A: Cooper's
Surgical Lectures
1793.






Lecture the 1st
On Action
The term Action is now used as much as
Humors were formerly: Diseases are in general
more owing to an alteration in the 
Solids than in the Fluids. Action may be 
defined to be a motion in Vessels inducing 
Circulation, Secretion and Growth, it may 
therefore be divided into general and local 
Action. General Action may be said to be 
that which necessary for the production
of Action in the Heart and Arteries: Local 
Action is that which takes place in certain
parts of the Body, for Secretion, Growth & 
Restoration of parts. We shall therefore
endeavour to show that the Action of one
part is different from another unless the
Parts are similar. Matter is formed by 
Blood and when formed from different 
parts is of a different Nature, for instance
in Fracture the blood is discovered oozing
out of the fractured ends, and in time form 
Bone which is stronger than before: The
Blood likewise forms the Tendons, Nerves
and skin. In Scurvy when the Gums
become loosened, and the Alveolar Processes
absorbed; on the recovery from the Disease




those parts are again formed by the blood.
The result these Actions depend on the 
Action of the Arteries. Growth of Muscles
is depending on a deposit of arterial Matter.
This is also is the same in Bones, as
may be seen by giving an Animal Madder
as the Bones formed after the exhibition
of the Madder are colored by it For this
information we are indebted to the late
Mr. Inc. Hunter.
The Action of the Blood is compared to 
Vegetation; It is be well known that
a branch of a Peach Tree may be engrafted
on a Plumb Tree and that Peaches will 
be the produce of it - The same with Apples
which are engrafted on a Crab Tree.
Medicine acts differently on the Body; Mercury
acts chiefly on the Salivary Glands
Cantharides on the Urinary Passage &c




Lecture the 2d.
On diseased Action
Whenever a part undergoes a change of Action,
it may be said to labour under Disease.
Disease is therefore to be considered as an 
alteration of Action: It is necessary that 
this alteration should continue some time,
As it may be present a short time without
producing Disease: for instance Blushing
is an alteration of Action in the Capillaries,
but is does not produce disease.
Alteration of Action long continued is in
general productive of Alteration of Structure
of Parts. Angina Pectoris seems to arise
from an alteration in the Action of the 
Heart; but after Death on examination
the Structure of this Organ is not found
to be altered - The same with Epilepsy,
there is no alteration to be found in
the Structure of the Brain of those who
die of this Complain altho' the attacks
have been very frequent - Its seat is 
certainly in the Nervous System, it
must therefore be an altered Action of
the Brain that produces Epilepsy
Mr. Cooper relates a case of a Gentleman




who had been subject to Epileptic Fits
from eight Years of Age; at first the fits
returned once a Month, then once a fortnight
- he was taken off by a fit at the Age of 23,
this was the second fit he had experienced
in the space of a Weeks - Mr. C. had
an opportunity of attentively examining 
every part of his Body, but could find not
the least alteration of Structure in any
part, the Brain was as sound as any Mr. C
ever dissected. - Those medicines that occasion 
death by acting on the Nervous System
produce no alteration of Structure _ The Nerves
appear liable to the same alteration of action, either
local or general. The painfull Sensation of parts
as in the Face and in Spasms, these take place
without any alteration of the Structure of those
parts. _ The Actions of the Body may be increased
by Inflammation, or they may be rendered slower
by Cold and thus induce Mortification, They also 
differ in kind as well as Degree; for instance
if Inflammation takes place in the Knee Joints
an Effusion of coagulable Lymph is the result
and at last of Pus - But the result of Gouty
Inflammation, is a deposit of Calcareous
Earth owing to the Action being of a different 
kind. Scrophulous Inflammation differs




from either of the Above as it deposits a curdly
Substance differing from coagulable Lymph 
and Pus. Some diseased Actions occur most
frequently in particular parts, as in Cancerous
complaints, the female Breast and the Testes
in Men are most liable to take on Cancerous 
action. The small Pox is a peculiar action
never affecting any part but where the Cutis
and Cuticle can be traced, which can be done
as far as the Cardia. Another Instance of particular 
path being liable to peculiar Action, 
is in the Venereal Virus never affecting any
of the internal lynphatic Glands, tho' we
know it generally produces a Bubs in the
external ones that it passes through.
Local Diseases are often produced by increas'd
general Action as in small Pox, and in
Fevers we often have Abscesses in particular
Parts. Scrophula is frequently brought on
by an increased general Action, as after the 
Small Pox Scrophulous Action is excited.
The same takes place in the Veneral Disease;
the Mercury excites the Scrophulous Action;
And we often have very troublesome Cases.
in Venereal Complaints where the Mercury 
brings on Scrophulous Swellings of Glands
which your patient considers as Venereal.




If you keep on with the Mercury the Scrophula
increases; if you leave it off the Venereal Virus 
gets ground - We also find that general increased 
action is often excited by local Complaints
as on opening large Abscesses, Fever is produced.
The same in Tubercles of the Lungs - White 
Swellings of the Joints are often inducing increased
general Action. It was supposed to 
be occasioned by Absorption of Matter, but we
find the Fever is not in proportion to the quantity
of Matter, but to the importance of the 
Parts to the general Œconomy.
Two Actions of a dissimilar kind cannot exist
at the same time, on the same set of Vessels:
this was first proved by Mr. Jon. Hunter
and which he endeavoured to prove by the 
following Circumstances. He says, if a person 
who has the Measles is attacked with the small
Pox, the latter will overcome the former, and
that the Vigor of the Measles will disappear
till the Small Pox has gone through its
stages and then the Measles will reappear.
He also asserts that if the Small Pox appears
first and the Measles after, the Small Pox
gives way to the Measles in the [cross out] same
manner. Many have denied this and said 
they have seen bath Small Pox and Measles
at the same time.






It is on this principle of a Part not being capable 
of taking on two different actions, at the 
same time that the Cure of many diseases depend.
- On this principle it is that Injections
are used for the Cure of Gonorrhea, for by exciting
a new Inflammation you get rid of the
old one. - The Lues Venerea excites a peculiar
Action on the part that it falls on; and Mercury
produces a different Action in the Body
and by that means cures the disease.
It is in the same Manner that Blisters are
usefull in Herpes, Mr. C. has lately had an
opportunity of seeing this in the Case of a 
Gentleman who had an Herpes on his Finger
and which had troubles him for a considerable
time; Mr. C. applied a Blister to the part
so as to completely raise the Cuticle & this 
was attended with Success.
General increased Action (as Fever) often puts
a stop to local increased Action - for instance
in Gonorrhea or Gleet, if a person is attacked
with fever, the Gonorrhea ceases till the
fever is going off. To illustrate this more
fully Mr. C relates a Case of a Gentleman
who had a violent Gonorrhea, and was seized
with a Typhus fever which continued 17. days
during the time the fever continued he had no




discharge; But it returned violently when the
Fever ceased. It is generally remarked that Ulcers
do not discharge in fevers.
An increased Action in one Part has a tendency
to decrease it, in a part near to it; as in Pleurisy
a Peripneumony, exciting external inflammation
by Blisters, we often relieve our patient, And
an inflammation of the Bladder sometimes
gives way to a Blister in Perinea like a Charm. The former
Idea of the Action of a Blister was that
the discharge occasioned the Relief; That this
is not the Case is evident from the Relief 
often preceeding any Discharge.
This is the Case in what are called Mr. Ports
Cases of diseased Spine, where a Blister Seton
or Issue removes the Inflammation exciting
in the Membranes of the Bones by exciting
external Inflammation.
Diseased Actions are often continued by
Habit after the Cause that gave rise to them
has been removed; When Vessels have got 
into a diseased Habits, it is very difficult
to remove it; for instance, Gleet which 
continues for Weeks or Months after the Cause
has been removed; This is the Effect of Habit
and can only be cured by giving the Mucous
Membrane of the Urethra a Stronger Action
vizt: inflaming by the use of Bougies




or Injections. - And in inflamed Eyes, which 
have long been accustomed to Inflammation
and induced the Vessels in a state of Debility,
these require a Stimulus to them to excite
the Vessel to contract.
Lecture the 3d.
On Stimuli and Sedatives
Whatever increases the frequency of Action
may be defined to be a Stimulus, - Whatever
has a tendency to diminish Action may be
trimmed a Sedative: A Tonic is that which 
increases Strength of Action: Some have confounded
Stimuli with Tonics: But from the 
above definition of them it is obvious they 
are different. - In order for any Substance
to act as a Stimulus on the Body, it is necessary 
the Body should be susceptible of 
being acted upon; for instance a Person
who has never had the Small Pox, his Body 
may be said to be susceptible of receiving it.




It is the difference of susceptibility that occasions
the difference of Temperament: Those 
that are very susceptible are said to be of an 
irritable Temperament: Those who are not 
easily excited to action are said to be of an 
indolent Temperament. Dr Hunter used
a Language in his Lectures and in his Treatise
on the Lues Venerea, that is somewhat difficult
to be understood: He says there must 
be a susceptibility in the Body of being acted
on, some Impression to act and a disposition
to receive the Impression, and then Action will
be the Consequence.
Stimuli may be divided into natural and 
Medicinal, Natural Stimuli are those which 
are exciting the different Actions
of the Body and which are created in us, as
the Blood which is a natural Stimulus to
the Blood Vessels, and the Bile to the Intestines
Also Affections of the Mind some of which 
are Stimulants others Sedative: These [are]
have an Effect only on those Parts they are 
destined to Stimulate, as the Blood when 
out of the Circulation have no stimulating
Effect. Medical Stimulants are either
external or such as are thrown 
into the Body: The strongest external



Stimulant is Heat: This is proved by many
experiments made by Dr. Fordyce on himself
He went into a heated Room with a Pulse at 
about 75, his Pulse very soon rose 144, here 
the excitement must have been very great
A more striking Instance is to be seen on 
Animals which are sometimes torpid.
Mr. C. had a Viper which he had open'd for
Injection and a Pipe fixed in the Heart:
On putting it into warm water it began to
show signs of Life and soon got out of the 
Bason, and attempted to bite those who endeavoured
to catch it. When it was put in
the Cold it soon became torpid again, but
on being again put into the warm water it
became lively and active, this could not depend
on the Circulation of the Blood, for that
must have been stopped by the Introduction
of the pipe into the Heart. The effect
of Heat is also shown by the Eegg which in
Consequence of long continued heat becomes
a living Animal. - Heat like all other Stimulants
soon debilitates, this is proved
by Experiments I made on Kittens; some 
of the Kittens I drowned in warm Water
others in Cold; upon opening them I found



that the Heart of those drowned in warm water
ceased to act half an hour sooner than those 
drowned in cold water, this he attributes to the
increased Action and consequences debility, produced
by the Heat. We know that the same
things happens to a Person who uses the warm 
bath, after being in it half an hour, when taken
out he will often faint: This may in 
some measure be owing to the Moisture as 
well as Heat. Dry Heat probably would not 
have the same effect as Heath with Moisture,
as Dr. Fordyce's Experiments seem to prove . -
When both Heat and Moisture are employ'd,
as in the form of Poultices, the Arterial Action
of the Part is increased and a larger 
quantity of perspirable Matter is removed
which emptying the Vessels abate Inflammation. -
Poultices therefore are used in
the first Stages of Inflammation to abate
it, and in the latter to hasten the Suppuratory
Process. - Cold is now pretty generally
allowed to be nothing more than a Diminution 
or Deprivation of Heat. When 
Cold is applied for any length of time it produces
pain, a Decrease of the size of the Body,



and its further Effect is that of producing Sleep
which the Person is unable to resist and wh.
terminates in Death. - Dr Salander relates 
an Instance of it in his Voyage with Capt Cook,
where two of the Company lost their lives - Mr. 
Banks was near falling a Victim to it at the 
same time. - We have strong Instances of 
the Sedative Effect of Cold on the smallest
Animals and Insects; for Instance, the 
common Moth becomes very torpid on the 
Application of Cold, but when Heat is
applied to it, it becomes lively and active,
Most Animals imported into this Country
from warm Climates, generally die during 
our Winter. and more old People are observed
to die in Winter than in Summer.
Cold may be applied so long to a part, as 
to deprive it of its Action, but it will be
removed by the application of Heat: but 
the reaction is so great that the part is incapable
of supporting it and Mortification 
is the Consequence. It is in this way Mortification
is induced in frost bitten person's
it is not the immediate action of the Cold



which kills a part, but it depends on the Reaction
of the Arteries. - Tho' Cold applied
for a length of time destroys, yet when applied 
a short time it excites Action. Mr. Cooper 
made Experiments with Snow, he covered
one Arm with it observing his Pulse when 
he first covered it, which he found to be
at 80. After being covered a short time it 
was increased to 86 on that side: the other
side which was not covered remain'd at 80.
It is a subject of dispute whether Cold
is, or is not a Tonic: I am very much inclined
to believe it is a Tonic. - Every 
person finds himself strengthen'd and 
braced when he goes into the cold Air after
being in a warm Room, the debilitating
Effects of which every one must have
felt; The way which Cold acts as a Tonic
is this, As Heat increases Debility and 
Cold necessarily diminishes Heat, 'It must
therefore diminish the Action, consequencely
remove the Cause of Debility - A Gentleman
in an extreme State of Debility in
Consequence of Hæmorrhage, found when he
sat near a fire or was in a warm Bed that



his Pulse rose from 90 in a Minute to
a 120 or 130 by exposing himself to a cool Air,
it was again reduced to 90. - Persons in Typhons 
fevers are much benefited by the admission
of cold Air into their Chambers, as
it diminishes the Stimulus - Cold may 
therefore be considered both as Stimulant
and Sedative. Stimuli instead of being 
a Tonic produces debility: We shod. therefore
be able to distinguish one from 
the other . -
Medicines may be considered as Specific or
general Stimulants; They are general when 
thrown into the Stomach, as they produce an increased
Action of the Heart and Arteries. Specific 
when they affect a particular part -
The Action of Cantharides is confined chiefly
to the Urinary Organs. Mercury to the Salivary
Glands, and Aloe at more particularly on
the Rectum. It is so also with Opium, this 
affects the Nervous System; Some have supposed
that Opium acts by increasing Action
and that the Torpor was the consequence:
But Wine and other Stimulants increase Action 
more without being attended with that degree



of Torpor; This Method of accounting for the Operation
of Opium does not appear well founded.
On Sympathy
The Definition of the word Sympathy may be 
said to be one part being affected in consequence
of another being diseased. - If we are not acquainted
with Sympathy, we shall not be able to 
understand many of the Phenomena of Actions
of the Body and also the Action of many
Remedies; This is dependant on the nervous 
System; Where Nervous communication does
not take place, we do not observe the Phenomena
of Sympathy; This takes place through
the medium of the Brain and Nerves.
Sympathy is either direct or indirect, Where
it is propagated by Nerves, it is direct as in
Diseases of the Testes, a pain in the Loins
is an Instance of direct Sympathy. - It is
often indirect as in Inflammation of the



Urethra, an Hernia Humeralis can only be
produced through the Medium of the Spinal Marrow
and is therefore indirect, the Nerves of the 
Urethra and Testes having no Communication.
It may be divided into natural and diseased
Sympathy; Natural is exemplified in the
Instance of the Breasts an Uterus; The Breast
having an increased Action in Consequence of
an alternation taking place in the Uterus of 
a pregnant Woman Coughing is another instance
of natural Sympathy arising from 
an Irritation about the Epiglottis, the expiratory 
Muscles throw out forcibly a quantity
of Air to remove the Cause. Sighing is another 
Instance of this, the Lungs being overloaded
with blood which causes the oppressive
Sensation and which is removed by the Muscles
of Inspiration sympathizing with 
the Lungs.
Diseased Sympathies are either of Sensation
or Action. Persons are found to have pain
in the Testes or Thigh in Consequence of the
Passage of Urinari Calculi - Pain is observ'd
in the Knee in consequence of diseases
of the Hip Joint - An Itching of the Nose



is another diseased Sympathetic Affection from 
Worms or any other Irritation in the Bowels -
Pain in the Shoulder is almost always a
constant occurrence in diseases of the Liver.
Also a pain is observed at the Glands Penis
where Calculi are present in the Bladder;
Pains in the Head are frequent in consequence
of Affections of the Stomach and
are relieved by Emetics. Mr. Hunter in his 
Lectures calls these Sympathetic Affections,
Delusions, as they led you and your Patient
to mistake the real seat of the Disease - He
has known some who having an Inclination
to go to Stool, thought that every person in
the room had - He says, this is particularly 
shown in drunken People, who often think
everyone else is drunk but themselves,
and are carefull least they should come to 
harm by tumbling &c. These however may
be considered as infirmities of the Mind,
and not sympathetic Affections. The Stomach 
is one principle Seat of Sympathetic Affections
an Injury on any Part affects this Organ, and 
every Injury of the Stomach affects other parts.
We know that a blow on the Stomach will
kill more suddenly than a Blow anywhere else



even on the Head. It seems to act from the Sympathy
exciting between this Organ and the Muscles
of Respiration, as everyone must have felt
who have received a blow on this Organ. A great
many Medicines act on the Stomach before
it is possible they can be absorb'd; Arsenic
acts by inflaming the Stomach; Vegetable Poisons
kill before there has been time for Absorption
to take place - Mr Cooper has known of
two remarkable Instances of Sympathy between
the Skin and Stomach. Two persons
in a few Minutes after eating Almonds had 
an Eruption come out on the Skin; This 
cannot be explained in any other Way than
by Sympathy. Vinegar will on some Persons
excite Perspiration almost immediately 
on being taken into the Stomach. The
Stomach is also frequently affected by blows
or other Injuries to the Head and Vomiting is
the Effect of them. Mr. Cooper knows a Gentleman
who two Years ago fell from his
Horse and injured his Head, at first he felt
but little Inconvenience from it about 
a fortnight afterwards he was seized with a



disagreeable sensation in his Head and violent
Nausea which now returns once in two or three
weeks rendering his life extremely uncomfortable 
from the violence of the Retchings.
We know that a Stricture on Intestines or
Omentum will produce Vomiting; Blows
on the Testes will produce almost immediate 
sickness - Pressure on Tendons with 
likewise produce Nausea. The Heart is 
another Organ that Sympathies freely with
other Parts; This effect on the Heart depends
on the important of the Part injured. For 
if the Intestines be wounded in the smallest
degree, the Pulse becomes scarcely to be felt
and is entirely lost some previous to Death.
The Heart Sympathies most freely in cases
of Wounds or Parts which Nature can't 
readily replace, as Wounds of Tendons will
much more affect the Heart than Muscular
parts - In Wounds you must consider the 
constitution of the Patient, for we find that
Injuries of persons of irritable Habit are
attended with more danger than indolent 
Habits - Those who are accustomed to see the 
frequent accidents brought into these Hospitals
can form a pretty good prognostic from 



the manner in which the Persons bear the
accident. Those who are very irritable and 
complain much have generally in a few
Days Inflammation and Gangrene which
proves fatal; Those on the contrary who complain
but little in general do well. -
Teething is another remarkable Instance
of Sympathy between the Gums & Bowels
If the Tongue be coated with Tinfoil from 
its Apex to its Base, and a price of Silver
be put in the Nose, and a communication 
between them kept up by a piece of Steel
and the Electric fluid be brought in contact
with the Tinfoil, a Flash like Lightening
will appear to the Eye.- This is a Case of 
Sympathy between the Membrane of the 
Eyes.-



On Wounds
A Wound is a Solution of Continuity of
part attended with a wound of the Skin:
When a Blow is inflicted on a part and there
is no wound we call that a Contusion - It
is a Fracture when the Bones are divided.
Union of Wounds takes place in three
different Ways. - The first is most
desireable in almost all Instances and is
called Union by the first intention, which 
is the Union of parts without any Inflammation 
- The second mode is where coagulable 
Lymph is thrown out by the inflamed
Vessels and which serves as a Bored of Union 
The third mod of Union is by Granalations
after Suppuration has taken place. 
When a Wound has happened the first
Effect is an Effusion of Blood, this is in
proportion to the size of the Vessel that
have been divided; The effused Blood accumulating
in the Celular Membrane
serves to stop the Hæmorrhage by compressing
the Ends of the Arteries and also 
by the Bloods coagulating for some distance
up the Artery and thus plugging it up.
We should in general endeavour to unite all 
wounds (except those mode by the Bite of



Venomous Animals) by the first Intention.
When Poisons are inserted it is best to destroy
or remove the part into which it is inserted.
In Bites of Vipers it is best to dissect the
part out immediately. - To unite a wound
by the first intention the lips of it should
be brought into close contact as possible
and if the Vessels have ceased to bleed for
some time, it will be proper (if the Vessels
are small) to make a fresh Hemorrhage
before you bring the Edges of the Wound
into Contact, for Blood that has been poured
out for some time, is not so good a Bond
of Union as when it has but lately escap'd
from the Vessels. This Union by the first
intention may take place between the 
soft parts and Bones; for instance, when 
the Scalp and Pericranium are divided
and the Scull laid bare; or the integuments
and Periosteum from the Skin Bone;
Union is taking place from the Blood
issuing from the Vessels entering the
Bones - The way in which Union by the first intention
takes place is by each side of 
the wound sending Vessels into the effus'd
Blood which thus becomes a vascular
Part as is proved by the Experiments of
taking out the Testes of the Cock and placing



them into the Parietes of the Abdomen of a
Hen, to which they unite, and may be injected
from the Hen; and also from taking off
the Spur of a young Cock and inserting it into
its Comb, where it will be nourished 
and grow; Mr. Cline has a preparation of 
this kind. Union will sometimes take 
place where the Parts are entirely seperated
A remarkable Instance of which Mr. C.
relates which came under his Notice whilst
he was a Dresser at St. Thomas's, A Man
came to have a Wound on his Finger
dressed, a [cross out] considerable part of wh
been cut off, which the Man took 
out of his Pocket, the Wound was made
to bleed a fresh and the Part which had
been seperated was replac'd and confined
by sticking Plaster & the greatest part
of it united by the first Intention - This
takes place more readily in Young than in
old Subjects; Union by the first Intention
takes place more readily in parts near the
Heart than in parts more distant from 
in Contusion checks the Union by the 
first Intention - It is also prevented by
extraneous Bodies lodged in the Wound,
or by Compound fractures where the Bone
is much injured, in short, every thing that



has a Tendency to excite Inflammation. Whenever
Union by the first Intention is attempted
every means to keep off Inflammation shod.
be employ'd. -
Division of Muscles and Tendons.
Whenever either of these are divided the immediate
Consequence is a Seperation of parts
to the greatest Extent that the Muscle is
capable of contracting to: The Space between 
the divided extremities is filled by an effusion
of Blood into which Vessels are shooting from 
each Extremity and which produces
Tendinous Matter forming a Bond of Union.
It is Tendinous Matter that is produced both 
in division of Muscles and Tendons - It 
was formerly the practice to bring the divided
Muscles or Tendons together by suture,
this is now very properly laid aside, as 
making a Suture through a Tendon excites
Inflammation, and very often a Sloughing 
of the parts - The skin in wound of
Tendons may be brought together by Sutures, 
& the Muscles brought together by
keeping the Limb in a proper Position,
so that the rends may be as nearly in
Contact as possible; This is very necessary
to attend to, as the extent of Motion is
diminished in proportion to the distance



of divided parts, the Muscle having a longer
Tendon will [?] consequently have less contractile
power; for instance if the Tendo Achilles
be cut thro' and the Ends seperated to a considerable
distance and suffered to heal
so, the Person will be lame from not
being able to lift that Heel with equal
Facility to the other. If Spasms take 
place, a Roller shod. be applied to prevent
them and thereby prevent a disunion;
Care is to be taken that no pressure is
applied on the Part itself, for if Pressure
is applied the End of the Tendon will unite
to the Parts below & Motion will be in 
a great measure impeded. A Sailor
had the Tends Achilles divided and a Roller 
was applied tight on the Part; When the 
Wound healed, he still found himself
as lame as before; Mr. Chandler dissected
the Ends of the Tendon from the Bone
to which it adhered, but could not do it
completely on account of the Artery; the
Ends of the Tendon united again 'to the 
Bone and the Man continued lame. -
Division of Arteries
This is one of the most important Things
a Mending Wounds; When an Artery is 
divided the Blood passes freely by the



Wound per saltem, and is of a florid Colour; If the
Artery is large the Patient almost immediately 
faints, and if it is the Carotid or Femoral Artery
the Patient dies almost directly; If the Artery
is small the fainting gives time for a Coagulum
to form wound its Extremities 
and some distance on its inside; But as 
the Patient recovers from the fainting,
the Circulation is increased by which the
Coagulum is forced off, and the Hemorrhage
often returns. - The Symptoms occurring 
from Hemorrhage are a Sense of Coldness,
a quick and very feeble Pulse, Tho' the 
Patient recovers his Warmth to the feelings 
of others, yet is very remarkable he does
not perceive is himself. - A divided Artery
generally contracts about two Inches, that 
is, an Inch at each extremity. If an Artery
has been completely divided, the Blood
will flow from both Extremities; From
the upper one it flows per Saltem and of a 
florid Color, and from the lower one it does
not flow per Saltem & is of a less florid Colour,
which is in consequence of its having gone
thro' the Anastamosing Branches - If an
Artery is incompletely divided, Hemorrhage
is more apt to continue, as it has not the power
of contracting - In the treatment of divided



Arteries it is best not to trust to pressure for altho'
it shod. be continued for two Days, the Hemorrhage,
will often return on removing the Pressure; Few
Patients can bear Pressure continued long; It
is therefore best to take up both Extremities
of large Vessels, as they would otherwise bleed 
so much as to kill the Patient. We shod. always 
have a clear View of the Vessels when going 
to tie them, as it is much better & safer
to enlarge the Wound a little, than to run 
the hazard of taking up other parts with the 
Needle; After the Vessels are tied, and the 
Ligature brought to one Part of the Wound
the other parts of the Wound shod. be united
by the first Intention. Inflammation & 
Hemorrhage are less liable to happen when
this is put in Practice. Mr Hunter in the 
latter part of his Life never had an instance
of Hemorrhage after performing the Operation
for Aneurism (which he perform'd very often)
& attributed the success to [cross out] healing the Wound
by the first Intention. -



Lecture the 6th:
On Wounds contind.
A punctur'd Wound of an Artery requires a 
different Treatment to a large one; For when 
punctured the Blood instead of flowing out
freely, in effused into the surrounding Cellular
Membrane, this is very improperly called
a Spurious Aneurism. A pulsation may
be felt in the Tumour which is firmer than 
that of a true Aneurism; When a spurious
Aneurism has continued but a little while
it requires a different operation from
that of a true Aneurism; For in the 
Spurious it is necessary to secure the Artery
both above and below, for if this is 
not done, the Sac will be supplied with
Blood flowing into it from the inferior
Extremity of the Artery; But if it has
continued some time the Pressure of the 
Sac & Cellular Substance will diminish
the Artery below; In this Case only one
Ligature as in the true Aneurism is necessary,
for the Blood will not readily
regurgitate into the Sac from the diminished
extremity of the Artery. The operation 
consists in cutting down to the Artery,
taking away coagulated Blood and 



the loosening the Tourniquet (which has been 
previously applied) the Opening in the Artery
may be seen; A Probe is then to be introduced
into it to skew the Course of the Artery & then
make a Ligature above and below. -
In Spurious Aneurisms of the radical Artery
it is always necessary to make two Ligatures
on account of the very free Communications
by its Anastemosing Branches. - There are
some Wounds that from their depth of 
Situation, it is not easy to secure the wounded 
Vessel by Ligature; Styptics must then
be made use of; there was one, which some 
time ago made a great deal of Noise & about 
which much has been written, vizt. the 
Agaric; Mr. Cooper tried it, but scarcely 
found any Effect from it. Mr. C. took off an
Excrescence from the Scrotum & tried every
Styptic he could think of, but without 
effect; at last it occurr'd to him to try the 
Oil of Turpentine which succeeded. Mr. C. 
thinks the Oil of Turpentine the best Stiptic 
we are acquainted with; If a little 
of it be applied on a piece of Lint it will 
not fail to stop those Hemorrhages which
are sometimes so obstinate after bleeding
with Leeches - When we cannot apply 
either these liquid Styptics or Ligatures,
two other modes may be tried, Escharotics



and Pressure. When Escharotics have been 
used the Hemorrhage is apt to return when
the Eschar falls off, - Pressure by a piece of
Sponge introduced to the Extremity of the
bleeding Vessel and assisted by gentle Pressure
is best.
Wounds of the Throat,
These do not always prove fatal, owing to
the fortunate Ignorance of those who endeavour
to destroy themselves; Their intention
in general is to wound the Wind Pipe
which they suppose to be mortal; A wound
of the Trachia is not always mortal as
persons may breath thro' the wound till
the parts are united. But a wound in
the Esophagus necessarily proves fatal,
as the Trachia must be divided at the same 
time and it is impossible for the food
to get into the Stomach, for the Narrowness 
of the Esophagus will be such, that 
the Food will be rather forced thro' the 
Wound than into the Stomach _ It also 
not unfrequently happens that in these
attempts the Carotids are wounded, Death
then inevitably follows in a few Seconds.
It is necessary in wounds of the Trachea
to bring the patient's chin towards his 
Breast and unite the Lips of the Wound
by Sticking Plaster or Suture. When Sutures



are made use of they shod. be simply thro'
the skin; For if any Part of the membrane
lining the [Trachea] Larynx is included, such 
Spasms are produced as to destroy the patient's 
Life -
Wounds of the Abdomen
In wounds of the Abdomen some part of
the Intestines generally protrude; Yet it 
is a singular Circumstance that they are 
seldom wounded; Mr. C relates an Instance 
of a Person who was gored by an Ox; The
Intestine protruded with so much force
that a stricture was formed on it and the
Wound obligated to be enlarged to return
it; In this Case the Intestines was not
wounded. Mr. C was also called to a Lady
who had cut her Throat in four different 
places, and likewise her Abdomen from 
the Pubis to the Ensiform Cartilage, &
altho' this was done with so sharp an
Instrument as a Razor not one of the 
Intestines were wounded, they were lying
in her Lap when Mr. C saw her; He replaced
them, but she died in about nine
hours afterwards. It is necessary to replace
the Intestines when it is not wounded,
and close the wound by Ligatures; It is
of the greatest Importance not to enclose 
The Paritonæum in the Ligature, if this 



is done such a violent Inflammation
ensues over the whole of that Membrane, as
to destroy the Patient - In those Cases
where the Intestines is wounded it requires
a different Treatment. - The Suture which 
has been recommended in Wounds of the Intestines
is a bad one; The interrupted Suture
appears to be the best After it has been 
used the Ends of the Ligature shod. be left
at the ends of the Wound, and the Intestine
secured close to the external Wound as in 
Case it shod. slough an artificial Anus
may be the Consequence; Sutures are then 
to be made thro' the Integuments. - 
If the wounded Intestine does not protrude 
Death must be the Consequence, as the 
Content of the Intestines must be discharged
into the cavity of the Abdomen.
Mr. C. never saw but one Wound penetrating
the cavity of the Chest. A Boy fell from a
Tree on a sharp Pole, which entered between
the Ribs between the Intercostal Muscles;
Part of the Lung on the left side protruded
thro' the Wound at every Inspiration,
The Wound soon healed and the Boy recovered
Simple Fractures
In a simple Fractures the first thing observed
on moving the Bones is the Crepitus, soon
after some degree of Swelling takes place.



Thus if a Roller be applied tight at first is
soon becomes intolerable to the Patient. -
Sometime after the accident, Spasms generally
occur After a few days in simple fractures
the Crepitus ceases to be observable. When
the swelling diminishes a circumscribed
Tumor is observed which is at first soft
& gradually hardens. - The internal Appearance
are at first an effusion of blood
and a red Colour, which don't seem to deposit
its Serum or if it does it is directly
absorbed, this Blood becomes coagulated,
a slight Inflammation on the Vessels
of the ends of the Bone taking place 
causes an absorption of part of the Earth
of the Ends of the Bone, so that they may be
readily cut with a Knife, and this is the
reason that the Crepitus is not observable
a few days after the Accident. Vessels now
begin to shoot from the Bone into the Coagulated
Blood, which now assumes a whitish
colour and appears like Ligament, It next 
appears like Cartilage, on which the Earthy
Particles are deposited in a Membraneous
Substance which is very vascular, as shown
by Mr. C's preparation. These internal appearances
explain the External - The Tension
is from the Inflammation; The Spasms from



the Inflammation of the Muscles; and the loss
of Crepitus from the softening of the Bones -
The circumscribed Tumour is owing to the 
effusion of Callous Matter, the quantity of
which depends on the degree of Inflammation
and laceration of contiguous Muscles;
For the Vessels shooting from the Bones are 
depositing earthy Particles into the surrounding
Parts; The time requisite for complete
Union differs according to Circumstances.
A Bone of the upper Extremity would unite
sooner than one of the same size of the lower
Extremity. - It also depends much on age;
A Fracture will united much sooner in a 
young than in an old person. Some Persons
have advised the laying aside the use of
Splints; But as the Posture of the Limb
is very apt to be altered by the Spasms, it
is much better to use them. Mr. C. knew an
Action brought against a Surgeon for 
MalPractice who had not used splints, he
not only lost is reputation but a considerable 
sum of money also. - In simple 
Fractures there is a seldom any Danger
unless the Patient is very old, when the
inflammation will sometimes kill them
In on instance Mr. C. knew a Patient



die from the Medullary Artery being wounded,
And another Instance where it would have 
happened had not Amputation been immediately 
had recourse to. - Flat Bones
have been supposed incapable of Union,
this is erroneous - A Man fell from a Scaffold 
and fractured his Scull a considerable
extent; the [Fracture] Trephine was applied 
and the Man recovered; But he died about 
two Years afterwards; Mr. C. examined his 
Scull and could readily trace the Fracture
which had united; The opening made by 
the Trephine was diminished in size
and filled up by a kind of Tendinous Substance,
The Reason of which is the Vessels
from the sides of the Bone were incapable
of shooting as far as to inosculate with 
each other and therefore the opening was
only partially filled up by Bone and the 
Rest by x the Vessels shooting up from the 
Dura Mater depositing a Tendinous Substance,
for Vessel that shoot from Bone 
deposite only Bony Substance, and Vessels
from other parts tendinous Substance.
There are some Fractures that happen in 
Joints that never unite, as in the neck of 
the Thigh Bone; the Blood is extravasated



into the Joint and only ligamentous matter 
deposited, the Vessels shooting into the Coagulum
coming from the Ligament. Another
Reason is the Part cannot be kept in Apposition. -
In Fractures of the Patalla or
Olecranon, Union takes place as in other Bones
if they are brought into Contact or nearly
so, if not the Union is by Ligament, and 
in these Fractures this kind of Union is 
preferable, as a bony Union after impedes
the Motion of the Joint.-
On Fractures Contind. Lect. 7th.
There are some Cases of Fractures [that] of 
cylindrical Bones that will not unite
by means of Bone. In such Cases the
progress of Symptoms are nearly the same 
as in other bones, but not so severe. Mr White
was the first who recommended in these
Fractures the rendering of them Compound 
and uniting them by Granulations, which
he practiced with Success. Mr. Cooper has
seen it tried in three Instances, in neither
of which did it Succeed - In the first Case
the Man was operated on in St. Thomas's
Hospital; The symptoms which were 
expected to be violent were but trifling
nor could sufficient Inflammation be produced.



The second operation was performed by Dr.
Aiken at Edingburgh, and the motion (after
the Wound was healed) was more evident 
than before. In the third case it was the Os
Humeri of a middle aged Man, the extremities 
of the Bone were laid bare by Mr Cline
and the ends of the Bone saw'd off, but little
Inflammation could be excited and no Union
by Bone could be brought about at tho' Stimmuli
were employed. - The Union is sometimes 
prevented by trifling Circumstance for a
length of Time and it shall afterwards unite
As for Instance the Exfoliation of a piece of
Bone will prevent the union for some
months and it shall afterwards unite by 
Granulations. And to the removal of some
such Cause. Mr. Cooper attributes. Mr. Whites
Success, for it certainly has met with little
success in the Practice of Others. This mode
of Union vizt. by Ligamentous Substance &
not ossific Matter, Mr. Cooper attributes
to a Want of sufficient Action in the Parts
to form Bone - It is perhaps a peculiarity 
of Constitution rendering them not liable to
take on Inflammation. A Man who had 
a fracture for several Months not united by
bone, was seized with a Fever, after which
the Fracture united. -



On Echymosis & Strains.
Echymosis is an Effusion of Blood from ruptured
vessels into the Cellular membrane in
Consequence of a Blow; The Blood appears
at first of a purple Colour, which as it is
absorbed changes to a yellow. Stimulant
Applications excite the Absorbents to act
more powerfully, as Spt. of Wine & Vinegar
Electricity also excites the Absorption of it.
When the extravasated Blood is so much in
quantity as not to be absorbed, it then produces
an Abscess - An Injury to the Ankle sometimes
causes an Abscess and the Joint becomes exposed
Mr. Cooper relates a Case of a Simple Fracture
rendered compound by an Abscess.-
Strains are owing to a Lace ration of the ligament
of the Joint. Ligaments are sometimes
torn to a considerable extent; In this Case 
it is somewhat remarkable that the 
Symptoms are not more severe than where 
the Injury is but small, and are often cured
as soon; This depends perhaps on the Limb
being moved after where the Injury is but
slight and thereby increasing the Lacerations
But where the Injury is great the Patient
is generally confined & Time allow'd for the 



parts healing. - These kind of Injuries often
lay the Foundation of white Swellings. When 
the Injury is but slight a Roller may be of 
service; But where it is much Blisters are
advisable. -
On Inflammation.
Inflammation is commonly defined from 
its external Appearance - It is said to be 
present when there is increased heat, Tumour
Redness and Pain. The increased heat has 
been considered by some as a circumstance
of Sensation only, and not to be discovered
by the Thermometer; The late Mr. Hunter
endeavoured to explain this by a number of 
Experiment made on Animals; He excited
violent Inflammation in the Rectum
of Animals by throwing up Stimulating
and Corrosive Glysters; He found that Farenheits
Thermometer was raised half a
Degree only viz, from 99. to 99 1/2 He also 
introduced a Solution of Salt into the Abdomen
of an Animal, having previously
introduced a Thermometer; Upon introducing
the Thermometer some little time after the 
Solution has been thrown in, he found the 
Thermometer not at all raised. - Altho' the 
internal parts do not seem to be heated



yet I think the external part may be; And
this owing to the Perspiration of the Body being
obstructed, on which the Coolness of the external 
parts depends. -
The Tumour which is produced depends on the
effusion of Serum and the Vessel of the Part
being more dilated and receiving more Blood.
It is owing to this also that the redness depends.
The Pain is probably owing to the Distention
forcing the Fibrilla of the Nerves asunder.
Inflammation is not always to be considered
as a disease, as it is necessary for the remove
of extraneous Bodies. - The effects of Inflammation
vary according to the importance of 
the Part on which it exists. Inflammation
in different part produce different Symptoms;
as Inflammation in the Brain, Stomach
and Lungs will produce different
symptoms. Inflammation very frequently
puts a stop to the Secretion of Glands
as of the Liver and Kidney &c. In the former
we see the persons Stools of a whitish 
colour as no Bile is secreted; In the latter
scarcely any Urine is voided & of which 
Complaint Garrick died. Inflammation
is exciting different effects even in the
same part - When Coagulable Lymph



is thrown out it produces adhesive Inflammation;
If the Inflammation goes on to excess
it is productive of Suppurative Inflammation. 
When Suppuration has taken 
place, Nature endeavours to bring it to
the Skin; The Absorbents are excited so as
to cause Ulceration for the Discharge of the 
Pus. The Constitution in which Inflammation
most frequently occurs is the
Irritable one, particularly when accompanied
with Plethora. - In this Habit the 
slightest Cause will produce violent
Inflammation, particularly if the Person
is addicted to drink spirituous Liquors. -
The slightest cause will under such circumstances 
be the Cause of the the loss of 
a Limb and often of Life.
The exciting Causes are too many to be
enumerated; Every thing that irritates is
an exciting Cause Fevers are apt to cause
it by a determination on a particular part
and forming what is called a Critical Abscess;
It was supposed that this Abscess carried off
a Humour which had been floating about in
the Constitution during the fever. -
The Proximate Cause of Inflammation 
is a subject of Dispute; Some considering 
it to arise from Obstruction others from



Debility: The Blood is cirtainly circulated
quicker thro' an inflamed part and the surrounding
Vessels have a disposition to 
determine more Blood to it, It seems therefore
that there can be no obstruction, the 
blood circulating even with greater freedom
than usual. It is a law in the Animal
Œconomy than when a Vessel is capable
of admitting more blood than usual (which
it is in consequence of being inflamed) that
the near it are sending more blood 
into it. Mr. Coleman supposes the
proximate Cause of Inflammation to
be debility; he says if you remove the
Debility the Inflammation ceases: Mr.
Cooper does not agree with his friend Mr.
Colman in this Respect. The consequence 
of the Vessels being over distended is that
their action is impeded & suspended, and 
if you restore their Action you remove 
the Inflammation -
Lecture 8th:
The Bones are undergoing the same effects 
from Inflammation as the soft parts; When
the Membraneous part of a bone becomes inflamed
the Vessels are inlarged and there is 
a slight deposite of earth on the Surface in




consequence of their increased Action. A Patient 
is able to distinguish Inflammation in a Bone 
by its being attended with a duller kind of pain
than that in the soft Parts
Adhesive Inflammation 
Whenever the Action of the Vessels is increased in
strength or frequency, the blood undergoes an alteration, 
that is a seperation of coagulable 
Lymph takes place; This being poured out cause
what is called Adhesive Inflamn. This coagulable Lymph
always at first appears transparent, as may
be seen in a Blister that has rose well, After
the Serum has run off the coagulable Lymph
may be seen of a transparent appearance. The 
coagulable Lymph always is deposited in a 
regular arrangement. When it is effused into 
the Cellular Membrane. It produces an effused.
Tumour, not circumscribed as when it proceeds
to suppuration. When Adhesion is taking
place the pain is not violent. Where a Tumour
goes no farther them this state, it is said to terminate
by Resolution, Union by the second
Intention is produced by the effusion of coagulable
Lymph; It Lint be applied to a wound 
in this state, it is found to adhere very firmly.
The Vessels shoot thro' the coagulately Lymph
on each side and Union becomes compleat.



Union by the first Intention is by means of
blood, the second by Lymph. Some parts of the
Body have a greater disposition to produce adhesions,
others suppurations. The abdomen
may be considered as a part disposed to adhesive
Inflammation; In wound of the Abdomen the
Omentum or Intestine is glued to the Peritoneum
by an effusion of coagulable Lymph and
thus prevent the Inflammation from spreading
over the Cavity. In the Chest this kind of 
Inflammation is often seen, this Pleura Costalis
adhering to the Pleura of the Lungs; The 
same circumstance happens between the 
Dura Mater and Tunica Archnoides. The 
Tunica Vaginalis is another part disposed to 
this kind of Inflammation, and so are the cavities
of Joints; the blood vessels when inflamed
pour out this coagulable Lymph. Mr. C. relates
an instance of an Abscess formed in the Longitudinal
sinns of a Woman. The Lymph
was effused to the size of a common Leech &
behind this was a quantity of Pus. The cellular
membrane under goes the adhesive Inflamn: very
frequently; Upon the whole the adhesive Inflammation
is to be considered as [of] being of
great Service;unless this was the Case when 
a cavity became exposed the whole would become
inflamed which it prevents. Adhesion



is often taking place in the Cavities of Joints
in white swellings, there is then a suppuration
on one side only. In every Intance of 
Inflammation in the Abdomen there is a disposition
to form Adhesions. In Injuries of the 
Dura Mater, unless this adhesion took place
between the Dura & Pia Mater, the patient
will most probably die under it. It don't take
place so readily when the Dura Mater in wounded
only, as when both Dura & Pia Mater are
wounded. Another good effect produced from
adhesive Inflamn. in that of circumscribing
Matter; thus the spurious Empyema is form'd
by the Pluma's adhering to the Lungs. Mr. Cooper
thinks the adhesive process tends to stop
Inflamn. - For the means of promoting Resolution
Mr. Bell very strongly recommends 
the Ag. Veget. Min. but Mr. C. think the 
application of Leeches will have a much 
greater effect. Some object to the application
of Poultices in the first stage of Inflamn. from
observing that they hasten the suppurative
process; They are frequently used in St. Thomas's
and are found to abate Inflamn. by producing
an effusion of fluid to the skin & thereby
lessening the inflamed action. Soap Plaster
is found to have the same effect. In Inflamn.
of the Abdomen Fomentations large and



emollient Glysters with free Vena section are
necessary; Purgatives are found to increase
it by exciting a more violent peristaltic motion
in the Intestines, which may be usefully
moderated by Opiates. Bones are undergoing
the same alterations from Inflamn. There 
is often a large deposit of ossific Matter on
them. In the early stages of these Inflamns.
Blisters may be serviceable, but afterwards
nothing but Amputation can be done. -
Lecture 9th on Suppuration
Inflammation is only necessary to produce
suppuration; It is then discontinued, after having
brought about an Action in the Vessels by wh.
they seperate Pus instead of their natural 
secretions. The formation of Matter has been
supposed to depend on the dissolution of the
Solids; this is pretty obviously not the cause, if 
it was we could have [no] suppuration without
destruction of Parts, which we after do have
in the Membranes which secrete Mucous, particularly 
the Pericardium Pleura &c, where even
a quart of matter has been found without any 
loss of Substance; on the contrary the membranes
generally becoming thicker in consequence
of coagulable Lymph being diffused



over it. If the Solid were destroyed by Pus an
Abscess could never heal as the Granulations
would be continually destroyed by it Whilst 
Mr. Cooper dressed at St. Thomas's, he put several
pieces of raw meat into different Ulcers
having previously weighed them; the next day
on removing them he found their weight
rather increased, whereas if matter had the
power of destroying dead animal flesh it 
ought to have been diminished.
The Nature of Pus.
Pus is a fluid composed of Globules floating
in a transparent Serum of a monkish, not 
acrid taste; the Globules may be readily seen 
under a Microscope. Pus has been examined
chemically with a view to distinguish it from
Mucous; but this cannot be done with any
certainty as there is a great similarity between 
all animal substances. Sal Ammoniac
will coagulate Pus which it will not 
Mucous. The reasons Physicians were so 
anxious to distinguish Pus from Mucous
were that they supposed they should then be
able to [distinguish] know when there were
Ulcers in the Lungs but as it is now well
as certain that on the slightest irritation



the Trachea is capable of secreting Pus. It wod.
not be of the use which they thought it would.
If the Inflammation don't terminate in Resolution, 
the symptoms become more violent
with a throbing sensation; there is also
fever, but this is in proportion to the size &
importance of the Part. The appearance of the
Tumour becomes altered, from being of a diffused
nature, it becomes circumscribed and prominent,
these circumstances denote Suppuration. 
In the last Lecture many parts were
pointed out which went into the adhesive Inflammation
before suppuration ever occurred. 
In many cases suppuration immediately
commences, as in all mucous membranes
a moderate Inflamn. is always followed
by a secretion of Pus; but if the inflammation
be very violent the adhesive Inflamm. follows
it. The Urethra, Vagina, Bladder, & Trachia
are all instances of this. If they were to take
on the adhesive Inflamn. like many other
parts we should often be the victims of it.
In the Croupe the Inflammation appears of 
a particular nature for instead of secreting
Pus, coagulable Lymph is thrown out which
the Trachea together and suffocates.



We find Inflamn. of mucous Membranes are
not attended with so much Pain as in Inflamn
of other parts. Natural healthy Pus has not
any thing in it putrid, but it may from a
bad habit of Body become disposed to putrify
Matter undergoes an alteration from anything
irritating the vessels which supply it; thus 
a small piece of Bone being loose will occasi
the Pus to become thin and saneous & have
a particular smell. In order for the formation
of good matter, an healthy state of the sore
with a certain determined action of the vessels
are necessary; if they are irritated beyond
this action, coagulable Lymph will be thrown
out; if not sufficiently active Serum will
be thrown out by them instead of the good
Pus. Pus may be as well considered to be
secreted from the arteries as any other of 
the Secretions, seeing that it depends entirely
on their Action. Inflamn. may be considered
as causing the necessary alteration
to take place in them, to render them capable
of secreting Pus. - Termination has
by some been considered as the origin of Pus,
and it has had, and still has, many able
advocates. If it is allowed to be the Cause of
Pus, their Idea of Fermentation must be different



different from what the Chymists annex to it.
The Putrefactive is the only Fermentation
that animal Matter is capable of, and in
this state Air is generated, whereas neither
Putrefaction nor Air are found in the formation
of Pus, in common Air is never observed unless
the Pus goes on to the Putrefactive state, Whereas
Chymists say, Air is necessary for Fermentation.
If you ask for a definition of Fermentation,
they say it is a decomposition, and 
recombination of Matter; when thus defined
Secretion and Fermentation are synonimous
terms.
There are two uses of pus which are very 
obvious. In Wounds where Union by the first
or Intention could not be accomplished. the 
Granulations would not becomes vascular
unless kept moist [by] and covered from the 
Air by the Pus. Another use is the occasion 
opening of Abscesses, by which any extraneous
body might be removed; thus it has the power
of removing or irritating Causes. When it
collects it presses on the Parts between it
and the Skin and causes their absorption
by the Pressure. Matter is likewise useful
in carrying off irritating causes from
other Parts as the Urethra &c -



Lecture 10th. On Ulceration
Absorption it is well known is necessary for the
support and growth of [Parts] the Body; Absorption
is acting more strongly in old than in young
Persons; Diseased Absorption is of two kinds,
one is that which Dr. Hunter gave the new name
of Intersticial to, the other is called Ulceration
The Intersticial is that which is producing a
general waste of the Body; thus the Adeps is 
removed from the Interstices of the Cellular
Membrane, and the Medullary from Interstices
of the Bone. Ulceration is where an original
part of the Body is removed, as if part
of a Bone be removed, but if the earthy matter
only is removed from the Membrane of the Bone
it is then the Intersticial Absorption. As the 
process of Ulceration is very generally attended
with the secretion of Matter, It is supposed
to be caused by it, but as Pus has no power
of corroding, the secretion of matter don't appear
to cause Ulceration. A High degree of Inflamn.
by which the Action of the Absorbents is increased
appear necessary for the production of 
Ulceration; It is hasten by Pressure. The pain
proceeding Ulceration is greater than during the
formation of Pus. They complain of a growing 
Sensation. Ulceration is a very quick Process



as much of the Body is often destroyed by it
in three days the Constitution can restore
in three Months; New formed parts are
more subject to ulcerate than original
parts of the body, as was observed in Lord
Ansons Voyage, when old Ulcers broke out
and the Callous of Fractures that had been
long united ulcerated in consequence of
Scurry. Ulceration has always a tendency 
to external parts of the Body, thus we find
Pus when formed will make its way outwardly,
for instance, when Matter is situated
between the Muscles of the Abdomen
and Peritoneum, it will sooner ulcerate
through the thick Muscles and Integuments
than through the Peritoneum which is much
thinner A remarkable instance of this 
happened in a man who received a Musket 
Ball in the Head the Bullet was situated 
between the Dura. Mater and Parietal
Bone; it ulcerated through the Bone and
Pericranium rather than thro' the Arm Peri
Dura Matter. Whether this is a law of Mature
or whether it depends on the structure of
parts is difficult to determine Mr. C. is inclined
to think the latter from observing
that the more vascular parts were the
more susceptible of ulceration they were.



Neither the Dura Mater or Peritoneum are 
near so vascular as the Bone Muscles &c. Ulceration
may be considered as usual in certain 
circumstances, as in extraneous Bodies, and 
in the exfoliation of dead Bones, & in no instance
more so than in the union of Bones.
A fractured bone, especially is compound, never 
could unite without ulceration taking place
in the ends of it which gives rise to the Granulations
that unite it. -
Abscess. - 
The formation of Abscesses has a bread been described,
that is, if Adhesive Inflamm. is not 
disccussed, Matter is deposited in the Center.
They do not ulcerate equally on all sides;
all the parts of the cellular substance around
an abscess are found loaded with Coagulable
Lymph which confines the matter, A
Poultice is the easiest and best application
during the suppurative state. In some situated
Abscesses it is necessary, to open them
very early as those situated near a Bone
otherwise the Pressure will occasion Absorption
of the bone which will be rendered 
inflamed and Carious; Also those situated
under Fascia; It becomes necessary to open
them early otherwise They spread a considerable



considerable way under the Fascia, because it is a part
that is the least susceptible of Ulceration
of any. The Nodes of opening them are either
by Knife for Caustic, nor does it appear material
which is used. It has been disputed whether
large or small Openings were the best. The
Symptoms are observed to be most violent when
large openings are made. Mr. C scarsely ever
knew a Patient recover when large openings had 
been made, but has frequently with small ones
A Seton appears the best mode opening Abscesses;
the Matter is then allowed to drain off
gradually and the consequent Irritation less.
The method lately pursued of opening Abscesses
by the Trocar don't appear to answer,
for though the wound will heal, yet it ulcerates 
in three or four days afterwards.
Hectic Fever succeeds the opening of Abscesses
and differs from other fever by the irregularity
of it Paroxysms, the hot fit sometimes preceeding
the cold, &c. The absorption of matter
has generally been considered as the cause of 
Hectic; Though it seems from many circumstances
that it is not; if Hectic was occasioned
by it, it ought to be in proportion to the quantity
of matter, which nee find is not that case,
for a large Ulcer on the Leg is producing no
Hectic, whilst a very small one on the Lungs



is attended with a great degree of Hectic. Large
Abscesses have been made to be absorbed by the
Digitalis(in Psoas Abscess) without producing
any ill effect. The Hectic is a general effect of
opening them, for whilst they remain whole
no Hectic is observed to take place. Hectic is 
often produced where no matter has been formed
as in white Swellings, Tubercles of the Lungs
&c. Matter is such a mild fluid as not to seem 
capable of producing such an effect on the 
Constitution by its Absorption. The fever seems
to arise from the irritation and Sympathy
of one part with another. 
Usually about three days after opening an
Abscess Symptoms of fever & Inflamn. come
on, the Patient can't eat or rest, has night
sweats &c. and after the Inflamn has a little
abated, the Discharge becomes considerable,
& the patient generally sinks under those
circumstances. The introduction of air into
the Cavities of Abscesses has been considered as 
the cause of these effects, yet it don't appear
probable that it is, because in Emphysema
me find no ill consequence arise from the Air.
If the Part has the power of closing which it
does by the inflammation causing coagulable
Lymph to be thrown out, the Inflammn
will be stopped. Thus it appears that the
irritation & division of the Vessels are the



cause of the Inflammation, and fever, which cease
if the parts unite; we ought therefore to be cautious
not to remove the Coagulable Lymph
by which a fresh Inflammation would be excited
Lecture 11th. Union by Granulation.
The third Intention of the aling a Wound we
define to be by Granulations; Granulations
are formed by the effusion of coagulable
Lymph becoming Vascular. It may be defined
to be a florid Body on the Surface of an Ulcer
& capable of forming Pus. Granulations
have also the power of throwing out more
coagulable Lymph. If a Granulation is 
injected it will be found more vascular than
the Part it arose from. An Ulcer has but
few absorbents & is therefore a bad absorbent
surface. unless it has continued long and 
become indolent. When Granulations are got
rid of by the Constitution, it is not by Absorption
but by their losing their Vascularity
& then slough off. They are considered as
being more sensible than other parts, this 
don't seem to be the fact; Their sensibility
always depending on the part they arose from



for instance, if a Granulation is on the Skin
it will be very sensible, if from a Bone insensible.
They have therefore a great many
or very few nerves according [from] to the part
they arose from. Granulations will form independent
of exposure to Air. After they have 
become even with the skin, Cicatrization
is beginning by vessels shooting from the 
Skin to the Granulations. A Cicatrix is
always larger & redder at first, the reason
of both is the same; the Vessels contracting 
carry less red blood, and diminish the 
size of the Cicatrix. It has been disputed
whether skin is formed or not, because
it has been observed that the surface of 
a Cicatrix is smooth & has not the Papilla
but as it has the power of forming cuticle wh.
no other part but Cutis has, we conclude
it is Skin. All vascular parts have the 
power of forming Granulations, tho' not 
always the same as themselves, for instance
the Liver will form solid substance without
Pori Biliari, & Muscle will form Tendon.
The skin, Bones, Tendons & Cellular substance
form their like. -----



The healing of Ulcers.
In every Ulcer two Circumstances are to be attended
to, vizt. the state of the Granulations
& of the Edges; for if the Granulations are
healthy, if the Edges are not, the Ulcer cannot 
heal. When the granulations are equal in
Height to the skin and the Edges thin, it is 
man healing state. But the Granulations
are often two prominent, the Vessels cannot
then shoot over them. The wildest
way of depressing them is by pressure,
but this often will not be sufficient, they
must then be touched round the edges with
Lunar Caustic. When the Granulations
are languid they may be washed with
a solution of Vitr. Alb. in Water, or a little 
of the red Precipitate in Ponder sprinkled
on the surface, not close to the edges as it
is apt to render them callous. Another circumstance
that prevents the healing of 
Ulcers, is the Granulations becoming inflamed,
they then discharge a thinner matter
of a brownish colour from the coagulable
Lymph not being healthy. In this case
Poultices are the best applications In very
debilitated habits Granulations are apt
to slough in this case the stale Beer



Poultices will often be useful with the Bark
internally. The edges of an Ulcer will often prevent
its healing from becoming thick & callous
and have a whitish look; the best and mildest
application to them then is the Mercurial
Ointment; Scarifications must be had recourse
to if the Ointment don't succeed. Lunar
Caustic is sometimes used but this is a violent
mode and not necessary unless the edges turn
in, it must then be used. Ulcers are also 
prevented from healing by extraneous substances
being lodged within them, a nail
is the most frequent, which ought to be
destroyed by Caustic or extracted by the Forceps
Ulcers often get into a Sinuous state; the 
best mode of treating these is, by making
another opening, as by Seton, if the Sinus
be of great length two opening may be necessary. 
The injecting of Tinct Canthar. has
been recommended but it will sometimes
produce a most violent Inflammation. In
Abscesses under the Fascia of the Thigh, 
the introduction of a Bougie every day is
very useful by exciting a little inflammn.
the size of the Bougie should be lessened
every day. When Ulcers are very painful



the Opiate Fomentation has been recommended
but a Fomentation made with Cicuta seems
to greater ease. We find Ulcers after long Voyages
put on disagreeable appearances, these are called 
Scorbutic; the alarming appearances go off
on Landing, by Poultices applied to the 
Ulcers, by giving Bark, Vegetables & neutricious
animal food which their bad appearances
seem to arise from the Want of. Ulcers in 
general will not heal except from their
edges; Mr. C. doubts whether they ever do.
In venereal Ulcers little insulated spots 
may be observed from whence they heal,
but these Mr. C. supposes are from the 
Vessels having 1 shot from the skin & been 
destroyed. Bones granulate like other 
parts.When a Bone is exposed it becomes
dead, and a Channel is formed round 
the dead part by absorption, after it is removed
the Chasm is filled by Coagulable
Lymph forming Granulation which become
boney; when they are equal in Height to the
skin, the cicatrize in the same manner
as other parts. It is from this Process Union
takes place in Compound fractures.



On Compound Fracture, Lecture 12
A Compound Fracture may be defined, a Fracture
of the Bone accompanied with a Wound of 
the Integnments by which Air communicates;
It is now considered (in the definition of compound
fractures) of no consequence whether
the Wound is made by the ends of the Bone,
or whether it is made by the Instrument
which occasioned the Fracture. When a compound
Fracture is inflicted an Hæmorrhage
ensue and this in proportion to the size of
the divided Vessels; Coagulable Lymph is
thrown out & after this has been continued
for some time, purulent Matter is discharged
and then Granulations take place which 
are the means of Union; In this Case the
ends of the Bone become soften'd and coagulable
Lymph thrown out, and osseous matter
is deposited by which the Union takes place
It is owing to this process that Compound
Fractures are so long uniting - In compound
Fracture altho' the Bones are seperated an
Inch or two from each other, yet Union will 
take place, which it would not do if it was
a simple Fracture.



The Treatment of compound Fractures where
the Bones not materially injured sh. be 
as simple as possible; The local applications
depend on whether Union can be brought 
about by the first Intention,which sometimes
may be done where the Wound is small; I have 
seem it in this Hospital, not withstanding 
the badness of the Air & Constitution of the 
Patient;If the first Intention can't be adopted,
then Lint applied to the Wound & proper
Bandages are to be used. The Position of 
the Limb depends on the ease of the Patient
and also the Conveniency of this Surgeon to
dress the Wound without moving the Limb,
as that would prevent the Union & on this 
account the Conveniency of the Surgeon is to 
be regarded even if it excites a little pain to the 
patient. Considerable Mischief is done 
frequently by repeated doses of Physic, as it
occasions the Patient to be moved often and
by which Inflammation and Gangrene is 
often induced; If the Patient is of a Plethoric 
Habit it is requisite to draw off a small
quantity of Blood; Local Bleeding seems
to have a better effect than general Bleeding.
We find in most Instances a number of untoward 



untoward Circumstances arising in compound 
Fractures; one is that the Inflammation being
extremely violent in Irritable Constitutions
and Vesications about the edges of 
the Wound & the Extremity swelled below 
and followed by Vesications there; After this the
upper part of the Extremity swells attended with 
Vesications; The Pulse now becomes quick
attended with great Debility & Delirium and 
terminates in Death; What is remarkable
just before Death, the Patient becomes
perfectly on rational; When the Inflamn
goes on to Vesication the Patient seldom
recovers. The Treatment in these case of 
compound Fractures shod be (locally) a
Poultice evacuation by Leeches; Opium
shd. be had recourse to procure Rest, Bark
and Wine in the beginning does not seem
to have a good effect, but when the pulse
is become quick and weak it is of great
advantage; Person who have been accustomed 
to drink freely of spirituous Liquors
should not be prohibited them entirely.
Other disagreeable circumstances sometimes
occurs in compound Fractures, such as the




Protrusion of Bone; If the bone is denuded of 
its Periosteum, it is best to saw off a portion
& then reduce it, as it will otherwise exfoliates,
If the Periosteum is not destroyed it is best to
enlarge the Opening & reduce the Fracture
in that Way without sawing off any portion
of it. Arteries are sometimes torn through
in compound Fractures & which is often
attended with very ill Consequences; I have
seen a division of the Anterior Tibial
Artery & that taken up without any ill
consequence arising from it; The Posterior
Tibial Artery on account of its situation
& Contraction can't be taken up; The 
mode here is to apply Lint and make pressure
on it; but when Inflamn comes on
Hemorrhage generally returns. Mr. C. has
seen the application of Lint bring on such
Inflamn. as to be attended with Mortification.
It is a diffcult, Point to determine in this case 
whether Amputation shd. be immediately performed
or not. Mr. C. would Amputate directly.
Another circumstance is the shattering of the
Bone, In this case it is right to enlarge the Wound
and remove the Splinter of the Bone, otherwise
Abscess after Abscess will be result, which 



delays the Cure and often causes Hectic. In these
Abscesses the best may is to open them early &
to the Bottom, and opening one to another to prevent
the Formation of Sinusses. Want of Union occurs
in Compound Fractures from two causes; one is 
there being a price of dead Bone situated between 
the two extremities of the Bone. The other Cause 
is the want of Action in the Granulations to
deposit earthy matter; In this Case Stimuli
and some degree of exercise are necessary. Locked
Jan sometimes follows Compound Fractures. 
It takes place usually about 10. or 20 days after 
the accident. Mr. C. has known it as early as
a week. A number of Cases in compound 
Fractures require Amputation, one is the
Splintering of the Bone to a great degree; A
great laceration of the Integuments renders
it necessary from the great discharge that 
attends it. The division of large blood Vessels
is another reason for Amputating. The Case of 
Suppuration in a Joint is another Reason.
It is wonderful how quick a Patient recovers
from Amputation where he has been much
reduced. Locked Jaw is another Case in which
it has been recommended, but it has been 
fairly tried in these Hospital without Success.
In forming a Prognosis in Amputation.



after Compound Fracture there are three circumstances
to be attended to, first, the part
it happens on; there is less danger in the upper
extremity than in the lower. The 2d is the
age of the Patient, young Persons do better than
old. The third circumstance is the Constitution
of the Patient; If he is of an irritable habit
it is a bad sign, the Symptoms in them being
more violent. It is a question whether it is 
best operate immediately or sometime after
the Accident, from The experience of these
Hospitals, it seems most unfavorable to 
operate immediately after the accident. When
the operation would produce no more irritation
than the accident itself, it would be best to 
operate. I think the success seems to depend
on the loss of Blood, as in Amputation in 
full Health, they seem to do best where Hemorrhagy
has occured. Those who die from Amputation
die generally in a few hours after
the operation; the Pulse becomes quick attended
with cold sweats & Delirium, after the 
Delirium has continued a few hours the Patient
becomes national and Dies, -



On Mortification Lecture 13th.
By Mortification is meant the partial death
of a part. It is divided into three stages [by] which 
are marked by the following different names.
viz.. Gangrene, Mortification and Sphacelous.
A part may lose its Action for a time without life
being destroyed entirely, as in suspended Animation,
it becomes pallid & cold and no blood
seems to be sent into the Part, but by being 
rubbed with Spirit of Wine the Action is restored;
this state may be called a state of Gangrene.
Mortification is absolute death and
where the Action of a part cannot be restored.
We use the word Sphacelus to express the parts
being in a state of seperation, the dead from
the living. The symptoms preceeding Mortification
are different according to the cause 
which gave rise to it. If from active Inflamn.
there are great redness, pain & tension in the 
Part, it then becomes less red, & the skin of a
dirty brown colour, the texture of the Part appears
the same, it emits a very fetid smell. 
If the part is cut into the cellular membrane
will be found distended with grumous blood, 
Vesications also appear. If Cold has been the cause
the Symptoms will differ the part then becomes



pale & benumbed and continues so whilst the
Cold is applied, when the cold is withdrawn, Heat
and Action return in the part with Inflamn. that
destroys it. It requires but little Inflamn. to kill
a part which the exciting cause is continued The
part therefore from cold becomes very hot & after a
few hours is unable to resist the Inflammation
Sometimes the sense of numbness will alternate
with that of Heat in the part for several Hours
and terminate at last in the death of it. In
no instance does Mortification take place without
being preceeded by Inflamn. Mr. Cline relates
a Case of Hernia where Ice was applied so long 
as totally to freeze the Parts, in a few hours 
Action began to be renewed, Inflamn. succeeded
and the Parts mortified. In this case the Action
must have been quite suspended for a time, but 
was again renewed. In cold Climates the Nose
& ears will sometimes slough of in consequence
of Inflammn. following cold. Putrefaction is
much longer before it takes place when Parts
are Mortified in consequence of Cold than from
active Inflammation, became in one case 
the Vessels are empty whilst in the other
they are distended. The Pulse is quick & weak
and there is always to be found a florid colour
as spot in the Checks. When a Part has



been dead 48 hours, a slight degree of Inflamn
may be observed round the living parts, a white 
line caused by the effusion of Serum may be
observed round the Part. Under this is a Groove
or Sulcus owing to the absorption of the living 
healthy park, this is continued under the dead
parts till they are thrown off, Granulations
arise in the hollow which assist in the throwing
off the dead parts. That this Groove is owing
to the absorption of living Parts is proved by 
the dead part continuing of the same size.
This seperation is a very curious, useful 
process, if it was not for this, it must be 
left to Putrefaction to seperate the Parts which
would be much longer. The Arteries ulcerate
through in the same manner as other Parts 
but without Hamorrhge ensuing, for they 
will be found in this state containing a
Coagulum through the whole diseased Part 
and some distance up the sound Part.
The Predisponing Cause of Mortification
are whatever tends to debilitate; The Parts
most distant from the Heart are most liable
to Mortification. A loss of a very small quantity 
of Blood will in debilitate Habits produce
Mortification, An Instance of which 
occured in Guy's Hospital, A Man was brought



in with both Legs Mortified & likewise his Nose,
after a time one Leg got well so did his Nose, but 
it was thought proper to amputate the other,
and though he lost but very blood Mortification
came on in a few hours on his Nose & likewise
on the Cicatrix of the other Leg which soon
destroyed him. Occasional Causes are
whatever induces Inflamn. When Inflamn
is running very high Bleeding is often
useful, but this will rarely do in Hospital
[cross out] Practice. In debilitated Habit it will
be best to take blood by Leeches.This is better
than using Purgatives,which if repeated do 
mischief. Poultices by producing a free evacuation
of Perspirable Matter. Opium also
in very large doses is useful. When the Inflammn.
is running very high. Bark appears
not to be serviceable, it seems to increase 
the Fever. After Mortification has taken
place it cannot be used in too large quantities.
The Poultice generally used in this Hospital
is that of the stale Beer Grounds. When a part
is benumbed by excessive Cold, rubbing it with
Snow is the best way to bring it to, the Friction
acting as a Stimulus is presented from
going into too great action by the sedative
quality of the Snow. With respect to Amputation 



Amputation of the Parts whilst they are sloughing
it is a dangerous Practice, for there seems
to be such a debilitated state of the Constitution
whilst Sloughing is going on as to be
unable to bear an operation. Indeed Nature
will often make as good or even a better stump
than the Surgeon. The bone seperates further
and higher up than the Muscles, The Muscles
than the Skin. This is in consequence of 
the bone being less Vascular is less able to 
resist the Mortification & therefore seperates
higher up; the Muscles seperate Higher up
than the Skin for the same reason.
Mortification of Bone or Exfoliation
When a bone is laid bare as it receives its vessels
from the Periosteum, so far it is denuded
will it exfoliate. This may be produced
by Inflammn. as well as by exposure,
and then it is very uncertain where it will exfoliate,
if on the internal part of the Bone
the Inflammn. is causing a deposit of
earthy matter by which the Bone is incased.
This often requires Amputation. 



On Gun Shot Wounds. Lecture 14th
Any Wound made by a Body (whether Bullet
piece of Stone or Iron) passing with great violence
may be considered in the same light as Gun
Shot Wounds, being attended by the same Symptoms.
A Gun shot Wound bleeds less than
any other Wound, seldom any thing is to be
observed till about 24 hours after the accidence.
When the part swells the Skin around becomes
red, a transudation of Coagulable Lymph from
the Wound; a considerable degree of Fever now
comes on with severe pain in the wounded
part. The nights now are restless & the Patients
Appetite lost. The Edge of a the Wound now black
forming an Eschar, till which is seperated.
Suppuration never comes on. It generally 
seperates [as] in about 10 or 14 Days sometimes
longer. When a Gunshot wound is inlarged
Suppuration comes on whenever the Knife
has passed about the usual time, i.e. 40 Hours, 
but where the Bullet passed it don't come
on till about 10 or 14; this is owing to 
the Contusion and is the reason Gun shot
Wounds are so much longer in healing
than incised ones. When the Parts suppurate
the violent Symptoms very generally



cease. It now and then happens the Inflamn
goes on as in Compound Fractures beyond the
Suppurative degree, Tumefaction then takes 
place above and below the Wound, Vesications
first round the Edges, which continue spreading,
with Fever and Delirium. These are the
Symptoms of Mortification having began.
These Symptoms do not so often occur as
Mr. C. has been taught to believe. He had
an opportunity of seeing a great number
of cases at one time, which were very judiciously
treated, and violent Symptoms but 
seldom occured. Another circumstance in 
which these Wounds differ from others is, that
that they are very apt to form Sinusses. Abscesses
in consequence of the extraneous
Substance being lodged in the Body are very 
apt to occur, This will be the case also from
small Shots. As Man received a quantity of 
small shot in his Thigh and every shot 
formed a little Abscess by which it was discharged.
Though this circumstance of an
Abscess being formed by an extraneous Body 
generally happens, yet it does not always for 
Balls and also splinters of stone have been [cross out]



known to remain during Life without occasioning
any inconvenience. The Surgeon is not 
always able to ascertain the extent of the Injury
when caused by a Bullet's passing into a Part,
the Prognosis should always be cautious, for 
though the Injury at first may appear trifling,
yet the contusion may have been so great 
as to cause very considerable parts to slough.
Wounds of this kind are very dangerous in
the Abdomen. A Ball may pass through
the Abdomen without wounding the Intestines 
in the first Instance, Yet in a few
days the Faces shall be discharged at the wound
in the Integuments; this happens from
the Intestine being bruised by the Ball in
its passage which part sloughing off the 
Faces are discharged at the Opening, therefore
we cannot at first say whether the Intestines
have escaped or not. The same thing occurs
when a Bullet have passed near a joint, tho'
at first it may appear to have been but slightly 
wounded, yet so much of the parts shall
slough away as to lay open the Cavity of the 
joint and render Amputation necessary 
when the Joint is large, Otherwise Irritation



occasioned by its exposure will bring on Hectic
Fever. - The reason why an Artery bleeds
less in a Gun shot wound is, that the cellular
substance being less firm than the Artery gives 
way more & forms a flap which falling over the
end of the divided Vessel catches the blood wh.
forming a Coagulum stops the Hemorrhage.
When an Artery is only partially divided it
bleeds as free as in an incised wound : You shd.
be guarded in forming a Prognosis when a
Ball has passes near a Large Artery, for 
if the Artery is injured the Part will slough
and Hæmorrhagy ensue many days after
the accident. Mr. Cooper relates an Instance
of a Man's shooting himself, the Ball passed
through the Stomach and all liquids which 
he took run out of the external wound; yet
this Man lived 30 hours; he had neither sickness
& Vomiting. In Wounds of the small Intestines,
liquid on being taken will come out
of the external Wound; this therefore may be
considered as a diagnosis sign of the Ball's [cross out]
having penetrated the Stomach or small Intestines, 
when the latter the fluids are longer before



they escape than when the Stomach is wounded.
These wounds must of course be fatal. When
the large Intestines are wounded by a Ball, the 
Faces being discharge at the external wound
is the diagnostic sign of it. The symptoms
by which a wound of the Lungs is known are
frothy blood discharged from the external wound
i.e. blood mixed with Air. The Patient has
Cough & expectorates blood mixed with Mucous
he has difficult respiration, is thirsty and always 
lies on the wounded side; this he does 
to give the sound Lung free liberty to expand 
Emphysema attends & this proves at once
the Lungs being injured. If the Patient recovers,
the difficulty of breathing goes off and the external 
wound closes. Where the wound proves
fatal, it is by the Fever and difficult respiration
increasing. It often happens that 
when a Ball has passed through the Chest 
it will, at the same time, have passed through
the Abdomen; this is a circumstance not 
generally observed. It is the Arch formed by
the Diaphragm. Mr. C. relates a Case of the
Stomach & Lungs being wounded at the same
time, and till the Body was opened the Ball
was supposed to have passed through the Chest
only. When the Heart is injured by a Ball 



passing into it, Death is the immediate consequence _.
Injuries of the Head from Gun shot wounds,
If the Ball has entered the Brain, the Patient
very generally dies, Mr. C is inclined to think 
Cranium and penetrating the Brain. We 
have many cases related of Balls passing 
into the Brain and remaining there during 
life without any remarkable inconvenience 
But in all those who have been opened after
death, who during life were supposed
to have a Bullet lodged in the Brain, the
Ball is always found in one of the Sinuses
of the Ethnoid Bone.
Compound Fractures from Gun shot wounds
are always worse than from any other cause
on account of the bone being in general
very much shattered and accompanied by
great contusion of the surrounding integuments. 
They are worse likewise from the 
agitated state of mind which they are always 
observed to be in after an Action. When joints
are exposed unless they are very small, the
irritation is so great as to render Amputation
necessary. A very curious and important



subject is the uncertainty we are in relative
to the direction which the Ball may have
taken. It is impossible to say where it may
be lodged, as Bone, may even skin is sufficient
to turn its Course. Diver's Man when attempting
to rob a Gentleman, received a Bullet 
at the Sternum, which was extracted near
the Spine which proved to be where the 
Ball had passed. Little Pain is felt when 
a Bullet enters a soft part, but when it 
strikes against a bone, the pain is severe
and the Person receives such a shock as 
to fall. 



Lecture 15th. Treatment of Gun Shot Wounds.
When a person has received a Gun shot Wound
the first question should be whether the Ball
has passed compleately through, or lodged in
the part, as they require very different treatment.-
Where a wound is made by a Bullet,
and the Bullet has gone perfectly through the 
part, if there is considerable Hemorrhage Lint
should be applied, but if no Hemorrhage ensues
Poultices are the best applications Evacuations 
are very proper, but with respect to
general bleeding, it should be had recourse to 
with canton, for the irritable state these
Patients are in at the time of receiving the Injury
that bleeding would be a means of bringing
on too great Debility. It is right to 
delay bleeding till the Inflammatory Symptoms
come on. Ag Veget. M. should be
frequently applied to the part; this plan
should be proceeded in, for nothing else will 
be requisite till the violent inflammatory
Symptoms comes on, which is in general about
40 hours after the accident. When these symptoms
come on local bleeding should be 
had recourse to. In the Year 1792 a Man



was brought to an Hospital in Paris with a Ball
passed through the Calf of the Leg; in a few hours
after the accident the Leg became violently 
Inflamed with considerable Tumor, so much 
so as to make the Surgeon suspect there was 
matter formed; an opening was made, but
no matter discharged; The blood that the 
Patient lost from the opening dispersed
the Inflammatory Symptoms; this shows
that Local bleeding should be had recourse
to when these Symptoms come on. Bark 
may be given when the Inflammatory
Symptoms are gone off, but not till then.
When extraneous bodies are left in the 
Wound, suppuration frequently is the consequence.
Sinuses are apt to form in
Gum thar: may be injected into them to endeavour
to bring on an Adhesive Inflamn. Bougies
should likewise be used. If the Bullet
is lodged in the part, and situated near a
large Artery, it would be dangerous to attempt
to make an Incision down to the Bullet
in this case long slender Forceps should
be used to attempt the extraction of it.
If the Bullet can't be felt it should not



be attempted to extract it. Old Surgeons 
are particularly fond of dissecting for extraneous
Bodies, but it is well known that 
wounds will sometimes heal without discharging
the extraneous Body. If an Abscess
should form from extraneous bodies, it
is right to make a large opening to discharge
the matter. It has been said that if an 
Artery is divided by a Bullet it will not 
bleed so free as an incised wound; but it
is right to apply a Ligature around the 
extremity of the Vessel, for Hæmorrhagy
will sometimes come on a considerable
time after the accident. It should be observed
in these kind of Wounds to take up the 
artery some distance from the mouth and 
include a portion of the Integuments in
the Ligature, for the contusion is so great
as to make the parts around slough off
in which case an Hemorrhage is likely
to ensue. In Gum shot wounds of the 
Abdomen Fomentations should be used.
no kind of Physic or anything stimulating
should be given by the Mouth, for 
if the Intestines should be wounded, it 
will escape by the Wound and raise



such an Inflamn. as soon to destroy the 
Patient. The best thing that a Patient
can take in this case is Milk, for Milk
will quench the Patient thirst, and it is
not likely to escape at the opening of the
Intestine, for it becomes solid soon after
it has been in the Stomach. In wounds
of the Lungs bleeding should be had recourse 
to, and to allay irritation Diluents with
Opium should be given. If the Ball is 
lodge in the Thorax, as in the Abdomen,
the Patient can have but little chance 
of recovering. I never have seen a patient
recover with a Ball lodged in his Lungs.
In Compound Fractures if Amputation 
be performed directly after the Accident
(especially from Gum shot wounds and on
the lower extremity) the Patient very 
rarely recovers, for he is in such an irritable
state, at the time of receiving the 
Wound as not to be fit to undergo such
an Operation. -



Lecture 16th. On Scrophula.
Scrophula is to be considered as an inflammatory
affection, or rather an attempt to
perform the operations of Adhesion, Suppuration 
and Uceration. It may be distinguished 
from Scirrhus by it being accompanied
with little or no pain. It is a Tumour arising
without any known cause, very indolent
continuing for weeks; it has redness, but
without other symptoms of common 
Inflammation. When Ulceration has taken
place a small quantity of thin Matter 
is discharged not perfect serum. The 
Opening, when suffered to burst, is very small
and the Matter is prevent from being
freely discharged by Lumps of coagulable 
Lymph with the Matter is mixed. The 
Granulations are of a pallid hue,& there is
a seperation of the Cuticle from the Cutis
at the Edges of the Ulcer and it always turns
in towards the Granulations, This is a
diagnostic sign of a Scrophulous Ulcer.
The Process of Cicatrisation is always very



slow. Scrophulous Complaints are very
numerous, The Lymphatic Glands are the
parts most commonly affected with it. Affection 
of the Joints, Psoas & Lumbar Abscesses, Contorted 
Spine, are all scrophulous affections of the 
Ligaments; There is also Scrophulous Opthalmia,
& the Rickets are of the same nature.
It is by no means peculiar to the human species;
Monkies generally die Scrophulous in
this country, also Birds that are brought
from a warm Climate to this die of it. It 
occurs seldom before two Years old and scarsely 
every after the age of 40 Children are most 
subject to the Affections of the Bones as Rickets;
and Diseased lymphatic Glands, Affections 
of the Joint, Psoas & Lumbar Abscesses
occur most frequently in Adults. [cross out] Phthesis 
Pulmonalis are scrophulous affections
which most commonly come on about the 
age of Puberty. You may distinguish Person
of Puberty. You may distinguish Person
of Scrophulous habit by their Completion
& make; the skin is either very white with 
light Hair, or dark with very black Hair.



the skin is always thin & the Body delicate. The
Pupil of the Eye is dilated, the Lips thick particularly 
the upper, but this last is not to be relied
on. Scrophula occurs in two very different constitutions
viz+. the Indolent and irritable, it 
is always much worse in the last. It is liable
to Metastasis especially in the irritable habit,
so that when it shall be cured in one Joint
another shall be affected with it. It must
be considered as a local disease, because it
takes place independent of Fever. It has been
called Hereditary, but no disease is now considered 
as such the requires occasional causes
to produce it. Children are often born with a
similitude of Figure which is a predisposing
cause. The Climate favorable for Scrophula
is not very hot, or very cold one, but the 
frequent changes from heat to Cold makes 
this Climate favorable for Scrophula. And
those that live near high Mountains are as 
subject to it as we are; the Vallies being hot 
and their Avocations often calling them to go
on the Tops of the Mountain where the Air 
is much cold than in the Vallies; It is therefore 
not the degree of Temperament but the



frequent charges of it that induces Scrophula;
the Spring & Autumn are the Seasons
that it most frequently appears. The occasional 
causes are those producing Debility; the
Small Pox, Mercury, large bleeding are often
the occasional causes of Scrophula; likewise
Bad Air, scanty Nourishment, & Blows, 
particularly on the Joints, tho' seldom can 
any occasional cause be traced. The proximate
cause is a debilitated state of the 
Arteries, which renders them unable to 
propell the blood with the same force and
quantity as usual. The Arteries of Scropulous
Parts are found full of Blood when examined
after Death not having sufficient
force to empty themselves as arteries always
do. Owing to this Debility of the Vessels you
have an imperfect adhesion and Suppuration.
The Proximate cause is Inflamn. with
Debility; remove the Debility and the disease
is cured.
Diseases of the Lymphatic Glands. 
Both the external and internal Lymphatic
Glands are subjects of this disease, tho'
it seldom occurs in any of the latter except



the Mesenteric. The symptoms of Scrophula
in lymphatic Glands are the same as in scrophulous 
affections of other Parts; they first become 
inlarged, and loose their tenacity and structure
being filled with coagulate Lymph; a Cluster
are often thus affected. Mr. C. saw a Tumour
of this kind taken from the Groin of a Main
which weighed 15th, out of the centre of it was
taken a large piece of ossific matter, which 
they generally deposit when they come to be 
very large. The enlargement of the Lymphatic
Glands every now and then are producing 
fatal consequences by pressing on the Trachea,
and also by preventing the free return of the 
blood has been the cause of Apoplexy. When 
the Mesenteric Glands are affected a swelling
and hardness may be felt by applying the 
hand to the Abdomen. A ravenous Appetite
is a bad symptom, it skews the Chyle is not
absorbed & that no benefit is deceived from
the Child's eating so much, for instead of getting
it looses flesh daily. A purging in this 
case is a common and bad symptom: Mr. C
has seen Ascite produce by it. Cold is the



most frequent cause of this Complaint, as we
often see on taking cold the Glands about the
neck and throat becomes enlarged, and are with
great difficulty discussed in strumous Habits
Treatment.
The removing into better Air is the first consideration, 
the Patients are often benefited,
particularly in Phthisis Pulmonalis by removing
even from a good Air into a [bad one]
more foul tho' warmer Air of a large city.
It is well known that Patients receive benefit 
from removing into better Air, though 
the removal into impure Air of cities has
not till lately been so well known to be
beneficial. It is therefore owing entirely
to the Temperature & not the pureness.
Bark, Burnt sponge and Sal Sodice are recommended, 
but Mr. C. [cross out] thinks Steel 
the best remedy & that the Flor. Martiales
the best preparation. If it causes Heat,
gentle Laxatives must be given with it
See Bathing & Sea Air are usefull. Mr. Hunter
from long experience found that the 
warm sea Bath was very usefull, the cold
Bath was found to Debilitate where they are
weak and much reduced.



The Aq. Vegeto Miner. applied to the Tumours
& sometimes bleeding may be admissable
by Leches, But the best way is to do it thro' 
the medium of the Constitution. Poultices
are the best applications to the Tumour.
It is best to let them break and not to open 
them. Sea water Poultices are very serviceable
in the cure of Scrophulous Ulcers.



Lecture 17th. On Scrophulous Diseases
of the Joints
The term white swelling has been applied 
to scrophulous diseases of the knee joint
only, yet it is equally applicable to the other 
joints. It is called white swelling because
the skin remains colorless. The first
symptoms are a slight degree of pain
in the part, succeeded by stiffness & smelling
After a time a Fluctuation may be felt by 
thePatella and the fluid accumulating
till the skin becomes thin, a slight Inflammation
ensues and Ulcerations follows.
A fluid mixed with Coagulable Lymph in 
large Clots will be discharged at the opening
In three or four days after Ulceration has 
taken place, the patient will have a violent 
pain in the Joint with Rigors, pains 
in the Head & back with profuse sweats,
loss of Appetite & other Hectic Symptoms
which with the Discharge is producing 
such debility as to destroy the Patients
life if Amputation is not had recourse to,



On examining the joints large quantities of 
Adeps are found under the skin, which is 
one cause of the great enlargement of the 
Joint. This is in common to many Parts,
where there is an increased Action in a set of 
Vessels adeps is deposited. As the Disease 
advances the Ligaments become very much 
thickened and at last Ulcerate; the Crucial
Ligaments of the knee Joint partake
of the disease & sometimes throw out coagulable
Lymph which forming a membrane
divides the Joint into two Cavities. The bones 
are also suffering as remarkable a change as 
the soft Parts, holes are seen in some places
deposites of Earth in others, Anchylosis is
formed by a deposite of earthy matter in the
cavity of the Joint. The causes of these 
swellings are not very obvious, but can 
often be traced to strains falls & other injuries;
they are very manageable when taken 
early; the plain which Mr. C. has seen most
successful & in most instances stop the disease
in Leeches or scarifying the Part and
afterwards applying a vinegar Poultice to



extend all around the Joint, this in a few
days will will irritate the Skin & cause 
Pimples to arise on it, the Poultice must 
then be taken off as it occasions a good deal
of uneasiness, Unctuous substances must 
now be rubbed on the part which have 
the power of confining the perspirable
fluid, by which a gentle irritation is kept
up, and not so much pain given to the patient 
as where blisters are used. This plan
is not generally followed. Flannels should
be wrapt round the part to encourage Perspiration,
this plan should be persued as
long as the pain continues which is the Criterion 
you are to judge of its good effects by
Soap Plaster by keeping at a gentle Perspiration 
in the part is found very useful when 
the pain has abated. This mode of treatment
is found more successful than the more violent
one of Blisters Setons &c, which always
do harm in the early states of this complaint
Setons have had a fair tryal in these Hospitals, 
but were not attended with the success
which was expected. Issues are now and [cross out]



then made by Caustic on the diseased Part 
have sometimes been found servicable, but 
on the whole it is a dangerous practice, for 
though Caustic don't act but to a little distance
on the sound healthy party yet its action is 
very apt to extend in diseased state of the parts
& induce great Inflamn. & Suppuration. If 
there is a fluid in the part, every thing that
will produce absorption will be of service
It will be even right to rub in mercury which 
in some instances has produced absorption 
of the Fluid, tho' at the same time it favors
the disease in general; yet as all the danger 
is arising from the Ulceration, we ought to
try every means to prevent its Electricity
has been found servicable. Laying open 
the Cavity of the Joint by Caustic, Seton, or any 
other way is productive of so much irritation 
as to destroy the patients life in a few days.
When this disease don't terminate in Suppuration
& Ulceration, it terminates either in
Anchylosis or in an alteration of the form 
of the Bones; both these are attended with loss 
of Motion in the Joints. A third way in which 
it terminates is by Adhesion of a soft Ligamentous 



Ligamentous Matter; here the Motion may be
partly restored by moving the Joints a little daily,
nothing but Amputation can save the 
patients life when the symptoms of Hectic
come on, with Suppuration.
The Disease in the Hip Joint.
This differs from the same disease in the 
knee joint in several circumstances, Pain
and stiffness is first felt when walking
up or down stairs, the swelling is best observed
from behind, the Leg appears to the 
Patient longer, not so much from any real
difference but from the Patient's bearing 
the weight of his Body on the other Leg.
The position of the Pelvis is altered by it.
presence of Matter cannot be readily known
here till it comes to the skin; there is 
always a pain in the Knee during the 
formation of this disease, which is a distinguishing 
mark of it. Hectic comes on here
as in other Joints when exposed & destroys
the patient, The Acetabulum is sometimes 
absorbed and the Matter discharged into the 
Cavity of the Pelvis. If the Patient recovers
after this Absorption, the Limb will become



shorter from the Ligaments being thickened
and the Head of the As Femoris absorbed. The 
Ligamentum Teres appears to be first affected
and the Cartilages abraded. Diseases of
the Hip joint sometimes prove fatal by 
ulcerating the Femoral Artery. The treatment
varies from that advised for the disease in
the Knee, Leeches & cupping are advisable
Issues or Setons shd. be made;there is no
danger of their hurting the Ligament here,
it being so deep seated. Mr. C. cannot recollect
but one instance of a perfect Cure in 
a true white swelling of the Hip. The 
cold Bath in young subjects as it strengthens 
the general habit.
Scrophulous Diseases of the Testicle 
This disease seldom occurs in Testicles 
after the Age of 30, or before Puberty. The 
Testicle or both of them inlarge without
any great deal of pain, unless it is by their
weight when they become large, The Scrophulous
Testis is hard and heavy which 
distinguish it from the Hydrated Testicle
and it is distinguished from the Scirrhus
by not being accompanied with pain. The 
Scrophulous Testicle may be generally traced



to a strumous Habit, The Testicle on cutting
into is found filled with coagulable Lymph,
The seminiferous Tubes, the Vesicula Seminales 
and Prostrate are found filled with 
it.
Treatment-
The Mercury is not advisable in general
in strumous Complains, yet a grain
of Calomel given every night and Morning
Mr. C. has seen attended with very great 
Success in reducing this kind of enlarged
Testicle, Tho' they may have been several
weeks in getting to the size, yet by taking 
the Calomel he has seen them reduced in 
as many days.



Lecture 18th. In Diseases connected with 
Scrophula continued On Psoas& Lumbar Abscesses
and Opthalmia
Psoas Abscess begins with Pain and weakness
of the Loins which continue for several 
months, at last a soft fluctuating
Tumour distending when the patient Coughs,
appears at the place where the blood vessels
come out under Pouparts Ligament.
There is some similarity at first between 
this and Hernia, but may be distinguished by 
attending to the preceeding and present symptoms.
This Tumour gradually descends lower
and lower and is a considerable time before 
it reaches theSkin; the Pus when discharged
is mixed with Coagulable Lymph; some time
after it has burst general symptoms of Fever
come on as in diseases of the Joints, occasioning
great debility under which the patient sinks.
The Lumbar Abscess is first observed between 
the Christa of the Illum and last rib. The Origin
of these Abscesses particularly of the Psoas,
have been considered as arising from Inflamn. &
Suppuration ensuring in the Cellular Substances



which is situated between the Psoas & Illiacus 
internus Muscles, But Mr.C. from a number
of instance upon examination has found
the disease to be beginning in the Ligaments.
The disease occasioning these Abscesses is
the same as that of the distorted Spine taken
notice of by Pot. The seat of the disease is 
in the Ligaments & the Bones are partaking
of the disease, Mr. C. has seen it extending as
high up as the last Lumbar Vertebra. Sometimes
instead of making its way along the
Psoas Muscle under Pouparts Ligaments it
will make its way through the Psoas Muscle
itself. The causes of Lumber Abscess is the 
same only in this Case, the Ligaments on
the side of the Spine are affected. Mr. C. has
seen them both exist together.
Treatments
Mr. C. thinks Absorption, if it can be procured 
is the most advisable method of cure, he once 
ram a case where the Digitalis was given in
such doses as it is given in Dropsies, & Absorption
was brought on by it without any inconvenience, 
the Lad was perfectly cured by it. If it
had been opened he would most probably have 
sunk under the Discharge. With respect to 
opening them; large openings are always found



to terminate in the Death of the Patient, small 
ones are attended with the same end only the 
patient lives longer [cross out] under the latter
method, large openings are now generally
laid aside. Setons in two Instances appeared
to Mr. C. to be the means of curing the Patient,
much less irritation following than where
large openings had been made, but they are 
not found generally successful. A practice lately
adopted and made public by Mr. Abernethy,
but which has not been attended with the 
same success in other Hospital as in St. Bartholemew's,
is as follows, When Absorption 
cannot be produced, he advises that a Lancet
shd. be introduced obliquely in the most depending
part of the Tumour before it has got quite
close to the Skin, a Probe is then to be introduced
that the Matter may be discharged, When 
about two thirds of the Matter have been let
out the wound may be dressed, a slight Inflammation
only follows producing Adhesion Another
opening [cross out]must be made before the Abscess
has got as large as at first, more of the Matter
may be now let out. This must be repeated



every few days till Granulations fill up the
Cavity and union takes place. This practice has
not been attend with the same [cross out] success in
others as in St. Bartholemews Hospital; it will 
be right to follow it for the irritation is much 
less that where it is left to ulcerate and the 
Patient Life is undoubtedly protracted by it.
Opthalmia
Scrophulous Opthalmia is attended with more
pain than any other scrophulous disease, It often
occurs without any obvious Cause, An Opacity 
of the [cross out] Cornea Trans; is more frequently the
consequence of strumous than of any other 
inflammation. Ulceration takes place in 
the Cornea frequently and now and then extending
into the anterior chamber of the Eye 
causing Inflamn & Suppuration of the whole
Globe, This Inflamn. is also often followed
by a secretion of purulent discharge. Adhesion 
of the Eye Lids will sometimes be caused
by it. Mr. C. relates the case of a young Gentleman
who had been blind three weeks from
an adhesion of the eye Lids, A Surgeon accidentally 
visiting the Family perceived that the 
Child could distinguished light from darkness
through the eye lids,which convinced him the



Eye was not materially injured, he therefore
forced them apart and the Child saw very well
directly, the Vessels had shot from one eye
lid to the other & might be seen. Before the 
Adhesion took place there was a slight opacity
which was quite gone when the Eyelids
were forcibly separated.
Treatment.
Opiate Fomentations and Poultices are good
applications to alleviate pain and Inflamn. Leeches
don't appear of service, the Opening the Temporal
Artery is advisable where there is danger
of opacity; it is not right to draw off too much
blood at a time. Opening the temporal Artery
is attended with this advantage, that less
blood is sent to the Eye from the Artery
being divided to stop the Hæmorrhagy. 
Blisters to the Temples early are useful.
Mr. W. directs a drop or two of Tinct. Theb.
made with wine to be dropped into each Eye
at Bed time; this has been attended with very
great success, yet it will be right to warn
the Patient of the violent Pain which it
occasions. Scarifying the Eye Lids is said to 
be useful Mr. C. never saw much good effects
arise from it and believes it has been more 
theorized than practised. When there is an opacity



opacity supplied by a pretty large vessel, the division
of it has been recommended, Mr. C. never
has seen it succeed. The Ungt. Citrin. with a
camels hair brush applied on the opacity
mill occasion irritation and absorption.
Ulceration cannot be removed, but will 
leave a speech and prevent perfect visions
In the Suppuration nothing can be done
but alleviating the Pain by Opiates.
All Parts of the Body except the Arteries, Veins
& Brain Mr. C. has seen affected with Scrophula. 
The blood Vessels of a part that
has been long strumous will partake of
the disease, but Mr. C. never saw it originate
in in them. -



Lecture 19th. On Poisons.
Poisons are divided into Vegitable Mineral
Animal & Morbid. Vegitable Poisons act 
on the Nervous System, Mineral act by 
Inflaming, the Morbid Poisons produce
local Inflamn. some of them produce general
Fever previous to their Inflammation, others
do no. The Vegitable and Mineral act in
proportion to the quantity taken, in this they
differ from the Animal & Morbid, the effects 
of which appear to be the same whether a 
large or small quantity of them is introduced
into the Habit. We know that the 
smallest quantity of variolous matter introduced
into the Habit will affect it as
much as if more was introduce; the same
in regard to animal Poisons; a very small
scratch from the bite of a mad Dog will 
produce Hydrophobia equally with a large
lacerated wound. The Animal Poisons in 
this Country are only of the bites of a mad
Dog, of Viper and the Sting of the Hornet..
There is something in the Constitution wh.
prevents it from being acted upon twice by 
several of the morbid Poisons, as Measles,



Small Pox. even the very frequently having
the venereal Disease will at last render the 
Constitution so callous to it, as to prevent
those pox ans taken it, though much exposed
to it, this Mr. C has seen in some of the 
Gentlemen who have attended these Hospitals.
The bite of the Viper is the most frequent
animal Poison we have in this Country,
the Symptoms frequently run very
high; They are similar to those which take
place on the bite of a Rattle Snake, only 
milder. A Man was bit in the month of June
by a Viper in the Palm of the Hand, in five
minutes, the pain was very severe, and the
part swelled, in ten minutes the swelling
was as high as the wrist & in half an
hour up to the Axilla; Viper Oil, Fomentations 
&c were applied & the Pain &
swelling went off, but for six months
afterwards, he was unable to use his fingers.
A Person may be bit several times & no such
symptoms occur, yet another they shall all
occur; it therefore seems to depend in some
respect on the Constitution being in a state
to receive the poisons. Tis the same in regard



to Dissection, a Person may often injure
himself & not be affected by the Absorption. Yet
at another time he will be much affected 
by it. There is likewise some difference
in regard to the Viper, if exhausted it Bite 
is attended with no ill effects. Mr. C. took a
Viper and made it bite several Kittens, those
first bitten soon swelled very much, but
those bitten the last hardly swelled at 
all. If called in at first the best way wod.
be to remove the part by the Knife or 
Caustic. Olive Oil rubbed in the part is
the best application.
Hydrophobia
This is a disease where there is excessive
irritability with a great dislike & difficulty 
in swallowing, Pain in the Stomach
quickly succeeded by Rigors & pain in the[par??]
bitten; he is uneasy and unable to Rest,
he complains of great thirst; the next 
Symptom is that when he is offered any
thing to swallow, he attempt it but is thrown
into violent Convulsions by it. The Countenance
is expressive of great anxiety and horror A
quantity of Saliva is continually running



out of the corners of the Mouth, which he is 
extremely anxious to have wiped off so extremely
irritable are patients in this disease that they 
are thrown in to convulsions by anything's 
touching them. Mr. C. saw a Man in Hydrophobia
thrown into Convulsions merely
by a Fly settling on his Face. For the first
three or four days the Pulse is from 120 to 130
and at last becomes so quick as not to be
counted, In a few days convulsion fits come 
on which last for half an hour at first with
an Intermission of half an hour between
them, but they gradually become quicker
& quicker till at last the Patient dies not 
in the Convulsion, but from the debility
occasioned by them. The Patient is very
thirsty, when he attempt to swallow he 
is thrown into convulsions, and the same
when he goes into a bath, which he is sometime
in summing up resolution enough
to do. He has a kind of Hiccupping (which
is an act of sudden Inspiration) which has
been called Barking, but Barking is always
an act of expiration. they have been said 
to wish to bite the standers by, but this is erroneous, 
for Children & Person who never have



heard of that, never attempt or think of it.
The notion arose from the patients being fearful
he shall, and desirious of not hurting his 
Friends; he therefore cautions them not to 
come near him, as he has heard that such
a symptom does occur and is fearful it
will in him, not that he has any inclination
to do it/ as is said.) It certainly is very 
improperly named, for it is not the dread
of water, or any other fluid, but of swallowing,
for Solids occasion the same convulsions 
as fluids. Mr. C. has seen several
opened who died of the disease & has likewise
opened several Dogs who died of it, & always
found a slight Inflamn. in the Stomach 
sufficient to account for the Patients thirst
but not for the Death and other symptoms.
This Poison appears to act entirely on the 
nervous System. Everything shows the
guest irritability and sensibility there is 
accompanying it. It seems very similar 
to Tetanus, there seems no difference but
the violent contraction of the Muscles of the
Jaw that accompanies Tetanus. This Poison 
will remain a long while in the Habit before
it produces an effect on the Constitution,



Instances are related of its being a Year or two
but we have reason to suppose it may be 
inactive for two or three months. The Patient 
complains of Pain in the Part and 
all along the course of the Limphaties 
Mr. C. inoculated two Dogs with the Saliva
of a Mad Dog & no symptoms of Hydrophobia
were produced. He injected some of the Saliva
into the Jugular vein of another Dog which
died in nine hours but without any Symptoms
of Hydrophobia.
Treatment. 
The Ormskirk Medicine has been recommended, 
but the success attending the exhibition 
of this and every other remedy must
be always equivocal, 1st because Dogs are often
only supposed to be mad and killed, It is then 
doubtful whether they were or were not mad 
2dly because two or more persons shall be bitten
by the same dog & only one shall have the 
disease; an instance of which occured in
Guys' Hospital, two Men were bitten both
of them in the Hand by the same dog and 
at the same time; the Man whose hand 
was bit last (he being taking the Dog from



the other person) died of Hydrophobia. & the other 
had no Symptoms of it. Sea Water has been 
called a Specific, Nothing can be expected from 
that or from immediately washing the Part
with any thing unless it be of a Caustic nature 
For we know by Experience that nothing but
Spt. of Wine will prevent a Person from
having the Small Pox when inoculated in
the usual way. The taking away the part 
by the Knife is the best way, but there are
situations where the Knife cannot be 
conveniently used, Caustics are then advisable;
The sooner the part is removed
the better, yet it ought to be done if the
Symptoms have not come on, even after 
a fortnight or three weeks, for there is no
knowing whether it has or has not been 
absorbed. -



Lecture 20th. On Poisons contind. 
The Vegetable Poisons which we shall here
speak of are, Hemlock, Opium, Tobacco and 
Laurel Water. Cicuta given in large doses causes
pain in the Head, Giddiness, sickness & Stupor, 
loss of sight and if the quantity is very large
convulsions followed by excessive Debility. 
Altho' Cicuta is very deleterious when given
in large doses, yet it is very useful both externally
& internally under proper management.
Mr. C. has seen Tumours not actually 
scirrhus but which would have been had they 
continued, discussed by the use of a weak
solution of the extract in Water, and given 
at the same time internally. In indolent 
state of the Testicle neither scrophulous or
cancerous a weak solution applied to the part
is very useful. The solution of it cases pain
more than external application of Opium.
A strong Poultice of it takes of the fungi accompanying 
Cancers - Tobacco acts in a 
similar manner, It produces pain in the head
loss of sense an Motion & introduced into
the Stomach quickens the Pulse at first 20, or 
30 strokes in a minute & afterwards renders it



10 or 12 slower than natural. The effect of 
Tobacco therefore seems to be that of at first producing 
great excitement followed by great debility. 
Mr. Coleman in his essay on suspended
Animation has inveighed very justly against 
introducing much Tobacco into those apparently
drowned, from the effect which he has 
seen, and from the experiments he made,
thinks he excessive debility following the 
Action of this Herb has often been fatal.
Opium when given in large doses causes a
loss of Sense & Motion and in a few hours
of life. They have the Apoplectic Stertor, and
are violently convulsed followed by great debility.
A young Lady took an ounce of Landanum 
by mistake and had the above symptoms; 
an Emetic was given and she was 
made to get up, & was led about the Room
but it was with difficulty they kept her 
awake; she often said if they would but
let her sleep she did not mind dying. Part 
of the Laudanum was thrown up by the 
action of the Emetic, she compleately 
recovered, as did a woman who took a TeaCupful
with an intent to produce Abortion



A Man at Guy's Hospital stole opiate Pills
out of the shop and took them several days
running, in a few days Delirium with fever
came on and he died raving mad. Persons may 
gradually accustom themselves to the use of 
it, it produces in them a kind of exhillarating 
effect. It may be given in those Cases where 
there is great irritability or Pain without 
producing any of its deleterious effects. When
Opium is taken into the Stomach it at first
quickens the Pulse but after a while
renders it slower. This effect it has in common
with the other vegetable poisons before
mentioned, and they have endeavoured
to explain its particular action on this
Ground viz: its first producing excitement
ending in Debility. But Wine increases the 
pulse without leaving Narcotic effects in
proportion to those that follow the exhibition
of Opium. Mr. C. thins that Opium and 
the other vegetable Poison act peculiarly
on the Nervous System, Water distilled from 
Laurel leaves when taken into the Stomach 
proves fatal without producing any appearance
of Inflamn. on the Stomach. This is of



Importance for Surgeons to know as they are
liable to be called on in courts of Justice to determine 
whether persons were or not poisoned. 
There is a kind of streaky appearance
on the Coats of the Stomach, but not Inflamn.
when an Animal has been killed by Vegetable 
Poisons. 
On TrvoMineral Poisons. Corros. Sublimate
and Arsenic
The symptoms produced from these are very 
dissimilar to those which succeed a large
dose of any of the Vegetable Poisons.
When a quantity of Corrosive Sublimate has
been taken sufficient to prove fatal, the 
first symptom is Purging which comes on 
previous to Vomiting, this must be from 
sympathy of the Stomach and Intestines.
Vomiting soon comes on, the person is very 
restless, is in great pain, and is very thirsty, 
Convulsions succeed before Death but 
they are slight when compared to those caused
by the Vegetable Poisons. Upon examining
the Stomach of those poisoned
by Corrosive Sublimate, the Peritoneal coat 
is found sound, but a very general Inflammn.





on the internal surface of it and of the small
Intestines, [vomiting soon comes on] Persons are 
poisoned by giving it in such quantities as to 
keep a purging & copper like taste in the 
Mouth; this is slow way of poisoning and proves
fatal by inducing great debility. Mr. C. was called
on to say whether a Child was poisoned or not he
collected the fluid found in the stomach and 
poured on small divided quantities of it, vegetable
fixed and fossil Alkali, a brownish sediment
was produced by both these, and a white one by 
volatile Alkali, he took some of this sediment
mixed it with powder Charcoal & applied heat
by which Globules of quicksilver were produced.
If a solution of Sublimate be injected into the
Vein of a Dog, it brings on inflammn. of the [cross out]
of the vein only about an inch above the part
it was injected into, but inflams the Stomach
exactly in the same manner as if it had been
taken into the Stomach. Arsenic produces 
the same. Arsenic causes symptoms similar
to Sublimate in some respects, vizt.
Vomiting, Pain thirst & Restlessness, Deririum
Convulsions stronger than those caused by [the]
[Vegetable] Sublimate, though not so strong as
those caused by the Vegetable poisons. It proves



fatal quicker or later according to the quantity
taken in. The appearance on the Stomach is
generally an inflamed part about the size
of a crown piece, this is owing to the Arsenic
not being very soluble, but very heavy, it therefore
sinks and is found adhering to the part. 
If some of the powder be placed between two 
pieces of copper and heat applied, it will make 
them of a silver hue.



Lect. 21. On Lues Venerea
The Lues Venerea has been considered by some
as of little consequence because we have a Specific
that will cure it; but we ought to look on it as a 
disease of great importance; deformities and sometimes 
fatal consequences ensue from it or from 
the remedy employed to cure it.
Gonorrhea is a discharge of purulent Matter 
from the Urethra, in consequence of the venereal
Virus having been applied to the Urethra.
The symptoms are an Itching, rather pleasure
than disagreeable, soon the lips of the Urethra 
become red and tumid, the natural Mucus of 
the Urethra become secreted in larger quantity
than usual; as the Inflammn. increased
the discharge becomes green & purulent
with pain in making water, called Ardor Urina;
at this time the Urine will be formed
from the Inflamn. Phymosis or Paraphymosis
occur in this stage, when the Inflammation
is abated the discharge very soon
becomes thicker and of a bluish cast & 
more in quantity. It will continued discharging
for six or eight weeks if nothing



is done to prevent it and then cease of itself,
this is called its natural cure; It is apt to 
degenerate into what is called a simple Gonorrhæa
or Gleet, which is merely from relaxation 
and weakness of the parts, & is void
of Virus. In the high Inflammatory 
state of Gonorrhæa, Erections are taking
place in the Night accompanied with
Hamorrhagies from the Urethra, this is very
alarming to the patient but not productive
of Mischief, it rather tending to take off the 
Inflammation. - Another very disagreeable
symptom is Chordee; it arises from 
an inflammation in the cellular substance
surrounding the Penis, by which the Vessels
are throwing out coagulable Lymph and filling
up the Interstices with it, preventing the
blood from distending it in the Erections, hence
the curvature & pain it occasions. Irritation
at the neck of the Bladder is another very troublesome 
effect of virulent Gonorrhæa. Enlargement
of several Glands in each Groin are frequent 
in Gonorrhæa; these are not Venereal 
but sympathetic; the Bubo from absorption
is only one Gland enlarged of a side, but here



there is a Cluster. Hernia Humoralis is another
effect of Gonorrhea, it is an inflammation
from sympathy between the Urethra
and Epididimis. Fever is generally producing
a stop to the discharge in Gonorrhæa but 
it returns more violently after the Fever is gone 
off. There is likewise what is called an external
Gonorrhæa, which is a discharge of
Pus from between the Glands & Prepuce
around the Corona Glands. This is sometimes
nothing more than an increased secretion 
of the natural Mucus - The time which elapses
before the appearance of Gonorrhæa
after connection with an infected Person is 
from about four days to seven. Mr. C. once
knew it come on it 24 hours & once as long
as 14 weeks. The seat of this disease is in the
Glands called Lacuna, which take on an altered
Action and secrete the Purulent Matter
All Idea of its coming from an ulcer is none
generally laid aside. A variety of opinions
have and still exist, concerning the manner in
which the Virus is conveyed to the Lacuna.
Dr. Monroe supposed the Urethra to act as a
capillary Tube and that some of the Virus might



mix with the last drop or two of Semen & be sucked 
up by capillary attraction. It is probable from 
the redness at the end of the Urethra in the 
beginning that it begins there and spreads up
to the Lacuna. 
Treatment
Mercury is now very generally laid aside in the
cure of Gonorrhæa; that is, impregnating the
habit with it, Calomel as a purgative is very 
useful. It is right to begin directly with 
Injections, but if the inflammn. and discharge
increase, they must be laid aside till Inflammation
abate which will be promoted by 
purging with Calomel, taking plentifully
of diluent drinks in which Gum Arabic
has been dissolved, which tho' it don't act
as is commonly supposed by sheathing the
parts from the acrimony of the Urine, yet it
is useful as it induces the patient to take
plentifully of diluents. Injecting a few
drops of Tinct Thebaic. with rose water, made
warm, into the Urethra and soaking the Penis
frequently in warm water serve to lessen the
Inflammn. Recourse, must be had again to 
Injections which must be continued for some
time after the discharged has ceased, for it is very
apt to return on any excess in exercise or Diet.



ꝶ Calomel pptt. ℥ij Aq. Calc ℥4. ♏︎. f. Inject
This is a very good injection and will cure
the Disease, but not so quickly as one composed 
of white Vitriol. On grain of white Vitriol
will make an ounce of Water sufficiently
strong at first, but its strength may be gradually
increased. It is right always to begin
with a weak injection some Urethra' being
so much more irritable than others. Injections
of Corrosive Sublimate are some times
used, not as a Mercurial but, like other Injections, 
as Stimulants; It is more apt to occasion
the irritation about the neck of the Bladder
than any of the others. Upon the whole
the Vitriolic Injection is the best Ext. Saturn
will sometimes cure, this seems to act as
an astringent. The way in which all stimulating 
Injections [have been long used]
act in promoting a cure is by inducing another
Action in the part secreting the discharge.
When Injections have been long
used they lose their effect; they should then
be alternated; The best Criterion of its having
sufficient strength is it giving some small
degree of pain. Injections shd. be used during 
the night as well as in the day. It shd the



used 5 or 6 times in the day & thrice or thrice in
the Might. Mr. C. observed Patients were always
worse in the Morning, but when they inject in 
the night this is not the case, It is right
to make pressure with the finger under the
Pubes when stimulating Injections are made
use of, otherwise the irritability of the neck
of the Bladder & Hernia Humoralis will
be brought on. Injection shd. be kept for
a minute or two in the Urethra and not 
suffered to escape directly. Bougies where [cross out]
there is difficulty of making water, and that
in a narrow contracted stream, must be
had recourse to, but shd. be avoided if possible
whilst there is any Virus remaining as it
may be carried to the Neck of the Bladder by
the Bougie & Hernia Humoralis be the consequence. -
The treatment required for a 
Hemorrhage from the Urethra is nothing
more than simply binding a roller around
the Penis so as to being the sides in contact
Mr. C. was obliged once to apply a little Oil
of Turpentine. This Hemorrhage is not
followed by ulceration in the Part.



Lecte. 22d Lues Venerea contd.
Chordee can only be radically cured by such means 
as will abate Inflammn. in general, Fomentations
of warm water with some Ext. Cicut. dissolved
in it applied to the Penis. Poultices to
the Penis prevent those painful Erections
that take place during the Night, which 
are often caused by the irritation of Faces
in the rectum, they ought therefore to be evacuated.
A good large dose of Opium shd. be given 
Cold water in bottles kept by the bedside & applied
are useful. C. has known a Gentleman 
suffer so much from this as to oblige him to
get out of Bed and set on a cold Marble slab.
Irritation of the accelerator Urine will be generally
relieved for a time, and often permanently,
by the application of Warm Water in a Bladder
to the Perineum, also large doses of Opium
shd. be given. The Uva Ursi given in doses of a 
℈i three times a day is found useful. Strong 
opiate Glysters will sometimes have the 
desired effect. Mr. C. relates the case of a Gentleman
who for 40 hours had a constant irritation 
about the neck of the Bladder. This 
returned every five minutes, he was in excessive



pain which was rather lessened by an Opiate
Glyster but totally disappeared on a Blister
being applied to the Perineum.
Sympathetic Buboes accompaning Gonorrhœa
are distinguished from venereal ones by their 
being several glands indurated in each Grain
they must be treated as other inlarged inflamed
Glands. Stimulant applications shd. be 
applied to the skin as Spt. of Wine & Vinegar,
the Bowels shd. be kept open, Mercury if used
except as a purgative, does a great deal of 
Mischief, often causing them to suppurate.
The External Gonorrhœa must be cured
by washing the part with the white Vitriol
Injection if the discharge be Venereal. If it
is only an increased secretion with a little 
ulceration of the Prepuce Ag. Vegit. M. will 
prove the best remedy.- 
Hernia Humoralis is an inflammation of
the Epididimis, there is first pain succeeded
by enlargement, the Scrotum becomes red, as
it becomes inlarged the Patient feels a dull
kind of and intollerable pain in the Loins.
Mr. C. has seen this inflammn. first begin 
in the Spermatic Cord near the ring and descend
The discharge from the Urethra is always



lessened and often stopped by Hernia Humoralis;
when the Inflammn. goes off in the Epididimis 
the discharge returns, this shews that
an increased Action in one Part tends to 
diminish it in another. The most frequent
cause of Hernia Humoralis [when the in]
is Gonorrhœa, and it usually takes place
where the irritation runs a good way 
down the Urethra, Injections shd. not be 
then thrown up high, for there seems to be 
a greater Sympathy between that part 
of the Urethra next the neck of the Bladder
and the Tester than the others. Bougies are
often producing it. Mr. C. saw Hernia Humoralis
on each side only from a Gentleman's injecting 
a little warm water to cure a Gleet
Mercury when introduced into the Habit
appears to increase all kind of Inflamn. except
the Venereal. It must therefore be only used
as a purgative. Mr. C. relates an instance of 
a Gentleman's bringing an action against & 
recovering damages of a Surgeon who had giving
him a great deal of Mercury for the Cure of 
Hernia Humoralis; the Gentleman applied
to another Surgeon who laid aside the Mercury 
and used the antiphlogistic plan & compleated



the cure with Bark. The first thing shd. be
to suspend the Testicle, the Bowels should be kept 
freely open. Drastic purges, independent of
the Evacuation they produce, are useful in 
lowering the System. Mr. C. never saw any good effect
good effect from the application of Leeches.
Emollient Poultices are very useful, they never 
produce suppuration. The Vinegar
Poultice, & sal Ammoniac dissolved in Vinegar
do harm by occasioning the Patient a
great deal of uneasiness, they take off the 
Cuticle which is more than a balance for 
the good derived from the increased action
brought on as a means to lessen the internal
Inflammn. Tinct. Opii with antimonial 
Wine may be given to promote perspiration,
a low diet must be observed. Some 
very obstinate cases will require very considerable 
quantities of Blood from the Arise
The Enlargement of the Epididimis is
seldom got rid of yet it does not interfere
with the Functions of the Testicles. Mr.C. paid 
particular attention to this, and whenever a
subject brought into the Dissecting room
had an enlarged Epididimis, he injected it & 
always found them pervious. The effusion



is in the Cellular Substance and not in the 
Tubes. When the hardness & enlargement remain
small doses of Calomel will be likely 
to promote Absorption. A Surgeon of 
Eminence in his Lectures used to mention 
as a proof of its being attended with no disadvantage, 
the he himself had both enlarged
and had since 14 Children. It now & then 
happens that suppuration has has taken
place before application is made to the
Surgeon, it then breaks, the matter is discharged
at the opening & a Fistulous Ulcer
the consequence, for the Semen being continually
secreted escapes at the Wound. It 
also generally happens that a Fungus so likely
a Cancer shoots out, that two or three in
St. Thomas's have undergone Castration for
it, tho' quite unnecessary; for on examination
it was found confined entirely to the
Epididimis & the Testis sound. The fungus
shd. be touched every Luna Caustic
till it is as low as the Skin when Cicatrization 
will follow.



Lectr: 23d. Lues Venerea contd.
Gleet is a discharge of Pus or Mucus from the
Urethra incapable of conveying Infection.
all the while the discharge is infectious it is
a virulent Gonorrhœa. A Gleet is from an increased
of natural Mucus at of Pus from the 
Vessels of the Urethra having become habitual 
to it. So it often is when Mercury & increases 
the Secretion of the Salivary Glands, the Silivation
will sometimes continue long after
the Mercury has been left off. A Gleet is also 
caused by stimulating Injections having been 
employed. The white Vitriol Injection more 
frequently leaves Gleet than the one with 
Calomel & Lime Water. The cure of a Gleet
becomes of great consequence on account of
the apprehensions of the Patient. They will 
scarcely ever believe the Infection removed, or
that it is not a discharge of Semen. When 
the discharge is but small, it is generally transparent
like the white of an Egg; but when 
the Discharge is greater it is white like Pus.
The charge from the former to the latter
will often take place in the course of a 
few hours if the person has been dancing



riding or drinking. Gleet is often combined with 
Stricture, indeed we scarcely ever meet with 
Stricture unaccompanied with Gleet. Gleet
is as apt as Gonorrhœa to produce that distressing
symptom of irritation about the neck
of the Bladder. A number a Medicines
have been recommended for the cure of Gleet
which stop whilst used but it returns when 
the use of them is discontinued. Mr. C. cured
an obstinate Gleet, which had resisted everything
that was the thought of, by an Injection consisting 
of Vitriol. Alb gr. vij. Aq. Pure ℥i this 
brought on a discharge of blood but cured the 
Gleet. Blue Vitriol & Ag Veget. Min will
stop them whilst used Mr. C. has known
Oil of Turpentine useful. All these after
been long used require an increase of strength
Mr. C. has lately used an Injection of Tinct.
Cantharid. gtt. x Aq. Pur. ℥i & gradually increased
the drops to 100. in an ounce of Water. This invariably 
increased the Discharged whilst used
but after left off in several instances where 
Mr. C. has used it, the Discharge abated and
gradually disappeared. He thinks it deserved
a trial. Mr. C. has known the injecting of cold
water in two Instances successful. Bark



made into a paste with Balsam: Copaiv & two 
or three tea spoonfuls of it given twice a day
but it apt to purge, Opium must therefore
be joined with it. Bougies are likewise recommended
to be used twice a day. Sometimes
they are medicated by rubbing Mercurial Ointment
on them or red precipitate made into 
an Ointment. Case shd be taken that the 
medicated part of the Bougie don't pass beyond 
the seat of the disease. When Gleet
is attended with Stricture Bougies must be 
used to cure the latter and the Gleet yeilds at 
the same time to the use of Bougies.
Gonorrhea in Females 
The Symptoms of Gonorrhœa in Women 
are first Pain & irritation in the Labia
& Nympha and tumefaction soon follows. 
The Discharge don't so immediately come on
as in Men; sometimes sympathetic tubaes 
will arise previous to any discharge
The inflammn about the Nympha spreading 
along the Vagina. The Meatus Urinarius
partakes of it. Pain in making Water
now begins, & there is also considerable 
irritation on the Bladder. In the Urine





discharged there is a large quantity of Mucus
which falls to the bottom and looks like Pus,
but it is the Mucus of the Bladder The discharge
is greater in Women than in Men 
& continues much longer infections. The
Inflammn.about the Month of the Vagina
and Meatus Urinarius prevents a secretion
of their natural Mucus, The Urine therefore
in passing over them causes the Pain. The 
pain is much greater in Women than in
Men from the Bladder partaking of the 
Inflammn.
The treatment shd be by opening the Bowels
and giving Diluents by which the Inflamn.
is abated, Fomentations may be externally
applied and also to the Buboes if any
If they don't yield to this Leeches must be
applied. Injections are recommended &
are useful but are not conveniently used
by Women. Mr C. recommends the use of
a sponge or rag wet with the Vitriolic Injection
applied to the parts, in this way it is 
that the disease is much sooner cured in Women
than in Men, in consequence of the
Injection's being more immediately applied



to the parts, though if less to itself it will 
continue much longer. It is difficult to 
know when the Virus is destroyed. Gleets are
now and then following, they must be treated
in the same way. Mr. C. was led to this practice 
by a Woman's applying to him for a specy
cure of a Gonorrhœa which she had, on account
of an Assignation she had made.
Chancre
When the Venereal Virus is applied to the 
Skin it produces Inflamn. & Ulceration wh
is called Chancre, When it is applied on a 
secreting Mucous surface it causes Inflamn
& an increased secretion without Ulceration
The first notice of a Chancre is an itching
in the part and a small Pimple is observed
on the centre of which is a little fluid and
on removing it a white surface appears.
the Ulcer has thick edges & is very deep in
proportion to its size. they frequently [are]
appear on the Prœpuce & are producing 
Physmosis and very frequent on the frœnum
which is soon destroyed by it. they are frequency
in the Glands and now and then, tho' very rarely,
on the Dorsum Penis. Mr. C. once saw



a Chancre situated on the Groin close to a
Bubo. Chancres now & then appear in the 
Urethra. Mr. C. saw one about a quarter of an 
Inch up the Urethra which got well under the 
administration of Mercury, though the matter
of a Gonorrhœa was continually flowing
over it. In irritable Constitutions Chancres 
are attended with bad Slough, they will
keep sloughing till the whole Penis is destroyed.
Mr. C. met with an instance where 
a Gentleman had a Chancre appear every 
third day for three [cross out] weeks. Sometimes 
they will slough down to the Urethra & the 
Urine come that way. Hæmorrhagy will 
frequently happen from these Sloughs.
There is some difficulty in distinguishing
Chancres from excoriations, the latter have
not the high edges nor depth of a Chancre
but spread more superficially and on a 
larger surface.



Lecture 24th On Lues Venerea contd.
Treatment of Chancre. The application 
of Caustic when the Chancre is small is
certainly adviseable, but we must trust it
for the Cure, But give or rub in Mercury
If the Chancre is large dry Calomel sprinkled
on its surface with dry Lint over it, this will
in general succeed in the worst kind of Chancre.
Where Chancre is complicated with Phymosis
the Lotion of Calomel & Lime Water
ought to be injected between the Glands and 
Prepuce with a Syringe, a Poultice applied 
over the part and the whole suspended by a
bag Truss. When Chancres occur in bad constitutions;
it often happens that Slough after
Slough will come away & the Chancre keep
inlarging till it has destroyed the whole 
Penis. The giving of Mercury for the first
few hours is followed by a better appearance
of the Ulcer, but in a few hours more, a fresh
Inflammn. & Sloughing come on, therefore 
the use of Mercury must be suspended, and 
it must be treated as common Inflammn.
having a Tendency to Gangrene. Fomentations



must be used, the Bark giving and Opium
to procure rest. Mr. C. thinks the Sarsaparilla
in powder in the dose of ℥ss four times a
day an excellent medicine, preferable to 
the Bark with which it is commonly joined
A removal into better Air must be advised 
if the patient be in bad Air, and any
thing agitating the patient's mind shd. be
avoided if possible. Mr. C. relates the case of
a Gentlemen whom he could not cure till 
he was removed from a distance from his
family. When the Chancre has penetrated
the Urethra and made a fistulous opening
the edges must be pared off & the wound brot
together by adhæsive plaster & a hollow Bougie
passed up the Urethra beyond the opening
Chancres are sometimes very indolent, Touching
the surface every two or three days with
Lunar Caustic will be serviceable. Chancres
in Women are generally on the inside of the 
Labia or Nymphæ sometimes in the Vagina
Mr. C. saw a case where it had penetrated the 
Urethra, and another where the Chancre had
penetrated the Rectum. When the Chancres



are situated on the Labia they are very apt
to slough & be troublesome, the Inflammn.
causing a good deal of coagulable Lymph
to be thrown out into the loose cellular substance
of the Labia, much Tumor & Pain
is the consequence. The Treatment must
be sometimes when there is much Inflamn
Poultices to the Labii, the Black Wash or
Lotion with Calomel & Lime Water used
as directed in Gonorrhœa, by wetting 
Sponge or rag & applying is to the part
when the Chancres are situated on the Nymphæ
or Vagina. Some have recommended 
rubbing in Mercury in the Vagina, but Mr. 
C. never saw any better effect follow this than
where the Mercury is used in the usual
way to the Legs or Thigh. It becomes necessary 
to lay aside the use of Mercury in irritable
habits [in] (in Women as well as 
Men. Mr. C. thinks a weak Solution of caustic 
Alkali or a strong solution of Soap
& Water would be a prophylactic, if the 
parts were carefully washed with it immediately 
after the infectious connection.



A Wart is a growth of the Cutis arising from
irritation on a part thinly covered with Cuticle,
It don't seem to signify what the irritating
cause is, for the secretion of the Glanula
Odorifera if suffered to become acrid
from want of cleanliness will cause them
[?] so will the matter of Gonorrhœa but it 
will not cause Chancre on the same person
it is secreted from. They sometimes increase
to a very great size particularly in Females.
that they are never Venereal is 
proved from many circumstance, if the
Wart is taken off down to the surface no
Chancre follows nor do they require Mercury
to be cured. There are two sorts, soft &
hard; the soft are easily cured by applying
a poultice with a strong solution of Sacc
Saturn in it, to the Warts which turns them
white, They loose their vascularity & drop
off. The hard ones must first be softened
by Poultices & then the same means had
recourse to as in the soft. Rubbing on 
them mercurial Unction every day will cure
them by irritating & Inflaming them.



A weak Solution of Arsenic has been useful, 
but it is extremely necessary to be cautious
in the use of this. Mr. C. has seen Inflamn.
of a Stomach & Bowels and even Death follow
the use of a very weak Solution on a 
part not abraded. Savin powder applied
to them destroys them though not effectually
they being apt to grow again. Ligatures
are sometimes had recourse to; but cutting 
them off with Scissors & then just touch them
with the Nitrous Acid is a much better
made. They are sometimes extremely troublesome
& being considered by the Patients
as Venereal. It is necessary to try the above
method of cure. Bubo is caused by the
absorption of the Venereal Virus which 
being carried by the absorbent to the Lymphatic 
Gland generally the not always
inflames it & causes Bubo, A stiffness is 
first felt in mooing the Leg and it soon becomes
plainly to be felt & painful to the 
Touch, with throbbing in it & darting and 
shooting pains similar to other Abscesses
when forming. A fluctuation is soon to be



felt, and Inflammn on the part with Ulceration
now follows the Matter is discharged.
These in some Constitutions proceed to very
alarming height. A Patient in St. Thomas's
had so far neglected himself, that when he
was admitted the Bubo was of an enormous
size, it had detached the femoral Artery from 
the parts which surrounded it & soon after the 
Artery became abraded & the man died of Hæmorrhage
Mr. C. saw another case where the femoral 
Artery was laid bare by the Bubo ulcerating 
so deep; the dilation of the Artery
might be seen; this Man recovered. Buboes
form in clusters in some constitution, where
there is a Scrophulous disposition. Bubo
is generally produced from Chancre & also
from Gonorrhœa after the matter has been absorbed
the Lymphatic Vessels that carried it may 
be [absorbed] generally traced up to the Gland
it may be felt in general, it partaking of 
the Inflammn.-



Lectr. 25th. On Lues Venerea contd.
In the cure of Bubo the first & most desirable
object is that of discussing it by rubbing in 
Mercury. it don't seem [whether] to be of any
consequence whether the Ointment is rubbed
in on the same side the Bubo is or any other 
part of the body, for it don't seem to have any 
particular effect in its passage thro' the Groin
Mr. C. thinks it don't pass through the inflamed
Gland, This he is induced to suppose from 
having always found that when attempted 
to inject quick silver into an inflamed Gland
by means of the lymphatic going to the Gland,
the quicksilver instead of entering the Gland
which in a sound state it would do, passes
over the Gland by lymphatics which communicate
with the one going to the Gland
but do not enter the Gland itself. The patient
shd. as little exercise as possible & abstain 
from Wine & other Stimulants whilst he is 
rubbing in Mercury, and indeed from any
thing that can occasion common inflamn.
Mercury will then act on the Venereal 
Inflamn. but it has a tendency to increase 



common inflammation. Mercury in some
constitutions will cause the pain & Tumor to 
increase, it ought then to be immediately laid 
aside, and the antiphlogistic plan pursued,
evacuating the system and applying Leeches
to the Bubo; after this plan has abated the 
pain and lessened the Tumor, Mercury must 
again be rubbed in; but in some cases notwithstanding
every thing proper has been done
to obviate suppuration, Pus will form; this 
is denoted by the same symptoms as in a common
Abscess. As soon as it appears that the 
Tumor will suppurate Mercury must be
discontinued otherwise the Ulcer which follows
the Suppuration will be of the worst
Phagedenic kind extremely difficult to heal 
which will often continue for weeks on 
Months. Mr. C knows a Gentleman who
has has an Ulcer of this kind for this last
twelve Years; therefore when we give up 
hopes of dispersing the Tumor, Poultices must
be applied & the Bubo treated as a common
Abscess. If the pain is violent Opium must 
be given which not only gives ease but stops 
the night sweats which are very prejudicial



to the patient. When suppuration has taken
place Wine may be allowed & the bubo left to
nature if it is small & situated at no great 
depth from the skin. If it is large & deep seated;
it is right to open it early as it not only 
makes its way towards the Skin, but also lateraly
and becomes enormously large; the best
mode of opening it is by Seton. the next best
is by making an opening at the superior.
& another at the inferior part of the Tumor,
by which the formation of Sinuses is prevented.
It unites in the middle & the two openings
heal kindly, which it does not when only
one opening is made in the middle of the 
Bubo on account of the formation of Sinuses.
If the Bubo is not large it is immaterial 
whether it is opened by the Knife or 
Caustic. In some indolent constitutions
matter altho' it can be felt fluctuating may
be made to be absorbed by rubbing in Mercury
without any Mischief happening to the 
constitution. In some Scrophulous Constitutions
there is a disposition to form several 
Buboes, which suppurate one after another
whilst these are suppurating Stimulants



ought not to be given, and the sooner they are
opened the better, It is not right even to wait
till the Induration is gone off, but open it &
the symptoms of pain, Inflammn. & Induration 
yeild. these seem to be a more of Scrophula
than of the Venereal Poison concerned in these
Buboes, which is evident from Buboes forming
below where the Lymphatic Glands
of the Penis are situated. By these means
the Buboes altho' formidable in appearance
may be speedily cured, but there are often difficult
cases on account of Scrophula being
increased by the Mercury that is necessary to 
cure the Lucs Venerea, Large indolent Buboes
must be treated by Sea Bathing Tonics
& Bark. Opium & Mercury may be given
together. When a large indolent Bubo exists
with a Sinus, it is wonderful how soon it
will disappear by injecting Tinct. Canthar
into the Sinus. Buboes after suppurating
will often have an erysipelatous Inflammn
for an inch or two around them, then we must
lay aside Mercury & give Bark or Sarsaparilla
but the chief thing that cures the Erysipelas
is the disuse of the Mercury which was the



cause of it. Ulcer formed by Buboes will
often not readily yield to the common application 
of Precipitate & c. then touching the 
surface so as to make it look white with 
Lunar Caustic every two or three days will 
often succeed, tho' it certainly sometimes fails.
Mr. C. then recommends the Practice of using 
no dressing at all. In about a fortnight
a Scab is formed under which is a fluid, into
which Granulations are shooting & Cicatrization 
takes place under the Scab. The 
Venereal Virus after passing the Groin is 
carried into the blood vessels, where circulating 
for sometime at last produces some 
effects on the Throat, Skin, or Bones generally
through not always in the order they are mentioned,
for sometimes the Bones shall be
the first attacked. The Venereal sore Throat
is attended with less pain than a common
Sore Throat. the first appearance is a slight
Inflammn. the exists but a few hours before
an Ulcer is formed & therefore frequently
escapes observation. The Ulcer has a 
white surface with an irregular or ragged



edge much thickened which makes it appear
of great depth. The Tonsil is the part most
frequently affected and least dangerous as
it may be destroyed without any material
inconvenience or danger ensuing. The Ulcer
will often extend to the Eustachian Tube producing
a Singing sensation & deafness of
the Ear on the affected side. The bony and 
soft palate are frequently affected & an opening
between the Nose and Month the consequence 
by which the patient will speak
through his Nose, & when he swallows,
fluids will be escaping by the Nose. The 
Uvula is often destroyed by these Ulcers. The 
Patient is then said to be subject to Cough 
owing to the Epiglottis not being as usual
admonished by the [illegible] that any thing
was passing, Therefore fluids &c will be 
getting into the Trachea & causing Cough. 
The Uvula is said to perform the office of
giving notice to the Epiglottis when anything
was passing into the Pharynx. The Ulcers
are sometimes at the back of the Fauces



which preventing the Opening into the Nose
from being covered, as in healthy states fluids
are passing into the Nose when the patient
attempts to swallow Mr. C. has seen 
these Ulcers prove fatal in three Instances,
In two the patents died from the Pharyngeal 
Artery becoming ulcerated, the Hæmorrhage 
being fatal; the other Instance the 
passage into the Air Tube was closed by the 
great effusion that took place from the
Inflamn & Ulcer.
Treatment
By rubbing in Mercury, also local applications 
are of great consequence, Mel. Agypt.
has been recommended by Authors and is our serviceable 
& so is a Gargle of Corrosive Sublimate
made weak. but the best application is 
the Acetated Mercury applied on the Ulcer
with a Camel's hair brush. In the bony
palate the Ulcers will not heal till all 
the bone that is diseased has come away.
These openings into the bony palate, if small
will now and then heal by Granulations
shooting from one side to another. If they do
not an instrument must be made use of



to prevent the Speach being affected. There
is some difficulty in distinguishing Venereal
Sore throat, but what was said in a 
former Lecture relative to Chancres will
apply here. The Venereal sore throat
has ragged edges, is deep, & the Ulcers
don't spread so much as the Excoriation
like that is often caused by the Mercury
itself on the Throat. -



Lectr. 26th Lues Venerea contd.
The Skin is, after the Throat, the next part
most liable to be affected by the Venereal Disease.
It shew itself on the Skin in Eruptions
of copper colour; these are usually
on the warmest parts of the Body, as the
breast, & under the Joints; the pain attending
them is but slight when they are small
except when a person is sweating, then 
the saltness of the perspiration gives a 
smarting sensation. A Scab forms on
the surface of those Eruptions, & is as good a
criterion of the disease as the Copper hue
of the Eruptions; under the Scab is a fluid.
Mercurial Unction is necessary for the 
cure of these Eruptions. When they are obstinate 
Corrosive Sublimate must be employed,
to which they yield quick than to 
Mercurial Friction. These Eruptions will
sometimes degenerate into large Ulcers, generally
of a Phagedenic kind. When they are 
very painfull Poultices of Cicuta are the



best applications. After the pain has been 
removed the application of dry Lint, or Lint
dipped in a solution of white Vitriol will
most times be sufficient to heal them. Mezerion
or the Bark should be given internally;
the former Mr. C. has seen very serviceable 
in these Cases. In some instances these Ulcers
are very indolent the application of Lunar
Caustic will then dispose them to heals
These Ulcers are therefore to be treated when in
an indolent state by Lunar Caustic, when in
an irritable state by Poultices of Cicuta, at
the same time the Disease must be eradicated 
by the Unction and Bark or Mezerion
as Tonics. When the Venereal Disease
affects the bones, It most commonly begins
in the thin bones of the Nose. the Patient
has at first a pain under the bridge of his
Nose, after blowing it he finds some scabs
& soon after some pus in his Handkerchief,
It goes on so for some time, at last the bones
of the Nose are destroyed by it, which is attended
with a deformity which cannot be
remedied. In some this Disease will go



on so far even to destroy life. A Lad in St.
Thomas's had the bones of his Nose diseased,
he was one day taken with a kind of Suffocation
which he got rid of by swallowing but 
was soon seized with Vomiting & brought
from his Stomach the Vomer of the Nose.
Mercurial friction must be had recourse
to & Fumigation. Mr. C has seen good effects
from introducing a solution of Corrosive 
Sublimate by means of a Sponge on a piece
of Stick. This will often not give way to
Unction so far as to heal 'till all the bones
have exfoliated but the Venereal action will
be destroyed.
Nodes have been generally supposed to be a 
Disease of the Periosteum, but it is now
well known from frequent Dissections
that it is the bone itself which is diseased
in a Node. A dull obtuse pain in the part 
precedes the swelling, the pain exasperated 
by warmth of the bed at Night, this presents
sleep. After the Tumour has formed some
time, a sense of fluctuation is given when
it is felt, This fluctuation is owing to 
a glory fluid collected, these from the



Bones ulcerating. This fluctuation becomes
greater and greater till the skin becomes 
inflamed & the Matter discharged by ulcerating
through, previous to this it spreads higher
up & lower down under the Periosteum
& likewise laterally. Nodes are very generally
situated in the most solid parts of bones & 
in these least covered as the Tibia & Ulna
Clavicles &c. It is therefore probable that 
Cold is in some measure the cause of their
inflaming & having Nodes. The bones are 
very late before they are affected with 
the Venereal Virus.The treatment must 
be by Unction. Sublimate would cure
them quicker than Mercurial friction.
yet the latter does not impair the Digestive
organs so much as Sublimate does.
The pain will sometimes continue often
Mercury has been long persisted in,
A Blister over the Node, then is advisable
to take of the Inflamn. in the Bone.
Somes Nodes there is so much matter
that it cannot be made to be absorbed.
It must be then let out with a lancet



Even after this the pain sometimes will 
not cease, the Patients appetite fails he 
is kept by the pain from resting & has
symptoms of hectic come on & Exfoliation.
Sarsaparilla should be given and 
Opium to procure rest. If after the Heath
is restored the pain shd continue particularly
of a Night, Mercury must be 
again had recourse to. Patients frequently
after having undergone a course of Mercury
complain of pain in their bones,
which they and often their Surgeons at
tribute to having caught cold whilst using
the Mercury, but Mr. believes they are
most times Venereal. The Patients account
will enable you to distinguish between 
those pains Venereal & those
which are not When they are Venereal
they complain of pain along the Tibia, 
Ulna, & head which is more severe towards
night & is relieved by Mercury. When 
the pains are Rheumatic, he complains
of pain in the Ancles. Shoulders &c. in the
parts where there are Fascia & Ligaments
which we know are the Seat of Rheumatism



Rheumatism. Mercury here does harm. It is 
wonderfull how quick the Nodes will increase
& diminish. A Gentleman attending
these Hospitals had a Node one Morning 
very perceiveable on his forehead. the next
morning it was not to be discovered. This show,
how quick  the Vessels in the Bones are capable 
of acting. 
Venereal Ulcerations
This differs from Nodes, It is [cross out] at first a 
small tumor with an evident Fluctuation
attended with scarcely any Pain till it is opened
which it is necessary to do in order to cure
it. On opening it a glairy fluid mixed with 
coagulable Lymph is discharged, the Bone
is found very carious & the pain is now very 
severe. The bone is removed a great deal by 
absorption & likewise by exfoliation. Mercury,
as soon as the Inflamn. consequent to opening
it, is gone off, must be used but not before. 
There are other modes by which the Venereal 
Virus may be absorbed besides that of the Penis;
It is seldom that it is absorbed from the
Hands or Arms; It seeming to require a thin
Cuticle or an abraded Surface otherwise Surgeons



surgeons would be very liable to receive it. Mr. C. 
has seen two Instances of its being absorbed
by the fingers. A Woman who had an Ulcer
on her finger was employed to foment the 
Labii of a Woman who had a larch Chancre.
The Woman finger swelled & inflamed and
was attended with excruciating pain; the 
Glands above the Elbow swelled & so did one
in the Axilla. Mercury was tried by increased
the pain. The Arm was much swelled 
but was relieved by Fomentations. Soon after
Ulcers appeared in the Throat which Yielded
to Mercury, afterwards Eruptions came out,
Another course of Mercury was gone through by 
which she was perfectly cured. The other 
case was similar. In both cases the absorption
of the Virus was attended with 
much more pain than it ever is from the
Penis or from the Labii --



Lectr: 27. On Lues Venera contd.
The Venereal disease does not produce any ill effects
on many parts of the Body; the blood Vessels,
the Heart, Lungs & all the Viscera and also the Lymphatic
Glands the are situated internal are incapable 
of being affected by it. The symptoms 
are either primary or secondary; those are primary 
that are affecting the Penis and Groin;
whilst the  Sore Throat, Node, Eruptions &c
are the secondary Symptoms. It is incapable
of producing its diseased Action only on particular 
parts, and also incapable of raising
fever. It must therefore be considered as a local 
Disease. The Introduction of the Venereal 
Virus is generally accompanied with a slight
inflammn. in good Constitutions, but in
bad Constitutions it is sometimes exciting
a great deal of Inflammn. Sometime elapses
previous to its secondary effects. Mr. Hunter conceived
an Idea that when a poison was applied 
to a part, the part took on a disposition
to disease, & that the diseased Action took
place in consequence of the part being disposed
to it. This was the language he used, but he



did not explain what that dispositions was.
The Ideas on this head are unintelligible. Mr. C.
has himself made many experiments why which 
he is convinced that the disease cannot be communicated
by the Matter of a Venereal Sore 
Throat, Eruption or Node to another person.
He last Summer inoculated several persons
with the Matter from a Bubo, but the part 
heated & no disease produced by it. The Matter
of Chancre we well know will not fail to produce
the disease. Mr. Bell has lately reviewed the 
old Idea that the Gonorrhea would not infect
the System, But M. C has seen many Instances 
of Bubo & Sore Throat from it. One 
reason why Gonorrhea is oftener producing
Sore Throat than any other secondary affections
is because the Lymphatics from the 
Urethra are very numerous and passing into
the Pelvis, are incapable of affecting
the internal Lymphatic glands; the Virus 
is therefore carried directly into the Circulation
and deposited on the Throat. The Virus
secreted by a person has not the power of 
affecting that Person altho it will another.
This is proved by persons having Chancres
on the Glands which being in contact with 



the Prepuce have no effect on that. So also
the matter of Gonorrhea is continually running
over the Glands without producing Chancre.
Some Persons appear to have little or no susceptibility 
of taking the Disease; thus we often
see persons who have been often exposed
to it escape. The Susceptibility of taking 
the Disease becomes less after having repeatedly
had the disease, nor is it so violent in
those who have often had it as the first or 
second time.
On the Action of Mercury in the Cure.
Very different opinion have been held relative
to the action of Mercury in the
Cure of Lues. Some have imagined that it
cured the disease by promoting all the Secretions
& that the disease was carried off
with the Excretions. But it is well known
that the Disease may be cured without 
the Secretions being sensibly increased.
Others have supposed that it acts by neutralyzing
the Poison; this dont appear to be fact,
for it could then only neutralize the Poison
which was formed, and not prevent the
formation of more. The prevaling Opinion 
at present is, that it produces



Fever & excites the Vessels of the part to a
different Action, by which the formation of
more Virus is prevented and the Disease cured.
The best way of impregnating the System with 
Mercury. Mr. C. thinks is rubbing in about ʒss
to a [?i] of the Ungt. Merc. into each Thigh every
other night; this way Mr. C prefers because it 
does not affect the Stomach & Bowels as the 
preparation given by the Month do. In some
Venereal affections the Sublimate is preferred
to Friction, because it acts quicker in
stopping the progress of the Disease, as in
the Ulcerous state of the Throat; but Mr. C. 
even here prefers using the Sublimate as a
local application and trusting to the Cure
by Friction; for by the latter the patients
constitution is much less hurt. If the 
internal application of Sublimate is at
the same time adviseable it is when there 
is an Ulcer at the beginning of the Larynx
by which the patients Life is in danger and
the disease being out of sight & reach for the 
external application of Mercury. The Cure 
of the Venereal Disease don't depend on the 
quantity of Mercury taken in a given time
but on the continuance of it Operation. 
A small quantity of Mercury will generally



as speedily cure the Disease perhaps sooner 
than a large quantity by which the Constitution
of the patient is deranged; you are then
obliged to leave off and begin with Mercury 
again which protracts the Cure longer than
it would have been had the remedy been gradually 
thrown into the System. A Gentleman
attending these Hospital rubbed in
half an ounce of a Ungt. Merc. every other night
at the same time took every night Calomel
gr. xv. without the addition of any Opiate,
yet this neither purged him or had any effect
on his Month till the quantity rubbed in was
increased. Mr. C. met with another instance
where the Ungt. Mercur. was rubbed in every 
Night for near six weeks without producing
any sensible effect. The reason why Mercury
don't affect person appears in a great measure
from the following instance, to depend 
on the strength of the Constitution. A
Person whom Mr. C. was very anxious to have
Mercury act on. to whom he had given a great
quantity without effect, Mr. C. ordered him to 
go into the warm bath & to stay in it till
he found himself faint; he remainded in
the bath half an hour, when he fainted



away & was put to Bed, when immediately
a most Violent Salivation came on with
swelling in the Mouth & Throat; great Slough
came away & Mr. C. was in great apprehendsion
that he would die under the severity of a Inflammn. 
&c. From this it seems to be in our
power to cause Mercury to act by reducing the 
strength. We judge that the Mercury is acting
if after the patient has rubbed in, he feels a
sense of coldness on his back, or finds his 
Urine or Sweat increased or if the Ulcer [pressure?]
on a better appearance you may then be sure
that it begins to act and the quantity ought 
not to be increased; for Salivation is by no
means necessary for curing the Disease.
In some Instances though they are very rare
small quantities of Mercury will not cure
the Disease & the Patient must be salivated
to get rid of it. The great Art in curing 
the Disease is in knowing when Mercury may 
or may not be used. When there is any more
than the Venereal Inflammn. or when Mercury 
excites Inflammn. it ought not to be 
used till the Inflammn. is got under by the
antiphlogistic plan. Some are very easily 
affected by this Mineral; an Instance of



which occurred in St. Thomas's. A Brewers
Serot. rubbed in only twice when his head and 
face became very much swelled, his Tongue 
sloughed out & he very soon died. We ought
therefore to proceed with Caution in the use 
of it. Mercury when rubbed in appears
after Death in Globules in the Bones. This
Mr. C. has seen, for sawing through a bone of
a Man who died under Salivation; he saw 
in the Cancelli Globules of Quicksilver pouring
out. Mr Hunter believed that previous
to the appearance of the Disease & that altho'
it was in the Habit, yet if it was not
acting, that Mercury would not cure the disease
or prevent it. Mr. C. thinks this has given 
rise to much bad Practice for Surgeons have
been induced to lay as[?] the use of Mercury 
too soon. Mr. C. says that the practices
of these Hospitals contradict this Assertion
of Mr. Hunters. For if mercury is not continued
for two or three weeks after the Complaint
has disappeared. The disease seldom 
fails to return under some form or other,
but there is scarcely an instance of its occurring
again when When Mercury has 
been properly persisted in. In some



instances the Salivation will continue
after the Mercury has been left off; this is
from Weakness in the parts and will yield
to Tonics & better Air. There is now & then an 
Instance of Mercury after having been used
a great while producing Sores which looked 
like Chancres & also Ulcers in the Throat, but
on leaving off Mercury they soon heal. In some 
instance there is difficulty in distinguishing
between Venereal Affections from others. A Gentn.
attending these Hospitals had a red line extending
from the Franum along the Raphæ to 
the Perineum & also a spasmodic Affection
of one Eye. Mr. C did not conceive them to be
venereal, but after using everything that
could be though of without effect, Mercury
was used to which they both immediately 
gave way
Finis.