1
Pestis or Plaque
To conclude the history of the order
fibres it only remains for me to treat
of Pestis. As I have told you opportunity
of seeing this disease all I can do is to 
collect from the writings of others, that is 
of most importance concerning it 
Cullen has placed this disease amon 
the Exanthemeta, and has defined it to 
be a Typhus fever eminently contagious
and characterized by peculiar debility
Whatever may be the correctness of 
the definition, the disease is certainly
not well located, for it is a febrile
one and should therefore be placed
in that order -
It only a few years since we have obtained

2
obtained any thing like a satisfactory
account of a malady, so highly interesting
and so long Known
Terror reigned with the Plaque
and a dread of its pestilential, influence,
always deterred the curious
from too close a scrutinizing
But on the invasion of Egypt
by the arms of France, the medical
men of both the English and French
armies had an ample opportunity
of enlarging the Knowledge and 
investigating the character of this 
disease. Contrary to all former
impression, they shewed that if the 
disease be at all contagious, it was 
not in a high degree; that casual 









3
intercourse or medical attendance
was not sufficient for 
infection, and that even the nurses
did not often take the disease
Dissections too, did not appear to 
communicate the disease -
Indeed from their reports it
would seem that contagion operated
only when the patients were 
crowded together in ill ventilated
apartments: and that even
then it did not appear to exert
more influence than our
common autumnal fever und
the same circumstances.
The only time at which the 
Plague naturally possessed such

4
power, was when the fever was at 
its height, and a free perspiration
on the body. when a near approx
was dangerous -
Disclaiming therefore contagion
as the cause of the disease
they refered it to the ordinary
scources of Pestilential fevers -
In Egypt it was attributed to
the exhalations which after the 
overflowing of the Nile, rose from 
the Country it had watered -
This disease made its appearance
afterwards, and deposited when the 
fields had been thoroughly dried
by the intense heat of the sun -
And beside like the other fevers

5
from a similar cause it assumed
various types, remittent and Intermittent,
altho' in general it became 
a continued fever of either
an Inflamatory or typhoid nature
These varieties seemed to depend
on modifying incidents or local
circumstances. -
The English practitioners remarked,
that the disease was, diversified,
and furthur, observed
that when the Men were crowded 
together in the close apartments
of an hospital, the fever was typhoi 
but among those encamped in
the open fields, it was of a directly


6
directly opposite character -
Admitting however that all
is true, it is not easy to resist the 
numerous assertions that at other
times, and at other places, it 
assumed a highly contagious
power, Not to repeat all the 
accounts, many of which were 
obvious exaggerations, I cannot 
however help taking notice of 
facts not long gone by, and delivered
as truths, by men of unblemished
reputation -
As to the accounts of importation
into European countries by means
fomites, and the uniformity of 









7
the Contagion there, exhibited by 
the disease I shall say nothing for they 
deserve no credit. But when the Plaqu
fifty years ago raged in Rome with horrid
malignity, tis said that those wh 
confined themselves within the walk
of the city. Monastaries &c. never took
the complaint
A similar impurity was obtained
at Marseilles by cutting off all communications
between the affected and 
those who in health -
To corroberate this testimony
there are not wanting similar
accounts by writers who have visited
Eastern lands, but these operations have 

8
been so positively contradicted, that 
it is probable that they are not at 
all true, at any rate this is certain
as regards Egypt.
Upon consulting the minute
history of the two diseases, we cannot
but be struck with the close
resemblance of Plaque and Yellow
fever. They arise from the 
same causes, exist at the same seasons,
both attack strangers more 
readily than natives, destroy susceptibility
to a second impression, are 
equally contagious under certain
circumstances, are capable of being 
imported, and both in the same way.

9
way. The points of difference are but few,
and such as may be accounted for 
by the effect which customs, climat
religion, and other such circumstances
have in modyfying diseases
confessedly the same -
The Plaque is in Egypt a highly
malignant Typhus fever -
This type of disease might easily
be anticipated by recurring the 
miserable, dirty crowded habitation
of an Egyptians -
But among the troops of England
whose wants were better
supplied and whose encampments
were cleaner & more airy it almost
always assumed an inflamator

10
aspect - Carbuncle, buboes &c usually
considered as pathognomonic of Plague
or as peculiarly characterizing it,
are by no means confined to that 
disease; but are symptoms also of 
Yellow fever, and appear as concomitants
of Typhus gravior, especially
in protracted cases -
Determining therefore from which
we have gathered at the best scources
of information there is no great 
difference between the Origin, nature,
and treatment of Yellow fe 
The Plague is first attacked
by exhibiting Emetics, which were 
given, in consequence of an opinion
that the cause of the disease resided 









11
in the stomach & that it might
be removed by means of them
Sometimes they were indicated
by symptoms of billious accumulations,
which when the fever seemed
to be remit or intermit was undoubtedly
correct.
The Alimentary canal having
been thus relieved, the next
remedy resorted to was pretty copious
venesections - This practice is very
ancient, having been used by 
Botellus and recognized and expanded
by Sydenham
Russel also prescribed bleeding
but he used the remedy with 
greater limitations, thinking it applicable

12
applicable only to those inflamatory
cases developing local congestion
On this head the physicians of 
the English and French armies differed,
some using the lancet to a 
great extent and others excluding
it in toto. - Determining from all
the arguments on both sides I
feel assured that the proper application
is to be found in a middle
course -
To produce diaphoresis in 
Plague has long been an established
practice, first perhaps taught, by 
copious perspiration accompanying
the disease
This practice was at 

13
one time urged very far most probably
from a prevailing notion at 
the time, that contagion depended
on a matter floating in the system
requiring elimination and best
driven out by the surface -
It has not been easy to collect
from the modern writers any sufficient
test of its value. They differ widely
But it would seem to have as in 
all febrile affections, that there is a 
point where diaphoretics are highly 
serviceable -
The milder medicines of this class
seem preferable to those of a stimulating
or heating nature and perhaps external
applications are superior to any 

14
internal exhibition. Conformably to the
fashion at the time the English and 
French surgeons used applications
of cold to the surface of the body.-
By some cold water reduced to the 
lowest temperature was thrown upon
the patient others applied it with a 
sponge, which is reported to have 
been attended with happy effects -
One or two writers have applied cold
by rubbing cakes of Ice over the skin,
which a Russian practitioner, who witnessed
the process declares to have a better 
effect than any other mode -
Its utility has been furthur proved
by the circumstances that soldiers who
in a delirium had risen from bed 









15
and plunged into the Nile, were 
when drawn out considerably better
and often afterwards recovered -
Buonaparte having once forced
a march when many of his troops
had the plague, exposed them to 
heavy rains for some time, which
operating like a cold bath was of 
obvious advantage to the sick.
These accounts are further corroberated
by travellers who have witnessed
similar accidents producing like effects
External applications have also been
reccommended of another Kind -
More than half a century ago extravagant.
accounts were given of the wonderful
effect of friction with Olive Oil 

16
Mr Baldwin the British Consul
general at Egypt reported that the 
simply smearing the body with this 
oil was a complete protection to the 
wearer and that even where infection
had got into the system, the disease 
could be cared by the same means
These accounts were in part confirmed
by his success or Mr Jackson
but after all it has been tried in vain
Mitigating some degree of irritation
the application did certainly mitigate
the violence of some distressing symptoms
but had no furthur effect.
In the advanced stages of the 
disease Blisters were of advantage
especially where connected with local

17
local irritation of the head and Stomac
At the same time stimulants, as Vol
Alkali: Camphor, Opium &c &c
were indicated, but remember that 
when the Brunonian system of treatment
was resorted to in an early
stage of the complaint, it invariably
aggravated all the symptoms and 
hastened the fatal termination -
Mercury here also was tried.
To it in this case be the same objection
as in Yellow fever; the 
salivation if effected was followed
by a recovery, but the fatal
cases were always too rapid and 
violent to be treated by so slow 
a process - Did we judge candidly 


18
of all that has been said, it would
appear, that notwithstanding the 
dreadful accounts of older writers
the Plague is not a more violent
or intractable distemper than 
our Epidemic Yellow fever
The bells of mortality upon comparison
contain about an equal
proportion of deaths, and the 
physician general of the French
troops reports the death of 1/3
of those who entered the hospital
which was the case in our hospital
You perhaps know that Dr Cullen
celebrated for experiments on Galvanism
and Electricity, lately visited
our city. He had been in 









19
Aleppo, Alexandria &c for the 
very purpose of making observations
on the Plague, He reported to Dr
Wistar that the results of all his 
experiments was, that the Plague
is contagious, and that he who had 
it once rarely took it again.
That the disease can be given by
rubbing the matter of its sores on 
any other person; That if the matter
of Plague & small pox be mixed
together and rubbed on one 
who had never either of these diseases,
it produced a mild case of 
plague and served for future
protection. The case was more severe

20
if the person had had the small
pox. If the matter was well mixed
with oil and rubbed on, in 
this case too a mild disease was 
the result, which also protected from 
future infection
These were the result of upwards
of 300 experiments, and 
therefore merit attention -
Dr Valee seems well entitled
to credit, having distinguished
himself among philosophers
without having had any charge
of exaggeration brought against him
He came to this country for the 
purpose of experimenting on the 
yellow


21
Yellow fever, and not finding any
cases here, embarked for the Havannah
and these fell a victim to his
enterprising experiments -

22










23
Second class. Or
Diseases of the Alimentary Canal -
As I mentioned Yesterday I am now
to enter upon the diseases of the Alimentary
canal; The intimate
connection of the natural function
with the whole system, and the variety
of diseases to which they are
liable, render this part of our inquiry
exceedingly interesting
At the head of the Organs to be 
considered stands the Stomach
I have more than once intimate
to you, the importance of this viscus
in the animal economy perhap

24
it is the first in importance; Destitute
of a stomach the vital functions
cannot exist for one moment. Life
may exist in an animal independently
of any other organ -
Numerous examples are recorded
of Fetuses having been born without 
Brain, spinal marrow, heart, liver,
or uterus. The instances of a fetus being
born without a spinal marrow seemed
to be contradicted by Le Gallois
and Brodic, and are to be found in 
Hallers, and London medical and 
physical journal by Barlow -
No instance however have I 

25
discovered in all my researches on
the subject, found a fetus born with
out a Stomach. It is most indispensible
of our organs being inseparably,
incident to every gradation and condition
of animal existence -
However inferior the animal 
may be it is never deficient in an 
alimentary canal -
In consequence however of this 
very important, its multiplied
relations and extensive influence
the stomach is more liable to derangement
than any other Organ,
and also more susceptible 



of remedies regulated & regulating
the motions of the whole system
and so exactly ordering all and 
preserving an equilibrium of health
Languido ventriculo omnia
languent, is an ancient of the 
medical school founded on the 
opinion of the dignity and controling
power of his organ -
Seated in the Centre of the system,
it appears to be the chief seat of 
vital principle, whence it extends
its influence over the whole in every
direction giving support to all 
its respective functions









If there be any diminution of Gastric
energy the whole frame becomes
enervated or enfleebled
There is no other organ but may be 
inquired at times with impurity, but 
the slight wound to the Stomach
or a blow or even the wind of a cannon
ball is generally fatal.
Contemplating its vast dominion
over the system, an ancient philosopher
emphatically denominated it 
the animal another the conscience
of the body, and by some it has been
called the seat of the Soul itself
It would be easy to pursue the subject 

28
a great deal farther, and to enforce
the correctness of our views
both by argument, and fact, but
this would bring us back, to Physiology
or anticipate what we 
shall have to say, when treating
of the particular diseases of that organ
Enough however has been said
to shew us that in all our Pathological
discussions we shall keep 
this viscus steadily in our view
When I am called to a patient I
always make it a point to inquire
what influence the Stomach may
have in the Case -



29
Of Gastritis.
The first Alimentary affection of which
I shall treat is Gastritis or simple Inflamation
of the Stomach - Most Nosologists
divide it into two kinds viz. -
Phlegmonous and Erythematic, according
as one or other of the coats
of the stomach were affected -
This is perhaps not a correct view of 
the matter. Erysipelatous inflamation 
arises from a peculiar action
commonly attendent on Malignant
fevers. Having before treated this case 
fully I shall pass to the consideration
of active inflamation of the Stomach.

It is commonly bro't on by cold, by swallowing
stimulating or acrid substances
and external violence; It is marked by
acute pain in the precordia, soreness
to the touch, irritable condition
of the Stomach, copious vomiting -
As it advances, a tension in the Epigastric
& Umbilical region, is felt
the pulse becomes small, hard, corded
contracted, and not very quick, and 
there is an uncommon prostration
of Strength. If not resisted, the disease
proceeds with almost unparalleled
rapidity, all the symptoms especially
of debility becoming more aggravated.










So little strength is left that the patient
faints on being raised up.
His extremities now become cold,
his eyes; wild countenance lank, his 
pulse feeble, nay almost imperceptible,
singultus supervene, and his
mouth and fauces become incrusted
with a dark matter, similar
to that in Yellow fever -
There is now a great distension of 
the abdomen from wind, which is 
the precursor of gangrene or an indication
of its having commenced -
These may be called the regular
symptoms but there are [cross out] anomalous

anomalous symptoms, and proceed from 
what has be concerned delusion symptoms
[crossed out] 
Sometimes the patient feels a pain
in his toe resembling that of Gout
sometimes he has an inflamation and 
pain in the groin - D Physic asserts
this latter to have been [crossed out] no uncommon
symptom in Yellow fever 
and that an inflamation & pain
in the female pudenda sometimes
took place in that disease which
denoted great danger & generally
terminated fatally, A spasmodic rigidity
of the muscles of one arm sometimes 


33
attend this disease. It is also Known in 
Yellow fever and after virulent poisons
have been swallowed; Another symptom
of aggravated cases of Gastritis
is a horror of water and of sudden
light, as in Hydrophobia, It may have
be remarked that all cases of spontaneous 
hydrophobia are accompanied
with inflamation of the Stomach.
In this disease the indication
of cure are simple and well marked
An inflamation in so delicate and
important an organ is very rapid in 
its progress. It is therefore necessary to
act promptly and to apply the most


efficient medicines at once. At the
head of these stands venesection
Regardless of the state of the pulse
or prostration we must bleed freely
or all is lost. Called in the 
early stage of the complaint take
20 or 30 oz of blood from any ordinary
robust patient. But even this will
be inefficient, and in a few hours
you will find it necessary to draw 
as much more. I am desirous of 
impressing upon you the great necessity
for copious venesection, the more 
so because in Most European writers
you will find frequent partial










bleedings preferred; but nothing can be
more useless than such a practice
Bear it in mind that neither the 
pulse nor the degree of febrile affection
should be attended to in 
certain cases of Gastritis, for precisely
in proportion to the violence of the 
inflamation is the depression of the 
pulse and prostration of the system,
and that there is no time much
febrile action. You will find on the 
other hand, that as you bleed the powers
and the action of diseases formerly
locked up by the very violence of 
the complaint will develop themselves 

36
and exhibit more decided marks
of inflamatory operation -
Sydenham appears to have been
the first who took notice of this singular
phemomenan, but to Dr Rush
is due a higher praise for having 
fully developed its causes and made 
a highly useful practical application
of the discovery -
Next in importance to the lancet,
are blisters. As the disease [crossed out]
is located in the Stomach
it is proper to apply our remedies
to the Epigastric region. Considering
the urgency of the case you will see
the

37
the necessity of making your blisters very
large. Among many errors in the application
of remedies, none is greater
than circumscribing the dimensions
of blisters in Gastritis, for a large one
gives no more pain than a small one
and produces a fourfold benefit -
To cooperate with them fomentations
to the abdomen are very serviceable.
These may be made with hot water
in bladders, or by clothes dipped in hot
water or Ardent spirits -
The excessive irritability of the 
stomach almost entirely precludes
the use of internal remedies -

It is of great importance however to
open the bowels and as we cannot
throw any thing into the stomach
we must have rescource to infection
These should be made of the 
mildest ingredients and so formed
as to operate also as formentations;
For these purposes 1 1/2 pt.
of tepid water with a little
sweet Oil or Molasses does well
Repeat them every 3 or 4 hours
as formentations.
As soon as the Stomach has 
been brought to bear any thing
administer a little oil or Calomel









as a laxative. I have in my practice
always prefered Calomel -
For as I mentioned before among the 
many good qualities it may be applied
to an inflamed surface with 
out irritating, nay I believe with 
good effect. It has too the advantage 
over oil in being given in 
pills therefore nauseating less and 
lying better on the Stomach -
Another laxative peculiarly
adapted to this case is the Sulp:
of magnesia - this is of the saline
cathartics the least irritating to 
the Stomach, and will be retained 

40
retained there when all others would
be rejected. Indeed I have frequently
administered this salt to check
vomiting in Cholera Morbus of 
children, with the happiest effect.
To calm and sooth the irritable 
seat of this disease as one of 
our most important indications
The Means formerly mentioned
for this purpose may be used, of 
which lime water and milk is 
most appropriate in the present case.
In some cases anodyne injections
will be found necessary, They soothe
pain, allay irritation and induce
a general


41
a general composure -
It is a common practice and 
sanctioned by high authority too
that a free use of demulcent beverage
is necessary in Gastritis -
I believe the practice to be pernicious.
It offends and irritates the 
stomach and helps to keep up
sickness & vomiting - It is absurd
also for what possible good can be 
expected to result from a deluge
of Gum Arab. Mucilage or flax-seed
tea applied to an inflamed
surface. Let it therefore be remembered 
that thirst is much better allayed

allayed by a tea or table spoonful of 
liquid repealed now and then, than
by a deluge, The proper articles for 
this purpose are toast and water, or 
mint tea.
Much has been said of the 
utility of the warm bath, which is 
certainly beneficial, but not till the 
violence of the disease has been subdued
by more active means -
Then it is eminently serviceable
exciting perspiration, restoring the centrifugal
force of the functions, composing 
the patient, and tending to 
allay vomiting &c - 










After all however not the least dependence
can be placed on any
thing but lancet & large blisters
to the region of the Stomach -
When early restored to and diligently
used, for in no disease may 
we raise so bold a hand, they will
in 999 cases out of 1000 lead you to 
victory. But partial measures
are totally futile & will not stem
the torrent of disease a moment -
Of Gastritis arising from ordinary
causes I have nothing to say,
but before dismissing the subject 
I shall briefly consider that Gastritis

44
arising from other poisons.
The articles which may produce
this effect are numerous and diversified.
The term poison is relative
for they are to a certain degree proportioned
[cross out] in power to the dose 
and condition of the patient at 
the time of taking them
Nay those things which in a state 
of health are both nutritious and salutary
are under certain circumstances
often very deleterious. It is a maxim of 
the Medical school that excellent Medicines
may in large doses be poisonous
and that poisons in small doses may be 
excellent-


45
excellent medicines.
The Materia Medica abounds with 
illustrations of this Aphorism -
Poisons have been variously arranged
and with great minuteness
but such labor appears unnecessary.
We shall divide them into 2 Classes
Narcotics and Corrosives, and consider
them accordingly -
Of the first class opium is 
most commonly mischevious, being 
oftenest taken too dangerous extent
accidently or to commit Suicide
When called in soon after such 

an occurrence, our first attempt
should be to excite vomiting by 
the most prompt means. The 
best emetics for the purpose are 
Emet. Tart: & Ipecac. because the 
combinations are quick and powerful
in its operation. Sulp:
Zinc has been long deemed peculiarly
suited to this case, acting very
promptly and with great power.
But as in all such cases the 
system is more or less torpid and not 
easily excited the dose must be 
much larger than usual 
At first you may give 6 yrs Tart Emet.









and 20. or 30. grs. [cross out] Ipecac
comb: which should be repeated
if ineffectual in ten or twenty
minutes. The dose of the Sulph
Zinc is from 20. to 30 grs - But
now and then we meet with a 
case so completely divested of susceptibility
that even these powerful
doses well not induce vomiting
I would then recommend to you 
to throw a quart or two. of tepid
water into the Stomach Cataplasms
of Tobacco have been found
to be among the most effectual
application in these obstinate cases 


48
Tobacco leaves soaked in vinegar
form the best Cataplasm. And to 
assist the operation of any of the 
foregoing prescriptions a feather
introduced into the fauces is useful,
for the fauces retain their 
sensibilities long after the stomach
has become torpid -
If all these means fail and 
they will sometimes fail. I would
strongly recommend to you an 
instrument used by Dr Physick
in such cases. It consists simply
of a flexible catheter introduced
into the stomach, and washing 

49
out the contents of that organ -
Indeed I am inclined to think it 
would be well to use it in the 
first instance.
Notwithstanding great vomiting
and washing, the impression
produced by the Narcotic
will often remain to marr our
efforts. The first symptom of which
is a strong propensity to sleep and 
stertorous breathing; To prevent 
the bad effects from this it has 
been customary to keep the patient
moving, or to agitate him as much
as possible.

I do not see any advantage in all
this trouble, but think it much
better to endeavour by sinapisms
and stimulating injections to
create a new impression -
I have seen such impressions
completely overcome the poisonous
one and to restore the tone
to the stomach; The sinapisms 
should be applied to the extremities
and the injections should be of 
the most stimulating kinds -
Flogging the patient who has 
swallowed opium has been much
recommended, and its advocates







Modus Operandi


say that large doses of opium fatal
to dogs at ordinary circumstance
are entirely inactive when the 
dog is severely flogged -
As palliatives in such cases we 
have heard the vegetable acid
much extolled, but have not 
found them at all [cross out] useful -
While a table spoonful of Vol:
Julep. or Aq: Ammon: will often
completely overcome the disposition
to Sleep -
After all this our best effort
are often abortive and the violence 

52
of inflamation, fever and determination
to the (head) brain succeeds -
The treatment in this case is 
very similar to that laid down in 
other cases of Gastritis, but it is proper
to remark that depletion is not 
borne to an equal extent, and 
that this form demands the Cordial
and stimulating remedies much
sooner.
With one single exception
this treatment is equally applicable
to all the vegetable poisons and 
that exception is of Digitalis and 
its kindred narcotics. Tobacco Spiggilia


53
Spiggilia Marylandica &c -
To obviate the poisonous effects
of Digitalis cordial and stimulating
applications have been found to 
be most effectual; even opium
has been given effectually -
The same with the addition of 
vol: Alkali: are applicable to
Spigelia Marylandica -
The treatment in cases where
mineral poisons have been swallowed,
was till lately universally
the same as then they were vegetable
poisons, but a number of the most 

members of the Medical School of 
France have recently published an
account of experiments from which
it appears that clinical remedies may
be so introduced into the stomach
as to correct or Neutralize almost ever
mineral poison -
The Result of their discoveries
was as follows vizt-
Corrosive Sublimate by means
[cross out] Albumen thrown in large quantities
into the Stomach -
The white of the egg is the purest and 
most convenient form - 









Verdigris. by means of sugar Syrup
molasses or any saccharine matter
It effects a chemical change on
the verdigris and carries off the 
mass by its cathartic power -
Muriate of Gin. by means of 
milk. The stomach should be 
filled with it -
Nitrate of Silver by means of 
muriate of Soda or common salt
in solution given in large quantities
as this medicine in now much 
used & therefore more liable to be 
taken too largely, you should remember
well the antidote -

56
Lead preparations especially
acet: plumb: by means of Sulph.
soda or magnesia -
Barytes, by the same as Lead -
Tart: Antim: by means of a strong
aceoct of tea, Peruvian Bark -
Galls, or any strong vegetable astringt-
This is the one for all the Antim
preparations, but so much is not 
said of its efficacy as the antidotes
for the other poisons -
Acids Mineral, by the carbonate
of magnes; when quickly and largely
administered
Alkalies by means of Acetic Acid
 

57
Arsenicums no antidotes yet found
or at any rate to be depended on 
Bertrand a Wench surgeon
lately declared he had discovered
Carbon to be one, but upon trial
by a committee of the national 
institute it was found to be mere
fiction. That these antidotes are
to be implicitly trusted to I am 
by no means prepared to assert, for 
high names have often propagated
errour, But it is right at least to reflect
that the foregoing report is not 
the offspring of individuals exertions
or supported by individual authority,

authority, it is the result of the experiment
of the most celebrated men in France
all pursuing one course, and ought
therefore to be treated with respect -
An antidote to arsnic is still
very much wanted, for even where
vomiting can be fully excited, it 
is seldom that all the poison can 
be eliminated, and a very small
quantity clinging to the stomach
will prove fatal -
All we can do in such
cases is to throw as great a quantity
of demulcents into the Stomach
as possible, such as Gum Arab Mucilage
flax seed tea &c -









Be very careful not to employ oil
for it has been observed to increase
the activity of it -
Notwithstanding all our endeavours
we are frequently mortified
to find them all abortive, and to 
see inflamation produced supervene
with all its horrid & painful
concomitants -
As I before observed the inflamation
produced by active poisons
resembles very much the Yellow
fever, and may be treated like
that disease, by bleeding, blistering
and soothing applications 

60
But the system is often so completely
prostrated and the susceptibility
so much impaired that 
it is not possible to pursue such
a course, We should then endeavour
to sustain the strength
of the patient by stimulating and 
cordial measures and Glysters -
All however is often unavowing
and our patient falls a victim
to the power of impressions
or to the portions of poison unremoved -


61
De Dyspepsia
As I said yesterday I am now to treat of 
Dyspepsia or Indigestion
This is a disease of so common an occurrence
an so accurately described by 
all writers on the subject that it would be 
an unnecessary waste of time to be too
minute in its history -
Its prominent symptoms and Nausea,
vomiting, sour eructations Cardialgia 
spasms, gnawing sensations especially connected
with acidity - Pyrosis - constipation
chilliness - pale surface. languor dejection
irregular disturbed sleep - These are the 
most common symptoms of Dyspepsia -
but there are others which occurring only
occasionally may be denominated anomalous 

These are an acute pain in the breast as in 
Phthisic pain in the side and sometimes
in the head with disordered visions
This affection is very singular - I have seen
total blindness occur from Dyspepsia -
Such cases have also been seen several
times by my medical friends in this place
All these cases were cured by the departure
of Dyspepsia proving their cause to have 
been that disease
Another Anomalous symptom of 
Dyspepsia is vertigo. And I have seen
violent palpitations of the heart produced
by Indigestion. So great indeed as 
to cause serious apprehensions of the organic
derangement in the vascular system -
I had lately a lady under my care from 









69
from South Carolina whose palpitations were 
so violent as to have convinced all her physicians
there, that she labored under some organic
disease in the aortic system - By means of
of emetic & tonic medicines she entirely recovered
proving her disease to have originated
in the Stomach.
In Dyspepsia the appetite is far from
being uniform, being sometimes unusually
voracious, and not unfrequently entirely
absent. Nor is digestion equally affected
at all times, or in all cases. Sometimes the 
appetite is very depraved desiring chalk -
dry dirt - green fruit & such trash -
The causes of Dyspepsia are of two Kinds Vizt.
Such as are directed on by the Stomach itself
or such as affect that organ through the 


through tho intervention of the system -
Among the causes of Dyspepsia affecting
the Stomach immediately, may be enumerated
improper indilgences in eating
and drinking both as to quantity as well
is quality of the food, and beverage as 
strong tea coffee, spirituous & fermented
liquors, flatulent vegetables and strong
gross food of any Kind - The practice
of taking certain medicines for a time
is another direct cause for Dyspepsia
The most usual are emetics and particularly
Opinion - Also most of the Saline Substances 
especially Nit. Potassa. The 
last named drug is hardly ever given
without producing this disease if Continued 
for any time - The second -

65
The second class of Causes of Dyspepsia
(those affecting the stomach intermediately)
are indolent or sedentary habits, intense
study, close application to any business
within doors, grief, vercation or any mental uneasiness,
exposure to cold, surpressed perspiration 
and cold feet - These are most of the causes
of idiopathic Dyspepsia, but indigestion
is frequently the result of Sympathy with a 
diseased state of the liver, spleen, pancrease
or uterus. Confessedly few diseases are 
more embarrassing than the one now before 
us. No two cases of it can be said to be 
alike, and hence no two cases will be 
remedied by exactly the same means
All I can do therefore amidst so much -


So much intricacy is to give you an account
of the most usual forms of the disease
and the remedies applicable to the majority
of cases occurring -
The first indication in Dyspepsia is to 
clean the Stomach, by removeing from it 
all acrid matters and thus pave the way to 
more permanent measures for cure
This indication is best answered by emitics
and it has been found that Ipec. is more 
suitable in this case than any other emitic 
for it is prompt in its action and seems to exert 
a salutary influence on the stomach at the 
same time - To render it effectual it is often
necessary to repeat the dose. - It is a general
rule that whenever acid accumulates
rapidly, and cannot be removed effectually









effectually by milder remedies, emitics are strongly
indicated - To cooperate in evacuation the 
the Stomach the milder purgatives, or laxatives
should be given, but we should be careful in 
our selections - All saline as well as Drastic
Cathartics should be studiously avoided
excepting Rhubarb which seems by its tonic
power well adopted to dyspepsia - The 
only objection offered to its use is that it is 
apt to constipate, but we can easily obviate
such an effect by combining some calcined
magnesia with the Rhubarb - When calcined
Magnesia is given in union with lac sulphuric 
the dose is ℥ss each mixed, and of the mixture
one or two tea spoonfuls at bedtime in new milk.
It is a most certain mild laxative, and admirably
well suited to overcome habitual 

habitual costiveness. When the mixture
proves offensive the Sulphur may be left out
and the magnesia given alone, or in union
with exeta preperata or powdered oyster
Shells. The latter is better suited to this case
than the chalk for it operates as an acid
The condition of the Alimentary canal
having been thus rectified, we shall use tonic
remedies, with infinitely greater prospects
of success Numerous as the tonics of our
Materia Medica are there is hardly one
which has not been tried in Dyspepsia
and with various success -
My experience approves most of the vegetable
Bitters, among the vegetable tonics, such as 
the hop & quassia. Gentian, Columbo,


60
Colombo and Peruvian Bark have been
likewise been recommended, indeed Peruvian
Bark once enjoyed great celebrity as a remedy
for the Dyspepsia but it has now fallen into
disease. The form of administrating it is in 
decoction, or infusion with some aromatic
to render it more palatable - Determining
from my own experience. I cannot recommend
this medicine much but that experience
assures me that hop and Quassia
an infinitely to be preferred. The Quassia
is given in pills or infusion. The Hop in tincture
or infusion. An extract of Quassia has
been lately extolled but I prefer the infusion
The Hop has been recently proved useful in one 
case when nothing else seemed to have any effect

effect the dose given being a wine glass full of 
the infusion four or five times a day -
After all however the mineral remedies especially
the preperations of Iron are much
superior to all other medicines in Dyspepsia
Of the preperations if Iron perhaps the Carbonate
rubigo ferri is the best. - Its done
is ten grains with a little ginger two or three
times a day or given in the shape of Chalybeate
wine made as follows, for the formula
in the dispensatory is not good - ꝶ Rubigo
ferri ℥s of Gentian & orange pul ℥ss of each
Port Wine a Bottle set this near the fire for 
two or three days, shaking it occasionally
then decant for use and give an half wine
glass full three or four times a day -
But in ordinary cases I prefer Sal Martis 







* The phosptate of Iron has lately been employed
with advantage as well as the tinctura
Mur of ferri 

Saliltartis which is the neatest and most effectual
of all the Chalybeates preperations. It
is commonly prescribed in Pill formed by 
taking ʒi Sal Mart. quant suf. Gum arab.
ft" 30 pills of which two or three - three times
a day * As thus laid down you have before
you the mode of treatment in simple and ordinary
cases of Dyspepsia - But this complain 
is after associated with or dependent on other
diseases which so modify it as to demand an
entirely new mode of practice. Among
these is a painful Cardialgia resulting commonly
from acidity. In such cases emetics
do not answer but we resort to lime water
and milk, to alkalies to all the absorbent
medicines - Of Magnesia we have treated 

treated. Any of the Alkalies will do and 
prepared in any way but when we use the 
Vegetable alkali the following formula
should be preferred - ꝶ. Sal. Tart. ʒjj
Compound Spt of Lavent. ʒij - Loaf Sugar ʒi.
Tinc Opii. 30 qut - and aqua pura ℥iij -
Table spoonful when uneasy - This is 
both agreeable and comfortable -
Vol. Alk. is perhaps superior to all the Alk.
It may be given in pill on the julip mentioned
or in a dose of half a table spoonful
of aqua ammonia -
In this deranged state of the stomach it is liable
to painful spasms turned Gastrodynia -
This is sometimes allayed by the measures mentioned
already, but it is often so violent
as to require Ether or Opium} to allay
musk volatile alkali &c 

73
to allay pain or irritation. Where these
spasms are frequent, it is best to apply
Blisters to the region of the Stomach, indeed
these are important and usefull in all chronic
as well as acute diseases of the stomach
But of all the remedies for Gastrodinia the 
best is one which an account of its simplicity
& homeliness promises least. But do not 
let it plainess deter you from making trial
of it, for I can assure you it possesses wonderful
efficacy having indeed saved the life of 
Dr Physic in a most obstinate case of gastrodynia.
ꝶ - Take of the cleanest Hickory
ashes one quart, of clean soot a tea cup full
on these pour one gallon of boiling water, and 
when cold decant for use - Dose from half
to a whole wine glass full several times a day.


As chemists we see nothing in this preperation
to be account for its wonderful efficacy
but the face is undoubted, and our reasoning 
is fertile in opposition to fact -
Pyrosis or water brash is another most
disagreeable accompaniment of Dyspepsia
This is a very strange affection, It is endemial 
in some countries, as Iceland
Norway Sweden, the Highlands of Scotland
and the Western part of Our country
Linneus attributed these affections to the habitual
use of the dried and smoked meat
and asserted that a change of diet affected
a cure. We have generally traced it to a 
meagre and penurious mode of living
though it does no always arise from such
a cause, but is often found affecting those 


To prevent the return of Gastrodinia vol ether or 
Kali in small doses frequently repeated is very useful,
and one of the most useful means of relieving
the spasms is to distend the stomach with 
warm water which overcomes the spasms & acts
as an emollent 





* Emetics have been employed with advantage
In pyrosis ol succini ol Terebinthea & Tinct
Hina picea are exceeding beneficial 

those who live luxuriously especially eating &
drinking to distension. Even water swallowed
of too largely has Induced Pyrosis -
It has been imputed to two proximaty
causes Vizt. to a morbid condition of the 
Pancrease, or a vitiated secretion of the 
Stomach - It may arise from the first 
cause but the second is much more common.
Most of the remedies already mentioned
for the Dyspepsia are useful in this 
form of it but the lime water and milk
are eminently so * Of Opium in such
cases a great deal has be said and its utility
has been sanctioned by the great name of 
Cullen, but although every opinion of his 
is entitled to our respect we cannot say 


say much for the usefullness of Opium in
[cross out] Pyrosis. It is no doubt an
excellent palliative but seem not to cure
Emetics are much better, not only evacuating
the accumulated watery crudities, but 
impressing a salutary action on the 
Stomach tending to change the morbid
secretion. So effectual is it that the 
disease often yields to a single emetic
followed by a proper system of diet -
As a usefull medicine in all forms of the 
Dyspepsia White oxide of Bismuth has been
brought forward. This medicine termed
by some the Sub Nitrat of Bismuth, we 
owe to Dr Gudier who in 1786 published
a paper on it and urged its high utility 
But unfounded prejudices at that time 

75
at that time prevented its progress so late
as the year 1799 we see the first English
notice of it so long did it remain unknown
or neglected - To Dr Marset of London
is due the credit of having revived the use 
and promoted the Knowledge of this valuable
tonic - He published an account of a 
case in Guys hospital whose obstinacy unmoved
by any other means yielded to the
efficiency of Oxide of Bismuth thus answering
the good opinion he formerly had of it 
Since that time it has been gradually extending
itself. The practitioners of New
York speak highly of its power, and the 
Editors of the New England journals call
it a mild and effectual tonic -
asserting its superiority in Pyrosis Cardialgia 

Cardialgia and Gastrodinia. The medicine
has not yet been fully tried in this 
City but if our experience is sufficient to 
warrant an opinion, we would not
go so far as the New England journalists,
but think it useful only in Gastrodinia
if it has any power at all
This is also the Opinion of all my medical 
friends in town - The dose of Oxide
of Bismuth is ten grains with from 
ten to twenty grains of gum arab in 
pill or powder, morning, noon, and 
night -
In my lecture of Yesterday
I concluded the consideration of the 
ordinary cases of Dyspepsia and also
those termed anomalous -
But to complete the consideration

When all these fail we must resort to the use 
of Mercury exited with a view to its alterative
effects on the system and for this purpose
the Merc pill will be the most useful
The dose is 5 grains given going to bed and purged
If in the morning by magnesia in this way it 
may be continued for several weeks with out affecting
this month, but in a few days its effects
the disease will be visible 







79
consideration of the less common forms of 
Dyspepsia, I shall now treat of the slow 
species of chronic inflamation sometimes
accompanying this disease. This is so often
met with in people of debauched habits
that I once believed excess in drinking to 
be the sole cause of this form of Dyspepsia
but I have since seen it in those who led
temperate lives and regular lives.
This case is distinguished by a very strong
and burning pain in the epigastric region
by a hard, corded, very quick pulse, small
diminutive fever, hectic suffusions - dry
cough, and a gradual wasting of the body
So strongly indeed does the case resemble
Phthisis pulmonalis that is has been
often mistaken for it - It exerts on the 
stomach


stomach an influence much resembling
some Kinds of Diarrhæa which are generally
cured by the directly depleting remedies
This led to the use of the lancet &c - in
this case also, and we must remember 
that the pulse is not our guide in 
gastric affections nor be deterred from 
a bold an steady practice by any condition
of the arterial action
But it is proper to remark that 
in this case small repeated bleedings
are preferable to the copious use of the 
lancet, required in acute gastritis
As auxiliary to the lancet I would
recommend gentle emetics, and afterward
very minute doses of Ipec. So as not 
even to nauseate - This will alter
the action of the Stomach improve its 

81
improves its tone and restore at length the regular 
functions of health - This is no new
practice. Half a century ago.
a physician of reputation mentioned Ipec
as a remedy in Dyspeptic affections. - Since
that time it has been sanctioned by many 
eminent practitioners - But they were
not careful to point out the particular
cases of Dyspepsia to which it was applicable -
I am of opinion that it is 
eminently suitable to the chronic inflamitory
state of Dyspepsia and perhaps to 
that alone - I have now completed the 
consideration of the most useful remedies in 
Idiopathic Dyspepsia
But besides such cases there are
Dyspeptic affections symptomatic of diseases 

diseases of the other abdominal vicera &c -
These are common especially in union with 
hepatic affections
As the cure of such cases depends
upon the removal of the primary disease
on which it depends we shall
not here enter upon the treatment
but reserve it for consideration when
lecturing on these diseases -
It is enough for us to mention
that the main remedies are Mercury
and the mineral acids - But sometimes
the idiopathic affections of the 
stomach may be traced to the use of 
ardent spirits - characterised by debility,
nausea, vomiting flatulency
loss of appetite, or if food can be swallowed








In this form of the disease the use of onions
Garlic Assafoetida will often aford great
relief while we are made in owing to remove
the disease 

83
swallowed by its immediate rejection or imperfect
digestion. Such a train of symptoms
may be suddenly induced by accidental
excess and is as easily subjected by remedies
as it was produced - But when they result
from a long course of habitual inebriation
and debauchery the difficulty of 
effecting a cure is much increased
Disections in such cases have exhibited
a vast degree of organic derangement
The surface of the Stomach appears
smooth and glassy in consequence of the 
absorption of angle & ville of the inner coat
The urgent symptoms require palliatives
Gastric irritation and its effects vomiting
and spasms are the most prominent
symptoms of this case - Many of the 

Many of the remedies above mentioned are applicable
here, but though they may paliate and balm
for a moment they cannot cure. We must
resort to the use of Opium, volat. Alk. Musk
&c - using the antispasmodics to relieve the 
Nervous symptom from those distressing tumors
and debility accompanying the disease
Health however is sought in vain from 
medicines alone unless the patient affects a 
total reformation of old habits and thus
assists the medicines - In vain is visceral
disease removed if the patient returns to 
his old habits adding fuel to a flame
which has been consuming him - 
Less can be expected from Medicine
in this disease than any other unless a 
strict attention be paid to diet of the patient.

87
patient As the Stomach is the seat of the disease
and the receptacle of the food it is of the utmost importance
to select such fare as combing agreeableness
with easiness of digestion 
Compared with all other food milk diet is certainly
to be prefered - By living on Milk alone
a patient has been cured of the most protracted
cases of Dyspepsia. But to produce such an 
effect even bread must not be taken with it 
and the milk should be swallowed frequently
in a day, and if possible immediately from the 
Cow - Milk is applicable to all cases of 
Dyspepsia, as well simple as when combined
with Gastrodynia, Pyrosis, Cardialgia
&c - It seem now generally admitted that 
no course of treatment is so useful in Pyrosis 
as a 

Pyrosis as a good milk diet. Cardialgia also is
promptly and effectually relieved by the same
treatment. But it is [cross out] no where so conspicuously
serviceable as in Gastrodynia. Milk
indeed seem endued with properties fitting
it to remedy all spasmodic affections of the 
stomach from whatever cause arising 
It has been Known to give immediate relief in 
flatulent or ordinary colic. It has relieved
Spasms in retrocedent Gout - 
Colonel Williams who labored under a 
gouty affection informed me that he was 
always relieved from spasms by drinking
a pint of milk when affected -
I do not pretend to say that milk will cure
all Spasmodic affections of the Stomach 









87
Stomach but this I will say that it relives spasms
in Gastrodinia sooner and more effectually than
any thing else - It is objected to the use of milk
in Dyspepsia that it is often disagreeable to the 
patient. There may be cases of idiosyncrascy
which produce this effect, but in general milk
always agrees with a person who continues to use it 
for any time. What led common people &
practitioners to such an opinion was the curdled
appearance of the milk rejected by a 
sick person - But when we Know that 
the first operation of the most healthy
stomach on Milk is to curdle it we shall
not be obliged to admit the objection 
Besides it is often when our course of diet is 
commencing both disagreeable & disadvantageous 


disadvantageous to a patient, but in two or three
days it generally becomes a perfectly agreeable and 
useful. Such an effect therefore should
not deter us from persuing our course steadily
It was long ago remarked by Dr Cadogan
in an essay on Gout that when milk disagrees 
much with the patient at first, he 
always conceived it an indication that 
the milk was necessary for it shewed
something present which the milk would
eventually remove - My own experience
convinces me of the justness of the observation.
Cases however do sometimes
occur where milk continues to be disagreeable
to our patient, arising either from 
predujise or idiosyncrasy - In such 

89
In such a case, Chocolate appears to me to 
be next in utility as an article of Diet - Not 
so however as it is commonly brought to 
table but made in the following manner
ꝶ - Boil the Chocolate in water then let
cool and remove from the surface all the 
oily matter &c floating there then boil again
and pour it on cream and sugar - This is 
a most palatable and agreeable beverage
Should your patient disrelish this also, let
him confine himself as much as possible to a 
solid breakfast. Such as Mutton, beef and
the [cross out] white kind of poultry, as fowls and turkeys
Tea and Coffee should never be seen on a 
Dyspeptic patients table, they never fail to 

fail to render a cure tedious if not impracticable
The dinner should consist of the same Kind
of light food named for breakfast. No
Pork, veal, Geese, or ducks, salt nor dry provisions
should be suffered at all, such
as ham smoked beef &c 
It is generally supposed that soups are 
light and digestable and therefore proper for 
Dyspeptic patients, but whatever may be 
the truth, as regards those in health, certain it 
is that soups of any kind are improper for 
Dyspepsia. They always turn sour on the 
stomach and aggravate the symptoms of 
the disease. The only vegetable to be used
in such cases are potatoes roasted & well boiled
rice. All deserts should be carefully excluded.
The bread should be particularly
well -









91
well toasted and eat without any butter
But as regards to diet, we should be 
still more precise - Direct your patient
to eat sparingly and frequently. Remember 
what was formerly observed that the stomach
like a school boy was always mischievous when 
idle - Employ it therefore by eating five or 
six times a day - and when very obstinate cases
occur it is well to rouse the patient once or 
twice during the night to eat, if this is 
neglected you will always find your patient
worse in the morning - The second Precept
is - Never combine many articles of food together
to tempt the palate or grafify the taste
But let the fare let only one single dish of 
the lightest food - Thirdly - Let the 
patient be enjoined to use as little beverage
as possible and none at tall at his meals.
In some 

92
In some cases of Dyspepsia the appetite is
voracious, but in general it very weak
In such cases we should endeavour to find 
out will incite to eat and to avoid
any thing that will disgust him
Never let him Know what he is to have
before he sees it. Do not suffer the fumes
to reach him before the food itself, for 
this purpose it should, if at all agreeable
be brought to him cold 
Lastly - I let the dish be a very small one 
for nothing is so apt to disgust a delicate
Stomach as the sight of a great quantity
of food at one table -
These may perhaps appear frivolous
and tediously minute precautions
but I Know that when you have 


93
you have been practitioners a time you 
will acknowledge their high importance
With regard to beverage - I am on the 
whole in favor of Simple Water alone
Old porter has been found usefull but it 
most usually disagrees with the patient
Wine is very generally pernicious -
Weak old Spirits or Brandy and water
are sometimes useful particularly to 
those patients who have much accustomed 
to stimulation - Whatever beverage
be allowed, let it be as sparingly
used as possible; else will you be defeated
in all your attempts to effect a cure -
In Obstinate cases of Dyspepsia which have 
long existed the ordinary remedies. I have 
resorted to such as effect the system generally.

generally. Among these I recommend the warm
bath twice or thrice a week which will often stimulate
and act as a tonic, and invite the defrom
the Stomach to the surface of the body
I have administered the cold bath with the 
same view. Confessedly, exercise especially
an horse back has in many cases effected a 
cure by itself. Walking is another mode
of exercised much esteemed. But to 
obtain the full effect of this remedy we should
send our patient on a long journey to some 
distant watering place. - There the mind 
is diverted from its habitual course, -
Amusement is unfettered by the causes of 
bussines, and enjoyment uninterrupted
by the vexations of professions.
The patient breaths the pure air of the country









country with double relish, for no inward cases
divert the current of thought from his own enjoyment.
The Chalybeate waters too have here
no opposing powers to contend with and therefore
exert a tenfold tonic influence
Let me not before quitting this subject forget to 
inform you of the great importance of clothing
on the result of our endeavours to effect a cure
You all know the intimate connection
which exist between the skin and stomach
and therefore should be carefull to clothe your
patient in the most comfortable manner
Let him wear flannel next his skin
winter and summer at all seasons -
I have already told you how apt cold feet
are to produce or protract Dyspepsia and 
Cannot tell you too often how necessary 


96
necessary it is to guard against this most potent
avenese to the Stomach Let therefore
your patient wear woolen or worsted stockings
and if his feet are very subject to coldness it 
will be well to sprinkle the stockings with 
some Cayenne pepper which will irritate the soles
and occasion an agreeable warmth -
Shoemakers wax has been recommended for 
the same purpose and produces a similar
effect- I have known the same expedient
usefully applied in cases of Amaurosis
Notwithstanding all our efforts we will
almost always fail unless we can remove
the remote causes of the disease, or those which
contributed to the production of the disease
If intemperance was the cause let the 
Patient - 

97
patient be sober. If luxury and licentiousness
let him be temperate. If indolence, let
him be urged to exertion by placing some 
Object in view to incite him - If study over
the pale and sickly toper, let him throw
aside his books and be take himself to some 
agreeable and active persuit -
If afflictions iron hand is upon him let the 
tear of Sympathy mingle with his sorrows
let the sound of friends lips sound in his 
ear pointing him to brighter days and 
happier hours - Hold up to view the golden
visions of hope and thus his soul with the 
flattering prospects of recovery and all the 

all the joys of renovated health -
Never abandon him to despair, but cling to 
him as he to life till the moment of departure.
Vast are the resources of our act
and many a potent weapon, maybe wielded
by the bold physician while his more
timid be other has been driven from 
the field - Remember the Adage"
While any thing remains to be done
nothing, no nothing has been accomplished.
end of Dyspepsia -

99




101
De morbis Intestinorum
The morbid affections of the Bowels are next
to engage our affections Of these the first we
shall notice is Enteritis, an inflamation of 
the Bowels - De Enteritide 
Much of what might be said on this disease
has been anticipated in our lectures of Gastrid
These two diseases bear a very great resemblance
to each other - They are produced by the 
same causes, exhibit pretty nearly the same
symptoms and requre a similarity of treatme
in most respects. Enteritis advances also
with as much repacity and destructiveness as 
Gastritis and demands therefore from the 
Practitioner the same bold and decided
measures to accomplish its solution
Here also the pulse is no guide to our treatment
and the only difference in the manner


2
of treating both complaints is that
Enteritis demands medicine to open the bowels, 
for constipation is a common symptom
in that disease. To remove the constipation
is a most important indication, - for if the 
accumulated focus are suffered to remain
they never fail to aggravate all the symptoms
It has been much recommended in such
cases to prefer enemata to purgatives. because
it is alledged that the latter proves injurious
by harshly irritating the inflamed surface
of the intestines - I have never been able 
to discover such bad effects from cathartics
and therefore deem it an ill founded opinion
always persuing an opposite course - 
I have commonly given Calomel in divided
doses untill I producd an aggregate
of power sufficient for my purpose and 
if it did not answer that purpose, but 
appeared to linger in the bowels. I have 









103
I have ordered Castor Oil or Sculp Magnisia
to assist its operation. Ten grains repeated
till effectual, or of usually slowin operation -
assisted by the laxitives mentioned, have generally
answered my first indication, as well as any
thing I have ever tried
After having thus removed all the contents
of the bowels, they should be kept in a soluble
condition by emolient glysters or gentle laxatives.
For the remainder of the treatment
I refer you to my lecture on Gastritis where you 
will find every necessary information


4
De Peritonitide
Closely allied to the last mentioned disease
is Peritonitis or inflamation of the 
Peatoneum. It is however a much more 
infidious and consequently dangerous
disease 
This complaint has not obtained
that attention which its importance
deserves and it is comparatively speaking 
little understood. - As however it requires
a peculiar treatment, I shall 
treat of it much more fully than I have
done of Enteritics
Peritonitis [cross out] has
been divided into acute & chronic which I
shall consider seperately Acute Peritonitis
is indicated by chilliness followed with 
fever, small quick corded pulse well calculated

105
calculated to deceive the Practitioner
But from the very common cement of the disease there
are some symptoms which if carefully attended to 
can hardly fail to lead you to a complete Knowledge
of the disease and these are a sense of heat & pain
of the Abdomen, sometimes circumscribed at others 
& most commonly diffused increasing on pressure
tenderness of the belly, Early also in the disease the
patient is troubled with thirst & some dryness
of the tongue and fauces - This appearance
of the tongue & fauces resembling their condition
in Typhus fever is among the most marked peculiarities 
of Peritonitis 
Such are the ordinary symptoms
which usher in this disease. In twenty four
hours, the tenderness of the Abdomen increases so as 
to be hurt by the touch of the bed cloths, the
pulse still small becomes much quick rising 

6
from One hundred to 120 - 130. 140 -
or 150 strokes in a minute, the tongue and 
fauces appears more or less encrusted with 
a disagreeable matter, the Belly becomes
tense, the Patient unable to lie in a straight
posture, reposes on his back with his knees
drawn up. This last is a never failing
mark of Peritonitis & for an obvious reason
for the Patient by such a position throws the 
weight of his intestines upon the Spina
and relaxes the abdominal muscles
Among the first symptoms of discovery is the 
ability of the patient to extend his limbs
which if not permitted by the supervention
of Gangrene is a certain sign of incipient
Convalescence. As the disease advances
it is attended with aggravation of all 
the symptoms especially of the tension of 
the Abdomen. At last in most cases 










107
cases the pain will suddenly as if yielding
to some remedy administered and the patient 
assures himself of a speedy recovery. But
his case is more hopeless than ever, for it is a 
deceitful calm, which like the silence after
an earthquake shock but harbingers a 
greater desolation for this sudden case is 
in auspicious, being the immediate
percussor of disolution - 
Simultaneously the pulse sinks yet increases
in velocity, a vomiting of dark offensive
matters take place or rather the matter is 
expelled by a singullus or Spasmodic 
action of the Stomach as in the worst cases
of Yellow Fever & continues often for three
or four hours before death. The extremities
lose their warmth, cold clammy sweats
supervene the countenance appears pale
collapse & haggard & at length laborious respiration 

8
respiration manifest the moment of 
departure. The departure of pain should
not be looked on as favorable, unless it 
takes place gradually and is accompanied
by improvement in the general respect
of the case at the same time
Dissections have shewn this disease to be 
an inflamation of the Peritoneum,
more or less extensive according to the
violence of the case or the mode of treating
it. This inflamation never extends
from the Peritoneum to the muscles of the 
Abdomen but often effect all the coats of 
the intestines in a violent case
There are two diseases
may be readily confounded with Peritonitis
and are not without great precission to 

109
to be distinguished from it. It seem therefore
fortunate that the treatment is so much alike
in all, thus rendering this difficulty less dangerous.
There is however one Pathognomonic 
sign of Peritonitis. viz - that whatever may be
the degree of irritation, the Patient never desires
to go to stool and feels no Kind of relief from 
evacuation, which is quite reversed in Colic and 
Enteritis
After this history of our disease we 
can hardly believe any doubts could be 
entertained as to the practice to be persued
Such is however the fact, There is no point
in Medicine more disputed or unsettled
while one party declares our only hope
to rest with opium, the other contend as strenuously
that in the lancet alone we must
trust for cure. Nor is the dispute among the 
lower orders of Practitioners. The most distinguished 

10
distinguished men of our profession are
arranged on each side of the question
The London sheet holds some singular
opinions on this subject, especially the
pupils of Sir George Fordyce from whom
came the Opiate practice. Confessedly
we are not well acquaited with the 
pathology of this class of disease especially
Peritonitis which is undoubtedly
in some respects a peculiar complaint
I however have no doubt as to the best 
mode of treating it, for I have encountered
it frequently and have experience
to attest the efficacy of my measures
Called early in the complaint I always
push the lancet as far as my patient
will bear & consistent with his strength
and the other circumstances at the time 









111
Here also as in gastritis I do not regard the 
pulse, for it is never strong & it often seems depressed
or locked by the violence of the disease
which then most especially requires depletion
My only case is not to forget how violent &
rapid this complaint is and that if not at 
once arrested it ever terminates fatally
Keeping this in view I take 30 or 40 ℥ of blood
from my patient at one bleeding and if 
he is not much relieved in two or three hours
as much more - I have thus in one 
day taken 60 or 70 ℥ of blood with the happiest
effect - But bleeding alone will not
cure Peritonitis - Such is the nature of 
this complaint arising probably from its
being seated among the capillary vessels
of a membrane, that alone 

12
alone will not as in other inflamitory
affections, restore the active of health.
It will however prevent the disease
from becoming more aggravated -
When my patient has been sufficiently
depleted, my next object is to create a 
profuse perspiration. For this purpose
external application are to be prefered
especially the vapour bath, It is necessary
however to combine with this some
external auxiliary I prefer Davey
Powders. When perspiration is excited
it aspirates like a charm - I have
Known it to be unequivocally usefull
even where the lancet was still necessary
It excites a centrifugal 
action, diverting the determination
from the inflamed membrane to the 

113
surface of the body, and thus restoring
the balance of Circulation
I [cross out] once saw a case attended by two eminent
practitioners who bled their patients
140 or 150 ℥ in 24 hours without being able
to reduce the pulse. Believing they had 
done as much with the lancet as could
prudently be done they attempted to 
excited diaphoresis, which was no sooner
accomplished than the pulse fell and 
all the symptoms of the disease gradually
disappears - Encouraged by such a happ
result I have ever since been in the habit
of using this remedy. I would not 
however permit it to supecede the use of 
the lancet but to follow it -
As regards the application of Blisters to 
this complaint not less has been said 
Determining from 

14
Determining from my own experience,
they are when timeously applied extremely
useful. But to give them full effect
they should be proceeded by the more 
direct evacuations mentioned and by 
warm fomentations to the Abdomen.
Blisters are usefull in all intestinal inflamation,
but particularly so in the 
present one. We se no reason why
this is so, but as we are so well assured
of the fact we must not relinquish
so good a remedy Evacuation of 
the Alimentary canal do not produce
in this disease much advantage, nor 
need you look for any alleviation of symptoms 
from the operation of cathartics
This should not however induce you to 
overlook the state of the canal, It is 
proper to Keep the bowels in an open 









115
open soluble state, which may be best accomplished 
by means of enamata for 
they not only obtain a discharge but may 
be so prepared as to assist also by fomenting
the part -
The Disease before us is one 
replete with dangers and difficulty
In general it is from the commencement
so well marked, as to enable us to as certain
the disease, but sometimes the symptoms
assume a most deceptive aspect
and are very apt to mislead and deter
the Physician from the vegerous
prosecution of such measures as are 
essential to the safety of his patient
In the very begining of Peritonitis it 
sometimes happens that the prostration
of strength & feebleness of pulse is such 
as to lead the physician to a conclusion


16
conclusion that the patient will not 
bear depleting remedies. This phenomenon
often arises from that overpowered
or locked up violence formerly mentioned,
and when such is the case depletion
is more urgently demanded -
But it does occur now and then that
the system has sunk too far to react
with any power, and great depletion
instead of developing as usual the unequivocal
symptoms of inflamations
only tends to sink the patient still
lower - In such cases an easy application
of the warm bath and all the 
means to effect diaphoresis are indicated.
It is proper notwithstanding
to bleed partially and occasionally
till by degrees the disease assumes its more 
distinct form. When the depletion
should be pushed to a greater extent.
There 


117
There are cases of this disease of an opposite nature
no less dangerous, that these, throwing the 
patient & physician into a state of false security
and gradually acquiring an unmanageble
superiority Such cases commence with a 
slight tenderness of the Abdomen, with a 
pulse somewhat quicker than usual
though not much corded -
I have seen three or four cases in which 
the patient felt so much security as not
to inform me of their condition till the discharge
of black matter from the mouth
told of dreadful danger 
Of Chronic Peritonitis
This form of Peritonitis is very obscure
and ill defined. It often approaches
for weeks, or as has been asserted for 
months, before it manifests its existence
or occasions alarm. In all cases however


18
however even at the commencement an 
occasional soreness of the Abdomen differing
from that of flatulence or tormina is felt
The Pulse is somewhat accelerated and the 
tongue in the morning fevered. A considerable
thirst is felt although no fever
or heat is present. On the contrary the 
face is pale with a remarkable appearance
of langour and distress - The patient
still continues up and about his usual
bussiness, till some exciting cause converts 
it into an active inflamation
Of all the cases of Peritoneal inflamation
this is the most dangerous and 
interactable, indeed all acute succeeding 
to chronic affections of every
kind, are more difficult to cure than 
their ordinary acute cases. In such 









119
In such cases the vessels seem to be confirmed
in their morbid action during the existence
of the chronic affection, & therefore resists
all attempts to restore a healthy action
when the acute disease supervenes -
Pulmonary consumption affords a good 
illustration of this where acute succeeds
to chronic inflamation
You all Know the disease incurable
Hydrocepalus is another. The chronic
action goes on sometimes for months before 
an acute one supervenes. This Also is incurable
Mania or mental derangement
affords perhaps a still better illustration
of the doctrine. This is usually chronic
for a time, and is concerted into an acute
case, by some accidental exciting cause
when, Almost no disease proves more intractable 

20
intractable or incurable
All which can be done in acute cases of 
Peritonitis, superveneing to a chronic affection
is to use the same remedies recommended
in ordinary cases - When however you 
suspect the existence of Chronic inflamation
of the Peritoneum, you should try 
to cure it by proper treatment and they
prevent an acute succession. This 
indication is answered by occasional
Bleedings, rest, and a strict and religious
observance of the whole antiphlogistic
regiment By such means we may
prevent a most fatal, distressing, and intractable
complaint from supervening.
And save ourselves much trouble and 
our patient much suffering. 


121
De Colica
In pursuance of the subject of Disease of 
the bowels I am next to treat of Colic
This is a frequent and depressing collection
calling into requisition at the resources of 
our art and demanding our greatest attention.
It is introduced by a painfull
distension of the lower regions of the abdomen
a twisting round the umbilicus, vomiting
Constipation, spasmodic contractions of 
the Abdominal muscles -
By Nosologists, this disease has been divid
into a great many species, distinguished
from each with elaborate minuteness
But for all practicall purposes it is 
sufficient to consider it consisting of 
but three kinds vizt. Flatulent Colic 


Bilious Colic, and Colic pictonum
The first of these, or 
Colic Flatulenta
Is known by the Flatus which attends it 
and the causes from which it arises -
The causes of Colic are indigestable food
as Cabbage, and Cold especially applied
to the lower extremities
When certain indigestable aliments have
given use to Colic it exhibits itself by spasmodic
pains and vomiting - The method
of Cure in this case, is distinctly pointed 
out by nature herself - We have only to 
assist the stomach to relieve itself of the 
contents which distress it which may 
be done by means of warm water an chamomile
tea. - Our next endeavour trust 
be to allay irritation and soothe the disordered
organ - This also is easily done in 









123
in general, by means of the carminative cordial,
and anodyne preperations. This last
indication is answered by warm tody, Ether
Hoffmans Anodyne liquor, laudanum, essence
of Peppermint or Oil of Cinnamon &c -
But when Colic has originated in Cold
the most certain cure is effected by directly
applying some of the above remedies, without
endeavouring to empty the Stomach.
Warmth applied to the surface is always 
useful &d sometimes indispensible, and
should be directed to the feet & abdomen
by means of the hot brick, water in bottles
hot ashes, sand &c. and boiled corn
hot oats &c - A mere reestablishment of the 
natural heat of the surface will after entirely
cure the complaint when arising from Cold.
After the pain & irritation are entirely removed
it will 

24
it will be proper to open the bowels for 
fear of a relapse, But as I mean to consider
this more filly hereafter. I shall not say 
more on it at present, In dismissing this 
subject however I earnestly press upon
your minds the difficulty & danger of this 
disease. The vomitings are sometimes
tremendous especially in those case produced
by offending the Stomach I once
saw Iliac passions produced by simply
eating Cabbage, where the most offensive
Stercoraceous matter was rejected by vomiting
and the patient fell a victim to the 
disease - 

125
De Colica Biliosa
Bilious Colic is endemial in the Unted States
especially to the Southward
It has been by modern writers correctly enough
considered as a bilious fever turned in upon
the bowels, It is sometimes produced by 
other circumstances, although it commonly
arises from the Same cause which give origin
to our autumnal fevers, It exists at the same
season is like them produced by a chill, is altered
with an accumulation of Bile and 
accompanied with high arterial excitement
It is also attended with excruciating pain 
about the simbilicus, aggravated by reching
and vomiting. The symptoms distinguising 
it from all other Abdominal affections
is its introduction by chill, which is its uniform
and inseperable harbinger. This may 


26
This may be therefore called its pathognomonic
symptom. The treatment of Colic Biliosa
may be told in very few words. Violent 
spasms, & high arterial action at once demonstrate
the necessity for the lancet, and 
demand it more imperiously than any 
other complaint of the same Kind -
By copious bleeding in an early 
stage, the complaint has been cured without
any other remedy, and where it fails to do
this, it almost always subdues the most 
painfull and troublesome symptoms
The lancet should not therefore be 
sparingly used but should abstract
from an ordinary adult at least 20. oz
of blood at the first bleeding -
Even where we do not gain all from such
proceedure, that might have been expected,
we at least guard against future 









127
future inflamation and pave the way to 
the more effectual operation of other remedies
which is by no means a trifling matter
We thus offer to these remedies a surface
lately entirely locked up by the violence
of the action, and under it more susceptible
of impression - The next indication
is to open the bowels which in this disease
are locked up - For this purpose cathartics
would seem best; but such is the turbulence
of the stomach that these medicines
are hardly to be retained, We should
when so endeavour to tranquilize it 
by any of those expedients formerly mentioned,
Perhaps the most suitable in the presen
case, are lime water & milk and large
anodyne injections. Much has 

Much has been said for Opium here and 
Intermit a good remedy althoug it is 
at best precarious when given pneum
for it is commonly immediately rejected
It is proper however to give it treat
for tho' generally it is not always rejected
Where it fails as I have mentioned before 
you should resort to injections
As an auxiliary in this indica
I would not have the warm bath to be 
overlooked. Although this application
will not check the vomiting. I 
have seen a patient while in the bath 
relieved from this a well as other troublesome
symptoms - Failing in all
to ally the turbulence of the stomach
you should again appeal to the lancet 

129
to the lancet and aperient emanata -
The common emanata consists of Oil, salt
& water, but in spasmodic cases it is better
to use an infusion of Senna which
will often succeed in open the bowels
and allay the irritability of the Stomach 
Terebin glysters have also been used
in Obstinate Cases successfully, more
particularly when the spasm has been 
excited and Kept by flatulency
ꝶ. Beat up one or two table spoonfulls
of Ol. Terebinth with the white of two or 
three eggs upon which pour a pint or 
more of water - Cold water has also
been recommended either dashed upon
the Abdomen and lower extremities
or thrown into the rectum - This was 


This was a favorite remedy of the late Dr Rush
who used it with most decided results
The colder it is the better, as ice water or 
the coldest pump water -
As you may recollect, tobacco, has been
exceedingly extolled in our disease
It should not however be used except
in very desperate cases, for it produces
so great a sedative effect, as to destroy
or unpair the vital energy. I saw 
a patient so completely exhausted by 
a small injection of tobacco, as to require
the utmost exertion to restore animation
Dr Parish has also informed me 
of a similar result in one case of his.
There are two modes of applying the 
tobacco injection. The most common










130
common form is. ꝶ - ʒj of tobacco leaves
in decoction with a pint of water. This is 
to strong. I have used only ʒss of the tobacco
The other mode is to throw the fumes of the 
tobacco up the rectum, which may be best
done by means of an apparatus constructed
for the purpose, where such is not to be 
had, the operation may be performed by 
falling the bowl of a common tobacco pipe 
with the leaves placing a piece of rag over 
it to defend the mouth and applying the 
small end of the pipe to the anus, blow
the fumes into the rectum - I saw 
this succeed admirably well in an obstinate
case of bilious colic 
I have to mention another injection
which ought by no means to be neglected
I mean a solution of Tart. Emetic Though 

32.
Though this is quite a modern discovery its
excellence has been fully proved an attested
ꝶ xx grs Tart Emet in ℥ III or IV aqua pura.
In very obstinate cases I have given three
at a time. This injection is perhaps
more effectual than any other
The last means left us to overcome unrelenting
spasms is mechanical distensions.
A syringe for this very purpose has 
been invented by Dr De Haen by which
any quantity of liquid may be thrown
into the bowels. Three or four quarts of 
tepid water will be sufficient often to 
overcome a spasm which had resisted
all other means - This instrument
differs from the common syringe in 
having a pipe so constructed as to permit
the cylinder being filled wet hout with
drawing the pipe 


133
Happily such obstinate cases are of rare occurrence.
The means before mentioned are
are commonly sufficient to allay the vomiting
and admit the exhibition of Cathartics
In such cases as in usual to select the most 
active purgatives and to administer them
in the largest doses - But it is well Known
that the most lenient laxative will effect
what could not be accomplished by the 
most powerful purgatives, and I have seen
a combination of Sac Sulphuris & magnesia
succeed when everything else had failed
There is a [cross out] connection between the remedy and tone
of the system requiring the greatest precision
to suit the one to the other, and when powerfull
medicines fail to operate when weaken
ones succeed tis there is a want of 
what is disseminated medical harmony 


34
Castor oil and Sulp Magnesia are among
the best Cathartics in the case before us, But 
my experience inclines me to prefer a combination
of Opium & Calomel ꝶ. Calome 
grs XII XV Opium grs III given evey three
or 4 hours in cases of emergency I mean
By the Union great advantages are gained
The Opium quiets the Stomach & allay the 
Spasmodic affections thus paving the way
to the operation of the Calomel which
passes off by cathartics. The Opium by 
quieting the irritation, procures the retention
of the Calomel, So Signal are the advantages 
of this combination in cases of 
great difficulty & danger that I can hardly
impress it to strongly on your attention
As yet I have not spoken of Blisters
although they constitute an essential 









135
part of the treatment, after all other measures
have failed I have seen Blisters applied to the 
abdomen relieve the Spasms excite gentle perspirations
abate the pains allay irritation and
restore the action of health - 

36


137
Colica Pictonum
To conclude the subject of bowels affections
I shall now consider Colica Pictonum
This was at one time a common complaint in 
this place but it is now so seldom Known
that I have not seen a single case for three
or four years. It is said to derive its present
name from Pictore a town in france where 
the disease was very prevalent. It has also
been called Devonshire Colic for a similar
reason. It was formerly supposed to 
arise exclusively from the agency of Lead
but it known now to be produced by other
circumstances, as acid drinks, unripe fruits
flatulent vegetables, cold, and an accumulation
of Acid Bile. Still the fumes of 
lead are the chief cause of Colic Pictonum



It comes on with a slow pain in the pit of the 
Stomach extending downwards towards the intestines
with a twisting sensation about the 
umbilicus eructations, sickness at stomach,
thirst, anxiety, obstinate, constipation with 
desire to go to stool. The pulse small, quick,
corded, differing from that of bilious Colic
which is full, strong, and voluminous
Indeed Bilious Colic is the only intestinal
affection with this Kind of Pulse.
In a short time pain becomes more violent the 
abdominal sore to the touch, the abdominal
muscles throw themselves into hard irregular
knots, the Spasms in some case is so strong
as to prevent the insertion of a glyster pipe
the Stomach ejects a hard poraceous bile
the head becomes affected more or less vision is 
is sometimes deprived, not uncommonly
becoming double and in some recorded 









139
cases being entirely lost -
The indications here are much the same as in 
Bilious Colic, nor are the medicines applied
materially different.
Notwithstanding the smallness of Pulse
writers are agreed as to the propriety of venesection
in this disease which should be proportioned
to the condition of the patient, urgency of the 
case, and as this is a more powerfull complain
than bilious Colic more copious venesectio
is commonly necessary -
Our next indication is to open the bowels
As this is esteemed a purely spasmodic affection,
Opium and other Spasmodic medicines
have been preferred - But though there 
are very suitable, they answer much better
when combined with calomel as before mentioned -
If all fail we must to the rest
of the means for this purpose as cold water

40
as cold water either dashed on or injected
which often affords immediate belief Castor
oil has been long consecrated to this disease
and in the West Indies where the complaint
is frequent it is a favorite remedy
But if my experience permit me to decide,
I should prefer the combination
of Calomel & Opium. - Sulp Magnesia
however should not be overlooked -
Gum Guaiacum has been much recommended
for the purpose of opening the Bowels in 
Colic Pictonum, &d I am readily induced
to believe its efficacy for I know it to 
be both a purgative and an antispasmodic,
and I have known it spasmodic affection 
of retrocedent Gout relieved by 
Gum Guaiacum - As in the other 
Abdominal affections large blisters
on the parts should not be forgotten 


141
for they are here equally useful
Constipation having been removed the 
Disease assume a more managable and less
alarming form. The Spasmodic action does 
not however always depart with the constipation.
To mitigate the severity of this 
symptom &d to remove it, the union of Opium
with some laxative &d anodyne injections
will commonly prove sufficient
But in this Stage of the disease no small confidence
has been reposed in Allum.
It has been recommended by Dr Percival
and some late writers - Percival gave
10 or 15 grs every 5 or 6 hours - Still greater
encomium does Mosely give it He prefers
a preperation called vetriolic solution ꝶ -
3 ʒ wht. Vizt. 13 allum 3 grs coccinella and 3 ℥ III
aqua pura. One table Spoonful every 3 or 4 hours 

To remove all danger of relapse and to reestablish
prefect health he recommends the patient
to take a table spoonful of this solution
every morning for 3 or 4 days - I have had 
no experience of its excellence. My practice
has been to give Mercury with a view
to salivation - This is not an altogether as 
modern practice. Fifty years ago it was practiced
by Dr. Warren & Dr Riess and more recently
by Dr Clutterbuck, who recommended
it in a treatise or [cross out] fevers -
There can be no doubt of the efficacy of 
Mercury - When the mouth is once effected
all the symptoms of Colica Pictonum yield
at once - It also prevents the occurrence
of palsy which commonly supervenes in this 
disease, or removes if it has happened
My practice may be summed up in a few 
words. I commence with copious venesection 









143
I commence with copious venesection then give
Opium and Calomel to open the bowels and auxiliaries,
injections &d Blisters and after the bowels
have been opened, proceed to salivate especially
if any Spasmodic disposition or tendency to Paralysis
still prevail - If I ever again meet
with this complaint while conducting the 
other means of Cure. I will apply Mercury
most copiously to produce Salivation both 
internally &d externally - So well pleased
have I been with its efficiency in former
Cases that I Shall hereafter trust to it almost 
entirely - Colica Pictonum when once 
it makes an attack is exceedingly apt to 
return - It will therefore be proper to caution
you patient, on this head and point out
the means of preventing it - He should
avoid all exciting causes, should wear flannel
and Keep his feet warm - It has been said 

44
said that when this predisposition exists
flannel rollers compessors or bandages applied 
to the Stomach &d abdomen are most effectual 
preventatives - I can easily see
the advantage of such an application since
it affords both warmth and mechanical support.
Diarrhea and bowel complaints
Dependent on debility have long made me
acquainted with the utility of the contrivance-

145
De Cholera
A copious discharge of Bilious matter both
upwards and downwards, attended with 
griping & spasms gives character to a disease
called Cholera Morbus -
Like Bilious Colic and other diseases of the 
same class, it has been termed a fever turned
in upon the bowels. It exists at the same 
period arises from the [cross out] similar causes and demands
the application of nearly the same remedies
Now and then it can be directly traced to other
circumstances such as irritating or indigestable
food - But cases of this Kind are 
comparetively of rare occurrence and never
perhaps without a predisposition previously
existing - Cholera morbus comes on with 
tenderness of the Abdomen pain flatulent
distensions &c - As it advances the pulse
weak before, becomes still more so accompanied 

46
accompanied with a fluttering and a corresponding
debility & Depression, with damp
pallid surface, cold extremities, difficult
hurried respiration, thirst restlessness gastric
distress, cramps, spasmodic affections of the 
limbs and abdominal muscles.
It has been remarked that this disease bears
very close resemblance to the other intestinal 
affections as is obvious from the foregoing Symptoms.
But it is somewhat peculiar and 
a little attention will enable you to distinguish
them. From Colic it is discriminated
by the Absence of constipation
and from Dysentery and Diarrhea by 
its pure bilious evacuations unmingled
with blood or fecal matter.
Correctly speaking this is a pure gastric
affection. The primary disease reside
in the Stomach, imposing on the hepatic 









147
hepatic system a sympathetic action.
We are led to this conclusion by the ordinary
Causes of Cholera - which are a constriction
of the surface by cold, and impression
upon the stomach my marsh effluvia or 
excess in eating and drinking, Corroboratory
of this view is the circumstance that is
the commencement of the vomiting the 
contents of the Stomach alone are ejected
and that bile is not thrown up till the 
biliary organs have been sympathetically affected.
Being once completely under a disordered
impression, the liver is stimulated
to action and the direct effect is a great
discharge of Bile. Now as far as I know
is the bile in this case characterised by
any unusual acridity as has been asserted
On the contrary it is to be presumed that 

48
that when so rapidly and largely secreted
it will be less acrid than a healthy secretion
Deducing our practice from this theory
it would seen that our only indication
is to remove the original irritation of the 
stomach, But it sometimes happens that 
a theory may be correct from which at 
practice directly deduced might be 
wrong - We have many examples of this 
in medical science, none of which are
more pertinent than the one before us 
In Cholera the bile accumulating
becomes so vitiated as to act like a new 
exciting cause acquiring removal previous
to cure. In some cases the
treatment is directly reversed and 
paliatives are administered previous to 
any evacuating remedy. Opiates given 

149
Opiates given at the commencement of will often
check the vomiting, counteract the primitive
irritation, repress purging, relax the spasms
and soothe all the symptoms of disease
Nevertheless as a common rule it is proper
in the first place to clear the stomach
For this purpose most practitioners
use diluent drinks such as chamomile tea
warm water, barley or chicken water in 
great quantities
No part of practice is more ancient
than this - It may be traced to the 
remotest ages and yet it is retained still
by the common consent of practitioners
Whatever merits this practice may boast of 
it was undoubledly dictated by false
theory. Conceiving the disease to arise
from the Acridity of the bile, they persue the 

50
the treatment for morbid poisons, pouring
delinquents into the stomach to wash away
the offensive accumulation. Whe the
Stomach should be deluged by those 
delinquents when emetics seem better calculated
for our indication I cannot
comprehend. I have since entertaining
this opinion always administered
emetics in this disease and have had
no reason to regret my Choice for their
operation was generally prompt and complete
XX grs of Ipec. promoting its operation
by the ordinary beverage for that purpose
have the effect of relieving the stomach
and system from oppression, pemitting
reaction & thus presenting the disease
to us in an open manageable Shape
Our next object is to calm the irritability 










151
irritability of the stomach and remove the 
Spasmodic pains. Several remedies are 
suited to this indication of which venesection 
is the most important. As in 
all other instances this is to be regulated
by the condition of the system at the time
Bear in mind that the pulse is not our 
only guide. However feble it may be 
if the patient has any Ordinary degree of 
vigor, the lancet may be safely urged -
I have ever acted so, &d found uniformly
the pulse rise under depletion. It may
therefore be laid down as a general rule
that in the early stages of all diseases, when much
pain is felt, and the pulse is at the same time 
feble, that this arises from an engorgement and 
is best remedied by evacuations. Admitting
the truth of this, there are still some cases in which 

52
in which depletion suddenly performed
well prove highly dangerous. In such
cases the system is incapable of reaction
or there is great obstruction of blood
from general circulation, being accumulated 
in the great viscera, whence in either
case copious sudden depletion will often
have at once fatal to life - It will be 
proper therefore to watch the effect of the 
bleeding & by abstracting slowly allow the 
recuperative energy to come fully into play
If the debility is great take little blood at 
once, if reaction takes place you may proceed
more boldly. By this manner of 
soliciting the reaction you may easily
obtain as much blood as you desire -
In doubtfull cases it appears to me prudent
to precede the lancet by the use of warm baths

53
baths-This has at all times been suitable to the 
case before & is usefull indeed in any stage
It generally diffuses an impression over the system
hardly ever fails to rouse the patient subdue
irritation and give him relief from the painful
spasms. Much has been justly said 
of Opium in such cases. As I have already
intimated, it should be either given at once
or after evacuations have been premised
But in whatever Stage it may be given 
most advantage will be derived from using
it in enama every three or 4 hours -
Where the prejudices of the patient or other circumstances
prevent this mode of application
the Opium should be given in pill per orem -
I find it is much less apt to be rejected
than Laudanum - To cooperate in the 
same viero vizt. allaying irritation &d pain 


warm fomentations are very usefull, among
these the bag of Cloves formerly mentioned
is well suited to our case - These are 
always comfortable to the patient and
sometimes prove more permamently serviceable,
Most of the remedies mentioned
may be used to check vomiting but the 
most appropriate is lime water & milk
If all fail me must apply a large blister
to the region of the stomach &d if there
is an appearance of sire King to both
extremities 
As I have laid it before you 
such is the case of Cholera Morbus
In a majority of Cases that practice is sufficient
to overcome the disease when judiciously
managed - But occasionally we have 
to encounter most tremendous attacks in- 









155
in which all the skill and resources of our 
art are called into action. Such violent
case sometimes terminate in a few hours
cases however so violent seldom occur
except when some malignant Epedemic
as Yellow Fever pervades the City. In Ordinary
times, it does happen now and there in 
this malignant aspect and runs its course
in 24 hours. Like many other diseases
Cholera Morbus when once an inmate
is very apt to repeat its visits - To guard
against relapse is an important indication
This is to be accomplished only by carefully
avoiding all exciting causes such as exposure
to the sun, night air, excess in eating,
or drinking, improper Articles of food,
immoderate exercise, violent paroxysms 

58
of the passions & above all cold extremities
particularly cold feet. Attention should
be paid to the bowels, which must be 
Kept in a soluble state by mild laxatives
as magnesia - The tone also of the 
intestinal canal should be improved
by the use of some of the Bitters, Of these
Quassia and still more Colombo are in 
high estimation - Flannel is an article
of dress should not be overlooked being
an important part of the prophylastic
system - 

157
De Cholera Infantum
By no abrupt transtion we may now pass to the 
consideration of the Cholera Infantum
This disease is I may say almost peculiar to
the United States of America. Children of 
other countries it is true are subject during
dentition to various diseases of the Alimentary
Canal. But these are none of them precisely
similar to our complaint - Much has been
written on this subject. I have not been able 
after the most diligent search to discover any
thing like a description of this very disease
except some obscure notice of it in Cleghorns
work of the disease of Minorca
Considering the Prodigious mortality
of Cholera Infantum amongts us our own writers
are strangely silent on it. As far as I know 

we have only two essays of this disease, one by 
Dr. Rush and another by Dr Jackson (see 
Rush's works vol II de Cholera Infantum)









159
One of the most common and extensive
causes predisposing to the disease is debility
produced by the impure and heated air of our 
large city. The exciting causes are improper
articles of food and clothing It is also brought
on and aggravated by dentition worms &c -
Distinct from the Causes and external
phoenomena of Cholera Infantum dissections
have informed us of the nature and state of the 
complaint. No traces of the disease does the brain
exhibit. the great vicscera of the thorax 
are as little affected, and it is on the contents of 
Abdomen alone the disease seems to expend its
force The Effects of previous inflamation
may be traced along the whole course of 
the Alimentary Canal. The mucous 
membrane seems to be the principle seal of 

60
of the disease being covered with dark livid
spots in the Stomach and intestines especially
the Duodenum. The Peritoneum 
also sometimes assumes the same appearance
but not commonly
As might be supposed the hepatic
system is a good deal effected. When I 
have examined subjects who have died
of this disease. I have always found the 
liver increased in size and much changed
in its appearance. I generally found it 
soft and flabby tho' sometimes indurated
the gall bladder filled with bile vitiated
and altered Of the condition of the spleen
and Pancreas, little has been noticed but
they are generally more at less involved in
the morbid action
Taking into view all we know of 


161
of the causes of Cholera Infantum and of the phenomena
it exhibits on disection we cannot reset
the conclusion that this is a gastric affection
and like all autumnal disease subjecting
the bileary apparatus to a sympathetic disorder
It appears from the history of Cholera Infantum
that it is particularly closely allied
to the disease of the bowels incident to advanced
life; being a gastric affection, bring the hepatic
system into sympathetic disorder. All evidence
arising from their causes symptoms phoenomena
on disection as well as their treatment warrants
such a pathœlogic conclusion 
As already mentioned Cholera Infantum
commences with a disordered condition of the 
Alimentary canal. And it seem now generally
admitted that we Should directly evacuate
the 

the stomach and bowels but as to the precise
course by which this indication should be 
effected no such unanimity exists
The most usual practice is to administer 
cathartics, especially Castor Oil for this 
purpose. When the case is a mild one this 
mode of proceeding will answer well enough 
but in violent cases attended with vomiting
there is an utter impossibility of keeping the 
medicine on the stomach, we therefore find
it necessary to endeavour to allay the irritability
of that organ, which is best done by the 
use of Anodyne injections, fomentations
applied to the Epigastrum, the warm bath &c -
After we have used this successfully we 
may recur to the purgatives - Except in the 
cases of very young children I know no 









183
I know no medicine so suitable for this 
purpose than a combination of Calomel &
and Opium, This compensation has these
advatages over Castor Oil, or other purgatives
that it is insipid, can be given in small bulk
and by its great specific gravity is not very liable
to be rejected even if vomiting occurs -
There are actual practical advantages of no 
inconsiderable moment, for the medicine
being retained produces the most effectual
evacuations the spasmodic uneasiness
is gradually mitigated or removed -
All tho is inteligible from the Known
effects of two articles when separate -
This is a practice well adapted to the 
generality of cases but not universally applicable
sometimes such is the vehemence of Gastric
distress, 

84
distress that it entirely precludes the use of 
purgatives - Every moment the patient
is afflicted with most violent vomiting
thirst [cross out] pain about the umbilicus
and all the symptoms of fever heat of 
the surface and a quick irritable pulse
What are we to do in such a case
We have no hesitation in recommended
an emetic of Ipecacuanha, this we Know
also from experience that it is a most useful
one, and therefore makes no difficulty about 
using it. - The emetic has been given with 
a view to check vomiting by other practitioners,
but it has ever been most sparingly
used and not even then without the most
anxious Solicitude. What is the reason
of this unfounded prejudice I cannot gues

155
When we have no reason to suppose the existence of 
inflamation, emetics are both safe & effectual
remedies relieving the Stomach of its offensive
Contents and at the same time giving tone enough
to prevent a relapse or recurrence of vomiting
they also determine from the intestines to the surface
equalizing the action and producing healthy action
generally - As in all bowels complaints any 
elevation of the pulse imperiously demands the 
lancet - Bearing in mind the insidious
nature of these diseases, which are very apt to 
mislead, that disection, everyday almost demonstrates
how fatally the lancet has been 
neglected and yet how much required
It has been my common practice to bleed
on the first attack always with immediate
advantage besides which it is an excellent

precautionary measure against inflamation
It has the effect of tranquilizing the Stomach
and general system. Here however as in all
cases the lancet should be used with great
discrimination - After having thus prepared
the Stomach to retain any thing we will find 
advantage in Mercurial purges, Calomel
alone or in combination with Opium is to 
be infinitely prefered for reason formerly
mentioned to Oil or any other cathartic
preperation Having once evacuated the 
bowels I have done with purging unless
there is an accumulation of bile or vitiated
matter in the Alimentary canal. It is 
my deliberate conviction that in this as well
as some other disease of the same Class we have 










157
have been in the habit of purging to much
Cherishing the doctrine of the existence of morbid
humours it is a general practice to go on with
purges so long as any discharge can be procured
under the impression that a vitiated condition 
of these is the cause of the disease. Now I hold 
the very reverse of this opinion to be here 
It seems to me to be the effect of irritation
of some portion or other of the intestinal canal
to be removed only by [cross out] evacuation -
Deducing our practice from such a view
of the subject we shall find it advantageous
after having once pretty completely evacuated
the canal and system to resort to such remedies
as will have a double effect of quieting the 
morbid actions and of determining to the
surface. Much of the mortality of this disease 

68
disease terrible for its destruction of life may
be ascribed to the plan of copious & constant 
purging - What indeed can be expected
from this but the exhaustion of the delicate
and feeble frame of an infant when we see 
such practitioners continuing their alimentary
evacuations every day or at least three or 
four times a week for weeks during which 
this complaint sometimes continues
Satisfied of having cleaned the alimentary
canal I proceed to the use of remedies
which will calm irritation and determine
distinctly to the surface. For the purpose
the following recipe is generally
sufficient ꝶ - Opium grs 1 Calomel grs 3
Ipec 2 - mixed ft sex pulveres One to be given
every two or three hours according to the circumstances
of the 

169
circumstances of the case. When the disease is attended
with violent pain & irritation are as usual
producing copious & frequent evacuations
the proportion of Opium should be increased
or what is more better anodyne injections Should
be used. And if the irritation does not abate repeat
the operation every third or fourth hour.
These remedies when properly exhibited
will generally calm irritation and as soon as this 
is accomplished another symptoms gradually
subside 
As entering more fully into the plan
of treatment, our attention must now be 
directed for means of producing a determination
to the surface and an impression on 
the cutaneous organs - For this purpose the 
warm Baths is a most excellent agent not 
only producing diaphoresis but other effects
equally important - In Cholera Infantum 

Infantum there is an irregularity of temperature
and while one portion of the body is parching
hot another is icy Cold. By immersion this is 
remedied. An equal temperature is diffused
over the body a pleasant glow is felt [cross out]
[cross out] and other statuary effects of equal 
importance. This good however is not open
moment, and therefore becomes necessary to 
repeat the operation every day or even twice
a day. The effect is improved by the 
addition of Salt Cayenne pepper, brandy
Mustard or bitter herbs of any kind to the 
water. As cooperating to the same end
Blisters must not be overlooked they are
usefull in any period of the complaint
and should be made very large and applied
to the stomach. Abdomen or extremities 









171
extremities according to the circumstances
After a few days sometimes or a week &c
in other cases the disease becomes a Diarrhea
accompanied with tormina and tenemus
It is usual on such occasions for the stomach
to be debilitated so as not to digest
and after too irritable to retain any nourishment.
The remedies in such a cases are the
Alkaline or cutaceous preparations variously
combined. ꝶ Prepared Chalk or 
dose a desert { Pulver Oyster Shells ʒij
spoonful - { Tinct Opii gr 15
every two or three { Loaf Sugar ʒi 
hours } Aqua font ℥iii 
Rhubarb is also exceedingly well adapted
to our present purpose and should be
prepared as follows.


72
ꝶ { Pulvis Rhei gr 10
dose { Magnesia gr 40
desert{
spoon { Tinct Opii qt 15
full { Loaf Sugar ʒj
as in { Ol. Anisi qt 10
former { Aqua font ℥ III
Cases {
This remedy is peculiarly suitable to cases
attended with tormina and tenesmus which 
generally exists in the second and third stage of 
the disease But after all the most suitable
remedy for such purposes is an anodyne glister
repeated as demanded
As it advances the disease loses almost all
it most acute symptoms and the Diarrhea
accompanying it becomes so profuse as to 
produce ten, twenty, thirty &d even forty stools
in a day. - But as the treatment in such
case is similar to that for growing person under
the like circumstances. I shall leave the 


172
history of it to a future occasion. All I shall now
say is regarding those remedies peculiarly applicable 
to the case of Children
Of the mineral astringents, I have
found none but Allum at all usefull.
This in a dose of 2 or 3 grains combined
with 1/4 to 1/8 of a grain of Opium, given every
two or three hours has produced excellent
effects Sauharum Saturn: has been lately
much recommended, by if my own observations
may be depend on it has no proved
useful being much to a astringent tormenting
the bowels - Chalk without an infusion
of Galls or tincture of Kin and a little 
Laudanum is a prescription worthy of 
notice. Columba in powder or infusion
has much reputation in our disease. But 

But of late the practitioners of the City have
been in the habit a good deal of using Hematox
Campech in infusion giving a desert
spoonfull every second or third hour
This prescription is a very favorite one of 
Dr Physick whose authority is a safe
guide to practice
But above all does my experience approve
a strong infusion of either species of the 
Rubus or Blackberry or dewberry root of 
our country. Six or eight years ago I 
introduced this medicine, long a popular
one into my practice and I believe it 
had never been employed before by any 
regular bred physician - It is the most
effectual astringent in this disease with 
which I am acquainted and not only 









173 
lies easily on the stomach, but produces a 
cure in many cases in a few doses. Indeed
so great is its astringent effect that a short
use of it constipates so much as to demand
the subsequent use of laxatives
The manner of giving it is in infusion ʒj
of the bruised root being thrown into a pint
of boiling water of which the dose is a desert
spoonful. After all the only sovering remedies
I might say infallible remedy is change of 
air. As long as the Child remain, in the 
City exposed to the cause in which the 
disease originated, we may perhaps suspend
or overcome it by efforts but no radical
cure can be accomplished - 
Relapse on relapse gradually inpairs the 

then energy of vitability till the little patient 
sinks under an accumulation of disease
But it is never to late to apply the remedy
of removal which is useful in every stage
of the disorder. Dr Rush during fifty
years practice never lost more than
two patients by this disease after their removal.
Althoug I cannot go so far as 
he has done in eulogizing the remedy -
I admit that no other means of cure half
so effectual has been discovered for Cholera
Infantum - The patient has hardly
breathed a country air till his attendants
may discern an improvement in his
Case. I have myself observed this
Change before the Child has been removed
from the Carriage Poverty and other 

177
other circumstances sometimes prevent the 
patient from obtaining a country residence
but as it is of the utmost moment to allow
him the free air of the country he should
ride or walk beyond the City once or twice
everyday. As this complaint is so fatal
and difficult of cure preventive measures
become of great importance
The Phrophylactic treatment found
most effectual is the following vizt.
Never permit a mother to wean her child
within a year of its birth, no food is so
salutary as the Maternal Milk -
Weaning predisposes the Cholera Infantum
the truth of which can be attested
by every practitioners in the City.
2nd- The Cold bath should be used daily
which opperates not only by promoting 

cleanliness, but also by exciting sympathy 
between the Stomach & Skin raises the 
tone and rigor of the whole alimentary
Canal. The Cold bath does not always
agree with a patient, when the warm
bath will be found equally advantageous.
3rdly- Let the patient constantly wear
flannel next the skin and worsted
stocking on the feet. We have already
informed you of the utility of this precondition
to grown persons afflicted with 
bowel complaint of Children. I have
seen a threatened attack warded off
by the simple application of warm shoes
and stockings to feet from which they 
had been imprudently taken off
4thly- Be careful with regard to diet 







A sheet very useful in those cases as well as in diarrhea 
in grown persons is prepared as follo take
of plain the wrap it is sensual the damp of 
linnen put it into a pot & boil for 5 or 6 
hours, when it comes out it will be very solid
this is to be grated, & milk thickened by it,
It is binding to the bowels & gratefull to the 
stomach, 

179 
with regard to diet, Let an excessive use of 
ripe and any use of green or unwholsome
fruit be carefully avoided - The most
proper diet for a child is milk and some 
of the pure farinaceous vegetables, as arrowroot,
tapiocha, or buscuit, victivals made
by boiling pounded crackers in milk
After a few months a little animal food 
is allowable perhaps useful by imparting
some tone to the digestive organs.
5thly During detention the gums should
be frequently examined, and if they appear
swelled or inflamed they should be freely
lanced. Lancing the gums of ten produces
a most extraordinary effect all over the 
system for almost every disease maybe
closely imitated during detention. I have 
seen cough hydrocephalus and all the bowel
complaints so well represented by the phenomena

phænomena during dentition as to almost 
deceive the most experienced practitioner
and which disappearing with the primary
irritating cause proved their origin
6thly. Hot weather and dentition
always predispose to Cholera Infantum
and when these circumstances concur 
to aggravate the disease, the case is always
very unmanageable. Many persons are 
a verse to the lancing the gums supposing
a cicatrix to appose a barrier to the 
growth of the tooth. Nothing can be 
now absurd than this opinion, for in 
the first place the tooth is not forced
out mechanically, but by the previous
absorption of gums and in the second
place a cicatrix is more easily absorded than
a sound part. After all our precaution 

181 
precaution our only security is in the removal
of the child to a freer air, before that season
arrives which bring on this fatal complaint
Let me therefore recommend to you always
to advise the parents of Children at all predisposed
to Cholera Infantum to remove
them from the City at the approach of this 
season -
Crossing the river in a boat several times
a day is very useful in this disease 



183





185 
1)
365
De Dysenteria
Our next discourse is of dysentery.
Cullen defines it to be "A contagious fever
in which the patient frequently voids muceous,
or bloody discharges attended with 
griping and followed [cross out] by tenesmus
the foecus being for the most part retained
Except in regard to contagion which is 
a raw attendant of dysentery. I do not Know
that the definition requires alteration or
admits of improvement -
As the history of the disease is so
accurately laid down by Cullen, I will read
you his description before proceeding to treat
of the pathology and practice. 











187 
To this excellent description. I have only one
observation to add, that in dysentery we have 
sometimes no discharge manifesting a most 
fatal case for the Absence of discharge is 
attributed to the high inflamitory action
transcending the secretory office and thus
preventing discharge. this case was Known to 
Sydenham. It is pretty analogous to those 
cases of Gonorrhea surpressed by inflamation
Much has been written concerning the causes
of dysentery and much diversity of opinion
existed on this head, though it was generally
believed to be a specific contagion generated
in one person and imparted to another
But I am persuaded such is by no means 
The general are uniform character of 
Dysentery but on the contrary is a rare 



raw accompaniment. A recent writer has 
ingeniously asserted that dysentery is only
a contagious fever when it is from its commencement
as seemed a typhoid action
or has in its progress degenerated into some 
degree of it. My own observations have
convinced me of the soundness of this 
view of the subject. 
It has however been contended that the 
contagion may be traced directly to the 
abcine evacuations, and perhaps much
more plausible to the secretions and 
excretions in a state of putrefaction giving
off infections effluvia
Neither of these opinions have been established,
nor has any evidence been adduced
to prove such effect to result from these
causes - A mere collection of filth 


189 
2
filth is not sufficient for this purpose, and 
if as I have formerly mentioned the perspiratory
or other matters of secretion gave rise to diseases
these would be as varied as their causes
But on the contrary where contagion is suspected
we look for our uniform disease, varied
only by constitution or grade of violence -
Moreover it has been proven that dysentery
can be propagated where the greatest pains
have been taken to Keep the patient & apartment
clean & airy. What then can we 
presume, but that in a typhoid state of dysentery,
the extreme vessels take on a peculiar
action by which contagious matter is formed
and alimented from the system -
This is one of the cases of dysentery though
it oftner arises from the sources of autumnal

autumnal fevers acrid accumulations in the  
stomach and is an epidemic at times dependant
on a peculiar distemperature of the atmosphere
Nor is it less dependant on sensible qualifies
[cross out] of the Atmosphere, for alternations of 
heart and Cold moisture and aridity
cause and dysenteries as well as other affections 
of the bowels. Checked perspirations
is another cause of it and it sometimes
accompanies catharides & alternates
with Rheumatisms. Whatever may 
be the mode of production it is of a febrile
affection directed particularly to the 
Alimentary canal. This was well Known
even in Sydenhams time -
The disease assumes different types
being sometimes remittent, at others intermittent,
and sometimes continued the 










191 
last species being either inflamitory or typhoid
The disease generally and always when produced
by miasmata has its primary
seat in the Stomach for here is the first 
symptom of disturbance, inducing nausea
vomiting and gradually extending
downward to the bowels -
Dissections also shew that the force of the disease
expends itself on the large intestines
Here we meet with mark of inflamation
and morbid action. Enough has now
been said to shew my opinion of the nature
and cause of dysentery, and if that opinion
be correct our indications of cure are 
obvious. But in order to render our
practice more appropriate we must consider
the disease under its various modifications.
As dysentery commonly

occurs we are called upon to remove inflamation 
with the morbid irritability and 
spasms. And when the surface is hot and 
dry we must [cross out] endeavour to restore
the skin to a natural condition
Sydenhams experience as well as many
other experience practitioners, gave them
assurance of the utility of commencing
by the exhibition of Emetics. Enamoured
of this remedy in most of the bowel
affections. I yet cannot say that they
are generally applicable to dysentery
In cases where the stomach is over 
loaded with Bile or any other foul 
matter, nauseating or producing
other gastric distress emetics are indicated
and prove usefull.
In Miasmatic countries - Dysentery 

193 
3
Dysentery is found commonly associated
with intermittent types which shall be
particularly considered hereafter -
Under ordinary circumstances; all remedies
should be proceeded by the lancet. this will check
the progress of inflamation, and open the system
to the more easy operation of the remedies Of all
the means to rouse the sensibility to the influence
of our medicine, venesection is by far the most
immediate and efficient; and as all the affections
of the alimentary Canal an Characterized by deficiency
of susceptibility of impression, the lancet is 
in dispensible. But independently of the reasons
now assigned, we have another motion for early
and copious bleeding in dysentery, connected with 
the inflammatory state of the bowels are always
find a certain degree of spasmodic construction
attended with severe pain, apposing a barrier



barrier to intestinal evacuations. 
To overcome these constrictions, venesection
possesses emuiatted power, and the heat and
dryness of the skin (not raw attendants) are by
its means removed, bring [cross out] replaced by
an agreeable moisture and relaxation.
After having accomplished these views, it is 
our duty to administer purgatives to clense to
alimentary Canal and evacuate the intestine
contents.
For this purpose Castor Oil has been long
selected, and is on mild curses are excellent remedy.
But to be effectual, a much larger do
is necessary than that Commonly given, such as
two or three ounces in a day. I have long thoug
that our dose of medicine, in bowel Complan
have been much too weak to be servicabl
Those who have seen Castor Oil adminis
Know that it passes very rapidly through the bowels-









195 
bowels-little altered by digestion, without carrying
with it almost any excrementitious, or bilious
accumulations. I cannot help, therefore,
during the mercurial purges preferable - especially
in the Dysentary of our Country, and more 
particularly when occurring in hot weather.
Do we not find this so in those cases where
thorough evacuations are desirable, and are
we not in the habit of giving them in all
bilious fevers; & what disease demands this 
evacuation So imperious by or Dysentary?
It is now a long time since I began to prescribe
Calomel in Dysentery either alone, or in Combination
with Rhubarb, and to use laxitive injections to 
facilitate a discharge when too long delayed, repeating
the injections till effectual. After having
obtained the discharge, I have not had occasion
to use Calomel again; Castor Oil, or still better
magnesia, being then sufficient to keep the bowels open.

No point in practice has been more warmly 
contested than with regard to the extent to 
which purging should be caused in dysentery -
It seems more pretty well settled
that we should continue the use of purgative
till stercoraceous or natural stools be produced.
This is a sound practical precept
and well worth remembering - Every and 
conversant with dysentery Known that while
any acrid matter remains in the bowels
it will be vain to look for a cure, for so 
long as it continues there it will aggravate
every symptom of disease
Bearing in mind that the discharges
are the effect of preexistent irritation - I 
have been in the custom of resorting to 
opiates sooner than any other practitioners
satisfied by my own experience of the utility 


197 
4
utility of the measure - I have no hesitated
because authority did not sanction or 
reputation compel - I have always considered
experience paramount to all
authority, and have when they opposed
sheet my eyes to the claims of prescription
practice and followed the dictates of 
experience - Ever since the days of 
Sydenham with but few exceptions
writers have been a verse to the Opiates
treatment. Even Cullen and the best
writers of the times make only distrustful
mention of it, or condemn it altogether.
Influenced by the now antiquated
nations of the humoral pathology, they 
seem to have mistaken cause for effect
and to have conceived the inflamation by 

by the discharge, but the discharge in dysentery 
is as much the result of irritation as 
that in gonorrhea or in the eye when excited
by the irritation of a grain of Sand
or other foreign matter accidentally
Cast into it. I am not however to
be understood as trusting to opiate alone
My object is to determine to the surface
as well as to allay irritation. The former
is very pointedly indicated by the condition
of the Skin, to which, the soundest
physiological opinions attribute in 
such case part at least of our disease 
I have therefore that sanction of or 
my practice. But it must still
be remembered that prior to all attempts









199
to all attempts to excite perspiration the
pulse and inflamitory symptoms must be 
reduced by the more direct depleting remedies
Without such precaution our attempts at 
diaphoresis will be unavailing
Dysentery perhaps less than any other of 
the bowel affections admits of a substitute
for the lancet. A practitioner of this city
was wont to say that with the lancet and 
opium alone he could master any case
of the dysentery. Though much maybe
done with these weapons. I cannot go
quite so far as he has done, nor exclude
from very practice many other remedies
which I have been taught to value
It is now more than half a century

century since Mark Akenside a distinguished
poet and philosopher, proposed the plan
of sweating for dysentery. Since that time 
his practice and theory with various modifications,
have been adapted by many eminent 
practitioners. Of these Richter is 
perhaps most zealous. He contended
that Dysentery is a Rheumatic or Catarrhal
affections of the large intestines and the 
biliary organs were only secondarily disordered
and were not therefore much to be 
regarded. I cannot go as far as Richter
either in theory or practice, In this 
case as often happens and excellent and important
[th??h] is injured by a too great disposition
to generalize. What is true in particular 
cases having been extended too far is in 

201
5
is in danger of being denied in to to a 
Catarrhal & Rheumatic cases of dysentery do 
indeed occur and there his practice is truly
useful. But the cases are rare and he who
assumes it as a general proposition & adapts
his practice to his theory may be tracked
on his own course by the mortality
which surrounds him, and follows
in his path. In delivering to you the 
cure of Dysentery, I had arrived in the 
end of last lecture at the consideration
of Deuphoretics. The Modus Operandi
of these medicines. I fully detailed to you 
in a former lecture. All which remains
at present is to point out the means of 
producing diaphoresis best suited to this 

this disease. My own experience has [cross out]
me to give a decided preference to a conjunction
of Ipec. Opium & Calomel in the 
following proportions
ꝶ. Opium grs. IV }
Calomel. grs. XVI }
Ipec. grs. VIII }
Confessedly this is not the most active and 
powerful diaphoretic we Know but it 
produces in dysentery effects more important
Composing intestinal irritation moderately 
relaxing the surface and gently opening
the bowels with other affects of as great importance
although not as readily understood
Indeed every practitioner has 
noticed the prodigious advantage derived
from small doses of Calomel in the 










203
Disease of the bowels which do good not 
less by checking the morbidly increasing
intestinal and hepatic secretion as by 
producing an immediate discharge from 
the bowels of that already secreted
Davey powder are infinitely more powerful and 
Certain, and where a copious diaphoresis is 
desirable will seldom fail to produce it -
but while intestinal evacuation is deemed at 
all necessary it is by no means so useful as 
the above prescription - No article of the
Materia Medica is so extremely usefull in 
dysentery as Ipec. either alone or in Combination.
Some practitioners have thought it 
peculiar applicable to those cases where the 
discharge of blood are so [cross out] profuse
as to resemble hemorrhage. This is no 

This is no doubt correct enough. But I see
no reason for confining its use to such cases
alone, deeming it alike to applicable to all
Dysenteries. I have seen it equally useful
in cases where severe pain was accompanied
by continual desire in to go to stool without
being able to evacuate. - This high 
opinion for Ipec. in dysentery Depends not 
on my authority alone. For more than 
half a century has it been used and extolled
by the most eminent practitioners all over 
the world. All of them unite in bestowing
upon it strong and unqualified commendation -
Nothwithstanding this unanimity
of opinion as to the utility of Ipec in 
Dysentery. Its mode of action is not so generally
agreed upon. - I cannot agree with Cullen 


205
?
with Cullen & Sir George Baker, that its whole 
utility consists in the purgative action it exerts
since an opposite affect is often produced
Nor that it depends on its diaphoretic influence
for we have many much more powerful
diaphoretics influence which still produce
not such an happy influence upon Dysentery -
I am aware that it has been 
said that the Antimonial preperations 
are better suited to some cases of dysentery
than even Ipec. itself I have given them
a fair and Candid trail and I must say I did 
not find them equal to Ipec. There is however
weight of authority against me Sir George
Baker declares the result of a long & observant
experience, to have been decidedly in favor of 
Antimony & Sir George Pringle and many 

and many writers of less note also give their suffrage
to Antimony. The attestation of Sir John
Pringle is not given strongly and unreservedly
I am willing to admit that cases have occurred
and will occur where the Antimonital
preperations may be & are superior in efficacy
to Ipec. which induces me to retain them 
among our means of curing dysentery
but as the cases in which this superiority is 
manifested have not been decremenated and 
as I have not seen them. I have always
given the preference to that medicine which 
has hitherto maintened in my practice
the highest efficacy ascribed to it 
As auxiliary to the Sweating plan you will
sometimes find warmth externally applied
of great utility. You all probably are acquainted









207
acquainted with the beneficial tendency of warm
fomentations to the Stomach and abdomen in 
diseases of these parts, particularly in relieving
spasms and promoting diaphoresis. It is 
not necessary to recapitulate the manner
of preparing them and applying these 
are already Known to you -
As might be expected from what was former
said, the warm Bath is also serviceable in 
this case as well the other bowel affections
an the same principle as the topical applications,
tho' much more effectual than they 
Nevertheless such is commonly the delay
and inconvenience in preparing the Bath
that it is not generally used in this case and 
may in most instances be dispensed with
It is however one of the resources of our art and 

and should be borne in mind being necessary
in extreme emergencies. As regards the cases
of Children these objections do not apply a
bath for a Child being easily prepared & and
is the more necessary being allowed to be more
usefull in such diseases of children than adults
Of late a remedy has been proposed to 
supersede the use of both the Bath and fomentation.
This is simply a roller or band of flannel
applied to the trunk of the body to afford heat 
See Dr Dewars } and mechanical support at one time
essay }
on bowel } Before commenenting on this remedy I
complaint }
shall read to you what has been said for it 
by the projector of the contrivance


209
4
As relates to the acute stages of Dysentery I have
had no experience with this roller but long before
I saw Dewars work on heard of his project, I had 
been in the custom of applying it in Diarrhea
the declining stages of Dysentery and especially
in Cholera Infantum. To its use I was led by
analogical induction and have found it
highly serviceable in the cases mentioned
After the inflamitory stages of dysentery
has departed it benefits as in Cholera [cross out]
Infantum by mechanically supporting the 
intestines and equalizing the temperature
But it is not particularly well adapted
to old chronic Diarrhea especially of 
elderly people By its application the majority
of cases may be overcome, without resort


to any auxiliaries and the same means will also
in most cases prevent an attack when threatened
Whether it is useful also in acute
cases, as I before observed I cannot say but 
I would not advise you to pemit it to supercede
those other measures so well there and approved
by all experience. Hitherto I have not
spoken of Blisters in dysentery. These are 
an important, and in many cases (consistent
with the safety of the patient) indispensible
application - They may be either applied
to the Abdomen or extremities - Here as in 
all other cases the remedy should be applied
as near to the seat of the disease as possible -
It is notwithstanding a very common practice
to prefer the application of the blisters to the 
extremities from the greater convenience of
(such 









211
such a measure. When the blister is applied
to the Abdomen, it is said the patient suffers
a great deal of pain from the effort at stool
But let me entreat you never to permit 
considerations of such a nature to deter you
from doing so when necessary - I have
always in my practice, after premising
a purge and one or two bleedings without
abatement or improvement always covered
the Abdomen with a blister, and have in
this as well as all the other intestinal inflamations
seen with delight the efficacy of
the remedy measure - Let me again enjoin you
in Dysentery especially when violent to Keep
your eye upon this remedy, nor suffer any 
tenderness for your patients feelings or pald
prejudices

prejudices prevent you from the application
of large blister. So great are these prejudices
that you will be obliged to exert
a good deal of authority at times, but you 
Know the necessity and must be determined
I have thus laid before you the general 
course of practice in ordinary cases of 
Dysentery; but there are one or two local
affections dependent on it so painful as 
to demand our particular attention
Of these the chief are tormina and tenesmus
Symptoms which sometimes attend the disease
throughout though they are generally seen towards
the close 
Many are the remedies prescribed
for their removal, into all of which Opium enters
largely When the tormina
 

293
8 
When the tormina seems connected with foul 
accumulations within, no remedy seems more 
suitable than the following
ꝶ. { Castor Oil ℥i
{ Gum Arab ʒij
Oleginous Mixture { loaf Sugar ʒi 
A table Spoonfull { Tinct Opii grs 60
every 3 or 4 hours { Aqua Menthi ℥ij
This mixture lies much better on the stomach
than the pure Oil and one or two doses of it alleviates
generally - The Cretaceous julep formerly
mentioned also does well and in this 
case. I have found much advantage
from a combination of Ipec and Opium
under the same circumstances, given in the 


in the proportion of One grain of the former with 
from 1/2 to 1/4 of a grain of the latter.
But in Tormina & Tenesmus nothing perhaps
is superior to Opium alone thrown into the 
rectum as an anodyne injection, Where such
a preperation from excoriation or other causes
irritates too much 3 or 4 grains may be formed
into a pill and thrust half an inch or so up
the anus and lodge there. This produces
much less irritation and at the same time
is quite as usefull as the liquid injection
It may be observed in passing that this 
mode of applying Opium is usefull in all
those cases where prejudices another causes
prevent the use of Opium or laudanum
by mouth Best of all however for tormina
and tenesmus is an injection of 
melted










216
melted butter quite fresh without any saltness
or rancidity. Half a pint or a pint of this 
may be thrown into the rectum every 3d or 4th
hours. This is much superior to Olive Oil
or any vegetable preperation. You should
know that fresh animal Oil is milder and less
irritating than the freshest and mildest vegatab
Oils, and therefore when you find in any case
when injections of Olive Oil are used that 
they irritate, substitute animal oil or butter
As yet I have made no observations on
Mercury given with a view to Salivate
Consulting Medical writers especially of 
the East and West Indies on the subject
I find they rely almost entirely on Mercury

Mercury in Dysentery. But all the 
objections which mutilated against its use
in Yellow Fever and other acute inflamitory
complaints apply with equal force in the 
present case. It is here as in the other
cases of very difficult to produce a salivation
and when the inflamitory action has been
so far reduced as to enable us to get at the 
impression, the patient would probably
get well without further treatment.
There are in this as in other violent disease cases of a 
protected Kind where as also when symptoms
of malignity or typhus appear, Mercury
is the best remedy. It should in 
such cases be exhibited internally and 
externally pouring in through every
avenue. To conclude the consideration


consideration of that form of the dysentery of which
we are now treating, we have only a few remarks
to make on the subject of diet -
Being an active inflamitory disease the 
aliment should be of the least irritating and 
offensive Kind rather fluid than solid to 
give as little stimulus as possible - What
practitioners as well as the vulgar have used
in such cases are demulcents, the least 
disagreeable of which are barley or rice water
mucilage of Gum arabic - flax seed tea,
Slippery Elm - leaf Sugar & Water. tapiocha
sago, arrowroot &c &c - It has been said 
of these demulcents that while they afford
proper nourishment they also prove usefull 
by diluting the acrimonious contents of the 

of the intestines and sheathe the viscera
from irritating matter. These are notions
borrowed from an absolute pathology
The idea of sheathing an active living
surface is a downright absurdity
Diluents are undoubtedly usefull
Kinds of nourishment, and when we have
granted this, we have granted all that an 
enlightened phylosophy, or sound medical
reason permits us to grant -

219

400-

221
401 
I had in the lecture of yesterday brought
my remarks on the acute inflammatory cases of 
Dysentery to a conclusion. I have now to treat
of the other forms.
In crowded places such as ships, jails
hospitals &c and render peculiar distemperature
of the atmosphere, Dysentery assumes throughout
some degree of Typhoid action. Under such 
circumstances it is sufficiently obvious that a 
practice different from that detailed must be 
pursued. The proper course is to address to this 
case the same treatment pursued for intestinal
symptoms of other low diseases. Therefore as 
in Typhus fever, emetics must be early administer
and after a moderate evacuation of the bowels, the 
plan of Stimulation with opium, vol. Alkali,
wine whey, and the liberal rise of Blisters must 
be 

be pursued, a course of treatment in which 
the most eminent practitioners repose full
confidence. But as I have observed an a 
former occasion when Dysentery displays from 
its commencement typhoid phenomena or 
acquires them in its progress. I believe the 
safest and most effectual plan of treatment is 
to at once administer Mercury with a view to 
salivation, Hetherta. I have never seen the 
System put completely under the dominion of 
Mercury without observing an immediate
abatement of the Symptoms and a subsequent
convalescence - The reasons why we do not 
recommend this course in all dysenteries I 
have formerly detailed to you, but the objections
to the practice in those cases are not applicable
to its rise in low stages, and as it's utility
is 










225
is undoubted. I earnestly recommend it to you.
During the application of the Mercury which 
should be both internally and externally, the patien
should be sustained by the administration of the 
diffusible stimulants. 
It is probably Known to you that Dysentery
now and then assumes a remittent or intermittent
form, Cleghorn notices such cases in his works
on Minorcal and I have seen them in Alm's
house patients from miasmatic places.
Moreton the Contemporary and rival of 
Sydenham first pointed out this peculiarly
recommending along with the usual treatment
the administration of Bark in the Apyrexia.
This practice has been imitated by Cleghorn
and many modern physicians. In spite 
of all this weight of authority I deem this 
practice

practice neither correct nor feasible - In
all the cases I have seen I never observed
any opening for the administration of Bark
and had it been given it would undoubtedly
have produced mischevious effects. No 
article of the Materia Medica is more 
irritating to an inflamed intestine than 
Peruvian Bark and even where sound, the 
effect is so disagreeable sometimes as to 
preclude it's use. My plan of treating 
Dysentery combined with an intermittent
action is to disregard the intermittent until
I have overcome the bowel complaint when 
I apply to the former the best remedy in 
such cases. Having hitherto treated of 
the acute forms of Dysentery. I shall
previously 

221
(2)
previously to dismissing the subject entirely, speak
of the chronic shapes of the disease.
To a certain extent this is a different kind
of disease, though it has not attracted the attention
it deserves. In this case although the acute 
symptoms have disappeared the bowels still
remain delicate and easily excited into action by 
the slightest causes. The evacuations though
small consist chiefly of mucus of a very feculent
and offensive nature, the voiding of which by 
stool is accompanied with more or less pain an 
griping. The appetite is very poor and the food
is not digested. The skin is dry and parched, th 
complexion sallow. the eyes sunk with an 
expression of meagreness diffused over the whole 
Countenance 

Countenance evidently indicating the 
confinement of the blood to the great vessels
with a diminished circulation of the surface
I have encountered many such cases
which I have always found to resist the 
ordinary treatment with tonics &c. But 
they have usually readily yielded to Dovers
Powders assisted by the means for producing
a gentle relaxation of the cutaneous organs
and a steady Diaphoris. This is a case
in which the flannel band or roller
formerly mentioned is of the most decided
utility. The most protracted cases
however are those where there is a morbid
condition of the liver or other visceral 
In such cases the best plan is, to add to the 










227
the means just mentioned Calomel in very 
minute doses which will be in general sufficient
for a cure.
10th feby 1817
Since lecturing to you on Dysentery
I have received a number of the Edinburgh medica
and chirurgical journal in which I find a 
new mode of treating it reported by a Practitione
of the East Indies. In eulogizing the 
virtues of his remedy he says. The medicine
I allude to is Ipecacuanha in a dose of from 
30 grs to ʒi in combination with an equal 
quantity of laudanum. In the years 1813 &
1817) being employed as Surgeon of an Indiana
I found that after a course of wet weather a 
Dysentery of so obstinate a nature attacked the 
crew that I could make no impression upon it 
with 


with the usual remedies. I therefore varied
their quantities and combinations in every way
but still without success. At last as I found 
a combination of Ipec and opium made mare 
impression upon the disease than any thing else, 
though it did not cure. I determined to try the 
effect of a much greater quantity than is usually
administered. I therefore laid my patient in 
a horizontal posture enjoined him to remain so
and exhibited from ʒss ad ʒi of Ipec with from 
30 to 60 drops of laudanum. The Dysentery was 
accompanied with [cross out] torminal tenesmus griping and 
tremendous fever, and yet though the first dose was 
generally rejected, the second remaining on the Stomach
gave pleasing relief There was no more 
inclination to stool for several hours when a loose 
discharge took place without termina and 
tenesmus. A second dose was not often necessary
The medicine was most useful when early administered.



229
3
De Diarrhea
That Diarrhea is closely allied to the 
milder forms of Dysentery is very apparent 
Nosologists have endeavoured to 
distinguish them by alleging that Diarrhea
is not contagious, is unaccompanied by fever
or inflammation, and that the discharges though
by no means natural are not mixed with bloody
or vitiated matter and are not attended with 
such severe tormina and tenesmus as Dysentery.
All this may be true enough in general
but if you take a severe case of Diarrhea and 
a mild case of Dysentery you will find it 
impossible to distinguish them from each other
Diarrhea may be defined a morbid 
increase 

increase of the peristaltic motion. So
numerous are the causes and so varied the 
forms of this disease that it would be vain
with our limited time to treat of all. I 
shall therefore consider Diarrhea as of two 
kinds, Idiopathic and Symptomatic.
The first or Idiopathic Diarrhea
may arise from causes acting directly on the 
Stomach or intermediately by impression on 
the general System - The first class of 
causes are generally ingesta operating either 
by their quantity and quality, and amongst
the latter may be enumerated checked
perspiration, vehement passion, excessive
fatigue and all those influences which 
operating more violently produce Cholera
morbus 









231
morbus or Dysentery - In the managemen
of Diarrhea two indications present themselves.
The first is to remove the morbid cause and the 
second to check intestinal action by allaying
irritation and promoting the tone of the bowels.
Persuaded that purges would but offend
the bowels I think emetics are best suited to our 
present indication after whose operation a dose
of Rhubarb may in most cases be usefully
administered. Should fever attend as is 
often the case venesection is required succeeded
most properly by those diaphoretics of which
Opium is the basis. Similar to the treatmen
described is that for those cases produced by 
other causes except that arising from checked
perspiration - In this latter case although
evacuations 

evacuations are excellent they are not totally
competent to a cure, but must be assisted
by some means to restore a healthy action
to the Surface. The means are the warm
Path and Spiritus Mindereri &c -
In recent cases of Diarrhea the 
treatment is very simple and the cure easy
But when they assume a chronic form 
or are more or less dependent on depraved
condition or organic affection of one or other
of the chylopoietic visceral - they prove
much more difficult to manage.
Here our first case should be 
directed to the State of the System. No
matter what may have been the cause if
the pulse be tense and corded we should 
not 

233
(4)
not fail to bleed. Experience has well established
the excellency of this remedy and dissection has in 
fatal cases shewn a degree of inflammation, condemning
the practitioner who had neglected to bleed. One 
bleeding will not, however copious generally or even
in a few cases prove sufficient. Chronic
Diarrhea though not so dangerous as acute cases
has a much more complete possession of the patient
having been established by time and therefore proves
much harder to combat - Be not discouraged then
if you find apparent good result from a first
bleeding, but persevere so long as the condition of 
the pulse and patient permits and you will have 
good reason to be satisfied with the remedy. I have 
in these cases bled a patient ten or twenty times
abstracting from six to eight ounces of blood each 
time


time; thus effecting cures which without a 
steady pursuit of this plan could not have been
accomplished - As a part of the same 
causes of treatment emetics of Ipec should be 
administered two or three times a week - 
Although the evacuation thus produced may 
be useful the chief advantage from the Ipec
is the breaking up the old chain of associations
renovating the system and establishing a new 
set of actions in the alimentary canal
After this full impression has been
made let the following prescription be 
administered
ꝶ Pulv Rhei - gr XXX
- Ipecac - X 
Gum Opii - V 
Divide 









235
Divide in pie decem sumeatur una 
gg secunda vel tertia hora per diem,
N Mocti X gr Pulv. Doveri cum
diluent: tepid.
Much advantage will the patient derive
from a regular and habitual use of the warm 
bath, but to obtain its full effect it will be 
necessary to mingle with it some stimulating
substance such as Salt mustard Cayenne
Pepper &c - After the patient goes to bed 
let him be rubbed with a flesh brush till a 
fine glow is diffused over the surface of the body.
If all these means prove unavailing we 
must then resort to some of the preparations of 
Alum, which are of high importance in Diarrhœa
especially this stage of it. It operates as a 
tonic 

tonic on the bowels, yet may be so
administered as to prove evacuant at the 
same time and where we have reason to 
suspect the least remnant of increased 
action in the bowels this medicine is always
selected. My mode of giving it is in a dose
of five grains with 1/2 gr opium three or 
four times per day - Cases occur
in which small doses of Ipecac are advantageously
administered They seem peculiarly 
suitable when the sky is dry and the bowels
affected with griping & other uneasy feelings.
It is with the utmost confidence
[cross out] I press this remedy on your attention
for many years of experience of its power
in Diarrhea entitles me to hold this 
language 

237
(5)
language and to decide upon it's efficiency
More than once have I alluded to a 
combination of Alum with while vitriol,
which has been so much extolled by Dr
Moseley in Diarrhœa & Dysentery under the 
name of the vitriolic solution -
Vitriolic 
Solution 
ꝶ White Vitriol - ʒiii
Alum - ʒi 
Caccinella - gr iii 
Aq fervent - lb i 
Cola Dos umem cochlear:
mane sine cibo - 
See Moseley on Diseases of Tropical Counties
Article Dysentery 











239
Of the excellence of this remedy I cannot 
say much from experience. I have tried it in one 
case and had reason to be pleased with it's effects,
It is however liable to excite nausea and othe
very distressing effects in the Stomach so much 
so that few stomachs will bear it in the smallest 
dose - It was nothwithstanding this much 
sided at one time in this place though now nearly
obsolete. Dr. Barton deemed it superior to every 
remedy in Chronic Diarrhœa and spoke of it
every where with enthusiasm, That it is a 
powerful tonic may be a priori concluded
from a consideration of the materials which
compose it. But it has also the evidence of 
many eminent men on this head. It is still my 
duty 

duty to tell you that notwithstanding all 
which has been said in it's favour that it's
other effects are so very disagreeable that 
the patient will hardly ever submit to 
a continuance of it's rise
It now remains for me to speak of 
Blisters. By the unanimous voice of 
Medicine are Blisters recommended in our 
present cases, they should be applied to 
the extremities, alternately to the wrists and 
ancles. It was the opinion of Dr. Rush
"That this alternation was of infinitely more 
rise in Diarrhea than any other mode of 
application." Blisters act on the principle of 
revulsion, abstracting action from the centre
to the surface. They benefit too by breaking 
down that confirmed and habitual train of 
associated 

241
(6)
associated actions upon which the disease
depends, but to fully accomplish such a purpose
they must be continued for weeks in succession -
The surface and intestines appear to be like 
analogizing powers and by thus continually
irritating the Skin we by degrees create an action 
which overpowers the preexistent action in the 
intestinal canal and restores the equilibrium 
of the System.
7th- feby 1817 
Of the several forms of Diarrhea 
proposed to be treated of one still remains. This 
is that Diarrhea which depends on a mere 
debility or relaxation of the intestinal canal 
This form of it often succeeds an inflammatory
one, but it is frequently a primary disease
derived from emaciation and weakness of the 
intestinal organs and various other causes. 

The indications to be pointed out in this 
form of disease are very simple try to restore
tone to the stomach and bowels. With this 
view the whole catalogue of tonics and 
astringents have been run through. Among
the best of these are Galls alone or in 
combination. The following Recipe I can 
recommend 
Mistura
Gallanrum
pro chron.
Diarrhœa
ꝶ. Infus Gallæ Robust ℥ IV
Cretæ ppt. ʒ IV
Tinct opii ʒ i
inf Cochl mag sumatur quaque
tertia quartave horâ - 
The next most useful remedy 
is Kino given in powder, in watery solution
or in Tincture. I am more partial to the 
following prepartion. 
Mistura 
Kino 
pro Chron. Diarrhœa
ꝶ Tinct. Kino ʒ IV 
Creta ppt. ʒ IV 
Tinct. opii ʒi
Aq font ℥ IV 
Dos. utsupral










[2?3]
As a mere astringent much credit has been 
given to Dogwood, which I have before observed was 
formerly employed in the city largely in Cholera
Infantum and Chronic Diarrhea. It is 
given in strong decoction a table spoonfull or 
more for a dose. Our own Country
produces several excellent remedies of this class
for Diarrhea. The first of these I 
shall mention is the Peranium Maculatum
The root of this plant boiled in milk is said 
to exert some power. I have had no personal
experience of the value of this prescription but 
have no doubt of it's excellence being attested
by men of eminence and veracity. -
The native article I have most successfully
employed and which I therefore prefer to all 
others, is the Rubus 


Rubus procumbens or Dewberry plant.
and 
Rubus and Villosus or Black berry plant.
The decoction of these plants has been most 
successfully employed both in Cholera
Infantum and Chronic Diarrhea and 
all the Chronic Bowel affections -
A comparative examination of the powers
of these two medicines induces me to give 
a decided preference to the Dewberry
I have already treated of the mineral
astringents, particularly of the preparations
of alum and lead. It is not necessary
therefore again to repeat the description of 
their properties or mode of administration.
I must not forget the great power of the 
mineral acids, especially in old protracted
Diarrhea

281
(7)
Diarrhea- While we recommend the 
mineral acids in these complaints, we will 
caution you not to use any of the vegetable
acids, which are not only disagreeable but 
detrimental, aggravating all the worst 
symptoms of the disease. But the mineral
acids have a very different effect. Of these
the Sulphuric and Nitric Acids are
most commonly employed. The latter is in 
my opinion greatly to be preferred and is given 
in a dose of from ten to fifteen drops
gradually increased until forty or fifty are 
taken 3 or 4 times in the course of a day.
Little very little however will the best 
remedies of our materia medical avail, unless 
great 

great attention be at the same time paid
to the diet and clothing of the patient, and 
all remote and exciting causes of the disease
be studiously avoided. -
Many Diarrhœas especially when of 
long standing are connected with Dyspepsia 
or a depraved condition of the Stomach.
Indeed I have never seen this form of 
Diarrhea unaccompanied by a greater or 
less degree of stomachic disorder. In such 
cases therefore the same rules respecting Diet
may be observed which were laid down in 
treating of Dyspepsia - Where the gastric
affections are well marked the tone of the 
Stomach should be promoted by those means 
resorted to for that purpose in Dyspepsia of 
which 









247
which the preparations of steel are most 
appropriate. By thus addressing your 
remedies to the symptoms of Dyspepsia you will
frequently remove the Diarrhea, especially as I 
before observed in those cases where the gastric 
disturbance is a prominent feature.
To the observations formerly made
regarding the equalizing the temperature of the 
Surface. I have only to add that the flannel
band or roller is here a most suitable
Instrument for that purpose.
After your most strenuous efforts
with the weapons already placed in your
hands to conquer this obstinate disease, have
failed, do not dismiss the case in despair 
for till you have tried Mercury you have 
no 

no cause to be hopeless - This is a 
medicine most imperiously demanded in 
all cases where the symptoms indicate
a derangement of any of the Chyloporetic
viscera and where this is not the case 
Mercury by instituting a new set of 
actions in place of the old morbid ones 
will commonly effect a cure where all 
other means have failed. Still if 
unsuccessful, we have a resource which is 
of most sovereign efficacy. I mean exercise,
procured by a long journey or voyage. It is 
indeed useful in any form but particularly
so on horseback which mode should be 
preferred when the patient's strength
and other circumstances permit -
De obstipatione 

249
(12)
A remedy for worms, long and highly
esteemed is Spigelia Marylandica or 
Pink root - This is given in powder or infusion
of the former to a child of three or four years of 
age five or ten grs. mane et vespere, to an 
adult ℈ij ad ʒi. Spigelia is usually combined
with Calomel or jalap in equal parts of 8 grains
each which hardly ever fails to cure. The 
most common preparation of spigel: perhaps is an 
infusion ten oz, of the bruised root is thrown into a pint
of hot water which is slowly simmer'd away 
to half a pint, and the dose of the infusion is 
to a child one table spoonfull three, or four 
or five times a day - It is a medicine which 
requires careful watching, during it's exhibition
for it now and then produces even in small 
doses 

doses a whole train of nervous disorders,
vertigo, pains of the head, perverted vision &c -
It has been contended that these effects
are the production of the parasitic plant
often found upon the Spigelia. But from my
own experience I give no credence to the tale.
An over dose operates like the narcotics, shewing
the quality of the plant which most probably
destroys the worms - Although the 
infusion is a common mode of giving it. I 
hesitate not to prefer the powder in 
combination with Calomel or Jalap by which 
means it seems to be divested of it's power of 
exerting a narcotic influence on the system
without having it's vermifuge quality at all
impaired. The same effect results from 
a 









[2??]
a combination with equal parts of Senna.
Virginia Snake root is said to divest it of it's 
narcotic, without injuring its anthelminthick powe
of this latter circumstance I have no experience.
Mr. Lehman a Druggist of this city vended
a medicine celebrated throughout the whole U.S.
for it's great vermifuge efficacy - It appeared
as a nostrum whose composition was studiously
concealed, but which has been discovered to consist
of equal parts of Spigelia & Senna with a few 
leaves of Gavin which was infused just as the 
simple spigelia alone. As a 
vermifuge of some power I shall next speak
of Helleborus fetid: of this the dose for an 
adult is from five to ten grains for several
nights in Succession, graduating the dose for children
according 


according to age and circumstances. -
For Lumbricoides this medicine is 
esteemed a very excellent Anthelmintic, and 
although I have not used it. I do not doubt
it's efficacy, which is well attested by the 
most eminent Physicians both of Europe 
and our Country. - Dr Dellitt celebrated
for his cures of verminose diseases endeavoured
to conceal the ingredients by whose combination
he produced his remedy. But after a time 
Dr. Coon discovered that it consisted of 
Helleborus fœtidus with a small portion
of Ethiops mineral - Great caution is 
requisite in the use of this medicine which 
is very poisonous and sometimes productive

[253]
(8)
De Obstipatione 
Before finally dismissing the subject
of bowel complaints, it remains for me to make 
a few remarks upon a very opposite condition
of the Intestines to that hitherto treated of 
I mean obstinate Constipation or Costiveness
This is a relative term for while some individuals
have lived days, weeks, months, years
without evacuation Men in general find a 
regular periodic daily alvine discharge necessary
to the enjoyment of a tolerable degree of Health.
Haller's great work on Physiology
contains many instances of the former and 
Dr. Rush relates the case of a Captain of a 
vessel 

vessel trading to London who from the 
moment of embarkation till his arrival at 
that port was without evacuation. Still
the world in general find such irregularity
incompatible with Health and that constipation
produces head ache, vertigo, nausea, fœtid breath
and many other disagreeable proximate effects
while it's remote consequences are still mare
disagreeable and sometimes fatal.
The numerous causes of this disease
may for our present purpose be included
under two heads vizt- , First, a deficiency
of irritability in the intestines, and secondly
a deficiency or vitiated condition of the 
biliary secretion. The disease produced by 
either cause may be commonly removed 
by 









2128
by a brisk purge, succeeded by the use of 
mild laxatives - The best laxative for 
this purpose is the combination of Sac Sulphuris 
and Calcined magnesia. The purges best
suited to constipation from the second cause 
are the mercurial purges, - they are peculiarly
suitable to correct the vitiated secretion in the 
liver. When they fail to effect this 
purpose a gentle salivation will do it. In 
those cases produced by a deficiency of bile
owing to what may be termed a locked up 
condition of the liver, you will find the bile 
of any animal an excellent substitute. I
have employed the bile of the Ox in doses of 
ten or fifteen grains in pill. 
To cooperate with these remedies
inculcate 

inculcate upon the patient the great 
importance of daily soliciting an 
alvine evacuations by regularly
repairing to the place for that purpose
even when he feels no desire whatever. 

217
191
De Vermibrus.
I know not how correct it may be to 
place the verminose diseases among the bowel
affections; but I do not see a more appropriat
situation for them.
The Worms inhabiting the human 
intestines may be distinguished by the terms
round and flat, each of these being a genus
of which there are Species. The Species of 
round worms are the lumbricus, the ascarides
and the Tricurides - The Species of the flat 
worm are the Tænia and Cucurbitinus -
The Lumbricus so nearly resembles the 
common earth worm that it has been 
considered as the same animal, but a closer 
inspection 

inspection discovers a difference. The 
residence of this worm is in the duodenum
jejunum and ileun. They are but rarely
found in the large intestines or Stomach and 
when there, have most probably been attempting
to make their escape, being rendered uncomfortable
by some disease or medicine - they are from 
five to ten inches in length and exist often in 
great numbers, twenty or thirty having been 
expelled by a single dose of medicine.
The Ascarides are generally found in the 
rectum, though from having been sometimes
seen in the Stomach, they have obtained the 
name of the mawworm, they have very much 
the appearance of pieces of cut thread.
The Tricurides or thread worm have a 
kind 









219
kind of tail with a very long proboscis which
they can retract & thrust out at pleasure. These 
worms are very rare and by no means fully described.
They reside in the Ileum. - 
Of the flat worm there is strictly speaking 
but one species the Tænia or Tape worm. This 
worm is often of prodigious length, extending from 
ten to fifty feet They are of a jointed structure
and these parts sometimes fall apart and it is 
said form a distinct worm called 
Cucurbitinus which some Naturalists
contend does not consist of a portion of the Tænia
but that it is an independent worm, sui generis
The origin of these worms in the human 
body affords an opportunity for a curious and 
highly interesting speculation. But as such an 
investigation 


investigation is beyond my province and as 
it would lead us into a consideration of the 
generation and mode of nourishment of all 
parasite animals. I beg leave to pass over
it in Silence. The several species I have
enumerated appear to be peculiar to man, not 
having been discovered elsewhere and perishing
upon removal. Professor Pallas has indeed
asserted that he has seen the tape worm in 
the waters of Siberia, but the Story is hardly
worthy of credit Although the 
origin of worms has not been ascertained, we 
are well acquainted with those circumstances
which favor their production. Thus when 
we see great emaciation and a debility
especially where the bowels share it we 
may 

261
(10)
may suspect in Children particularly, the 
existence or at any rate the speedy generation
of worms - Children appear more liable
to worms after five years of age than at any 
other period of live, which though certain enough 
has not been well accounted for. It has been 
imputed to the superior quantity of mucus then 
generated which forms a nidus for the production
development and nourishment of these animals.
It is now a long time since the dispute
commenced which still exists, whether worms 
are in themselves noxious or ever produce
originally or necessarily any disease - This 
point was most warmly contested. One party
affirmed that all the diseases of children were 
produced 

produced by the irregular movements of 
these animals in the intestinal Canal; while
the other alleged that they were so very 
harmless as to deserve no consideration
whatever; Nay that they were even useful
being employed as Scavengers, to remove the 
undigested sordes and thus to cleanse the 
Stomach and bowels - The latter opinion
is not only incorrect but when carried into 
practice, dangerous also. Whoever is at all 
experienced in the diseases of children knows 
this. I have seen not only febrile, but 
many other kinds of diseases produced or 
aggravated by worms. Indeed there 
is hardly one single disease which may not 
be 









263
be excited or imitated by this cause.
Epilepsy Chorea, Dysentery, obstinate cough,
affections of the head, Cynanche Trachealis &c 
have been known to result from worms.
Dr. Huxam details a case of Pleurisy
succeeded by a discharge of worms, which could
not be cured till then - In this city I attend
with two eminent Physicians a case of Dysentery
which resisted our utmost efforts to overcome it
The accidental discharge of a worm gave reason 
to suspect the cause, Anthelmintics were 
administered and an immediate recovery
followed. I was called up in the night to see 
a child with croup, and found those remedies
which had been so certainly successful in other 
cases 

cases totally inefficient here. But towards
morning the efforts to vomit brought up a 
warm and from that moment the whole
Symptoms abated and the child got well.
All the neuroses have been produced 
by worms, but there often results from them 
a peculiar febrile affection which we may 
well term the Verminose fever.
This is a slow irregular remittent fever 
attended with heavy drowsiness during the 
exacerbation and morbid vigilance during 
remission. The bowels and pit of the Stomach
are pained, purging occasionally occurring and 
great gastric distress. There is sometimes
Stupor and sometimes delirium, the eyes
wild, the pupil dilated, the alæ nasi 
contracted, the cheeks flushed, the forehead 
polished

208
(11)
polished; every symptom indeed, giving this 
disease so much the appearance of Hydrocephalus
internus, as to readily cause a mistake.-
Two circumstances however are sufficiently
distinctive vizt. the strange alternation of the 
voice and sometimes total loss of speech in the 
verminose disease - It is my duty here to inform
you that Dr. Butter a Gentleman of great celebrity
and knowledge has positively denied that this 
peculiar fever is occasioned by worms, asserting it's
cause to be an accumulation of crude matter in 
the intestinal canal, and recommending purges
alone, for it's removal. - In most cases I 
believe him to be right but think his 
position too general and indiscriminate.
Considering worms therefore as sometimes
productive 

productive of a peculiar febrile affection
I shall proceed to point out to you the 
appropriate remedies. The Lumbricus
as has been observed before may be suspected
in emaciated children with weak bowels
especially when the Stools are mucous or 
slimy. But they are often found also in 
children of quite an opposite appearance
being florid and robust in whom they seem
to exist without injury. The disease they 
produce is known by intestinal irritation
pain in the belly frequent Diarrhœa, a 
variable appetite, craving food immediately
after a meal, or refusing all food, gorging
voraciously and sometimes desiring the most 
indigestible or outre articles, a fœtid breath 
in 










267
in the morning, pale complexion, swelled upper
lip, livid circles round the eyes, tumid belly at
night, disturbed Sleep starting, grinding the teeth
and frequently waking, picking the nose in the 
day time, head ache, dry cough, slow fever,
spasms convulsions. None of these Symptom
alone are sufficient to enable us to ascertain the 
disease fully, but a concurrence of several of thes
would be enough to justify the conclusion that 
they were produced by worms. 
Dr. Heberden after fifty years
experience declares that he considers the swelled
lip and contracted condition of the ala nasi 
to be almost certainly pathognomonic of worms.
For Lumbricordes perhaps the most 
useful and efficacious remedy, is large doses of 
Calomel.

Calomel- As an Anthelmintic it 
should be administered in doses of seven or 
eight grains to a child two years old, and 
worked off next morning by means of Castor
Oil and other Medicines of the same nature.
If this does not succeed in expelling the 
worms the Calomel should be repeated and 
followed again by Oil &c every second or 
third day till effectual - The Drastic
purgatives all of them, possess more or less power
in this disease, they once were looked on as the 
sole Anthelmintics, but whether they exert
any more than a cathartic power seems
problematical, though they certainly pave 
the way to the more effectual operations of 
more determinate vermifuge medicines 
A

[209]
(13)
productive of very bad effects -
Melia Azedarach. - or pride of 
China or India is also extolled for its anthelmintic
powers - As a vermifuge the virtue resides in the 
root or rather the bark of the root. It is in very 
high repute in the Southern section of the U.S.
where it is commonly given in decoction saturated
of which the dose to an adult is a small tea cup
full. - the Powder is also sometimes exhibited
but the former mode is preferable . -
My own experience with this article is 
too limited to enable me to decide on it's powers,
but in the few cases in which I have given it
I was very much pleased with the result -
Such however is it's reputation in Georgia and S.
Carolina that it has nearly entirely Superseded
the 

the Pink root in those States. It seems to 
be most effectual in cases of Lumbrici. and 
I do not know whether it is useful for any 
other of the round worms - I have been
informed however that it has been successfully
administered for Tænia - As this medicine
also is narcotic and sometimes productive
of the nervous disorders, circumspection is 
necessary in it's administration. 
The Chenopodium botrys or 
Jerusalem Oak is also to be placed among
our vermifuge remedies. No part of the 
tree is destitute of anthelmintic Virtue.
The expressed juice of the recent leaves
may be given to a child in a table spoonfull
dose Māné et vespere. The seed
however 









271
however are much more commonly given in the 
same dose with Molasses It has been lately
fashionable to prefer the Oil especially for children
which form has nearly superseded every other in 
our City. - I once esteemed this Medicine
very highly, but of late my confidence in it's 
power has been much shaken by a number
of failures with it - It is nevertheless so 
much esteemed by many of my most judicious
medical friends that I would not be warrante 
in denying it's utility - The dose to a child 
of 3 yrs of age is five or six drops, māné et 
vespere. After 3 or 4 days the oil
should be laid aside and a mercurial purge
administered. If the worms do not come
away, begin again with the Oil and pursue 
the 

the same course - This dose is much
too small; 12 or 13 drops being necessary to 
produce a full effect. This Oil as well as all 
the other preparations of the plant are
objectionable on account of the acrid disagreeable
taste and unpleasant odour which it is 
altogether impossible to obviate being so 
tenacious. So valuable is this medicine
that if we could divest it of these defects it 
would rank as a vermifuge next to the 
mercurial preparations. These are perhaps
all the anthelmintics produced by our 
Country; a very remarkable proportion.!
Among the foreign vermifuge
medicines is the Geoffroeal Inermis or 
Cabbage - Bark tree, or worm Bark tree 
of Jamaica,

[275]
(14)
of Jamaica, the bark is the only part of the 
plant possessing this power and may be given in 
powder, decoction or extract: The decoction is to 
be preferred, formed by boiling ℥i of the bark in 
a quart of water, till the liquor becomes of the 
colour of madeira wine. This medicine
also requires caution in using it, for it is apt to 
produce many bad consequences such as violent
vomiting, purging, delirium &c. especially when 
given to delicate women or children. So loudly
however do the practitioners of the West Indies
as well as of England and America, speak in 
favor of this remedy, that I recommend it in 
spite of the bad consequences sometimes resulting 
from it, The dose of the decoction is two table 
spoonfulls 


spoonfulls for an adult, of the Extract. three
grains, and of the powder are drachm, graduating
the dose for Children in proportion to age and 
circumstances. These are all the 
approved remedies for cases of Lumbricoides,
and we are thus brought to a consideration of 
those appropriated to the treatment of 
Ascarides. - These as I formerly
observed are small worms inhabiting the 
rectum or lower portion of the intestinal tube
occasioning an itching in these parts, and 
sometimes considerable irritation especially
when the patient is in bed thus disturbing 
his rest and preventing Sleep - They even 
occasion at times tumefaction and 
inflammation of the fundament with 
Tenesmus 









275
Tenesmus and evacuations of blood. Resides
these symptoms which are peculiar to the 
Ascarides, they occasion all the effects and 
phenomena presented by the other Species of 
worms. There is one very conclusive proof of 
their existence viz. when they as frequently happen
creep out of the anus or are found entangled 
in the feces when evacuated. Of the 
general remedies. Calomel combined with som 
of the drastic purgatives, seems to enjoy the 
greatest confidence - I have administered this 
medicine with very varied results, which seems 
to be pretty much the character of all the 
general vermifuge remedies. From this 
particular determination to the rectum, the 
Aloetic purges seem peculiarly suited to the cure 
of 


of Ascarides. Given alone Aloes act as any 
other purgative, but in combination with 
Canella alba they exert a peculiar power on 
these worms. This combination called 
Hiera picra from the Arabic operates as a 
vermifuge with much greater power than Aloes
alone, but why this is so seeing Canella has no 
power itself has not been accounted for.
But as I have often observed when facts run 
counter to theory it is folly to indulge in the 
speculation - This is deservedly a very 
popular remedy in this place and has been 
found to succeed in expelling Ascarides
when every thing else had proved ineffectual
ꝶ Hiera picra pulv. ℥i. }
sprt. Ardent lbj }
digere - dos cochl }
magnum. in aquâ }
donec purgat }


277
(15)
After all nothing in this case is so 
certainly effectual for the expulsion of Ascarides
as injections, for they can be applied without 
change to the worms & wash them out by 
mechanical power, when their medicinal 
properties do not suffice for expulsion.
These injections consist of lime water, or Olive
Oil, or animal butter or fat, the expressed juice
of rue, tansy, wormwood - the smoke or infusion
of Tobacco, Camphor tea, solution of assafœtida 
hepar sulphuris or mercurial ointment or 
Salt - All of these are admirably
adapted to our case especially Salt. They should
be repeated as often as expedient and an active 
Cathartic should be afterwards administered to 
drive out the worms now weakened by the 
action 

action of the injections. Of all the
species of worms the Tænia is most difficult
to remove. The symptoms attending the presence
of Tænia are very much like those occasioned by 
Lumbricoides, but there is besides these
a gnawing sensation at the pit of the Stomach
with an indescribable feeling of wretchedness
and gastric uneasiness. Here as in 
the other cases the mercurial preparations have 
most power, though even they cannot be 
depended upon for a cure. I have used
them lately with very poor results. The 
mercurials commonly used are Calomel.
Ethiops mineral and Corrosive Sublimate.
The Corrosive Sublimate is given in Solution
because 









279
otherwise 'tis impossible to graduate the 
dose which must never be more than 14 or 16 of 
a grain at a dose. - The drastic purgatives
Jalap, Colocynth, Scammony and Gamboge especial 
the last have been much used for Tænia. The 
Gamboge must be given a dose of 15 grains to a 
adult to do good & so proportionally of the rest -
I have not much experience of the value of these
medicines but in one case where I used Gamboge
met with great success. The Gardner of a 
Gentleman in the neighbourhood of the City had 
been affected for five years with Tænia, had tried
almost every thing usually given for such a case
and failing of success applied to me. I gave 
him a large dose of Gamboge which produced are 
evacuation 

evacuation of at least fifteen feet of a tape 
worm, since which time the Patient has 
enjoyed good health -
Polypodium Filix mas. or male 
fern has been known in this disease ever
since the time of Gaten and has always
maintained so good a character, that though
my experience does not approve it, I must 
place it among the means for curing Tænia.
The dose is from one to three drachms
in syrup or water which should be followed
by a brisk Cathartic after a few doses, and 
if the worms are not expelled the same 
course should be again pursued - Cullen
imputes it's virtue to the Cathartic alone by 
which 

[281]
which it is followed, but this is erroneous for 
the German Practitioners always employ the 
Poly podium without any purgative and say successfu 
They mention many instances of this. Dr. Jon 
of New York after all other means had failed
procured a discharge of 45 ft. of worm from a 
lady by giving her at several times some gallons
of a decoction. This plant is further remarkable
for being the basis of Madame Nonffer
pills, to whom Louis XV gave a great price
for the secret - Dolichos Prurien 
or Cowhage is another remedy for this worm 
It is brought from the West Indies. It is 
prickly and is therefore supposed to act in 
this mechanical way upon the worm - It h
been objected to this opinion that if the Cowhage
exerted 

exerted such a power on the worm it would
also act in the same way upon the inner
coat of the Stomach and intestines. But 
experience has taught us the reverse of this 
I have never tried it, but it is well thought
of the dose is a table spoonfull in syrup.
Many are the other medicines which 
have been recommended for Tænia such as 
Blue Vitriol, Tin, pewter, Arsenic and very
lately the rectified Oil of Turpentine, which 
is the only one very deserving of attention.
It is given in doses of from ℥ss to ℥ij early
in the morning when the Stomach is empty
It occasions warmth at first without any 
gastric uneasiness - then giddiness and 
thirst which however soon depart The 
medicine 









[283]
Medicine does best when given alone, nor need
you fear Stranguary from the quantity for I belie
there is less danger of such an effect from a larg 
than a small dose.
My own experience does not enable me to 
decide upon the utility of this medicine - In
the only two cases where I gave Turpentine
suspecting Tænia. Lumbrici were expelled
and the patient recovered - There can howeve 
be no doubt of it's power, for the London period
journals contain many well authenticated fac 
of the Kind - The London practitioners give 
it in large doses even to the amount of a win 
glass full at a time which gave their patien 
no more sensation than a glass of Brandy &c
No instance of stranguary is mentioned as 
resulting 

resulting from such free use of it -
I have now finished an outline of 
the most approved treatment for the 
expulsion of worms, for I believe the means 
used for Lumbrici will also cure Tricurides
which are very rarely indeed to be met with.
These medicines may cure the disease but 
the labour of the practitioner will be thrown
away unless are taken to prevent the 
reproduction of worms - The indications 
in such case are to obviate the causes and 
take away the nourishment of these animals
A depraved condition of the digestive
organs is favourable to their production
and support. We should therefore
endeavour 

[285]
(17)
endeavour to improve the tone of these organs
by the means recommended in Dyspepsia for 
that purpose, such as lime water, bitters, steel,
regular diet, exercise and all those means 
which the experience of the patient finds
most promotive of recovery and confirmatory 
of Health. - 



287