
sutures are necessary at the lower part & at the 
upper part adhesive plaister. apply lint. a compress
& T Bandages -


205
Aneurism -
An aneurism is a tumor situated upon an artery
arising either from a wound or from the dilatation
of its coats - Divided into True & False  -
Modern Surgeons have subdivided them into
Circumscribed True & False and Diffused True
& False aneurisms - A False aneurism is 
formed (by the wound of an artery) in the surrounding
cellular membrane, or confined by fascial expansion
or circumscribed by muscles. I have seen
it sometimes extending from the ends of the finger
to the shoulder -
A true aneurism is understood 
to be that the inner coat of the artery takes
on a disease of some kind or another, & in a 
vitiated constitution -
An aneurism has 3 Stages -
1st Is that in which by pressure made upon it 
the tumor will disappear - 2d. Is that in 
which the blood is coagulated in the tumor, some 
point or other will be found where the pulsation
may be felt, the limb becomes oedematous -

3d Stage - The tumor is very firm - skin livid
of a dark brown colour & crack open from 
which issues a sanious fluid - This precedes the 
bursting the Aneurisms - We may prevent a fatal 
haemorrhage for some time by this application of 
adhesive plaisters -
Aneurisms are seated in different
parts of the body - 1st Just about the arch of this 
aorta, involving the vessels of the neck, It produces 
a pulsating tumor under the sternum
2d Just below the curve of the aorta, pressing
upon the spines 3dy Just above the diaphragm
when it bursts here, it produces instantaneous
death. 4th immediately where the coeliac artery
is given off, attended with a strong pulsation
in the Epigastric region -
New York Feby 28th 1826

207
Lecture Feby 25th 1826 Dr Mott -
Another situation for aneurism is about the emulgent
arteries, making its way to the back, they have in this 
situation been mistaken for abscess & opened -
Aneurisms seated in the internal parts of the body
are for the most part without the reach of an 
operation. We can only use palliative means - For this 
purpose the patient should avoid all severe exercise
which would favour bursting of the Tumor -
Some recommend digitalis, but it is very disagreeable
to the Stomach & therefore it would be better to
enjoin upon the patient to live abstemiously -
Cure of Aneurisms, In general it can only be 
cured but by obliterating the artery above the Tumor 
which is effected by a Surgical operation, We may 
be appeased of the fact however that nature may 
obliterate the cavity of the artery, this is very rarely
the case - When an aneurism is cured spontaneously
it is effected by one of two ways 1st The artery is 
obliterated above the tumor by the pressure of the 
[illegible] - 2d by the current being interrupted the 
[illegible] finds its way, through the inoculating branch - 


Pressure has been tried & recommended for the cure
of aneurisms - but the only effectual means for the 
cure, is to cut down upon the artery & apply ligatures -
Papliteal Aneurism is the most frequent, occurring
between the hamstrings of a pulsating nature -
(For the method of operating See Page 133) -