J.W.
John Wills,
Sturmenster,
Dorsetshire
from Sir Astley Cooper
Surgical Lecture
early 19th Cen.







1
On Constitutional Irritation
This depends upon the principle
of Sympathy, by which is meant
one part becoming affected for another-
Sympathy is of two kinds 
first-in which parts are only 
feeling for others-second-in which
parts are acting for others-of the
first there are many Examples, one
of the most common occurs in the 
Disease of the Hip Joint, when the
pain is felt at the Knee-also in
diseased Liver, where the pain is felt
in the Shoulder. The Existence of the 
stone in the Bladder is partly confirmed
by a peculiar pain being felt in the 
Frenum Penis after voiding the last
drops of Urine. Inflamation of the 

2
Testicle will often produce a pain In the
Loins-Of the Second where parts
are taking on diseased Action for others.
we have also a numerous Examples: 1st.
Inflamation of the Testicle arising
in consequence of Inflamation of the 
Urethra 2nd. Hiccup which is a spasmodic
Action of the Diaphragm, being produced
by Mortification taking place
in the great Toe-Third-Blows of the head
causing vomiting-The General Effects
of parts acting for others is the Derangement
of the whole System-A Bougie
introduced into the Urethra of an irritable
person will during its Introduction cause
fainting, which is a total Cessation of the 
Action of the Heart, or Suspension of all
sense and motion-Teething will produce
fever and has been known to bring on a paralytic 
affection of one side. One of the 
most remarkable causes produced by general
Sympathetic Affection is by an unexpected
Blow on the Stomach, causing immediate
death which it does by suspending the

3
Action of the Diaphragm and Intercostal 
Muscles-Symptoms of constitutional irritation-
Pain in the Head-Back, and Loins, then
the different Parts of the Alimentary Canal
become affected-Tongue white-and as it 
increases or is extensive, Yellow and Brown-
The Stomach next sympathizes by loss of Appetite
and vomiting, the latter a very unfavourable 
symptom, The Bowels in the first
stage are a obstinately costive, the opposite 
state sometimes tho' rarely occurs, the Secretion
of the Liver becomes altered sometimes
entirely stopped. The secretion of the Kidneys
and Skin much altered in their qualities
and often put a stop to-The Lungs and
Heart, also partake of the affection
breathing is difficult, Pulse hard and
quick in more advanced stages irregular
and intermittent the latter rather dangerous
but not to be considered so in old
people, as slight injuries will produce it
in them next restlessness succeeds with 
delirium, and not unfrequently with Subsultus
Tendinum other occasional symptoms occur sometimes 
such as retention of the Urine &c. &c.

4
The above mentioned symptoms are varying 
in their violence from three circumstances-
First-whether the parts injured be vital or not
if the former the symptoms are more urgent
and often producing death in a few hours-
The Second depends upon the difficulty of restoring
parts, as in wounds of Muscles and Tendons
the former uniting most readily & the latter with
much difficulty-Third The Constitution of 
the Patient-Treatment consists of three
parts-first when any vital organ is affected
it is expedient to take away Blood, to diminish 
Vascular Action, of the quantity and Mode see 
Inflamation. Second to restore the different 
Secretions-of the Bowels by giving Calomel
if that of the Skin be diminished by administering 
Calomel &c Antimony, and putting the
parts into a Warm Bath, in Adults Calomel
and Extract Cathart. third to lessen Nervous
Energy by giving opium combined with Sudorifics
and Salines, and at the same time due regard
is to be paid to the removal of the Exciting
cause without which no progress can be made.
Irritation of the Bladder will be much relieved
by administering Soda, whether from Stone or 
any other cause or in Constitutional Irritation
in general, for Soda appears to operate in the same 
manner as opium-

5
Inflammation
In external parts of the Body is manifested
by increased Redness, Sensibility, Heat and 
some degree of Tension.-The First is owing to 
an increased determination of Blood to the part.
The Second thought to arise the Blood vessels
of the Extreme fibres of the Nerves being distended
with Blood-The Third has been a Matter
of doubt. The Fourth to the Effusion of coagulable 
Lymph-Terminations of Inflammation-
Into Resolutions, Suppurations, Ulcerations
and Gangrene, of the first the parts
become glued together by the Effusion of coagulable
Lymph, this is called adhesive Inflammation,
Suppuration is a secretion of pus
or matter-the Blood undergoing a change in 
absorption of those parts most inflamed-
Mortification is a destruction of the life of the 
part-Inflammation differs in appearance
in different parts of the Body, in the skin it 
is generally very extensive and when [crossed out] unbroken
and extreme degree of redness attends, the cuticle 
becomes raised under which contained a quantity 
of Serum, the constitution suffers much 
it generally occurs in debilitated constitutions

6
When Inflammation is accompanied with
fever it is called Erysipelas-Erysipelas is
generally more or less attended with Vesications
and may be brought on by the Slightest Causes.
it most frequently terminates in Gangrene rarely
in Suppuration-Treatment-In Town &c
country varies much. In the former the Tonic
in the latter the Antiphlogistic plan is pursued
Mr Cooper recommends the Tonic he gives a Dram
of Bark every four hours with a moderate
Quantity of Wine-Uses Evaporating Lotions-
viz-Sht:Vin:Rect: Aqua pura a a P A-
Bleeding is rarely necessary only when accompanied
with difficulty of Breathing, he has 
the greatest objections to fomentations and 
poultices, the use of Leeches is very injurious
as they very frequently produce Erysipelas
when applied for other causes-
Arteries become inflamed in consequence of 
tying them in Aneurisms or after Amputations
and where the Constitution is irritable [crossed out]
proceeds onwards to the Heart and to Suppuration-
Symptoms stifness of the Limb, Delirium,
with an exceedingly small but quick pulse-
In Veins it is less extensive & rapid than in
Arteries, the Valves seem to set bounds to it
glueing its surfaces together, are always attended
with a great degree of hardness along their

7
Course and abcesses are often the consequence-
Of Absorbents these are Distinguished by red lines
extending in the course of the inflamed Vessels and
feeling like knotted Cords, generally stopping at the 
first Absorbent Gland, and producing great Constitutional
Irritation-Inflammation of Membranous 
Cavities resembles much in Symptoms Inflammation 
of Arteries such as the Pleura Pericardium.
Of Bones is accompanied by excessive pain very
obtuse and difficult to endure, the general Effect
is Exostosis-will go on to Suppuration and Gangrene
as in other parts, tho' extremely slow in its progress owing
to the circulation of the Bones being slower in proportion 
to other Parts-
Muscles when affected are affected with Spasm, which 
is most violent when the Patient is about to fall asleep
and at waking-Muscles rarely suppurate but ulcerate
and go on to a state of Gangrene-
Tendons rarely suppurate but slough to a great extent
possessing but little living power-
Nerves are rarely attacked with Inflammation 
when they are it is accompanied with excessive pain,
which is much aggravated with the least change of 
Posture & Motion, the Motion of the Muscle pressing 
when it excites twitching and spasm-
Sciatica generally attacks old people and always
proves fatal, at the commencement is attended with
very little pain, but it gradually increases until
the patient is worn out with Irritation-
palliate with Opium is all that can be done-
Of Glands If their whole substance is inflamed
their secretion becomes stopped-
Of Lungs-Symptoms-Pain in the side with
difficulty of breathing-Pulse low and sometimes
quick. Constipation, with vomiting & Hiccup-

8
Heart very peculiar pulse being hard and
of great breadth-
Brain violent pain in the Head, vomiting 
delirium, with extraordinary pulsation of the 
Carotid Artery, very large Abscesses will form
in the substance of the Brain, producing Paralytic
Affections, and Stupor without at all 
impairing the faculties of the mind, Suppuration 
rarely remains sufficient time to 
produce Gangrene-
Inflammation is divided into common
and specific, the latter in which the action
of the vessels is changed, in the former it is 
only increased and is what has just been
described, Common Inflammation is either
healthy or unhealthy, the latter most
commonly turned Chronic, the former is
set up for the Restoration of parts, as in 
the Division of an Artery &c &c without
which Union in no Case could take place
Specific is of two kinds the first arising from 
a peculiar state of the Constitution, being 
a simple Change in the Action of the Arteries
The Second the result of the Introduction of Poisons-
Of the first as Gout-Cancer-Fungus
Hœmatodes &c-of the second as small pox 
vaccine, Measles, Venereal Affection &c-
When Poisons are inserted into the Body, the 
Disease becomes communicable from one to another

9
another-Inflammation the means by 
which almost all diseases are formed-
Predisposing Causes Inflammation 
when arising spontaneously is the result of a 
weak state of Body and Parts affected and
is generally more extensive-
Occasional Causes are any part being put 
into an unnatural state-An Effort made 
in the sound part to restore the injured-An
increased action of the Vessels of the surrounding
parts-In case of a wounded vessel it is 
the inflammation which is the Division excites-
Extraneous Bodies, Fractures, and Division
of external parts, over Distention of the Vessels,
as from sudden transitions from heat and cold 
over Exertion &c &c-
Proximate Cause is the existence of the 
Disease or an increased Action of the Vessels
with Dilatation-
Treatment is either Constitutional or Local-
when on Vital Organ is affected or sympathizes,
the first means generally used is 
Bleeding which answers two purposes-
First by lessening the Fromentum of the Blood 
to the inflamed part, Second diminishing the 
Power of the Constitution and irritability of the 
Brain and Nerves; the more suddenly the 
Blood is removed in that Proportion is the 

10
Benefit received, therefore it is always best
to Bleed from a large orifice, which is most
likely to produce Fainting being always favourable 
in lessening Inflammation; the 
Quantity taken must be regulated by the 
Age and Constitution of the Patient, great
Advantage in derived from Local Bleeding, as 
in Inflammation of the Brain, opening
the Irregular Vein and Temporal Artery-
Cupping near the part affected-Indications
to bleed-first by finding the Blood sizy
but this is not to be relied on, Second
Blood being cupped and turned in at its Edges,
with a small Quantity of Serum, this will also 
be an indication for repeating your Bleeding.
Pulse hard with some degree of Quickness from 
76 to 100-Next Means to be employed is trying 
which acts in three ways. First by 
relieving the Bowels of accumulated Fæces
or the irritable substances-Second by restoring
the Secretions of the Mucous Membranes
of the Intestinal Canal and Appendages
and drawing blood to and from the Surface
of the Intestines, purging is the chief
means to be relied on in Children-give Calomel
grs ij 2 nd vcl 3rd nocte united with so
many-Iatal or saline purges according to 
the urgency of the Case-For Adults give

11
Calomel gr i Ext Cath grs vi nocte maneque
in Acute Inflammation, but when it is of
the Chronic kind it should not be repeated so
frequently, Magnes, vit. may be given afterwards
if the Formula above prescribed do not prove
sufficiently active-
Perspiration is useful and benficial and
should always be excited, it acts by determining
the Blood to the surface of the Body; there
to be carried off in the Form of perspirable 
Matter-Means of Exciting it by putting 
the Patient into a Hot Bath, which is always
rendered more effectual after Venesection, 
giving Warm diluents, Hot Water
put in Bottles or Bladders and applied to the 
soles of the Feet and between the thighs:
giving Antimonials as Parts Ipecac comp 
vel Pulv jacobi grs iij ter die-
Chronic Inflammation
In this the treatment differs much 
from the Acute-give Hyd Muriate grss 
in Decoct Cinchona ℥ii -bis terve die
vel pil Hyd grs x nocte maneque cum Decoct 
Cort vel Inf Rosar being very careful not to 
produce Salivation-and after the Bowels have
been sufficiently evacuated, give repeated
doses of Antim Pulv. so as to keep the Patient

12
in a constant State of Nausea-Warm Bath
is also very serviceable-Local Means, Cold Applications
are generally used, it acts by lessening 
the Diameter of the Vessels, and by diminishing 
the Action of the Muscles-this shd. not be 
persisted in for too great a length of time else
the Part may become frozen and Sloughing will 
be the consequence-When Ice is applied this point 
shd. be particularly attended to, and may be obviated 
by pounding it and putting it in a Bladder
before it is applied-Evaporating Lotions 
are useful, the best are Spt. bis Rect. Aqua pura 
aa PQ. or Aqua Litharg Aut cum Aqua, the 
latter has [crossed out] direct Operation on the 
Nerves; Heat is sometimes useful and when 
employed shd. be united with Moisture-it
acts by exciting Perspiration and a greater
Secretion from the Part-is best applied in
the form of a Poultice or Fomentation-
Leeches and Scarifications are beneficial in unloading 
the Vessels of the inflamed parts-
Stimulants are used to excite counter Irritation 
or Inflammation, as two Inflams. will 
not go on in the neighbourhood of each other,
it is therefore highly necessary in Inflam of 
the Joints or where any vital organ is affected
Blisters must be applied as near to the part
as possible-when in Joints the Remedies
usually had recourse to are Blisters, Issues- 
Setons, Stimulating Liniments and Poultices
Form for Liniment By Liniment Ammon ℥i

13
Antim Tart ʒij which shd. be employed till Eruptions
are produced-Vinegar and Oatmeal for 
Poultices for remaining hardness apply Blisters
with the part with ung- Hyd- Mit cum Camphor rd
Antim-Electricity-Much relief has been obtain-
by Friction-it is this that Mr. Grooves of Oxford
has obtain'd so much Credit for &c by which he has 
cured so many Cases-Rest &c Support are in
many Cases absolutely necessary-
Irritable Inflammation may be much 
allayed by giving Opium in Haust Salin and
applying it to the part-
Mr A P Coopers Remedy for Colds-I mean 
what is commonly called a Cold-he takes
a large Bason full of Tea about 7 in the Morning
as hot as he can drink it, he repeats
the dose at Nine which puts him in a profuse
Perspiration, he afterwards lays till
10 or 11 in the Day, or till such time as the 
Perspiration has in some Measure subsided
when he gets up quite well-he also washes 
himself every morning all over in cold Water
before he dresses which he thinks very condusive
to health-
Adhæsive Inflammation
Is generally set up for the Union of injured
parts, which become glued together by the Effusion
of Coagulable Lymph at which time it is always
thinnest but coagulate more speedily and with
greater Firmness-

14
Symptoms-Tension-Pain and increased
Sensibility but not redness, the Swelling is more
diffused, all exhalent surfaces and Cavities adhere
more readily than other parts and more extensive
The most common seat of Inflam. is in the Cellular
Membrane and is generally adhæsive, arising from 
the peculiar Structure of the vessels not allowing
the red Particles of Blood to pass through them so as 
to produce pus-As soon as the Inflam. begins,
a diffused Tumour is produced by the Diffusion of 
Coagulable Lymph, which when first produced is like
Jelly, talking on a regular Arrangement like Cellular
Membrane, and has a net Work Appearances-
The Vessels of the part in Contact became elongated
and shoot into coagulable Lymph and thus it becomes 
vascular, sometimes in 24 hours, but after the 
Application of a Blister it is produced in Six
hours-
Its Use First when the formation of an Abscess
would rapidly extend, causing extreme danger
Coagulable Lymph is diffused, forming a wall or 
Boundary to prevent its extension-Second in 
large Cavities a Partition is formed to prevent
the whole from being affected, in which case matter
may be poured into one part without the least affecting 
the other. Third that of incasing Extraneous Bodies
but the principle is as before mentioned to restore
injured or divided parts, There is no such principle
as union by the first Intention; Extravasation of the 
Blood much becomes the Bond of union, except in 
the division of a vessel in general the less Blood
there is, the better is the Union-There are only 
two modes of union, by Adhæsion and Suppuration
of Granulation in Inflam. of the Bones
gelatine is effused-Adhæsion will proceed to such
length as to extarpate large cavities, the Pericardium will 
become glued to the Heart, Lungs to the Thorax &c &c

15 
Suppurative Inflammation
When Inflam. had passed the Bounds of Adhæsion,
Suppuration is produced, Serum and Blood
are poured out instead of coagulable Lymph, the 
Symptoms are sudden prominence, the Centre 
becomes soft, the surrounding parts much increased
in hardness, this bing pain with the Skin
Red, which strongly marks the state of the parts
below, in general a distinct Fluctuation is perceptible,
Chillings succeeded by Heat, and Shivering
when the Inflam. is extensive on the part affected
is of great importance to life-Suppuration 
is the usual consequence of Inflam. of Secreting 
Surfaces as the Urethra, Trachea, and Membrane
of the Nose &c-it is thus wisely ordained by 
Nature else Death or the Destruction of the Part
must be the consequence-if the Inflam.-is
violent or of a peculiar kind it will produce
Adhæsion, or if long continued. Suppuration
always precedes Adhæsion but is not always able 
to prevent it-
Uses to cover Granulating Surfaces, and
keep them in a moist state by its opening
promotes the Absorption of Parts and for the 
purpose of discharging Extraneous Bodies

16 
Nature of Matter and Mode of Formation
Pus is found to be composed of Serum &c
white Globules, the latter similar to the red 
Globules found in the Blood thro' some what 
smaller, Put coagulates with Muriate of Ammonia,
whereas Mucus will not, it was formerly
supposed to be a solution of the Solid Parts,
but it is now well known not to be the Case-
some have attributed it to a process of Fermentation
but it is an absurd Idea, it may be formed
without the Application of Heat or Air-
True Pus is a Secretion of the Blood Vessels poured
out in the same manner as Synovial Fluid or
any other Secretion-Blood is produced according 
to the Quantity of Pus secreted, hence the 
Ill Effects of stopping too suddenly large secreting
Sores-producing Apoplexy &c the Blood being 
then forced to some other part of the Body-
True Pus has not the power of irritating 
any part to which it is applied, except some
Irritation is applied to the part, it then becomes
icherous and offensive, such are the Surfaces 
where Bones are exposed, If the Irritation 
amounts to the Production of Inflam. all Secretion
stops. Or if any Poisonous Matter
is applied to secreting surface, it becomes 
inflamed and produces a Poison simular to the 
one applied, which becomes generated in various
parts of the Body. When a poison has been long

17
subject to the discharge of Pus, it was formerly 
customary to substitute another, but this practice 
is now rarely followed-
Treatment-is simply purgative Medicines 
judiciously employed will answer every purpose-
Drastic Purges answer every Intention 
of Issues without the least Inconvenience-
Ulceration
By this is meant the Absorption or Removal
of the natural formed solids of the Body
commonly accompanied with a Discharge of 
Matter, but this is not necessary-in general 
it is the result of two circumstances, Inflam 
and Pressure, the former rarely the Cause unless
accompanied by the other, Pressure not only 
cause the production of Pus but also much increases
the Action of the Absorbents, thus Pressure
from an Aneurism wile cause the absorption of 
Bone &c When Matter is forming in Bone its 
first Appearance is a if worn, eaten, attended with 
a very gnawing Pain-Pus has a general 
Tendency to the Surface, which is attributed to 
these parts possessing but less living power, thus
Matter will form under the Scapula and will make
its way thro' the Bone in preference to passing
thro' the Cellular Membrane into the Thorax-
To also send Abdominal Muscles, but will not pass
thro' that transparent Membrane the Peritoneum
Parts newly formed are none readily absorbed than 
original-

18
Ulceration is quicker Process than Restoration-
in parts most remote from the heart, the more
speedy is the process of Ulceration and so vice versa-
Absorption is increased in proportion to the Inflam.
Cicatrizes absorb more readily and rapid than other 
parts, and with this intent we lance the Gums of 
Children-Altho' Ulceration is productive often of 
Disease, still it has its Uses of which that of discharging 
Extraneous Bodies is the Principle-
Abscesses-
An Abscess is a Collection of Matter contained 
in a Cyst prior to which Coagulable Lymph is 
poured out forming a Wall, painting out its Extent,
in the Center of this a Drop of Pus is deposited and by 
its Pressure promotes the Absorption of part of the 
Coagulable Lymph deposited and a Cavity is thus produced
in which more Matter becomes lodged, this Process 
continues until the parts become absorbed
to the Surface of the Skin, it then bursts and the 
Matter evacuates-but in some Constitutions the 
Vital Powers are so much weakened by constantly 
laying a bed, Debility &c that thus boundary can
not be formed as in Ulcers of the Back, they extend 
so wide that the opening them proves fatal-
The Danger arising from formation of Matter
depends-1st upon the size of the Abscess-
very large Abscesses will be formed under the 
Fascia lata of the Thigh containing Matter to 
the Quantity of three Pints-and still larger

19
in the Liver and are not considered so dangerous
as the former, because as soon as the discharge has
taken place, by the pressure of the Intestines
the parts become placed in close Apposition and 
Adhæsion is the Consequence and from thence a cure-
Second from their being situated on or near parts 
important to life, when Abscesses are situated between
the trachea and Shine unless discharged 
will cause difficulty of deglutition, respiration
and suffocation, behind the Urethra causing retention 
of Urine. Bones when exposed by Matter
require sometime before Granulation can be 
produced-
Treatment-If an Accident is the Cause, or 
a lodgement of an Extraneous Body Fomentations 
and Poultices shd. be used and if the Person
is of an indolent Habit Bark and Wine shd.
be used pretty bountifully, shd. be allowed a 
generous diet and poultices of a stimulating
Nature shd. be applied, as Salt and Water
with a sufficient Quantity of Bread Meal &c
Mustard and Stale Beer Grounds with the same 
Intent-Emplast & Lytharg C. sometimes it
will so happen that Abscesses will not seem
inclined to come to a Crises in which Case 
the Emplast Lytharg Com may be employed with 
Benefit, as it will often cause its absorption
but this practice has Objections often producing
Erysipelas and Erythema which may be speedily 
relieved by warm Bath- 
The best Method of Opening Abscesses is with the 
Lancet and which may be performed as soon

20
as Fluctuation is visible-In many Cases 
it is advisiable to open them early, always
where they are situated under the Fascia,
thick Skin or near Bones-In very large 
Abscesses under the Fascia lata from the pressure
of the Matter, the Limb becomes much 
contracted, therefore the Puncture shd. be made
at the most depending Part and rollers applied 
rather tightly around the whole Limb except 
the Punctured Part-
Hectic Fever does not depend upon the 
Absorption of Matter as it frequently takes
place before the formation of it and is more 
violent after its Absorption than whilst it was 
actually taking place, it is in part the means
by which the Matter is formed-In Acute Affections
of Bones without the formation of Matter
it will be produced, it being only sympathetic
Fever-
Secondly it becomes proved that it is not from
Absorption of Matter as the Fever is not in proportion 
to the size of the Abscess-Thirdly because
when Matter is absorbed by the Influence of Medicine
the Fever is by no means increased-
With this view Psoas Abscess has been attempted
to be absorbed by Digitalis but with Benefit
The Fever was not increased nor the Abscess
cured-The symptoms were in some degree mitigated
and the Abscess still remained
Stationary-

21
Fourthly Hectic symptoms will occur independant 
of Abscess, when the parts require constitutional 
Assistance, By many it has 
been supposed that the Admission of Air to injured
parts was the cause of Abscesses-but this
is denied, as it is not the consequence in the fractured
Ribs, where Emphysema is produced to such 
an Extent as to blind the Patient neither is Air
the Cause of the Inflammation which ensues after
the opening of an Abscess, but the Division of 
the Vessels producing an unnatural state in 
that part Opening Abscesses by Caustic causes
Inflammation by destroying the living Power-
Union by Granulation-
Granulations are those processes of Flesh arrising
from wounded surfaces which usually takes
place three days after the Abscess has been opened-
When an extensive wound is made, Inflammation
arises which occasions an Effusion of
Coagulable Lymph and that in Layers and which
Coats the internal part of the wound in a few 
hours, Vessels then shoot into it an in 5 or 6 
Days it becomes vascular, a living organized 
Mass, these Vessels terminate in Open Mouths
upon the Surface of the Lymph and from 
these fresh Lymph becomes poured out untill
the part is perfectly restored these Vessels
secrete Pus as well as Lymph to lubricate
the surface and keep it moist-

22
Granulation then is a new formed Substance 
secreting Pus first formed by Coagulable 
Lymph and differs from Adhæsive Inflammation 
by the Vessels of the latter not
terminating in open Mouths and not requiring 
so much Inflammation for the Process-
The Structure of Granulation is much the
same as Glands and are extremely vascular-
and when recent have but few Absorbents, but 
old Ulcers have in Abundance, possess some
sensibility, but those of Bones, Tendons and 
Fassia when not inflamed do not-Granulation
when closely approximated to each 
other will readily unite, but when only superficially,
Sinuses are produced-
Wounds of the Scrotum shd. be always closely 
approximated and suspended else you will have 
Sloughing- 
Cicatrization
When Granulations arise a little above the 
Skin the process of Cicatrization begins which 
is the formation of new Skin on the Surface
of Granulation-it is simular to the process
of Granulation, Granulations of the Skin are
formed in the same way which unite with the 
nearest Granulation of the Sore thus from
all the Surrounding Edge, they keep shooting
out till the surface of the sore is quite covered

23
its Vessels are from the Skin, the Rete Mucosum
is not so quickly formed as the Cuticle are Cutis
Parts restored are in general similar to parts
lost, as Skin for Skin, Bone for Bone &c-
except Muscles which are supplied by Tendons-
Cartilages of the Ribs by Bone, this applies to 
the Adhæsive as well as the Granulating process-
Glands reproduced have no excretory Ducts-
When new Skin is formed it is at first redder 
from its great Vascularity, but afterwards becomes 
much Whiter from the Diminution of its
Vessels-
Ulcers.-
An Ulcer is a granulating surface secreting 
Pus-When perfectly healthy, the Granulations
are of a florid red Colour, and the surrounding 
Skin closely approximated to the surface of the 
Granulation-
Treatment Dry lint shd be applied to 
the surface to stop the Bleeding, and to act 
as a stimulant, which is to be removed in 4 
or 5 days, by which time Pus and Granulations
are formed, afterwards a Poultice shd. be applied
to promote granulation, when in a few days
they rise to the surface of the skin and look
flabby, dry lint is again to be applied to 
the Centre, and Unctious Substances to the 
surrounding edges at the same time the
Patient may be allowed Bark and Wine 
with moderate Exercise-

24
Impediments to Healing
First Granulations arising too high preventing
the skin from shooting over;-
Treatment, Bandages, with Sheet Lead
Caustic, around the Edges but not over the whole
Surface-Second they will often be in a liquid
state having a glassy appearance which is 
owing to the coagulable Lymph not becoming vascular
Treatment Ungt c Precip: Rub: also vitriolic
Lotions-Rs Ol. Vitriol guttæ ij Aguæ pur ℈i
vel Tinci Vitriol grs ij Agus pura ℈i The Sal 
Glaud may be used for the same purpose and 
in the same proportion-Tight Bandages as
they give support to the Vessels-
In the Inflamed State-Fomentations
and Poultices, Rest & Purgative Medicines-
Sloughing State the best Application
is nitrous Acid in the proportion of 50 drops
in Aqua Hij-Poultices of Port Wine and State
Beer Grounds, when very irritable cannot poultices
are very beneficial-The Nitrous Acid 
has great Power in diminishing the Discharge
and Fætor of it-In Mortification of the Toes
Mr. Cooper prefers it to any other Remedy-
Ulcers met with about the Abdomen and 
necks of Children are beneficially treated by 
the use of the Black Wash-Calomel ʒi-
Aquæ Calcis ℈Vi-

25
When Sinuses are formed it is adviseable
to open them and use Injections in the first Instance-
as Hyd Muriat grs ij Aquæ puræ ℈i Jr
Cantharidis is sometimes used to bring Adhæsive
Inflammation-If Sinuses have an opening
at each Extremity, it is usual to make one in 
the Centre and Apply stimulants, Caustic Bougies
are used with Benefit-when ulcers are 
prevented from healing by extraneous Bodies
as Bone &c-Apply Acids with Lint upon
the exposed part, Fistula in Ano always requires
to be opened, because every time the 
Rectum contracts the sides are drawn asunder,
preventing any time taking place-
Ulcers connected with any Periodical Discharges
as obstructed Menstruation, to be treated locally
with Ungt. Mercl. vel Aqua Calcis cum 
Calomel and at the same time correcting
the general Habit-
Nail growing into the Toe
The Toe shd. be put into warm water every
night and there kept till the Nail obtains some
degree of softness, afterwards to be removed &c
wiped dry when it shd. be scraped with a piece
of glass till it is sufficiently thin to allow of 
its being raised from the Toe when it may be 
cut off, if not removed in this way, serious 
Consequences will sometimes ensue producing

26
a diseased state of the Nail, and requiring its 
removal with the Gland from where it grows-
when they turn black from the Cause use Aqua 
Calcis Calomel vel Argent Nit-
Sores in the lower Extremities proceeding 
from diseases Viscera, and the Limb being in 
an Anasarcous state, shd. have applied to them 
Ungt. Hyd Mit-and remove the Cause by Calomel 
and Ext Cathart. Gambog-Silla Digital-
Rs Tr. Digital ℈ss-Tinct Cinchan Comp ℈i sum Coch i
bis die in wine. Ulcerated Varicose Veins proceeding 
from Debility and most common to old People 
attended with extensive Dequamation of the 
Cuticle shd. be treated by applying Aqua Calcis
i Calomel upon Linen Rags, over these oiled Silks
and Rollers and a recumbent Posture-When Hæmorrhages
ensure which is not uncommon apply 
Dossils of Lint, tight Banndages &c The Saphina
magn: Vein has been repeated by tied for its Relief
but is always attended with Danger and rarely 
success. Mr. C thinks it a most dangerous Remedy
The Ungt. Merl. may be used where the above
Lotions are too irritating, when Sores have thick 
White and callous Edges, apply the Ungt. to Merl
and if it do not succeed scarify the Edges-
When the Edges of a Wound turns in it is a mark
in general of Debility of the Constitution frequently
of Scrofula, Apply a Solution of Argent. Nitr Ol
Sulph &c and at the same time strengthen the 
Constitution-
The Edges of Sores turning out indicate
their being of a Cancerous Disposition-

27
Irritable Sores are frequently met with 
which will not yeild to common Treatment, no 
unaccompanied with Inflammation but excessive 
Pain-Treatment Poppy head fomentations
Opia the Ointments as opium ʒi Ungt Cetucci ℈i
but the best Application is Opium Ungt. Hyd.
Nit. in the same proportion-Opium Internally
is highly requisite. Irritable Sores of Stumps
will be much relieved by this last mentioned
Remedy-Nitrous Acid Opio has been applied
tho' not with the same good Effects-Adhæsive
Plaister is an excellent application for 
sores in general but not to be applied to 
those of a specific and Gouty Nature, it acts 
by Stimulating the Granulations and thus 
drawing the Edges together-Exercise may be used
in indolent Sores when properly supported with 
Bandages, but in irritable sores it is highly 
improper-
Death of the Cellular Membrane
The first Appearance is swelling unattended
with Pain and the Skin having purplish 
there-Inflam-then takes place tho' not having 
that Appearance common to Inflam in 
general-Sloughs then take place to an excessive 
degree-They much resemble venereal 
affections and are often treated as such 
which mode always proves injurious-
Are the result of great Debility-

28
Treatment-Pil Hyd grs v nocte maneque taking 
care not to affect the constitution, Give 
Bark &c Ammon- &c Ammon I Aqua Menthæ
bis die-Local Applications such as Aqua Calcis
c Calomel-Sol Argent Mitt ʒi to Aqua ℈i applied
with the Camels hair Pencil-When produced 
by obstructed Menstruation give Myr c Ferro-
Gangrene
By this is meant the death of any part of 
the Body-The effect of two different States
of Parts-first from a high degree of Inflam
Second from weakly Inflam. or the Application 
of Cold-Symptoms in the first Instance
the Parts are red and painful, suddenly they become
quite void of Pain, the red changes its Colour
into a dirty Brown and vesications suddenly 
appear, containing a Bloody kind of Fluid, the 
Pulse is quick, small and Intermittent-
Delirium oftens occurs and Hiccup is almost 
a constant symptom-When Gangrene 
takes place from Cold different symptoms
occur-the part becomes quite numb and upon 
exposure to hear, excessive painful and slightly
red-Cold applications for the time subdue the 
pain, in 24 hours first, Inflam arises and by 
repeated Inflam the part becomes so weaken'd
that its living power is destroyed-slight
flushes appear on the check but no 
Hiccup ensues- 

29
Different Symptoms from the the two former
also appear when Gangrene attacks old People,
when any part has last its Vitality the Sound
part takes on a new Action to remove the part
destroyed: around the dead part in about two days
a white and prominent line appears, the Cuticle
is raised under which a small quantity of Fluid
is contained, in twenty four hours the Cutis becomes
absorbed and next the Cellular Membrane
which is a much slower progress, then the Muscles
which are quickly absorbed but of Tendons 
and Fascia a long time is required for 
their absorption-A dead plate of Bone will
be absorbed in the space of six weeks or some
time it requires 2 or 3 Months, but this process
may be quickened by Nitrous Acid. If a whole
Bone is to be absorbed it is often the process of 
two years. By Absorption the largest Arteries are 
eaten thro' without the loss of much Blood-
Predisposing Causes-A weakness of the Constitution 
or of Parts, sometimes after Fevers 
and considerables Hæmorrhage- 
Occasional Cause under all Circumstances
Inflam. if any Exception it is in Hydrothorax-
Treatment-two principles are to be in view
first to diminish the Action of the surrounding 
Parts, by local Applications as Leeches &c 
second to strengthen the Constitution- 
In the Commencement it is not adviseable 
to apply stimulating Poultices but let them
be of the common kind, give Opium internally
in preference to Bark gr one Morning, Noon

30
an Night, if the Bowels have been previously
evacuated which must be attended to before it is 
given-Opium is particularly beneficial in 
preventing the progress of Gangrene-Use
stimulating Poultices made with Linseed Meal
and Port Wince or Stable Beer Grounds-Give
Bark and Ammonia and Wards paste the doses
shd. be small else it will be apt to disorder
the Stomach, excite Nausea &c which shd. 
be carefully avoided, may be in great measure
prevented by combining Opium within, but 
the greatest dependance is to be placed in Wine 
and Opium or Opium &c spts. if the Patient
has been more accustomed to the latter-or strong
Beer, Porter &c-to those who accustom themselves
to it-Spt. of Wine and Vinegar is a good local Application,
it promotes the seperation, decreases 
the Discharge and diminishes the Fætor-to be 
used in proportion to the Patients feelings-
when the Pulse is quick Opium shd. be always
given-Amputation shd. not be performed
till the line of Seperation is quite complete
except in the division of a large vessel
Gangrene occurring in old People in consequence
of Ossification of the Arteries mostly
takes place in the great Toe and in those persons
of a tall Stature and who have lived 
intemperately, Very frequent Causes are cutting
Toe nails, Corns, Bunnions &c and leaving
off an accustomed Quantity of Wine Spt &c

31
Persons thus attacks experience great Numbness
in the lower Extremities and much Fatigue 
in Walking-The Treatment differs but little
from the Treatment of Gangrene in general 
but is much more difficult to arrest its progress,
The Limb shd be kept moderately warm,
recumbent Posture, Warm Spt of Terpentine
to the part, Opium in large doses, Wine and 
Brandy-
Carbuncles.
Is an Abscess when the Cellular Membrane
becomes in a Sloughy State, at first it has 
much the Appearance of a Boil, varying only 
in size, for Boil in Species of Carbuncles
they generally contain a bloody Sonum and
when it breaks it does it by many Apertures,
which is a most stiking diagnostic of the Disease,
afterwards the Skin Sloughs and exposes
the Cellular Membrane in this State-The disease
generally occurs in old People of intemperate 
habits and previous Debility, are most
frequently seated on the Back and Nates which
are generally recovered from, there is no instance
of a recovery when they have been seated upon
the Lead-
Treatment the same as in Notification 
in the Commemencement stimulating Poultices
and Fomentations highly requisite, hot Terpentine

32
time &c making incisions into the parts 
relieves much-give Wine, Brandy, Bark,
Conf. Opitat and Ammonia-
- Injuries of the Head-
The general Symptoms of which are loss of 
Sense and Motion, the Pupils are dilated, Bleeding 
at the Nose & c Ears always indicating a Fracture
of the Basis, the Breathing difficult accompanied 
with Apoplectic Stertion, the Pulse
is slow, laborious and intermittent, Vomiting 
which almost always takes place immediately
after the Accident; Vomiting of Blood is 
not to be considered of any Consequence, it being
occasioned merely by the Blood halping down the 
Esophagus-Costiveness, but not often the 
contrary effect takes place, the Urine and 
Fæces passing off involuntarily- 
The Symptoms are distinguised in general
into those of Concussion and Compression, the
latter proceeding from three Causes-Extravasation 
of Blood, Pressure of Bone and the formation 
of Matter-
Of Concusion the Patient appears as if 
in a sound sleep and when attempts are made
to rouse he appears as if void of all Sense and 

33
Motion, he breathes with all ease, and the pulse 
by no means affected, except much roused, Vomiting
generally attends- 
Concupion is distinguised by the immediate
Succession of Symptoms and no cessation of them
till the Cure commences, By Persfiration being 
free and the Pulse regular In general it produces
such as altered Action of the Vessels of the Brain
as to prevent their Fermetions, but if the Violence
is great the Brain becomes lacerated which
is the Case when death is the Consequence-
Frequently a person after sustaining an injury
of the head will long in a State of Stupor
and not be able to answer any Question you may
Just to it, but will still get up and do certain
offices which are the most habitual to him
such as Shaving Wasching &c &c
Mr C has often disected many cases of Injuries
of the head and had frequently found the Bile
changed from a green to gentle white colour
and almost transparent-
Treatment Vomiting suddenly relieves, in 
restoring the functions of the Brain, with this
vico Emectics have been given, but which are
seldom necessary, as vomiting most frequently
occurs spontaneously- Two objects are to be 
had in view, first to prevent Extravasation
of Blood when lacerated &c second to guard
against and subdue Inflammation-

34
Of all the Remedies made use of Blood Coting 
is by far the most efficacious, but it 
is prejudicial for the first few hours after
the Accident, till the Pulse begins to react,
and as soon as it becomes hard &c full the Remedy
shd. be employed the Quantity to be regulated
by the state of the Pulse and Constitution of 
the Patient, more benefit will be derived
from frequent and repeated small Bleedings
than taking a large Quantity at a time, the
Criterion for the Necessity of Bleeding is a 
strong Pulsation in the Carotid Artery,
even better than the Pulse, the Patient shd.
be visited often, three times a necessary
and according as you find the Pulse rising 
of falling in that proportion will you regulate
the Use of the Lancet, if it rises two 
oz may be drawn two or three times a day- 
Local Bleeding as opening the Temporal 
Artery, and jugular Vein, Leeches, are highly 
beneficial especially in Children and as the Jugular 
Vein is much more easily opened in Children
than the Vein in the Arm the former is 
generally had recourse to -
The Bowels shd. be kept open and in a constant
state of Irritation by Calomel &c Magnes vit
Pulse Jalap &c &c Perspiration shd. be encourage

35
encouraged by Sudorifics, but Antimonials shd. not 
be used so as to excite Nausea, Opium in Concussion 
does not in general agree. The Application 
of Blisters to the Nape of the Neck and Scalp rank
not in Efficacy to Bleeding, it may not be 
adviseable to apply them in the first Stage unless 
much pain in the head is present with Symptoms 
of Phrenitis-
If the Injury is accompanied with a wound 
of the Scalp Stimulants shd. be applied to it.
All Stimulants internally to be carefully avoided.
The Antiplolgistic Regimen to be strictly
adhered to, exclude all Light, prevent Noises
and Conversations of all kinds, let his Drinks
be of an Acidulated Nature as Lemonade &c &c
Fruits may be allowed pretty plentifully, The 
Feet shd. be put into hot water every night
but to be done so that the Patient may not 
be in the least disturbed, he must not even be 
raised in his Bed-
Trephining of no Advantage in any one Symptom
of the Disease-After all the Symptoms
have subsided an imperfect State of the Mind
will be the Consequence with the Loss of an Eye,
Limb &c Strabismus and perfect Idiotism,
also loosing the power of retaining and speaking 
foreign Languages, thus the Germans cannot
speak English-the English, French but may
sometimes be restored by Electricity-

36
Of Compression. The Symptoms attending 
Compression differ from those of Concussion
in being accompanied with difficult and stutorous
breathing, with a slow, irregular and intermittent
Pulse, proceeding from three causes
as before mentioned, viz Extravasation of 
Blood, Depression of Bone and formation of 
Matter- 
The Symptoms attending the first Cause
generally take place gradually, when not 
accompanied with Concussion. The Effused 
Blood is situated in three parts-first on the 
Surface of the Dura Mater-second between
the Pia Mater and the Brain /which is frequent/
third in the Substance of the Brain and Ventricles,
when in the Brain itself the Symptoms
do not occur so soon- 
Treatment consists in preventing further
Extravasation and the Inflammation from going
on to Suppuration-Bleeding is the chief 
Remedy to be relied upon, and the same
time due attention to the State of the Bowels-
Trephining is only useful when the Blood
is situated between the Dura Mater and the Skull
and shd. not be employed till all Remedies have failed
In generable the Pericranium is detached where
the Blow is received, here the Operation shd. 
be performed, but if the Extravasation shd.
not be here found, it is wrong to attempt 
the second time, but some recommend trephining

37
[trephining] till the Extravasation by found.
Mr C is not of that Opinion. Where there is 
depression with laceration of the Scalp Trephine 
is not generally requisite, but the depressed 
part shd. be elevated-
If the Blow shd. happen to be upon the Ant. 
Inf. Anglc of the Parietal Bone and is violent
it is adviseable to trephine the part, as the spinous 
Artery of the Dura Mater passes in a Grove in 
the above described part, and extravasated Blood
is more frequently the Consequence of a Rupture 
from this Artery- 
In Depression where the P, even at the time
experiences no Inconvenience from the price
of Bone depressed, it is adviseable to elevate it,
else the symptoms are liable to occur at any 
distant period, being produced by Intemperance
&c besides which it is not infrequently 
the cause of Epilepthic Fits- 
Fractures of the Cranium
If unattended with Extravasation of Depression 
are to be treated as fractures in other parts
only recollecting their Vicinity to the Brain,
therefore requiring that the Antiphlogistic
Regimen shd. be more rigorously enjoined-
Treatment Fractures are frequently accompanied
with depression without the Symptoms
of Compression; the Symptoms of depression are  

38
exactly similar to those produced by Extravasation
in a Fracture with Compression whether there
be a Wound or not, Trephining is necessary
if in a few days the Symptoms are not more
mild, however before performing it is better to 
take away some Blood, as in many Cases it has
been known to render the operation useless-
Fractures with Depression, with a wound leading 
to the fracture and unattended with Symptoms 
of Comprion, it is requiste to raise the depressed 
juice and when it cannot become the operation 
will be necesary-
First. Fractures attended with Depression and 
neither Symptoms of Compression or wound being 
present still trephining is necessary-
Second. If attended with Depression and External
wound communicates with the fracture
it is necessary to elevate the Bone, even when 
not attended with Compresion. When Inflammation 
has taken place upon the Brain Trephining 
is of Course useless-
Third if attended with Symptoms of Compression
and no relief it obtained by V S then also Trephining 
is necessary-
If the Symptoms shd. occur at any distant period
after the Accident the Operation may be 
performed with almost equal Benefit-
Sometimes Funguses sprout from the Surface
of the Brain from wounds of it in part coagulable
Lymph and in part Brain pass openings but little

39
little Vascularity; when it projects above the Surface
of the Bone it may be removed with safty either
by Ligature or Scissars after which Lint dipped 
in Lime water shd. be applied with a Capilary
Bandage over it- 
Formation of Matter on the Brain-
In Injuries in general Inflam. arises
in a few days after the Accident, but in the 
head it is protracted to a much longer 
Period, 7. 10. 20 and often even 30 days- 
Symptoms Pain in the head with a Cessation 
of the Discharge from the wound, the 
Surface of which appears glassy and sloughy
being previous by granulated and having 
a perfectly healthy Appearance the Scalp
pits as if anasarcous owing to the Effusion
of Coagulable Lymph the Countenance
appears flushed, not constantly but frequently,
the Tunica Conjunctiva becomes
often red, and vomiting is not infrequently 
attendant, but the most striking symptom 
is repeated and frequent shiverings.
The Matter may be either situated between
the Dura Mater and the Cranium, upon the 
Pia Mater and substance of the Brain-
In the first Case trephining gives immediate 
relief, and when the afore mentioned

40
Symptoms occur it is highly necessary.
The greatest Danger is to be feared from the 
formation of Matter in either Situation,
neither is it much lessened by the Operation.
When under the Dura Mater a recovery is not 
at all to be expected-
-Trephining-
In fractures without depression a longitudinal 
Incision is best, but when the contrary a 
Crucial one answers better; when the Bone is 
depressed apply the Instrument on the part
not injured, that is apply it 1/3 over the injured
part and 2/3 over that which is not,
and pass the Crucial insicion thro' the Periosteum
and let it be turned back with the 
Integuments, always use the smallest Trephine 
and apply it with the Pin down till a complete
Circle is formed, then slide it up again else
it may be apt to perforate the Dura Mater-
The Operation shd. be performed cautiously 
and slowly frequently examining the Circle,
as soon as Blood is perceived the Trephine 
has reached Diploe, but in Young and old
Subjects this must not be expected, they
having none, consequently in both requiring 
the greater Caution. As soon as the Bone is 
completely sawn thro' apply the Elevator and 

41
raise it completely out and afterwards to put 
the depressed part into its proper Situation,
this being done bring the Integuments into their 
former Situation and the Edges into close up
position and unite them by the Adhæsive Process-
If after reaching the Dura Mater a Sense of The situation 
is perceived, it is not improbable but
Matter may be there situated, if very Evident
a slight Puncture shd. be made-
After Injuries to the head Erysipilalatous Inflam 
will often supervene, denoting, Injury 
to the Occipito Frontalis, and making great 
debility, after evacuating the bowels it will 
be proper to give Bark- 
Under the Occipito Frotlalis also Matter 
is sometimes formed-In such Cases
make several opertures, and leave them 
open that the Matter may escape freely,
confining the other parts by Bandage,
When Matter is situated under the Aponeurosis
of the Temporal Muscle early incision 
is remommended-
Hydrocele
By Hydrocele is meant a Collection 
of Water between the two reflections of 
the Tunica Vaginalis Testis-
Signs- A flacid Tumor possessing but

42
little weight and commencing at the Bottom
of the Scrotum, as it increases in size it
looses its flacidity and becomes tight and 
elastic, and taking on it a pyramidal shape,
it is unattended with Pain unless originates 
in acute Inflammation, often it increases
to a great size without being perceived by 
the Patient, but as the Tunica becomes 
distended, pain will be produced in the Loins
The Tumor is mostly transparent forming 
its most distinguishing Mark. In 
general the Scrotum does not become discoloured,
and the size of its Vessels but little 
increased, Fluctuation is perceptible
throughout the Tumor, distinguishing it
from the Fluctuation of Fluids by its 
extent-
This Complaint is subject to variations,
sometimes forming a double Tumour
on one side and extending above the Abdominal 
Ring, and frequently Hydroceles will 
form on each side, in some Cases the transparency 
of the Tumour cannot at all be distinguished 
owing to the state of the fluid or the 
thickness of the Tunic or sometimes Ossification 
of it, the fluid will often be contained 
in Cysts in different parts of the Tumor

43
owing to the partial Adhesion of the Tunic, and 
sometimes Cysts will form upon the Epididimus,
thus the water is contained in the Tunica Vaginalis
In Hydroceles in general the Testicle is situated
2/3 of the [crossed out] length of the Turn or downwards
and posterior to the Hydrocele, but will sometimes
happen to be situated anterior which shd. first 
be assertained when going to operate else it may 
be injured by the Trochar, in most Cases the fluid
in colourless and transparent, in others a bloody
Sanies is contained and often of a purulent Nature,
in such Cases shd. there be great tenderness 
on pressure the injection shd. not be but 1/3 of 
it Natural strength-Crassamentum and 
Cartilaginous Substances have been found,
and depending upon a higher degree of Inflammation- 
Diseases with which it is likely to be mistaken
first with Hernia which might be 
distinguished by the History of the Case, by 
Hernia dilating when the Patient coughs and 
by the growth of the Tumor downwards, but 
when the Hydrocele extends above the Abdominal 
Ring it is sometimes difficult as it dilates
also with coughing, the transparency 
of the Tumor will in general be the distinguishing 
mark-

44

45
Second with diseases Testicle, by the Redness of the 
part and by the largeness of the Vessels, if it is a 
pulpy disease by pressure giving pain and Fluctuation
is scarcely perceptible-
Third With Hæmatocele, or a collection of 
Blood in the Tunica vaginalis testis, by its 
being of great Weight, not transparent possessing 
but little Fluctuation, but generally 
Tension and always the Consequence of a Blow. 
it is in the last mention Disease the greatest 
doubt often exists, in which Mr. C recommends 
and incision to be carefully made thro' the Tunica
Vaginalis Testis, and if water be found to discharge
it, but shd. Blood follow the Incision shd. be dilated, 
the Blood discharge and the Parts treated by 
Granulation- 
The real Cause of Hydrocele is an increases Action 
of the Vessels of Tunic Vagin Test, but it has been 
supposed by many to arise from relaxation 
of the Absorbents Gonnorhæa is a very frequent 
Cause-
Palliative Treatment
If the Patient of a timid and a weakly
Constitution we cannot always put the Radical
Cure into Execution but it becomes requisite
to discharge the fluid which is done be the following
Methods, embrace with your left hand
the posterior part of the Tumor and pass the 
fluid forwards and as certaining that the Testicle 
is at the posterior and inferior part

46

47
then make a Puncture with a very small Trochar
at the Anterior and inferior part of the Tumor about
2/3 of its length downwards, directing the Trochar
with a degree of Obliguity upwards and discharge the 
fluid- afterwards apply externally Aqua Ammon
Acct ℈vi and Ammon Murias ʒi to prevent further
[Accumulation] of Water, altho' it rarely succeeds
in the palliative Treatment it is often necessary
to repeat the Operation twice or three times a year
sometimes it is reproduced in a Week and the indicating 
a Dropisical Tendency and requiring Medicines to 
be given purposely. Altho' this Operation is simple 
it is not unattended in irritable Habits with Danger
and requiring that the Patient shd. be kept extremely
Quiet, have a spare Diet and kept in the recumbent 
posture for two or three days after the Operation
Radical Cure
In Young Patients this may be effected by stimulating 
Lotions applied constantly to the part such as 
Aqua Aummon Acct ʒvi Ammon Mur ʒi and always
shd. be attempted, in the Adult it rarely succeeds-
When in Children (as is frequently the Case Hydrocele
has a communication with the Abdomen) injections
shd. not be used, but a Truss shd. be first applied
to shut up the communication and afterwards the 
common means as before mentioned be had recourse
to- The Tent was formerly made use of but 
the practice is now abandoned, as it only throws the 
Tunic into Folds and produces only partial Adhæsions,
and the Disease is reproduced.-
Setons are not adviseable except in Children on account 
of the Difficulty that there is in property injecting

48

49
them from their being so extremely irritable and 
their over exertion often beings on violent and extensive 
Inflammation after the Operation it also may be 
employed with Advantage in the Adult where from the
Enlargement of the Testicle there is some Danger
of wounding it by the Trochar- 
Excision of the Tunic Vagin Test and Caustic are 
entirely exploded; the latter only objected to because 
it produced partial Adhæsions producing dangerous
by the Irritability it is apt to produce, in the 
difficulty in ascertaining to what extent it may 
spread itself on the Scrotum, and that it may
destroy the Scrotum without penetrating the Tunic
Vaginalis Testis- 
Two Operations are now only employed viz.
Incision and Injection- 
Incision is performed by embracing the Tumor
in the left hand and making an Incision 3/4 of
its length downwards, leaving 3/4 of the Testicle-
the Water being discharged a little Flower must be 
sprinkled between the Two Tunics, to produce
Union by Granulation and put a stop to the 
Secretion-The Advantages attending this mode 
of Operation are our being enabled to ascertain
the State of the Testicle, and if any Cysts are formed
upon the Surface of it or the Tunics, which 
if left would reproduce the Disease, Objection
it being a very violent Operation occasionally 
proving fatal-
Injection have clearly ascertained the transparent 
of the Tumor it is to be punctured and the Water
discharged after the Method explained in the 
Palliative Treatment then having properly secured 
the Canula within the Tumor, inject some 
stimulating fluid and let it remain in 

50

51
some minutes or till the Patient experiences 
some Pain in the Loins, Kidneys, Bladder or 
thighs, shd. not the transparency be perfectly distinct
it is proper as before mentioned to make 
a small puncture with the Lancet thro the Integuments
to ascertain its Nature-
The Trochar which is used shd. be small and 
about 2 Inches in length the Canula to fit very 
tight at the End and to have no Slit at the Side 
the Injection shd. be thrown in by the Elastic
Bottle which shd. have a stop Cork and hold
about 4℈ and it is not necessary that the 
Tumor shd. be fully distended with the Injection
as if too much is thrown in there is some 
danger of Extravasating-
The Injections commonly used are-viz 
Wine 1 part to water two parts-or ꝶ Zinc
Sulph ʒi Aquæ Abi. This preferred to the former
in consequence of the Uncertainty of 
the strength of the Wine-When Brandy
is used it is 1 pt to 5 of Water-In the Young 
Subject Water may be sufficient- 
If Milk is injected it produces the highest
degree of Inflammation-If after the 
Injection has remained from 3 to 5 minutes 
and no pain is felt, the whole of 
it shd. not be evacuated, we are not to judge 
of the success by the Violence of the pain
produced-
The Symptoms of Inflam and a Cure 
ensuing are, in about 24 hours after

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the Operation the Scrotum becomes red 
in 48 Hours the Tumor reappears but not 
so large as the former, and when lifting it 
up assumes a heavy feel proceeding from 
the Effusion of Coagulable Lymph not the return
of the Water; Inflam continues from 
7 to 10 days when it begins to decline and after
three Weeks entirely disappears-
If the Patient experiences much Pain after 
the Operation he shd. lay down and a dose of 
Opium administered, if on the other hand he
experiences none which is requisite he shd. do, 
gentle exercise shd be taken and a moderate
Quantity of Wine given-
The greatest danger attending the Operation
is from the Extravasation of the Injection in 
to the Cellular Membrane, producing Violent 
Inflam. Gangrene and Death, most excrutiating
pain is felt in the part and the Tumor
is pressed appears to retain the fluid-In this 
Accident the Incision of the Trochar shd. be dilated 
and if possible most of the Injection 
shd. be got out and warm water thrown in 
to dilute the irritating effects of the Injection
and diminish the the Violence of the succeeding 
Inflam. Danger often attends when the Tunic
Vagin Test is not closed but has communication 
with the cavity of the Abdomen-it is not uncommon 
in the Young Subjects and shd. be treated
as before observed before the Operation can

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be performed, but in the Adult their Method 
will not succeed, nor is the Operation of Injection 
of any service it being a Disease of the Peritoneum
and not of the Tunic Vagin which from it constant
secretion produces constant Accumulation-
The Objection brought forward against
this method of Cure is that we cannot assertain 
the true state of the Testicle; enlargement of it 
shd. not be any means prevent us from operating,
as frequently the Inflam. which is 
set up for the Cure of the stops the progress of the 
other if not entirely cure it- 
Hydrocele of the Spermatic Cord
When the Species is situated above the Abdominal 
Ring it is accompanied with all 
the Symptoms of Hernia, neither is possible 
to distinguish it till it has passed the Abdominal
Ring, and then its transparency,
enables you to deside the Operation shd by no
means be performed till this point is 
clearly assertained-
Aneurism-
An Aneurism is a pulsatory, Turmor, containing 
Blood in the situation of an Artery
Its symptoms are divided into three stages
First when Examination a small Turmor is 
perceived having a strong Pulsation the skin
is undiscoloured is unattended with Pain 
and be compressing the Artery above the Tumor
may be emptied of its contents viz uncoagulated

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Blood-
Second the Tumor becomes solid, because the 
Blood is somewhat coagulated, is attended with 
Pain the Limb becomes œdematous the Artery
if compressed above will cause the Tumor to
yield a little, The Tumor still being prominent 
and a thrilling Sensation is to be felt in the 
Tumor owing to the Blood rushing in at its 
Orifice-
Third The Skin becomes discoloured (being of a 
reddish brown) the Cuticle seperates from its 
Surface, under this slight Ulceration takes
place, the discoloured part looses its Vitality
at the Edge a small Aperture forms and a Quantity
of Blood is discharged after this a clot forms
and fills up the Aperture putting a stop for a short
time to the Discharge, the Ulceration keeps increasing 
in size, and a much larger Quantity 
of Blood is lost and thus is keeps proceeding 
until the Patient is lost from the Violence
and extent of the Discharge this process may
be treated by the Application of Emplast
Ashæsive and Lint with a Bandage: When in 
larger Arteries in the Cavity of the Abdomen
it bursts and immediately puts a stop to 
the Patients Existence- 
The Seat of the Complaint is very various
as are its symptoms according to its seats-
if in the chest, it frequently foams no external 
Tumor, attracts adhesion to the Pericardium 
and bursts within it, but few Symptoms to 
mark this Disease, the Chief are upon quick 
notion a Difficulty of Breathing with an 

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uneasy Sensation at the Scrobiculus Cordis- 
When in the Aorta near its curvature it presses
upon the Sternum and Cartilages of the Ribs
forming a Tumor on the right side of the Sterum 
opposite to the 2d. 3d. and 4th. Ribs and 
sometimes ascends in the form of a Pouch
along the Larynsc producing Symptoms singular
to Carotid Aneurism, when in the descending 
Aorta it causes Death by its Pressure on the Œsophagus
and Trachea, when near the Stomach
causes Vomiting, and if at its posterior part presses 
on the Vertebræ so much as to cause their 
Absorption, descending down the Back it has 
not been unfrequently mistaken for Lumbar 
Abscess- If in the Mesenteric Artery it does
not impede the Functions of the Bowels, it sometimes
forms in the Arteries of the Pelvis-
When Aneurism occurs in the Extremities it is 
mostly situated at the Joints by reason of the 
frequent Flexures of the Vessels of those parts-
on the account Popliteal [Aneurism] so often occurs.
The Diesease rarely occurs in the smaller Arteries,
but has been known in the posterior Aural,
pudendal, Occipital and frontal Arteries. no
Example of Brachial except from Accident 
Aneurisms will form in different parts
of the Body, and when it does not appear at 
the Joints shews a predisposition to the Disease,
but this shd. not deter you from Operating 
Formation in the first Place the Artery undergoes
a process of Inflam the Coats of it be

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come thickened, opaque, and of a yellow colour,
opposite this part the Process of Absorption takes
place and forms an Opening there, which leaves
the Artery only covered by its Sheath Coagulable
Lymph is effused, which fill up the space, this 
not being possessed of the Elasticity of its Original 
Coat has not the power of resisting the Impetus
of the Blood, but gradually protrudes it into the 
form of a Sac-In time from the Pressure of the 
Blood, the Coats of the Sac become absorbed, and thus
no part of the Original Artery forms a part of it-
The Age at which it most frequently occurs is 
from 30 to 50 years, at that time of Life when the 
Labor is disproportioned to the strength-
Distinguishing Marks, the Pulsation is not to 
be depended on, as a Tumor situated over an Artery 
will sometimes possess it: when in a practicable 
situation raise the Tumor and it it is not an 
Aneurism it will not prossess any pulsation, or 
if in the Thigh is deep seated, stop the Circulation 
at the Groin by means of Pressure and the Tumor
if Anerurism will immediately subside and 
become flacid, by taking off the Pressure it 
will as suddenly rise. Aneurism is much less
frequent in Women than in Men, more especially 
in Popliteal, they will sometimes take
on a spontaneous Cure but this is of rare occurrence,
when it is situated so that the Operation
cannot be perfromed the Patient's life
may be prolonged by strict Attention to diet,
Rest, and Evacuants-

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Operation, may be divided into old and new the
former is now rarely performed, it consists in 
applying a Tourniquet upon the Limb as in Amputation
(supposing it Popliteal) and making 
an Incision in the Ham from the Top to the Bottom 
of the Tumor, and removing the Clot of Blood,
afterwards the Cavity was sponged out clean, loosening 
the Tourniquet and finding where the Blood issued
into the Sac-a probe was passed into the orifice of the Vessel,
and a Cut being made on each side of it, a needle 
& Ligature was passed under it about an Inch
& a half from its Orifice and secured, the Same
Method was also followed in the lower Orifice-
This Operation was universally unattended with 
success, for obvious reasons: first laying bare
so large a cavity, and the Exfoliation of that 
part of the Bone laid bare by the Sac-Mr.
Hunter was the first who made an Improvements
upon it, and his Method of Operating was 
merely to take up the Artery about the Middle 
of the Thigh leaving the Sac to be absorbed, which 
is now universally followed, with some Modifications-
It is prudent before Operating if 
the Patient be of a full Habit to bleed, if not 
at any rate to purge- 
Popliteal is performed by making an Incision
thro' the Integuments in the Thigh in the 
direction of the Femoral Artery beginning it 
about 1/3 of the length of the Thigh downwards,
from the Spine of the Ilium to the Knee,
extending it about four Inches in length,

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which exposes the Sartorius Muscle, the Limb
is to be kept during this time in [crossed out] the flex Position
resting upon the Outer part of the Foot, the
Sartorius Muscle next to be seperated from the 
Adjoining Ones, which lays bare the Sheath of 
the Vessels, and when opened the Artery will be 
found above, and to the inner side of the Vein
and must be seperated from it by a common
Elevator; an Aneurismal Needle or a flat Eyed
Probe is then to be passed under it armed with a 
double Ligature which are to be seperated about
an Inch from each other and to be tied very 
firmly, the Artery, afterwards to be divided
not quite in the Middle of the two Ligatures
but rather nearer to the lower one, either
with a Knife or a Probe pointed Bistoury; after 
the Operation the Edges of the Wound are to be 
united by Adhesion, for which purpose Apply 
adhæsive Plaister but not around the Limb,
and at the same time not entirely covering 
the Wound with but leaving sufficient room
for Matter to exude else Sinuses may be
formed, neither is any Roller to be applied
to the Limb but when the Patient is put to 
bed shd. be laid in such a position as will
best tend to increase the Circulation of the 
Limb by laying upon the Operated side
and placing that Extremity lower than 
any other part of the Body at the same 
time applying Flannel or a Moisted Stocking
to promote Warmth & c & c-

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67
It becomes necessary sometimes to Bleed after
the Operation according to the State of the 
Patient, the Bowels shd. be always kept regularly
and freely open-The Ligatures generally 
seperate about the 12th. or 14th. day,
tho' frequently [protrected] to a much longer
period-The Limb that has been operated on
is always weaken afterwards, and subject more 
or less to Ulcers-Aneurism or any other Affections
of the Anterior and Posterior Tibial Arteries 
may be cured by the same Operation as performed
in Popliteal- 
Aneurisms being in a sloughy State shd. 
not be any means prevent the Operation
being performed-
In Papliteal after the Operation the Limb is 
nourished by the Branches of the Profunda 
anastamosing with the posterior Tibial Artery
Inguinal is in the Femoral Artery at the 
Groin just below Poupart's Ligament between
it and the Origin of the Arterior Profunda-
The Operation consists in making an Incision 
about 3 Inches long just above Pariparts 
Ligament so that it reaches within an Inch
of the Spine of the [Ilium], The Tendons of the 
Oblique, and transversalis are then to be cut 
thro' Exposing the Internal Oblique just above
the Ligt. which is to be detached and is most readily
done by the Finger, the Artery is then exposed 
on the inner side of the brim which is 

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to be seperated from the surrounding parts 
and raised from out of the Cavity, a double Ligature
is then to be passed under it and the Artery 
divided as directed in Popliteal, it is necessary 
to guard against peritoneal Inflam. The Limb
is afterwards nourished by Blood being sent by 
the Int. [Pudend] to the Ext [Pudend], from the Gluteal
to the Ext. Circumflex from the Obturat. 
to the Cirumflex, from the Ischiat. to the Profund-
Carotid An Incision about three Inches long 
is to be made an the inner side of the Sterno
Cleido Mastoid Muscle, on raising the Margin 
of this Muscle the Omo Hyoid Muscle is seen 
crossing the sheathe of the Vessel, the Nerves descend:
Nani is also exposed; upon seperating 
the Sterno Mastoid from the last mentioned
one, the Jugular Vein is seen, laying to the outer 
side of the Artery, which is to be seperated
from it, and held to one side by the Finger, as 
it produces the chief and almost only difficulty 
in the Operation, from its constantly, filling 
and emptying under different States of 
respiration, the Par Vagum is situated avoided 
being included in the Ligature, as the lying it 
would prove fatal, the other steps of the Operation 
are to be put into Excention and much Attention
must be paid to the Patient afterwards
Subclavian An Incision is to be begun
about the Middle of the Upper part of 

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the Clavicle, and extending about three Inches
in length, the Axiliary Plexus lays above
the Artery, great difficulty arise in passing 
the Ligature under the Artery, there are various
Instruments for the purpose which are of 
Service, When situated on the left side care
shd. be taken lest the principal Duct of the 
Absorbents be wounded which would prove 
fatal-
Innominata does not admit open Operation
Brachial if very high up requires that 
the Artery in the Axilla shd. be secured-
Cataract
Cataracts are of two kinds Crystalline &
Capsular, that may also be divided into Genital
and Adult. In the first the Humour is 
only affected, in the second the Capsule and 
sometimes both- 
Symptoms in the first instance the Patient 
experiences a Mistiness of Vision and 
when looking upon a fixed Object something 
appears intercepting his sight, (which when 
floating is a disease of the Optic Nerve) his power
of distinguishing and Object never appears to 
be entirely lost. (A Circumstance to be bourne 
in mind) he can see better in a weak than a 

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strong light, The Pupil seems as if it had a 
Part behind it, the Crystalline Humour has 
a whitish Appearance, but is often various in 
this respect, being sometimes Yellow or brownish 
but in the Adult almost always solid, has 
been focused partly solid and partly fluid when 
solid it may be distinguished by its being of 
a uniform Colour and when fluid having 
white Streaks and a glistening Appearance 
like Mother of Pearl-there have been instances 
of its being ossified-
When the Capsule is affected it may be
known by its close connection with the Pupil,
it frequently adheres to the Edge of the Iris, in 
such Instances before operating it is adviseable 
to indroduce a small Portion of Exit Belladon
which will cause the Pupil to dilate and enable 
you to see the state of the Eye-
When Cataracts are found loose in the 
Eye they are named Floating in these the 
Tunic Aranea absorbed- 
The Cause of Cataract is not well understood
but is generally supposed to have its [brigen] 
in Inflam. altho it is often Consequence of it
it may be produced without it. Three Operations
are had recourse to for this Disease
viz Extraction, Couching or Depression, and 
Puncture- 

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Of Extraction before the Operation it is 
necessary that the P shd. be purged, and if of 
a robust Habit be bled; drawing a probe over
the Eye for some time before the Operation 
has been recommended to accustom it to 
bear the Stimulus; The Light in the Room
shd. be an Oblique one and not a strong one,
the Surgeon shd. sit in a Chair about six or 
eight inches higher than the P. and the latter
Shd. sit forward in his having a pillow or 
two placed behind him; The Instruments 
necessary are a Lancet shaped Knife, a small
Tenaculum formed Needle not much hooked,
Silver Scoop, and a pair of Forceps-The Head
shd. be held by an Assistant understanding 
something of the Matter who shd. prep the upper
Eyelid against the Superciliary Ridge, keeping 
it quite away from the Globe, being previously
wiped, supposing it to be the right 
Eye he shd. hold it up with his left hand et
vice versa-The Surgeon shd. place his Foot
upon the Patient's Chair, and upon his Knee
his Elbow and hold the Knife in his right hand
supposing it to be the left Eye et vice versa.
pressing his Finger against the Temple and 
the Finger of his other hand shd. press the Globe
to keep it steady, at the same time confining
the lower eyelid with it, The Knife shd. be 
held between the Thumb and two Fingers
and introduced an Hoins Breadth before the 

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Junction of the Cornea transparency and 
Cornea Opaca and carried directly thro' to the 
Opposite side and by one cut to be divided downwards,
when this is completed, the Aqueous 
Humor discharges itself, the Tenaceuluim is 
then to be introduced with its back turned
towards the Capsule, afterwards turned and the 
Capsule punctured, withdraw the Instrument 
as introduced and pressing upon the Globe of 
the Eye the Chrystalline Humour becomes discharged;
if it shd. prove partly solid and partly 
fluid the Scoop shd. be used to eathout it, before
the Flap of the Cornea is closed the Iris shd. be carefully
placed in its proper Situation, if any of 
the Capsule is opaque remove it with the Forceps,
the Eye during the cure is to be kept shut, and 
covered with Linen moistened with Saturnine 
Lotion, all Light from the room, Noise and 
Conversation shd. be carefully avoided, his head 
shd. be kept very much elevated, and almost
in a sitting position. If much Pain is felt 
the following day Leeches shd. be appplied, it extreme
bleed from the Arm or temporal Artery.
Inflam is the greatest danger to be feared,
your greatest dependance will be upon 
bleeding for the first few days he shd. be as 
little as possible disturbed with Stools-
Shd. there be any defect of the Optic Nerve the
Operation probes unsuccessful. The Opening

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made to discharge the Crystalline Humour
shd. not be too small, else much danger will 
be feared by making too great pressure upon 
the Globe, it may discharge also the Vitreous
Where it is necessary to make an 
Artificial Pupil it is best done by transverse
Incision, but is seldom or ever successful-
Care shd. be taken that the Knife be carried
thro to the Bottom, else the Patient will see 
thro' a Cicatria, if be accident the Knife shd. pass
between the Lamina of the Cornea it will 
produce Opacity of it and make the Operation 
of no service- When the Iris is wounded 
it produces great Hæmorrhage in the Eye
Belladonna is not now much used as it 
dilates the Pupil so much as to endanger its 
being wounded, it also diminishes the Quantity 
of the Aqueous Humour- 
Couching or Depression is the removing 
the Cataract from the Axis of the Eye, preventing 
it intercepting the Rays of Light
to the Retina-In this operation the P. is 
to be seated on a low Chair, and the Operator 
in an elevated one as recommended in Extraction,
the Light shd. be strong. There are 
three kinds of Needles used for this purpose
but Mr. Keys is preferred, which is to be 

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81
introduced the 16th. part of an inch behind
the Junction of the Cornea transparens with 
the Cornea Opagna in the direction as if it 
were to be passed to the Centre of the Eye, and 
when it has passed the Cilliary processes the
handle is to be depressed bringing the Point
to the Centre of the Pupil-resting it upon
the crystalline Humour which is either to be 
pushed to the bottom or side of the Eye, the 
former the best the Operation is then finished.
In moving the Humor it shd. be done with the greatest
caution for fear of wounding the Retina-
The Advantages of this Operation are preferable 
to Extraction, 1st. that shd. it be a fluid Cataract
it is sure to succeed merely by rupturing the Capsule
in children this is generally the Case 2. that if the first attempt does not succeed it may
be frequently repeated, and perhaps succeed at last
whereas in extraction the Operation is so severe that the 
loss of the Eye is the Consequence if it does not prove
successful- 3rd. from its Simplicity-Objections 
1st. the Cataract will sometimes rise to its 
former situation, 2nd. when the Capsule is opaque,
it gives scarcely any relief, as the broken
pieces will generally rise and obstruct Vision-
3rd. where the Capsule adheres to the Iris-
3rd. Puncture This Operation consists in 
passing Mr. Hey's Needle thro' the Coats of the Eye
either Anterior or posterior to the Junction 
of the Corena transparens with the Cornea

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Opaque. (but the former is recommended) & 
puncturing the Capsule of the Crystalline Lens
and suffering the Aqueous Lumor to pass upon 
it, which will quickly absorb it-This is the 
Operation which was so successfully practised 
by Mr. Saunders, and proved so much so in 
Congenital Cataract-Before the Operation 
the Pupil shd. be dilated with Belladonna
which may be applied either to the Eyelid or 
the Ball itself in the latter it may be comepletely
dilated in 10 minutes. The Patient shd. 
be placed in a recumbent posture upon a Table 
close to the Window and well secured by proper
assistants-The Head may be placed upon 
a Pillow and close to the Edge of the Table-
The Surgeon shd. stand behind him when it is 
the right Eye, but when the left it may be 
more convenient for him to lean over the 
body, a Speculum may be used to keep up 
the upper eyelid, as likewise the other rules
just laid down for keeping the lower down
and fixing the Eye shd. be attended to-
Hernia
Is always given the termination of 
the Surgical Lectures but for Convenience 
&c is here placed - 

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-Hernia-
By this is meant a Protrusion of and [viscus]
from its proper Cavity, but Abdominal
are the most frequent, and upon which 
we shall fix our attention. Abdominal
Hernias are divisible into 12 Species-
1st. Inguinal, the most common is that 
which passes thro' the Abdominal Ring in 
the course of the Spermatic Vessels into the 
Scrotum-
2nd. Femoral on Crural which passes under
Poupart's Ligament in the Sheath in the 
inner side of the Femoral Vessels- 
3rd. Umbilical which appears at the 
Umbilicus-
4th. Ventral which passes out at the 
Lin. Alb: Lin: Semilunar. and Lin. Transversal:
the latter the most common-
5th. Vaginal, descending by the side of the Vagina
6th. Perineal appearing at the Perineum.
7th. Pudendal, protruding by the Ramus
of the Ischium into the Labia Pudendi-

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87
8th. Thyroideal, appering at the Foramen
Thyroid-
9th. Ischiatic, lodged under the [Gluteatery]
Masc: Muscle-
10th Phrenic, passing thro' the Opening of 
the Diaphragm or by unnatural Perforations
11th. Mesenteric, contained in the folds of 
the Mesentery-
12th. Mesocolic-
Where The Kidney [crossed out] protruded [crossed out] it is call 
[crossed out] Lumbar, but Mr. C has never met with 
a single Instance of it-
Inguinal is divided into four Species
requiring different modes of Operation-
1st. Oblique which is the most frequent
taking its Course along the Inguinal with 
the Spermatic Cord and descending into 
the Scrotum-
2nd. Direct takes a direct Course thro the Abdominal 
Ring, pushing before it the Tendon
of the Transversalis when it does not happen to 
split it which sometimes occurs- 
3rd. Congenital that descending into the Tunic
Vaginalis Testis by the course of the Inguinal 
Canal and it contained in the Space where the

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Water is in Hydrocele, in the Contact with the Surface
of the Testicle-
4th. Incisted contained in the Sac or Sacs of the 
Tunic Vaginalis formed by previous adhesions
and which becomes gradually elongated so as 
to contain Hernia of considerable size-
Of the Oblique it will be necessary before
describing this to make some few remarks
upon the Structure so the Parts-When the 
Abdominal Ring is dissected it will be found 
to be covered by a thin Aponeurosis which is 
given off by the External Oblique, this is its 
natural Structure is not dense, but by the 
Pressure of hernia becomes much thickened,
when this Aponeurosis is removed the Margin 
of the Abdominal Ring is brought to view 
and not till then, which is composed of the 
Tendinous Fibres of the Ext. Oblique united
together by cross ones, making it tense & tough,
when this part is laid bare and the finger attempted
to be pushed into the Abdomen, the Opening 
will be found shut which was produced by the 
Tendons of the Ext. Oblique at the Upper part,
by the Transversalis behind, and for the better
securing of it, the Ext. and Int. Oblique Muscles
are bound behind by the Tendon of the Rectus,
but upon introducing the finger more obliquely
towards the Pubis a small Aperture is discovered
which is for the passage of the Spermatic
Cord and to which it is united by a very 

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thin Aponeurosis Pouparts Ligament does
not terminate as usually supposed at its Insertion
at the Ilium and pubes but sends off 
3 Portions or three distinct Fascia, two of which 
proceed upwards to shut up the Cavity of the 
Abdomen, the other passes down upon the 
Thigh and forms the Fascia Lata, The Anterior
portion assending is called the Fascia transversalis,
in which is the Aperture called the 
Abdominal Ring, the posterior is the Fascia 
Iliaca-
Inguinal Hernia, begins midway between 
the Spine of the Ilium and Symph Pubis, the 
first appearance of Tumor being immediately 
over the Iliac Artery, the first part that is 
protruded is a very small portion of the Peritoneum
which is the Commencement of the Hernial 
Sac, to its inner side is placed the Epigastic Artery 
and contains either Omentrum or Intestine 
and most frequentlhy both in descending it takes
a turn inwards & downwards, being so confined 
by the Ext. Oblique as to prevent its proceeding 
in a straight direction, after passing 2 Inches it 
begins to emerge at the lower Aperture-
Whilst it is in the Inguinal Canal it is commonly 
demoninated Bubonoaele and has for 
its coverings the common Integuments and 
the Tendon of the External Oblique behind the 

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Hernia is situated the Spermatic Cord and behind
these the Tendons of the Internal Oblique & 
Trans: Muscles, so as to shut it from the Abdomen
when it has passed the King and got into the Scrotum 
it obtains the name of Scrotal Hernia and is covered
by the common Integuments, Aponeurosis
of the External Oblique, by the Cremaster Muscle
which is be far its thickest Covering and lastly 
by the Hernial Sac which is its thinest-
Behind the Sac is situated the Spermatic Cord
and below it the Testicle on the inner part of 
its Mouth in oblique the Epigastic Artery is placed
and in direct the Contrary of Course-
The Average Number of those that have Hernia
on the right side is 65 in 100
Diagnosis It is generally to be the distinguished 
from other Tumours at the Abdominal Ring
by dilating with Coughing, descending in the erect 
Posture and ascending in the recumbent, shd.
it be Intestine it returns with a [gurgling] Noise
or Sensation, when Amentum it possesses a doughy
feel, when both the Tumor has the elastic feel of the 
Intestine and the doughy one of the Amentum, however
it is difficult to distinguish when both are down 
and the Knowledge of it is of no important Use, Another 
distinguishing mark of Hernia is by the Tumor 
beginning from above and gradually increasing 
downwards, also sometimes accompanied with 
interruptions to the Fæces-

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95 
Hernia is liable to be confounded with certain
Diseases-
First, with Hydrocele, this will sometimes 
appear above and below the Abdominal Ring
each forming a seperate Tumor, in which 
Case it dilates with Coughing and can be only 
distinguised by its Transparency-
Second, with Varicocele-which is more likely
to produce embarrassment than any, 
for it will nearly disappear in the recumbent
Posture and dilate with Coughing, to distinguish
it direct the P. to lie down, and raise the Testicle
so that the veins can be completely emptied, 
afterwards press upon them at the Abdominal 
Ring, and still altho' he is in recumbent  
Posture and the Rind secured it will reappear,
and upon directing him to rise still pressing 
on the Ring it will become much increased 
in size; it generally likewise feels like 
a Bundle of ropes in the Scrotum and by applying 
a Tulp much Pain is produced from preventing 
the free return of the Blood-
Third, Hydrocele of the Spermatic Cord is liable
to be mistaken for it, as it dilates with 
Coughing and may be pushed partially into 
the Abdomen, there is no certain or safe way 
of distinguishing till it has passed the Abdominal 
Ring, when it Transparency will be 
observable, therefore nothing shd. be done [crossed out]
in such a Case, but left entirely alone till
it descends into the Scrotum

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Inguinal Hernia is sometimes of a Complicated 
Nature being sometimes connected with 
Hernia and in passing down splits the Spermatic
Cord placing the Vas Deferens on one side and 
the Artery and Vein on another therefore requiring
that the parts shd. be well examined before 
the Sac is opened-
Hernia vary much in size being sometimes 
so small as to be hardly perceptible yet produces
fatal Consequences at other times of extreme dimensions
(as will be taken notice of hereafter) extending 
down as far as the Knees, the Skin covering it 
becoming so think as that the Parystatic motion 
of the Intestines may be easily perceived 
this most commonly occurs in Umbilical, 
in these large Herniæ the Pylolic Ext. of the 
Stomach is brought down to the Orifice 
of the Sac-
If in Hernia connected with Hydrocele 
much doubt exists, it may be prudent to 
discharge the water by making a small Puncture
with a Lancet, it may occur both in 
Congenital and Adult Hernia, in both of 
which Case it will equally hold good-
The Causes of hernia are two fold, first 
that which enlarges the Viscera, and second that 
which relaxes the Body or Abdominal Viscera 
An Increased Presure of the Intestines will arise
from Pregnancy and Obesity, the last the 
most common; Old People are more subject 
to it than Young and those who have worked

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hard pursuing Labour more than equal to their 
strength, Mr. C. thinks one in fifteen have Hernia
in England, but it exists in much larger 
Proportion, the French are very liable to it, supposed
so from their living so much upon Vegetable 
Diet, at Malta it may be seen (as Mr C
terms it) in Perfection, Riding rough Horses
and in rough carriages is a very frequent Cause,
after a fever to sudden exposure to rough exercise,
but the most common is lifting heavy weights,
also those labouring long under a tedious and continued 
Cough, strictures in the Urethra &c are 
much subject to it-
Direct Inguinal Hernia passes (as before
mentioned) the inner side of the Epigastric
Artery, for the Discovery of which we are indebted 
to Mr. Cline, it takes its course immediately thro'
the Ext. Ring and pushes before it or splits the 
Tendon of the Transversalis, when the former occurs
it impedes much the growth of the Hernia
therefore they are generally of a small size, it has 
the Spermatic Cord and Cremaster Muscle to it's 
outer side (distinguishing it from the Indirect)
from the latter of which is does not receive a 
covering, This Species is by no means of common 
occurrence. Mr. C believes one in twenty-
Reducible Hernia if it is ever so small requires 
that a Truss shd. be applied for the smaller 
Hernia greater in general is the Danger,
and all that is necessary for the fitting of One
is to take measure of the Pelvis, The Pad shd.

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be placed immediately over the Iliac Artery
and not on the Abdominal Ext Ring, but in the 
middle of the Inguinal Canal, for this purpose 
the neck of the Truss shd. be short but if the Hernia
is very large the form of the Pad must differ 
from the common for instead of being placed
obliquely it shd. be placed at right Angles with 
the Arm of the Truss so as to give it a perpendicular
bearing-To establish a certain Curve it is 
necessary that the Truss shd. be worn 2 years Day & 
night except in old People where there is no chance
of Success, it is for this reason that Mr. C objects  
to Mr. Patent also Young Men dislike them in 
Consequence of the bulk discovering their Infirmity.
The Effects of wearing a Truss is the Production
of Adhæsion between the sides of the inner part
of the Sac, consequently excluding the Entrance 
of the Gut &c-
Also the Cure is much quickened by the Action 
of the surrounding Muscles as well as the 
Pressure of the Truss, particularly that of the 
Cremaster, for which reason Inguinal Hernia
is more readily cured than Femoral-
Sometimes after the Application of a Truss and 
the Obliteration of the mouth of the Sac is the effect
an Hydrocele is produced or the Hernia will 
protrude above the Pad, and frequently on both
sides when a double Truss shall have been applied
Mr. C recommends double Trusses always to 
be applied in old People as from the relaxation 
of the parts they are apt to appear on both sides-

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Hernia is supposed to be hereditary in Consequence
of the Form of the Rings for in some Families are 
so large as to extend to the Spine of the Ilium
Irreducible Hernia is of 2 kinds, one being 
rendered so without Inflammation, and the other 
the effect of Inflammation as in Strangulation
Causes-First An Extraordinary Growth of 
the Intestine or Amentum, the latter is sometimes
very rapid in it's Increase, Second-
Adhæsions of the Hernia to the Inter. Surface
of its Sac-Third Membranous Bands 
forming across the Hernial Sac-
Fourth, An Entangled State of the Omentum Intestine
Fifth. Persons being thin when they were first
attacked and suddenly becoming fat is by no 
means an unfrequent Cause-the lives of 
those who are troubled with irreducible Hernia
are always in Danger, as a sudden Blow
or extreme exertion would be liable to rupture
it, which would most likely prove fatal,
therefore such people ought always be upon their guard.
Omental Herniæ that have been long
irreducible will sometimes take on a cancerous
Affection in habits that have such 
a Tendency-
Treatment, Many Hernia and even very 
large ones will be a long while in an irreducible

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irreducible State and still produce no kind of Inconvenience,
altho' this is the Case and no relief
can be given by manual exertions it may 
be accomplished by the long and continued
application of Cold, Mr. C had never tried it in 
the Female but has always found it prove
successful in the Male, the best form of using 
it is by putting pounded Ice in a Bladder,
If this Mode of Treatment does not succeed a 
laced Bag Truss shd. be applied so as to have the power
of Contracting it as occasion may require or 
the Tumor diminish in size, if it has not 
the Effect of reducing it, it may probably reduce
its size Providing the Hernia be an Omental 
one [crossed out] a Truss may be applied with good
Effect, by producing an Adhæsion between it 
and the Sac, thus preventing further Protrusion,
but as it was before observed there being 
no precise marks to distinguish which the Sac 
contained, its Application must be regulated
according to the Patients Feelings, who shd. be 
visited soon after its Application and if produces
[crossed out] great [crossed out] Pain it shd. be taken off
but if none it may then be left on-
The pressure in the first Instance shd. not 
be very powerful therefore the Spring of 
the Truss shd. be made slight-
Strangulated Hernia the bad Symptoms 
attendant on this State of Disease are in

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consequence of the constriction made on the 
Terminal Contents, on the obstruction to the passage
of the Aliment and Faces thro' the Intestinal Canal,
and on the inflamed and even gangrenous state
of the parts contained in the Hernial Sac-
Symptoms are divided into three Stages 
First Pain in the Region of the Diaphragm
or rather a feeling at the Scrobiculus Cordis
as if a tight cord was bound round the Chest
considerable Flatulence, with particular Inclination 
to pass it downwards without being 
able, A Symptom to which much Attention 
must be paid for if it still exists after the 
Operation or Attempts at reduction and many
is expelled upwards, it may be depended on
that the Stangulation remains, Pain
in the Tumor but is not considerable and 
after it has continued sometime becomes
tense-Violent Vomiting and the Intestines
take on an Antipary staltic Motion-
Constipation ensues, but not so much as 
to prevent Stools passing, as they may 
sometimes be procur'd by Glisters, if only
the Omentum is down the Stools will pass
readily and not attended with that degree
of Vomiting as is causes by the Obstruction 
to the Functions of the Bowels & &c-
afterwards the Bowels become tense, produced
in Consequence of Flatulence and not of 
Inflammation; Pulse is generally hard, Quick and 

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not small indicating Venisection-
Second stage-The Abdomen becomes tender
and in this proportion is the greater
danger both for the recovery of the Patient
and success of the Operation, the Pulse is 
small and thready and that which indicates
Blood-letting, which would not be supposed
by an inexperienced Practitioner, the Vomiting 
is not so violent, but Paroxysms of Pain take 
place, in this state the P shd. be visited often
as the Abdomen increases in tenderness the 
P. experiences degree of Hiccup which is no sign
of Mortification, the Tumour varies but little 
in size, if any Alteration takes place it is 
rather more tense- Third stage. When Mortification 
takes place the P becomes free 
from Pain & tenderness of the Abdomen 
The Tension is extreme the result of Peritoneal
Inflammation, Pulse is extremely
small, hardly perceptible and intermittent,
the Extremities becomes cold and the 
Surface of the Body cover'd with cold clammy
Sweats, great Dejection of Countenance
and has scarcely power to shut his Eyes,
which appears quite glassy, the Hisup lepus
tho' not entirely ceases the surface of the 
Tumor becomes œdematous and frequently 
Emphysematous, and then a cracking Sensation
is produced when you press upon 
it, mind is generally perfect to the last- 

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Appearances after Dissection-
Coagulable Lymph is thrown out in consequence
of the high degree of Inflam. which attends and often
Adhesions take place between it and the Sac or 
from the Violence of the Symptoms and the 
Stoppage of the Circulation, the Intestine or 
Omentum becomes mortified, when in the 
former it is generally in small spots and 
easily tears with the finger, the Spots are sometimes
green & sometimes black- when the
latter namely the Omentum is viewed it appears 
red on black according to the Violence of 
the Symptoms having a crispy feel & is extremely 
offensive, when the Cavity of the Abdomen
is opened the Intestines appear very much inflated
with Air, and the Inflam rather extensive 
tho' the Appearances are not so much altered
as would naturally be supposed-
Seat of the Stricture in large and old 
Herniæ it is generally situated at the Exter
Abdominal Ring-
Second at the Orifice of the Hernial Sac
which is the most common-
Third Membranous Bands forming across
to the Intestine or [venting] it or Omentum 
to the Sac-
Fourth From the parts becoming thickened
by the pressure of the Truss or Adhesion-
Fifth the Intestine and Omentum becoming

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entangled with each other-
The Danger of Stricture is not merely from 
putting a Stop to the Functions of the Bowels
but also as much by stopping the Circulation
Treatment of Strangulated Hernia, when a 
Practitioner is called upon to reduce a Strangulated 
Hernia, he is to consider that there
is no means of giving relief but by putting 
the Parts in their Proper Places, But little 
dependence is to be placed in giving Medicines
by the Mouth, altho in large Hernia much 
Dependence has been placed in active purgatives-
The Next means to be employed and 
which is most likely to produce the best effects
is applying the Taxis, which is to be performed
in the following Manner, Embrace the 
Hernia with the right hand (supposing it to 
be on the left side) then placing the finger & 
Thumb of the left hand a little above the ring
and steadily press on the Hernia below at 
the same time moving it from side to side
or rather kneeding it with your fingers, (that 
is between them) thus a gradual pressure shd. 
be employed till the Hernia is reduced, remembering 
at the same time not to make too 
much force as to endanger the bursting of the 
Intestine, it's reduction will sometimes be 
much facilitated by just drawing the Hernia 
downwards during the making of the Pressure-

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The Position best calculated to ensure reduction
is to have your P. laid in the recumbent 
Posture and in such a way that his 
Shoulders & Pelvis may be much elevated,
The Knees shd. be bent at the right angles
with the Body at the same time crossing
the Legs, a position that is often resorted to 
by the P. himself and tends much to relax 
the Abdominal Muscles-
In a robust young Man where the Strangulation 
is brought on by accident & when the 
Tumor is touched much pain is produced 
it would be injurious to adopt the Use 
of the Taxis immediately but other means 
shd. be first employed, as Blood letting
applying Ice well founded in a Bladder
or Cloths constantly wet with Cold Water
to the Part- in the Winter Season Snow 
or in Summer when Ice cannot be procured
the following freezing Mixture may be 
employed- By Sal Ammon & Sal Nith
aa ℈v Aquæ Hi applied in a Bladder,
After these means have been employed
and relief is not the consequence The 
Taxis may be used providing there be no 
Pain in the Tumor, after it has been used
some time without success Venesection 
shd. be had recourse be taking away a considerable 
Quantity 16 or 20 oz or in short

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till fainting is produced, the Surgeon shd. 
not be fearful of taking away too much 
blood, for if it does not succeed it renders
the subsequent Operation safer and those 
who have been bled largely always do 
better after the Operation has been performed,
if still all efforts prove unsuccessful,
a Tobacco Injection shd. be thrown 
up in the proportion of a Dram to a pint 
of Water, after infusing it for 10 Minutes, half 
of it shd. only be thrown what once and if the 
first does not answer the 2nd. may be used
a quarter of an Hour after, if Fainting shd. be 
produced by either of the above mentioned means
the reduction shd. be attempted as it is then most
likely to succeed, the Application of Cold & 
the Tobacco Injection if employed at the same 
time will be likely to have more avail; The 
Warm Bath is highly recommended by some
but Mr. C does not think it equal to the Cold
Application, likewise Fomentations give but 
trivial relief, besides the Application of Cold
if it does not prove successful, allows time
for the employment of other means, in general 
the Stomach is too irritable to allow
of much Medicine being given if much pain 
is present Opium may be administered, or

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Vomiting, Calomel given in large doses followed
by Salts or other Aperient Medicines of 
a mild Nature may be attended with good
effects-
Operation, when about to determine upon 
the most appropriate time for operating the 
Abdomen shd. be well considered, for if it 
shd. be very tense and tender to the touch 
it will most probably be of no avail, as 
it indicates that Inflam has taken place
in the Peritoneum, which is the only danger
to be feared from the Operation, It is best not 
to operate until all the above means 
have been employed without success, unless
the Surgeon shd. be called in sometime after
the Strangulation has commenced which 
is too often the Case, but the state of the P. at 
the time must be your Guide, in old people 
it is not necessary to take away large Quantities
of Blood, indeed it is injurious-
Much Depends upon the Manner of proposing 
an Operation to a Patient in respect to gaining 
his consent, the Dangers of the Operation shd 
not be magnified but described in the simplest 
Manner consistent with Prudence-
In old people repeated attempts at the Taxis 
shd. be made, and may probably prove successful
at last, but in Young if it does not 
succeed in the Commencement if will not at 

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all, and the loss of time is more dangerous as 
the Inflam, when it takes place proceed rapidly.
After all the above mentioned means have
been employed nothing can give relief but 
operating which is thus performed-
The Patient shd. be placed upon a table three
feet high with his legs hanging down or
resting upon Chairs, and the Surgeon to place
himself between his thighs, his Shoulders
shd. be a good deal elevated that the Abdominal
Muscles shd. be as relaxed as possible, the 
Hair is next to be shaven from off the Pubis
and wiped cleanly away as any of it getting 
into the Sac would afterwards act as an Extraneous
body and produce extensive Suppuration, 
having embraced the Tumor with your 
left hand, and pressing it rather lightly begin
your first Incision at the Abdominal Ring
or rather an Inch and a half above the Spinary
Process of the Pubes, which is be passed thro'
the Integuments to the Inf. part of the Tumor,
its centre being the direction of the Incision,
this exposes the Aponeuroses of the Ext. Oblique,
which is to be divided, but the Incision is to 
be begun full an Inch below the first, in
cutting thro' this covering it may be more prudent
as soon as an opening is made into it to
pass in a Director to prevent any further mischief,
when this is divided a small portion

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of the next covering shd. be nipped up between 
the Fingers which will be found to possess
some degree of Density and it is the Cremaster
Muscle, the Division of which is to be made
in the same Manner as the former covering,
and then brings to view the Hernial Sac 
which is to be rubbed between the fingers to 
carefully ascertain that no portion of the Intestines
is included, an Opening shd. be made 
into it large enough to admit the Director
by holding the knife in the Horizontal Position,
when the Sac is penetrated a small 
Quantity of Fluid issues, having introduced 
the Director the Sac shd. be dilated upwards 
to within an Inch of the Abdominal Ring
and downwards to the bottom of the Tumor,
exposing the Omentum and Intestine, the 
Omentum generally foremost covering 
the Intestine, a very common Method of 
Opening the Sac is by pressing the fluid
it contains forwards and making a puncture
with a sharp pointed knife. In making 
these different Incisions only one circumstance 
is likely to impede the Operation,
which is in dividing the Integuments
the Ext. Pudend. Artery is generally cut 
thro', requiring to the secured before proceeding 
further-
The next step of the Operation is to 

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find the Leak of the Stricture, and 
for which purpose the finger is to be 
introduced into the Abdomen in the 
direction that the Omentum took out
and shd. it be found at the Ext. Abdominal 
Ring all that is required is to 
cut down upon it and dilate it sufficiently 
to return to the Hernial Contents
with a probe pointed Bistoury 
it will bear considerable dilatation
there being no vessel there likely to be
injured, but shd. not any stricture be 
here found it will be neccessary to pass 
further on and it will be found at the 
mouth of the Sac midway between the 
Ilium and Pubis, at the place where
the Spermatic Cord quits the Abdomen 
in such a Case it becomes requisite to 
consider which will be the least disection 
to divide the Stricture without wounding 
the Epigastric Artery, now this Vessel 
in one species of Hernia passes to the 
inner & in another to the outer side
of the H. Sac, depending upon whether 
is be direct or oblique, therefore if 
doubts exist as to the direction of the 
Hernia it is the safest plan to cut
anteriorly to the Sac on it's middle & 
fore part and directly upwards by introducing

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introducing one of the fingers of the the left hand
up to the Stricture and upon it the Probe
pointed Bistoury flat to the finger when 
arrived at it the Knife is to be turned & 
the Stricture divided by gently depressing
it's handle and is afterwards to be withdrawn
as it was introduced, Much difficulty 
often arises in oblique Hernia
of long standing because the inner Ring
is often brought down close to the Outer -
If after same trials no Stricture is to be 
found the membranous Bands are to be 
searched for & divided, but if the Adhæsions
are universal you had better divide the
Stricture & let the Hernial Contents 
remain in their situation-
After dividing the stricture the Omentum
& Intestine are to be examined 
but not till then, if the latter be mortified
it will have purple & livid 
appearance, sometimes in spots & at 
others general, the Discoloration often 
proceeds from the Effusion of Coagulable
Lymph or the Effect of the Strangulation
When Mortification has taken place &c
that only in very small spots it may
be returned into the Cavity of the Abdomen
opposite the Mouth of the Sac, but the 2
following rules must be adopted- 

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131
1st. dividing the stricture without disturbing 
the state of the Intestine & [crossed out]
[crossed out] 2nd. to cut into the Intestine 
& Evacuate the Fœces else the Symptoms
must consequently continue after 
which a Poultice must be applied-
Supposing you were called to a Case where
the Intestine was mortified only in 
a single Spot & a large portion of 
it dawn irreducible, your plan shd. 
be to make a small opening into the 
Mortified part and bring it down to 
the outer wound, closing it all round 
& leaving the rest to Nature, and suppose
a similar one shd. occur reducible the 
same treatment wound be equally adviseable,
tho' it is a case that rarely
happens, another great difficulty often
arise from adhesions taking place
around the mouth of the Sac to the Intestine
which can only be divided by 
the knife, or if they are slight by gradually
pulling the Intestine down & tearing 
them, to return the Intestine without
dividing them would be making 
bad worse-
Of Omental Hernia, if a large
Quantity has descended it will be 
necessary to remove it, if any Vessel of 

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considerable size shd. bleed very fine Ligatures 
shd be applied, if small nipping 
them with the forceps will be sufficient,
the part remaining shd. not be returned
into the Abdomen but placed directly
opposite the mouth of the Sac, to which 
it will adhere and prevent the further
descent of Hernia- If the Omentum
(shd. it be ever so small a Quantity)
appears in a Schirrus state or likely to 
go into one it shd. be removed, so likewise 
if mortified- The Practice of 
applying Ligatures around the Omentum
when mortified, altho' so recommended by 
Mr. Hey - Mr. C thinks very injudicious,
for as he very justly remarks the Object
of the Operation is to remove the Stricture,
and a fresh one is to be put on more
complete than the former, & the P. to 
remain in the same state as before
with all the symptoms of strangulation
When the operation is completed the Intestine 
&c returned, the Edges of the 
Wound are to be brought into close Opposition 
by means of Sutures & the P- 
kept in bed in the recumbent posture- 
Administering Medicines after the Operation 
is in general of very little use
Opium is seldom necessary for the P

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being relieved from the severity of his
Sufferings previous to operating falls 
asleep- Purgatives shd. not be immediately
given, but if anything is 
done a mild Glister shd. be administered
to excite the [Parystatic] motion of 
the Intestines. Before the Wound is 
quite healed a Truss shd be applied & 
to prevent its being painful soft 
Linen or Lint shd. be placed under
the Pad, the Advantage of this plan 
is to produce Adhesion between the sides
of the Sac- It was formely the practice
to remove the whole of the Sac- and apply
a Truss early with the same Endeavours
but it does not prove so effectual-
When from using too much 
force with the Taxis the Intestine becomes
ruptured, the Opening shd. be nipped together 
& a Ligature applied around it Mr. C has
tried this in several Cases & has proved successful-
Of very Large Irreducible Hernia
when large Hernia have long existed and been 
irreducible the Cavity of the Abdomen will
be found so much lessened in size, as not to
admit of the return of the Hernia-

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The Operation consists in making a small 
opening into the Aponeurosis covering the Sac
& introducing a Director under it into the Abdominal
Ring, & then with a curved pointed
Bistoury cut thro' it & the Abdominal Ring
at which place the Stricture is always to be 
found, after this the contents of the Intestines
shd be pressed into the Abdomen, but not the 
Intestines themselves for that is impossible,
but if any part of it can it may as well 
be done, too much force shd not be used, if 
Adhesions exist they shd. not be removed-
Bubonocele, or Hernia of the Inguinal 
Canal where it has not passed the Ext. Abd. Ring
the Operation for which consists in making 
an Incision thro' the Ext. Oblique Tendon as 
in cutting down upon the Ext. Iliac Artery 
& laying bare the Sac & Into Abd Ring, where
the Stricture is dilated & is universally to be 
found, which is to be done by cutting Directly
upwards, the Epigastric Artery is situated to the 
inner side- A very small part of the Hernia
often only protrude, even only half of the Cylinder
of the Intestine, which may be drawn down
to see whether it has recd. any injury, the 
Stricture is often so tight as to ulcerate 
or cut thro' the Gut-
Direct Inguinal Hernia passes thro' on pushes
before it the Tendon of the Trans-Muscle, directly 
thro' the Ext. Abd. Ring, the Stricture being 
[??sed] at the Mouth of the Sac [of] or Tendon of 

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The Transversalis; this Species of Hernia is 
usually of small size, & may be distinguished
from the Oblique by the Spermatic Cord always
being situated to the outer side whereas in oblique
it passes behind the Hernia, 2dly there being 
no distinct Tumor above the Ring, but this 
latter is not always the Case- When a Truss
is applied in Hernia of this kind, the Pad shd.
be at right angles with the spring of the Truss,
when is strangulated much Caution must be 
used in applying the Taxis as it will appear
as if it was returned into the Cavity of the 
Abdomen when it is only pushed back thro 
the Ring & lodged between the Tendons of the 
Oblique & Transversalis-
The Operation is performed similar to 
the Oblique, the Epigastric Artery situated
on the outer side of the Hernia, therefore the
Stricture may be dilated with safety by cutting 
inwards, but as it may be often mistaken
for oblique were he to cut in that Direction
the Vessel would be most certainly wounded,
therefore Mr C recommends as in all species
of Inguinal Hernia to dilate the Stricture 
forwards & upwards & no Mischief can 
be done-
Hernia in the Female differs but little 
from the Male, only in having but one covering
to the Sac, they require the same Treatment
in the Reducible state & the same operation 
when strangulated. The Inguinal takes 
the course of the round Ligaments & is extremely

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141
extremely rare, & when met with are generally
oblique, Mr. C has never seen but one species of the 
Direct Kind, the Ring in the Female is much more 
complete than in the Male & the Tendons more 
strong- Stricture usually at the inner ring 
Mr. C has seldom seen it at the External-
Hernia Congenita is formed in consequence 
of the Tunic Vaginalis Testis not being
naturally closed & thus the Sac is within the 
Tunic Vagin Testis- In general it appears 
soon after Birth but may appear it the Adult
When in the Fœtus only the Intestine is down
because the Omentum is too short to reach so 
far therefore possesses much Elasticity and 
are always oblique & where returned always 
make a juggling noise, when it is protracted 
to the Adult period it may be in consequence
of the Opening not being sufficiently large 
to admit the Intestine to pass down but dilated
by exertion- &c- The Epigastric Artery 
is on the inner side- This Species of 
Hernia is more obscure that others & oftener
splits the Cord in general the Testicle is not 
perceptible but the Cord is most distinctly
up to the Canal which is not in Inguinal-
Treatment A Truss shd. be applied as 
soon as possible but without a Spring 
at any rate till the Chd. is able to [run] along
having the under strap applied pretty tight
to keep it in it's proper Situation, if they 

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shd. become of very large size a laced Boy
Truss shd. be applied- When Strangulated are
more difficultly reduced than other Hernia,
The Stricture is generally placed at the Orifice
of the Sac, but it will sometimes occur at
the Abdom. Ring & may be divided with 
safety upwards- When the Stricture is at the 
upper Orifice it may sometimes be effectually 
reduced- by the P. standing up & putting 
the Foot upon a Chair of the side that the H. 
is with [crossed out] the Knee bent as [illustration] Half the Sac will 
sometimes contain very large Quantity of Water-
In very large, old, Irreducible Hernia,
cut down upon the Stricture & divide it with
making an extensive opening for it as it is 
dangerous & in general the Adhesions are extensive,
Instances have been meet with where 
a Hernial Sac has been formed within a Sac.
in consequence of Partial Adhesions in which 
is embedded either Omentum or Intestine
& often both which becomes gradually elongated
as [illustration] Abdom Ring.
Where such an Instance is meet with
both Sacs must be [Divided] Opened & the 
Stricture Divided as usual-

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Femoral Hernia Pouparts Ligt. is 
formed by the Tendon of the External Oblique
Muscle [crossed out] which gives off the Fascia Lata
of the Thigh covering the whole of its fore part
as low down as the Knee over this also is [crossed out] 
seen the Aponeurosis is given off from the same
as covers the Vessels of the Cord called the Fascia
Superficialis_The Femoral Ligt forms a semilunar
Edge for the Passage of the Vena Saphessa
Magna- below the Fassia Lata will be found 
the Sheath of the Femoral Vessels being formed
on the back part by the Fascia Iliac, & an 
the fore part by the Fascia Trans- uniting to 
each other on the sides, in the middle of which 
is a Septem dividing the Artery from the 
Vein, on the inner of this Sheath it is perforated
by the Absorbent Glands of the Thigh & 
it is at this part that the Hernia protrudes
pushing before it this part of the Sheath-
it does not come in Contact with Gimberuets
Ligt. neither does it touch its Edge as is generally
supposed- The Epigastric Artery is always 
to the outer side at least it never varies except
in very large Hernia. On the the fore part
of the Mouth of the Sac is the Spermatic Cord
in the Male, & the round Lig in the Female
on the inner side there is nothing but the 
Tendon of the Ext Oblique- The Sac lays Exterior 
to the Fascia Lata & passing under Pauparts
Lig enters the Crenal Sheath as before 
mentioned-

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& has in general the Appearance of the Elastic
Bottle, it being broad at its fundus & narrow 
at its Cervix which is the Chief Seat of Stricture,
The fundus of the Tumor passes upwards & backwards
over Poupart's Lig & becomes even with 
the Mouth of the Sac, its coverings are two- 
first- the Aponeurosis of the Ext Oblique, second
the Bay in which the Sac is contained which is 
the Sheath of the Vessels & may be called the 
Fascia propria, In fermoral Hernia there is 
in general great freedom of Motion in the 
Tumor. Femoral Hernia is apt to be mistaken 
for other Diseases & to distinguish them 
often is Difficult-
First with Bubo which is to be distinguished 
by inquiring into the Symptoms
Mr. C recommends you not to be too hasty in
deciding upon cases of this Nature, as he has
known He opened for Bubo & by that means
an Artificial Anus has been produced which 
must always be a great Infinnity to the P-
& on the other Hand the Practitioner can 
forgive himself for committing a great 
Error-
Second with Inguinal, by (in Fermoral 
Hernia) the Spinous Process of the Pubes being 
to the inner side & in Inguinal to the outer
side, but if very small you may know 
it by pulling down the Hernia & its exact
Course may be seen-

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149
Third from Psoas Abcess because [to] it dilates
with Coughing & returns partially into the 
Abdom but not entirely- Psoas Abcess
is attended with Pulsation & much Pain in 
the Loins- In these Cases the Application of 
a Truss it extremely dangerous- Femoral H
does not in general proceed to any very large
size & when it has not protuded the Sheath
there is little Danger of Strangulation Mr. C
has never met with an Instance of it-
Sometimes tho' rarely the Obturator passes over
the Sac- when it arises from the Epigastric 
Treatment In the reducible State a common
Truss like those used in Oblique H
shd. be warm, but having the Pad more curved
at right Angles with the Arm- if the Hernia
is large a piece of Leather shd. be placed under
the Pad, & a thin leather strap passed round
the thigh so as to keep it in its proper situation
(from the bottome of the Pad)-
In most Cases of Femoral H a radical Cure
is not to be expected unless the P- is very
Young, the reason of which is, that Poupart's
Ligt will not allow of proper pressure from 
the Truss it making such a Space between it
& the Bone-
Irreducible Feml. Hernia & Truss formed
like a Cup with a hollow Pad shd. be applied
to prevent the Enlargement and Injury to the 
Hernia, but shd. not be pressed too hard to give 
Pain-

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If only Omentum is down this Pressure
will cause its Absorption-
When Strangulated have recourse to the 
Tobacco Enemas & at the same time apply
Cold as recommended in Inguinal as it is most 
to be depended on, in general there is but
little probability of reduction therefore little
time shd. be lost but every means had recourse
to as quick as possible- If the Symptoms
do not abate in 24 Hours after the P- was first 
attacked Mr. C recommends the Operation to be 
performed & even if they are very urgent
& Hours after as he has seen Pts. last in consequence 
of Delaying it even a shorter Period-
Taxis- The Position best suited for the purpose
is that as recommended in Inguinal, & 
that Thigh upon which the Hernia is when the 
legs are crossed shd. be placed under the other-
This Species of Hernia is not to be reduced
by pressing it immediately back but first 
push it down by placing one thumb upon 
the other & thus knead it down & then upwards
as fermoral Fe always turns back upon itself-
Operation- begin your Incision about an inch
above Paupts. Ligt. & extend to below the Middle
of the Tumor, then another Incision shd. be extended
transversly & immediately below the 
other forming an inverted T [illustration], else you will
find yourself much embarrassed for want

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of sufficient room, disect back these Corners 
so as to form flaps, & having done this you 
proceed to cut thro' the Aponeurasis of the Ext-
Oblique which shd. be done laterally, when 
you have [done] raised this you expose the Fascia 
propria & having cut thro' it you [cut] lay 
bare the Hernial Sac which is to be opened
as advised in Inguinal, & Stricture Divided
(which is at the mouth of the Sac, tho' some 
have supposed it may exist at Gimbernats
Ligt. but its impossible) by passing up the 
Director as the finger cannot be introduced
into the mouth of the Sac, its Size sometimes
not exceeding that of a Quill, having got in
the Director pass upon it the for the pointed
Bistoury & dilate the Stricture directly upwards
towards the Navel, & by these Means you will
make full room to return the Hernia, & 
cutting inwards would not & avoid wounding
the Obt. Artery shd. there be any variation 
The Stricture shd. then be divided as the Knife is passed
inwards not as it is withdrawn-
After the Operation the P requires a Truss
as in Inguinal & to be applied as early-
Umbilical Hernia is situated in the 
Lim Alb where the Tunis passes into the Abdomen
& arises in Consequence of the Vessels
having been large & after the Absortion 
a space is left for the Intestine &c to pass thro'
in Adults it may proceed from Obesity &

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in Woman in the early stage of Gestation
by the Uterus pressing up the Intestines- but
Young Children are most subject to it- Umbilical
Hernia will proceed to an immense 
Size, in a Case related by Mr. C which he saw,
it's Circumference measured 11d. 4 in- 18 in from 
above downwards & 19 in across- It has sometimes
two openings, therefore contained in two
[crossed out] Sacs & a Septum between them-
Children born with any Malformation of 
the Abdominal Muscles are almost sure to 
have Hernia- 
Treatment when Malformation is the 
Cause is very simple, requiring only the 
Integuments & Abdominal Muscles to be cut 
thro' & dilate the Opening where the Hernia
protruded & return it then pair off the 
Edges & approximate them very closely by 
Adhesive Strap & heal them as quickly as 
possible-
When Malformation is not present an 
Ivory Ball shd. be cut in half & the flat 
parts to be placed upon the H over this 
is to be applied Adhesive Plaster & a bandage
over all extending around the Abdomen
& will be better secured in its Situation
by straps passing from it between the Thigh
& carried under & fastened behind- In the 
Adult a common Inguinal Truss of a Water
or the Common Umbilical Truss- When the

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Truss does not succeed Mr. C recommends 
a Belt to be put round the Abdomen over
the Umbilicus, & another passed around the 
pendulous part just above the Ilii & fastened
to each other by means of Straps [illustration]
In the Irreducible State a Cup shd. be made
of Tin or Copper well padded with Leather
& placed immediately over the Hernia & held
in its place by Bandages passing round the 
Abdomen-
When Strangulated is attended with the 
same Symptoms & require the same treatment
as Inguinal & Fermoral but I must here
likewise observe, that the Tobacco Enema may
be administered with more success than in 
the former mentioned & shd. never be omitted
if it is required- In attempts at Reduction 
the Hernial Sac shd. not be grasped by the hand
but gently pressed upwards as it is also a 
pendulous Hernia, & as it is in general
much covered with Adess the pressure shd.
be gradual & slow- The H- Sac frequently 
becomes partially & even wholly absorbed
leaving the Intestines covered only by the Common
Integuments which has led people to 
suppose that Umbilical H had no Sac but where
this Absorption has not taken place the Peritoneum
forms one, it also sometimes receives 
a covering from the Aponeurosis 
the Ext. Oblique, Active Purgatives as Calomel

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159
& Salts &c will frequently reduce them,
but if the Sickness be very violent it will be 
as well not to administer them-
Operation make a Cut thro' the Integuments
from the Top to the Bottom of the Tumor
with the greatest Care possible as from the
Absorption of the Sac the bowels are so very 
apt to be wounded- The Stricture to be dilated
outwards- If of a very large size, the 
Omentem in a Schirrus State &c &c Treat 
them as recommended in Inguinal &c &c 
When the Omentum is down in all species
of Hernia cover the Intestines with it when 
you dilate the Stricture [from] that it may 
defend them from sustaining any Injury-
Ventral Hernia is similar to Umbilical
passing thro' the Foramina where the Vessels
enter in the Lin. Alb. Lim. Senilum. & Lin.
Transver- commonly just above the Navel
but are more obscure and oftener receive a 
covering from the Aponeurosis of the Ext. Oblique
When occuring opposite the Stomach sometimes
after a full Meal part of it will be protruded 
causing violent Sickness & Vomiting 
& when low down will have the Epigastric Artery
close to its Orifice- The Medical Treatment
is exactly the same as the foregoing, & when 
Strangulated the same Symptoms are present
& require the ... Operation- As the other 
Species of Hernia of so rare occurrence &
so of course them out of all reach of Operation

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It is not necessary to say more upon this 
Subject turn to the first Page upon the Treatise
& all [I] will be found that is necessary-
Burns and Scalds.-
May be divided into three States each requiring 
a different Kind of Treatment-
First Vesications your first Object shd.
be to prevent the Bursting of them for their 
Suppuration immediately ensues & to 
prevent Inflam. by applying as quick as 
possible Evaporating Lotions- As Lig. Plumb
Acct c Spt. Vin. Rect. Spt. Vin R & Aque
Spt. Vin. R & Vinegar or Spt. Camph. the 
former is least likely to prevent the Seperation 
of the Cuticle, [i????ing] the part 
is Cold or Common Vineger will be attended
with the best Effects- If Matter shd. form 
or seem likely to form under the Vesications
they shd. be opened & the Matter Discharged
but still continue the use of Evaporating
Lotions- Fomentations & Poultices shd. 
never be applied, they produce a most 
Copious Discharge & even Death-
Second State. Is when the Cuticle is Detatched 
& consequently the Extreme B. of the Nerves
becomes laid bare producing great Constitutional 
Irritation- The Pain is most 
excessive & in extensive Scalds or Burns

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The Pulse becomes small & Quick; Countenance
pale, & dejected, Body Cold, followed by Heat & 
Shiverings- In this State your first Object
shd be to cover the nervous Papilla of the Skin
which have been bare, the best Application
for this purpose is equal parts of Ag. Calcis
& Lactis, & the wound will rarely want any
thing else during its progress, sometimes a 
little opium may be added but in Children
it is apt to produce unpleasant Symptoms
as Coma & c - & will when applied to the Skin
act as powerfully as when given by the 
Mouth- Spt. Terebenth has been much recommended
[by] Mr. C has found no good effects from it except in 
Burns occasioned by the Explosion of Hydrogen
gas or where the part has been Destroyed in 
a similar way, it is apt to increase the Discharge
which shd. be always avoided when 
applied to common Scalds &c- When it is 
attended with Rigors Port Wine & Bark shd.
be adiministered & if much Heat of the Skin
is present occasional Doses of Calomel- The 
Lungs of Persons who die from accidents of 
the Nature appear much affected there
being previous to Death great difficulty 
of Breathing & tightness across the Chest-
Third State Is when the Scald is not very 
extensive but Deep- in which Case stimulants
are necessary- Warm Terpentine is an excellent
application for this purpose & shd. be 
applied extensively to the sound as well as to 
the injured part, & after some little time

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Fomentations & Poultices but not the surface
so extensive- In the Constitutional 
Treatment Opium is the only remedy [that] 
that can be relied upon in the first Instance
with keeping the Bowels regular-
when Suppuration commences Wine & Bark
must be given especially if the Pulse be quick
& with these there is shivering. Mr. C has seen
the Pulse reduced from 120 to its natural 
standard & that quicker than imaginable.
Frequently after Scalds & Burns their surfaces
will granulate too quickly- if so apply Ag
Plumb. Acct & Zinc. Acct. also Aq Calus c Calomel 
is a good remedy-
Great Deformity sometimes produced by Scalds 
&c such as the Chin growing to the Chest, Thigh 
to the Abdomen &c & cannot in any way 
be remedied, it has often been divided but 
without success, it is general laid to the 
charge of the Surgeon but it cannot be avoided 
being produced by a Contraction of 
the Skin in healing-
Tumors.-
Are an increased Growth of any part of the 
Body either natural or diseased-
First Steatomatous- are mostly unattended 
with pain & not tender to the touch are generally
[attended with] occasioned by Prepure & produce but little
Inconvenience to the P. except from Bulk
may be distinguished from other Tumors by 

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drawing the Skin tight over & if Steatorn 
will be joined to be divided into may Lobes-
These Tumors appear to be only an unnatural
Growth of Fat & when dissected perfectly healthy
& for this Reason are more generally found upon 
the pates & between the Shoulders & upon the Back
Blows are frequently the Cause & have been known
to grow to an enormous size, the largest Mr. C
has seen was 28 lbs they will frequently arrive 
to 20 & 14 lbs Their removal is merely 
a simple piece of Dissection, by making 
in the middle of the Tumor and Elicptil Incision
thro' the Integuments & leaving sufficient 
to cover the Parts afterwards there is 
no Danger in wounding any Vessels-
Second Encysted are produced by an Obstruction 
of the Follicles & in course of time a 
large Collection of Matter resembling Sweat 
will be deposited that Tumors of Considerable 
size will be formed & even many on the 
same Body & even in the same Family that 
they have been said to be hereditary. Their
most common Seat is in the head & Neck, & have
be found in the liver & known to be filled
with Hair Coagulable Lymph & Bone-
May be distinguished from other Tumours
by their circumscribed appearance, distinct
Fluctuation as much so as in Abscesses
& being generally quite free from pain-

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Treatment there are three Modes-
First when upon the Head it is best Dissect 
them clean off previous to which it may 
be proper to evacuate the Fluid- second if 
on the Neck, cut into them & discharge their 
contents then introduce a Tenaculum into 
the Cyst & draw it towards you & after making 
two or three Cuts upon it, it may be readily 
removed from it's Situation- 
Third as if an Hydrocele, by Injection see 
that subject for particulars- 
If these Tumors are left themselves they will 
now & then become malignant producing 
Fungus Hæmatodes or will burst & produce 
those Horns which Men are subject to, if not 
by Disease by being planted there by their 
Wives- 
Third Glandular, When the Glands of the 
Neck are affected it is generally the Parotid 
but all are susceptible- This Disease differs 
from Scrofula by it's swelling very gradual & 
occurring at that time when Scrofula is not
likely to take place, from steatematous 
in not possessing that lobulated Appearance 
& being extremely hard, these Tumors will
proceed to Ulceration, but is a very gradual
process existing some years previous also 
Cartilaginous & Bony Matter are deposited,
Cancerous Affections also are not uncommon 
& will destroy life- When speaking of the Steatorm
Tumor we said nothing was so simple

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as their removal- but in this Species it is 
quite the reverse, requiring much Anatomical 
Skill in consequence of the numerous 
Blood Vessels entering them especially when 
situated on the Neck- In these it is only 
a piece of Dissection but the Vessels must 
be attended to with the Greatest Caution, when 
you have got down to the surface of the Gland
you will find it is contained in a Capsule
which is to be dissected from it before you 
[& before you] entirely remove the Gland the 
main Artery which enters it shd. be secured 
else you may have much Hæmorrhage.
The Carotid Artery is often laid bare in the 
removal of these Tumors- Mr. C believes 
that what are called Veins are Tumors of this 
Description, but are commonly believed 
to be Steatomatous-
Fungus Hæmatodes-
No part of the Body appears to be 
exempt from this Disease but appears 
to be more particularly connected with the 
Tendinous, as the Tendinous Coverings of the 
Muscles, Scleratic Coat of the Eye- &c It
begins by a small blue colored Tumor like
a varicose Vein, but it's being hard will 
easily distinguish it from it- it fluctuates
is unattended with Pain & generally thought

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173
lightly of by the P. in their early period if 
opened it greatly increases their Growth, requiring 
Amputation to be performed very soon
after; as the Tumor increases in size it puts 
on a brown brick Dust Appearance by which 
the Practitioner will immediately discover 
it's Character, at length it bursts & ulcerates 
sending forth a finger of a Purple Color
resembling that purple appearance Blood has 
after it has stood same time accompanied
with a Bloody serous Discharge, this fungus 
is extremely Vascular so much so that if you 
prick it with a plobo you will have great 
Hæmorrhage, which may be easily stopped 
with Pressure, during the Progress of the Disease
the P still experience but little pain 
& that only from the Distention of the Parts-
This Disease is also marked by it's great Secretion,
for if you apply a towel to it, it 
will become perfectly wet in a very short 
time- As the Tumor increases in Size it 
begins to slough, Instances have been known
of its sloughing quite off- it has occurred
2 or 3 times under Mr. C observation, but he 
doubts whether it would prove a permanent
Cure; Nitros Acid will increase this disposition 
to slough- The System will become 
affected by this Disease both by Absorption 
& Circulation, affecting the Liver, Lungs,
Ovaries &c- Sometimes the Tumors are 
encysted & a Bloody Serum with Coagulable
Lymph, & extended by the Growth of Cyst only

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175
Amputation does not succeed only in the very 
recount State, Mr. C has also removed them but 
they have always returned not in that part but 
in some other of the Body, when they are removed 
much of the Surrounding Sound part 
shd. be removed with it, Fungus Hamatodes 
was first described by Mr Hey-
Treatment. The best Application is Nitrous
Acid in the proportion of 50 Drops to a Quart
of Water- Caustic has been applied without Success
& has rarely been cured by local remedies-
The Operation is by no means formidable
if you avoid cutting too near the Tumor,
but shd. you happen to wound the Vessels of 
the Tumor you will have excessive Hæmorrhage
owing to their being so much enlarged that 
they cannot easily retract-
Hydatids are frequently met with of different
Kinds-
First are composed of a number of Cysts like
the Hydatids of the Testicle, possess much Vascularity,
even to [crossed out] require that the 
Vessels be secured during their removal altho'
the Tumor be but of small size, they contain
a yellowish coloured Fluid- 
Second when several Hydatids are contained
in one Cyst & are said to contain a live Animal 
in each, that propagate extremely fast 
at length they burst & suppurate but will 
do well if removed- 
Third Hydatids of the Ovaries which are of a 

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different Species having a Foliated Appearance
& growing to an immense size will occur in 
the Internal as well as the External parts of 
the Body as in the Liver, Lungs, the Placenta 
is sometimes converted into a Substance entirely 
of this Nature- 
Ganglions or Tummors of the Bursa Mucosa
& mostly situated at the Wrist & Knee Joints
but the latter most common, caused by 
Friction, Pressure, & Blows & generally 
contain some Synovial Fluid, When situated
upon the Wrist Mr. C generally disperses 
them by hitting them with a Book, but when 
it cannot be thus accomplished you shd. 
prick them with a needle & hit them with 
the Book as before, or if this does not succeed 
pass a Needle & Ligature thro' it & let it 
remain till the Part becomes red, & some 
Degree of Inflam: is excited, which will 
produce Adhæsion & it's Cure-
Cartilaginous & Bony Substance are frequently 
deposited in them, do not by any 
means cut into them as you will have 
sloughing ensue, if any thing is done 
you had better remove them wholly-
When situated on the Wrist will have communication
with the Joint sometimes, avoid
Opening them & applying Setons to them also-
Mr. C thought formerly that these Tumors did 
not admit of Remedy but has since altered
his Opinion as he has seen them effectually
removed by the application of Arsenic & 
absorbed by Blisters & Emp. Adhæsive. which

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shd. be employed if the Use of the Book does 
not succeed-
Nevi Materni, are Tumors incident to 
children & arise from two Sources from Enlargement
of Arteries & Veins, most commonly 
in the former from want of Elasticity in the 
Coats of the Vessels- When they are situated
over a Bony Surface such as the Head shd. not 
be removed, but may be cured by Pressure
namely by placing a piece of Silver upon the 
Tumor, for Instance a Shilling & over this 
a piece of Adhæsive Plaster or Bandage-
but when situated upon soft parts where Pressure
cannot be applied properly, shd. be removed as they 
will grow to a considerable Size. The operation 
shd. be performed as expeditiously as possible 
by making a circular Incision around the Tumor
as they are very vascular & children cannot afford
to loose much Blood, do not prolong the Operation 
by taking up the Vessels as what do Bleed
are only Cutaneous, Lint with Pressure is always
sufficient- A Poultice may be applied afterwards
to prevent any ill consequence-
Are supposed to be caused by impressions of 
Women during Pregnancy-
Ossific Tumors or Exastosis, are of 
two kinds first a Growth of Callus from the
surface of the Bone, mostly from the Surface
of the Periostium & adhering firmly to it's
Surface- Cause is host frequently from Blows

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181
& may be easily dissected away- Common 
seat is the internal part of the Thigh, just above 
the Knee & are extremely slow in Growth often
40 Years- Second species proceeds from the 
Cancellated structure of the Bones and less
firm is texture appearing also to be of a 
malignant Nature, for if they are removed 
generally sure to return again in that or some 
other part of the Body, therefore no relief
is to be expected but from Amputation 
grow to 15 or 16 lb. Wt.-
Warts are merely excrescences of the Skin
produced by Pressure &c- and arising from 
various parts of the Body- if too much 
irritated at a certain period of Life, are apt 
to produce Cancer, especially if caustic
be applied & the P. picks them off- tho' Mr.
C does not believe they are truly Cancerous
as they do not extend by Absorption, but 
recommends that they shd. not be trifled with 
Treatment apply Arsenic ʒi and leng. Cetacei 
ʒi, and at Intervals Caustic-
Poisons.-
Any Substance may be considered Poisonous 
which produces any Delaterious Effect on the 
Body- Poisons are of 4 Kinds- Viz Animal,
Vegitable, Mineral, & Morbid, & act upon

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183
the Body in different ways, some upon the
Nervous System as Opium, Others by Inflam.
as Hyd. Oxymur, this may also have some effect
upon the nerves- Whilst others act upon 
the Nervous & Arterial System as Arsenic-
Vegitable & Mineral Poisons act in proportion 
to the Quantity taken, but quite the reverse
in Morbid, in all, the symptoms are aggravated
if the Constitution is in a state to receive
them- When a Poison is to act upon the 
Body it must previously be disposed to receive it,
for instance in the Small Pox, Chancres,
Bubo one Person will receive it most readily 
and another with the greatest Difficulty so 
also the Same Body at different Periods, the 
Predisposition will be much altered by Habit
as in taking Opium, Venereal Affection &c-
& by Illness- The time that poison requires
to produce its Effects is variable in Different 
People, but in general in Small Pox
12 Days is the Period, in Vaccine 9 Days, Scarlatina 
7 or 8 Days- Measles 8 Days- Intermittents 
are the most uncertain & are protracted
longer than any other Poisons except Hydraphobia
Animal Poisons the stings of Animals 
in this Country do not in general require 
Medical Assistance, are chiefly those of the 
Bee, Wasp, or Hornet- The best Application 
to which is P. Opii. Ol. Amydal, or Common Oil ℈i

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185
The stings of Vipers act upon the Arterial 
& Nervous System when a person is bit with 
one of them, A Ligature shd. be applied above 
the part Bit so as to stop it's Absorption as 
tight as it can possibly be borne for full 24 
Hours the part having been previously cut 
out-
Bite of mad Dogs. The Poison of Dogs 
in this state resides in the Saliva & is supposed 
to have originated first in the Wolf the 
Chief it attacks is the Dog, Cat, Fox when it 
occurs in other Animals it arises in consequence 
of being communicated by some one of the 
foregoing mentioned, not being communicable 
either by Horse or Hog tho' in every species 
that it attacks the Appearances & Symptoms
are the same- & called Hydrophobia-
When a Person has been bit by a Dog supposed
to be mad, from the Appearance of the 
wound it is impossible to tell whether any 
Poison has been inserted, it can only be told
by the Circumstances of the Case, & the State 
of the Dog- it's effects are not produc'd immediately
but often protracted for a considerable 
time even years, the usual time
is about six Weeks-
Symptoms pain in the part followed by 
some Degree of the Inflam, which after a few 
Hours extends- If the Hand has been bit

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187
into the Axilla, if in the thigh into the Groin
but the Lymphatic Glands do not become 
much enlarged, after this a very peculiar Degree
of Irritability succeeds, becoming much
disturbed at the least possible Noise, Eagerness
& Quickness of the Eyes, taking particular Notice
of every Body & every thing, with great 
repugnance to take any kind of Fluid, even 
hearing water poured from one Bason to another
chills them with Horror, During this time
the P. appears quite rational- it is called 
Madness but differs totally from it, but in 
the Advanced Stages Delirium comes on-
If the P. is prevailed upon to Drink he appears 
strangulated in the Effort, & is even much 
convulsed, it does not appear that they have 
any Dislike to fluids or that they are afraid
of them as is generally supposed, but that
they are totally unable to swallow any thing,
the Disease appearing to affect the Esophagus 
& Stomach very much, & upon Examination 
these parts are found much inflamed,
Too great a degree of Light is very Disagreeable 
even any thing touching them affects 
them much- they seldom live longer than 
24 or 48 hours, tho' Instances are recorded
of their living 4 or 5 Days they seem worn
out by Irritability, the Brain is unaltered
in its structure, but may be altered in it's
Functions- Dogs will take fluids & Pointers will 
stand-

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Treatment When this poisan has been inserted 
or only supposed to be so, the first & greatest
Care must be to extirpate it & this can
only be done by cutting out the part or applying
Caustic- When it is amongst tendinous 
parts Caustic shd. be applied, as by removing 
them you would [remove] destroy the Action
& Use of the Limb as likewise in the Eye-
even in very muscular parts this may be
done more beneficially as it is difficult to 
ascertain the Distance the Poison has spread,
especially if it has been infected long, & it 
will not only destroy the injured parts but 
the surrounding cellular Membrane that may
have absorbed it- If the Parts have been 
healed & the Animal proves to be mad then
it will be necessary to apply Caustic tho'
it may not succeed it is better to give it 
a Trial- 
Vegitable Poisons Cicuta (by what [which] 
Socrates was poisoned) occasions Giddiness
Pain in the head, Loss of Sight, Vomiting,
Weak Pulse, Convulsions, Coma & Death-
Is of no use in Cancer tho it is so frequently
employed & seems gradually sinking out 
or repute- Tobacco is a most violent Poison
when used largely even in some Constitutions 
a very small Quantity will very 
soon extinguish Life, as has been evinced by

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applying it to the Scalp in Tinea, & Enemas
in Hernia &c- Opium produces Symptoms
exactly similar to Apoplexy, & after 
it has been taken some time all attempts to produce
Vomiting prove fruitless, but an Emetic shd. 
always be given, if sickness cannot be the 
consequence the P. shd. be kept in constant
Motion as also whenever Opium has been 
taken- The Emetics to be employed shd. be 
of the most Active Kind- as Cupii Sulph.
Zinc. Sulph. Infus Ipecac, the latter highly 
recommended by Dr. Curry- The Quantity 
to be taken necessary to destroy life varies
much- 6 oz have been taken without Effect 
Opium injected into the Vessels & Veins acts
the same as if taken- it always increases 
the Pulse therefore in Tonic Inflam. shd.
not be given till Blood has been put into 
Execution- Vegitable Poisons produce no 
visible effect on the Stomach & could not 
be sworn to in a court of Justice-
Mineral Poisons- Arsenic & Hydrarg 
Oxymur or Sublimate are the principal which 
as soon as taken cause great urgency to go to 
stool, Most violent pain in the Stomach with
thirst & afterwards very frequent Vomiting
even more violent than in Hernia- When 
Arsenic is taken it is rarely that its effects

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can be counteracted, but something shd. be 
tried; encourage Vomiting & dilute largely -
Arsenic being so very Difficult of Solution,
ulcerates & inflames the Stomach only in 
spots whilst Sublimate is usually general- 
in small Quantities does not destroy Life
but produces an Effusion of Lymph from 
the Coats of the Stomach in which it is suspended, in this 
case give Potassæ Sulph ℈ii disolved in 16 oz
Ag: sumat ℈ii every ten Minutes-
To Detect whether it has been taken in examining 
the Body after Death, heat the Contents
of the Stomach over the Fire in a copper plate
& a vapor will arise having the smell of 
Garlic & at the same time gives the Copper 
a Silvery Appearance- 
When Sublimate if no Medicine can 
be procured soap & water may be given 
with the best Effects as a Substitute for Potassæ,
even if they can a better remedy cannot
be employed. Chalk & Water also but 
is not so good- to Discover whether it has 
been taken heat the contents over the Fire
& Globules of Quicksilver will seperate 
from it- By adding Ammon to it, it precipitates 
a white Powder & Alkalies a Brown. 
Both Sublimate & Arsenic when injected into 
the Veins produce the Same symptoms as 

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when taken & inflame the Stomach also equally.
Lead. Is not in general taken as a poison 
but produces its delaterious Effects by using 
it, as in Painters &c- it does not inflame 
the Stomach & Intestines but produces the 
most violent spasms drawing then quite
into Knots & even rupturing their Vessels -
it paralyzes the Muscles & produces Hæmiplegia 
&c-
Oil of Bitter Almonds is a most 
pernicious Poison & causes almost instantaneous
Death, preceded by the most violent 
Convulsions- 2 or 3 Drops is sufficient to 
destroy a Rabbit-
Ticunas- is also a very violent Poison it's
effects are instantaneous, is what the Americans 
destroy & take their Animals with 
by imbibing Arrows with it-
Morbid Poisons are such as one communicable 
from Man to Man & are so 
numerous that we must pass by them 
in silence, & as also they have been treated 
of in other Lectures-
Fistula Lachrymalis-
Is an Obstruction to the Natural Course
of the Tears in Consequence of a Stricture
in the Membrane lining the Ductus ad Macscym
& exists in 3 Different States-

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First being an Enlargment of the Lachrymal
Sac, forming a Tumor at the inner Canthus
accompanied with a flow of Tears over the 
Cheek which when pressed discharges a 
Mucus by the I Puncta Lachrymal: the Skin
is not discoloured, remaining so even for 
years & without the least Pain-
Second Inflam of the Skin over the Sac takes 
place, the Tumor becomes red, tumid & 
painful, the Eyelids are swollen & instead
of Mucus Pus is discharged, still the Tears 
pass over the Cheek-
Third An Abscess is formed 3/4 of an Inch 
below the Sac from Extravasation of Tears
into the Cellular Membrane & a Fistulous
Orifice is the Consequence out of it sometimes
a Fungus proceeds, & the Tears are 
constantly discharging that makes the 
operation indispensibly necessary-
Instances have been known of a Spontaneous 
Cure taking place but are very rare-
Cause Most general in Catarrh in Scrofulous 
Habits, & from Lues Venerea or 
Pustula of the Small Pox-
Treatment, in the first Stage, shd. be 
to endeavour to force a passage by injections 
thro' one of the Punata, those commonly 
used are Saturnim with Opium [&] or Quicksilver,
the latter mostly recommended [but] 
neither shd. be used when the Passage is at all 

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inflamed- One Puncta shd be stopped whilst
the other is injected. Mr. C has known Mercl.
Friction to the part of Service giving at the 
same time doses of Calomel pro re mata-
The Second State requires an Operation to 
the performed in the following Manner- x2
having felt the Edge of the Orbit, the 8th. of 
an Inch within this an Opening is to be made 
at the Tendon of the Orbicularis with a Phymosis 
Knife about 1/4 or 1/2 an Inch in length
and the Matter will be discharged, then pass in 
a probe down the Passage & withdraw it desiring 
the P. to blow his Nose & if the Duct 
is open Blood will be discharged, after this 
a Style is to be passed in, its End resting upon 
the Corner of the Edge which shd. be suffered 
to remain in as long as purulent Matter
is discharged by its Side, 3 Months in the 
time usually necessary for it to remain, 
if much Inflam shd. arise a Poultice shd. 
be applied-
The Third stage requires the same Operation
except it has been of such long 
standing that the Duct has become impervious,
then it requires that an opening 
be forced [&] the Os Injuries & the Style 
be pushed thro' and remain as long 
as just recommended-

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Removal of the Eye-
This Operation becomes necessary in Consenquence 
of Cancer & Fungous Hæmatodes in 
this [of] Organ- The latter commences in 
having the appearance of a Mirror in the 
bottom of the Eye of a blue purly colour
attended with inconsiderable pain but defect 
of the Sight. Belladonna may be 
used to ascertain its state more particularly 
In the second stage of this Disease, the Eye
appears white mixed with Bloody spots 
& considerably swollen, The Vessels of the 
Tunic Conjunctis. distended with Blood 
of a venorus colour, a Tumor becomes 
formed that bursts & a fungus issues
from the Orifice of a Bloody colour,
sloughs off, the Eye sink into its Orbit
& the Eyelids close, the Fungus again shortly
rises & again sloughs during which Period
the P. experiences much pain even 
sometimes to produce Delirium, at 
length it extends backwards thro' the 
optic Foramen & the Brain becomes 
affected in a similar Way- The P. becomes
Comatose & Blind, dying shortly after 
with Symptoms of Compressed Brain.
This Disease commences in the Sclerotic 
Coat & extends by Absorption-


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True Cancer is a disease extremely rare
Mr C remembers to have met with one 
Instance only, it generally occurs quite 
at the latter period of life whilst Fungus 
Hæmatodes attacks all Ages even the very 
young-
Except this Operation is performed in its 
earliest state it cannot be successful
it is one of the most unsuccessful Operations 
in Surgery- it consists in passing 
a Needle & Ligature thro' the transparent
cornea for the purpose of securing the Eye
& bringing it out of it's Socket, so that the 
Knife may be passed behind it which shd
be a double Edged one, the 2 Eyelids are 
to be enlarged at each Canthus, then push 
down the Knife to the bottom of its 
Orbit and carry it round the Edge with
a sweep to detach it from it, having got 
down to the Optic Nerve let it be divided 
with a smaller Knife as also the undivided 
straight Muscles & the Operation 
is finished by removing the Eye
A piece of Lint pressed upon the 
Opthalmic Artery is generally sufficient 
to stop it's Bleeding-

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Polypi of the Nose
Are of three Kinds- the first resembling a 
portion of Jelly like Coagulable Lymph of 
a Yellow transparent Colour, in a Bladder
of a pyriform Shape, hanging from a Narrow
neck, is very moveable, so that in breathing 
will sometimes pass backwards [like a] behind the Uvula,
possesses very little Vascularity & is not painful
in the incipient State, the only inconvenience 
it occasions is in preventing Breathing 
going on freely thro' that Nostril especially
during sleep, becoming larger in Wet
Weather et vice versa in Dry & always grow
from the outer side of the internal part of 
the Nostril, never from the Septum, their 
removal is extremely simple, viz. Having 
found the neck of the Polypus with a Probe,
pass up a pair of Probe pointed Scissars & 
divide it as closely [to] at its origin as possible,
then direct the P. to close the other nostril
& blow thro' the one that has the Polypus
& it will be discharged, if too large to be 
forced down by blowing may be pulled
down with Forceps, removing polypi
with a Ligature is often practised, but 
is not so good as the Scissars so likewise 
with Forcep which is apt to break them 
in pieces & if any remains is sure to 

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return again- 
Second Kind Hydatid, in which a great 
number form in one Nostril, to be distinguished
from the foregoing by seeing a Quantity 
of fluid issue first at the Nostril when 
they are pressed & a simple membrane remaining-
are easily cured by applying Solut. Hydrarg 
or Arsenic the latter never tried by Mr. C-
In Scrofulous Children the pituitary will 
become enlarged & may be distinguished by 
their redness, bleed freely when opened & shd.
not be removed, but have astringents applied
to them-
Third Cancerous, This Kind of Polypi is 
solid, fleshy & of a purple Colour, occasionally
excessively painful, bleed freely & 
generally extend into the Lachrymal Sac or 
Antrum Maxill- are incurable by any 
operation & only to be palliated with large 
Quantities of Opium, taking also internally
Cicuta, the less that is done the better- 
Removing of the Tonsil Glands-
Becomes necessary in Consequence of Enlargement
in Scrofulous Habits- before performing 
the Operation their reduction shd. be 
attempted by Caustic & Scarifications-
When they hang by a simple Peduncle & that 
a small one, a single Ligature is to be passed
around it by means of a [single] Tonsil Iron

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209
& suffered to remain till the Gland ulcerated 
away, if one Ligature does not effect this process
a second shd. be applied, when it does not 
hang by a Peduncle a double Ligature will 
be requisite- 
Paracentesis Abdominis-
This Operation is requisite when an Accumulation 
of Water has taken place in 
the Abdomen- & is of two Kinds- Peritoneal 
& Ovarial- in the first the Water is 
contained within the Cavity of the Peritoneum
& proceeds from diseased Liver, drinking 
large Quantitites of Spirituous Liquors,
Grief, any [crossed out] Sudden Emotions of the Mind
or Debility of the Body- Is distinguished 
from other Enlargements of the Abdomen
by its extensive & distinct Fluctuation
Operation is performed by making an 
Opening about an Inch below the Navel
in the Linea Alb with a Lancet or Trochar-
Mr. C strongly recommends the former, he 
makes use of it himself & discharge the 
Fluid- previous to the puncture being made 
the P. shd. be seated in a low Chair, & have 
a round Towel or sheet passed around him 
that is the lower part of the belly & held
behind him by an Assistant pretty tightly
to prevent the ill Consequence of the 
sudden deprivation of the Pressure of the  
viscera from the Diaphragm, after the 

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211
Water is evacuated a Flannel Roller shd. be 
bound round the Body rather tightly-
Second Ovarian is of two Kinds- first when
the Coat of the Ovaria & second when the 
Hydatids are formed- may be distinguished
from Peritoneal by the Tumor commencing 
on one side just above the Brim of the 
Pelvis- The Operation is similar to the 
Lancet- shd. not be performed till Fluctuation
is very perceptible or while the 
Tumor rolls from side to side, as in the 
incipient State it does not adhere to the 
Peritoneum & as also the Septa of the Ovum
are not absorbed, therefore the Operation
would prove fruitless as only one part of 
the fluid would be evacuated- The Fluid
is often changed in its Quality being sometimes
serous, ropy & purulent of the Colour 
of Coffee Grounds- from its Pressure
upon the Viscera it will sometimes impede 
their Functions producing Costiveness 
&c-
Hare Lip
Is a Fissure generally in the Upper Lip
& most common to Children being a
disease with which they are born, sometimes
two fissures exist & one [of] or both extending 
back into the Soft Palate, often also 

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the Bone is affected & wanting, Hare Lip admits 
of no relief but from operation, & the 
only consideration is at what time it shd. be 
performed- Experience proves that it shd. 
not be attempted till after the age of two Years
The Mode of performing it consists in pairing 
off the Edges from the Top to the bottom over 
each side, & bring them in contact by means 
of sutures, one to be applied midway between
the Lip & Nose & the other thro' the middle of 
the red part of the Lip- the Use of pins is quite
unnecessary- Adhesive Strap may then be applied 
over the Sutures- When two Fissures exist 
one shd. be healed up before the operation for 
the other is attempted, where a piece of the Upper 
Jaw projects it may be right to remove it-
The Ligatures in the Adult may be removed 
about the 4th. or 5th. Day & in the young Subject
about the 6th. if the Discharge is very 
great on the 5th- if the Lip yields when they
are removed, Adhesive Plaster must applied
in long & narrow strips- Hare Lip 
seldom or ever occurs in the lower lip,
but is subject to a Cancerous affection requiring 
a similar Operation, that is to 
take out an angular piece, & apply there
Sutures- When Hare Lip is complicated with 
defect of the roof of the Mouth, it is necessary
to have an Artificial one to supply
its place made of Silver- When there is 
a fissure extending along the soft Palate to 
the Uvula, & no Malformation of the Bones

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215
no Instrument I am doubtful can be made 
to be permanently useful but various 
have been invented- 
Tic Douleureux-
Appears to be an altered Action not a Disease 
of the Nerves, all of which have been known to 
be affected, but it most commonly attacks 
the Suborbital, is attended with most excruciating,
fluttering, or thrilling pain, resembling 
quick & repeated shocks of Electricity passing along
the Course of the nerve or nerves diseased & often 
excites from its violence Considerable Fever-
the most trifling Causes will bring it on even 
a decayed tooth, the drawing of which does not 
in general appear to give relief, the Skin undergoes
no change in colour, when the portio
dura of the 4th Pain is affected no operation 
can be of service-
Treatment. Nothing appears to give permanent 
relief but dividing the nerve or branches
of nerves diseased & even this sometimes fails,
but Arsenic in Solution has been given with 
Benefit- in the commencement 7 Drops may 
be given three times a day increasing it to 15 
according to symptoms, Some examples of its 
Cure by Mercury have appeared but Mr. C has

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217
never formed it successful- Cicuta of little or 
no Use, Ice applied to the part in a Bladder
will give temporary relief- Alum gradually
dissolved in the Mouth does the Same- Caustic
applied to the part has entirely cured it, not 
by dividing the Nerves but by exciting counter
irritation- When the Nerves
of the Face are diseased it will extend backwards
to the Brain & produce Delirium,
here also the Solut. Mineral has been given with 
Benefit-
Operation. consists in passing a short 
pointed Bistoury down to the Bone & dividing 
the Nerve, if in the Suborbital the Edge of the 
orbit is to be felt for & from 1/4 to 1/2 an Inch 
this nerve passes out at the Suborbital Foramen
& the Bistoury introduced at its outer side
& carried up to the surface of the Skin, but not
thro' it as as little wound as possible must be 
made, repeating it till a totall numbness of all 
the contiguous parts is felt, as every [thing] ought 
to be divided, if the wound bleeds freely from 
the division of the Suborbital Artery, pressure
is sufficient to stop it. The pain will return 
sometimes before the tension of the nerves can 
possibly have taken place- Shd. the division 
of the Opthalmic Branch be necessary it shd. 
be performed in a similar way, the nerve presses
our at the Edge of the Eyebrow; The Eye after the 

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219
Operation generally becomes black in consequence
of Extravasated Blood but soon disappears-
When the Inf. Labial is to be divided 
from the inner side of the Mouth opposite
the first biscuspid Tooth. The Pes Ansemomus 
has twice been divided by Mr. C. he made
a Incision with a Knife thro' the Integuments commencing
it at the Zygomatic Arch extending 
it downwards about and Inch & the Nerve came 
immediately into the Vein which was raised with 
a Tenaculum & divided- The Parotid Gland
becomes exposed which shd. be avoided wounding. 
Where the Pain has not quite subsided after the 
Operation the application of the Solut. Arsenic
to the Wound will be attended with relief-
Aura Epileptica is a Species of Tic
Douleureux extending backwards to the extremities
of nerves to the Brain producing 
Epilspsy- In an Affection of this nature of 
the Radial Nerve in a Lad of 4 1/2 years of Age 
admitted into Guy's Hospital under the Care 
of Mr C where the pain extended the whole length 
of the Arm to the Brain & occurring in Parodysms 
at each of which he was seized with 
a Fit that left him motionless & senseless
during it's continance- Mr C cut down upon 
the nerve at the Extremity of the Radius & 
removed five eights of an Inch of it, His Symptoms
somewhat tho' not entirely subsided,


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The Paroxysms occurred less frequent & the fits 
of less violence in this State he was discharged
from the Hospital but eventually recovered-
Tic Douleureux occurs most frequent in Persons 
from 40 to 60 Years of Age-
Diseases of the Testicle-
The Testicle is subject to four Kinds of 
Disease for the Cure of which its removal 
is necessary- 
First Hydatid- which is a number of 
Cysts forming in the Substance of the Testicle
containing Fluids in different States 
& very vascula- it commences in the Epidydyimus,
gradually & slowly extending into 
the Substance of the Testicle & gradually enlarging,
increasing much in size, afterwards 
extends to the Vas Deferens but never into 
the Cavity of Abdomen or affects the Constitution,
its Bulk & Weight seem to be the [crossed out] only 
Inconvenience that the P. suffers from it,
The veins of the Scrotum become Varicose
& swelled to nearly 3 or 4 times their natural
size- Fluctuation is perceptible but not 
so extensive as in Hydrocele, is never in 
the least degree transparent & its Weight & 
Hardness considerable exceeding that of Hydrocele,
being sufficient Marks to distinguish it

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223
from that Disease- People from 20 to 30 
Years old are most subject to it-
Second True Schirrhus is a very rare 
disease (Mr C remembers to have seen only 4 or 
5 cases of it) it begins in the Body of the Testicle
extending throughout the whole Circumference
of it affecting also the whole of the Epidydymus
& lastly attacking the Spermatic Cord proceeds
into the Abdomen its strong hardness marks 
its Distinction from other Diseases of this part,
& is generally occurring in advanced Life, when 
the Virile Power begins to diminish, a dropsical 
State of the Opposite lower Extremity is not 
infrequently an Attendant- When the Testicle
is cut open it is found to consist of 
Coagulable Lymph of uniform Texture, in 
some parts rather more vascular than others,
but generally perfectly white-
Third Pulpy or what is now termed Fungus
Hæmatodes- & begins first in that part
of the Epidydymus which is applied to the 
Testicle extending most rapidly into the 
Abdomen, has been known in a few Weeks
even to reach the Thoracic Duct- When it
is pressed it yields like the Hydatid, but 
feels more like Anasarca, when extremely 
distended like Schirrhus- When opened looks 
similar to Fungus Hæmatod of other parts 
is extremely Vascular- the Spermatic cord
has often a Number of Tumors formed up
of the same Nature, Unless the Operation is 

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225
performed in it's earliest Stage it cannot 
be successful- 
Fourth Scrophulous produced in 
Strumous Habits in consequence of Blows,
& readily subsides by strict attention to the 
Antiphogistic Regimen, but upon Exercise 
as readily returns, attended with Considerable
Pain especially to the Touch, from its being 
so constantly troublesome the Operation becomes 
necessary- Sometimes a Fungus issues
from the Testicle, requiring to be removed,
without the removal of the Testicle, & the 
Edges of the Scrotum to be paired & brought
together by sutures & Adhesive Plaster, & 
it will do perfectly well-
Operation- An Incision is to be made 
from above the Abdominal Ring to the bottom 
of the Scrotum, the Spermatic Cord
then becomes exposed which must be 
held firmly by an Assistant between his
finger & thumb, or if sufficient confidence
cannot be placed in him the Artery & Vein 
are to be seperated from the Vas Deferens
& a Ligature applied around them only tied
in one knot, the Cord is then to be divided
& the Vessels be secured seperately/ being the 
Artery of the Vas Deferens, Septum Scroti 
& sometimes, a Branch of the Ext Pudendal-

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227
by no means inclose in the Ligatures the 
Vas Deferens as it gives most excruciating 
pain & is attended with no Advantage, next
proceed to dissect out the Testicle from the 
Integuments & remove it, the Edges of the 
Wounds are then to be brought together by 
3 Sutures as they are always necessary, because 
from it's possessing such a great degree
of Laxity the Edges are apt to be everted & 
Union cannot take place, over the Adhesive
Plaster shd. be applied & Union forwarded
as quickly as possible-
Diseases of the Breast-
Hydatids Begin in a variety of Tumors
forming different parts of the Breast,
the P. at the same time appearing in apparently 
good Health- The Tumors appear 
Elastic, varying in size from a pin's Head 
to a pea, & are unattended with pain, spreading 
in this way all over the Breast, Inflam.
next takes place in the Tumors, attended
with considerable Pain, then proceed to 
Suppuration & burst discharging a Fluid
resembling inspissated [Matter] Mucus 
mixed with Matter & now & then of a brownish
Colour, from this they go into a Schirrhus 
State, & from time to time burst & continue 
so for Years, but never to any great

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229
extent, not even into the Axilla- Shd. there
happen to be onhy one large Cyst it may 
be successfully injected as in Hydrocele, but 
when many exist it's removal becomes 
necessary-
Schirrhus, commences most commonly 
with a discharge of Blood from the 
nipple if the Tumour is placed near it,
but if it shd not the first symptom is 
a sense of uneasiness in stretching the Pectoral
Muscle, soon after this a hard Tumor 
is perceived in some part of the Breast-
perfectly undetached from the surrounding 
parts & very moveable as it increases
in size it is attended with occasionall, extremely 
severe pain, lanncinating & heating pain 
not confined to the part but extending into 
the Axilla; upon the further increase of the 
Tumor it becomes adherent to the skin, causing 
it to pucker like a Cicatrise, when the 
cellular Membrane also partakes of the Disease
the whole of the Breast becomes extremely hard,
& not at all moveable, this variety is not 
common, next the Glands near the Jugular
Vein [crossed out] & tho inner side of the Cartilages
of the Ribs become diseased after this Inflam 
arises & a fluctucting Tumor is formed of 
a purple Color, discharging a samious Serum
which shd. never be opened, Granulation takes

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place but not such as in a healthy State,
being irregular Process- The pain becomes 
increased but the Tumor not more painfull to 
the touch, the Edges of the Sore are generally 
above its Surface & invariably turned out,
seldom just an a healing process, Bleed freely 
giving the part some degree of Ease, in this 
State it may exist for years without destroying
Life, but when of great size may by
it pressure (accompanied with Enlargements
of the Glands of the Axilla) upon those Vessels,
causing Tumifaction & Mortification- Upon
Dissection of the Tumor it will be found to 
consist of Coagulable Lymph of unusual 
firmness, having a number of White Fibres
extending across it & sometimes containing 
a Portion of Cartilage. This Disease most 
commonly occurs in advanced Life rarely 
before 30 generally between 40 & 50- Those 
Tumors occuring before 30 will be found
generally not a Malignant Nature- Schirrhus 
Tumors are more incident to Females
about the Period when the Menses shd. cease
& who have never been married, may be
considered Constitutional-
Pulpy Tumor or Fungus Hæmatodes
first appears in the form of a small Elastic
Tumor almost always unattended with pain 
is more moveable than true Schirrhus-

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233
& does not posses its usual Hardness, it grows 
from the Fascia of the Pectoral Muscle of the Tendinous 
Coverings of the Breast, has a Disposition 
to suppurate but in an imperfect State, becomes 
of large size & sometimes forms a Cyst resembling 
Hydatids, but here Injection proves of no 
service, The fluid discharged is like Whey & 
Pus now of then, from this Opening a Fungus
Sprouts having the usual Appearance of Fungus
Hæmatodes- This Species is extremely rarified 
in it's progress, much more so than true Schirrous
& it's removal is often followed by a Tumor
of the like Nature, when it is the Fascia covering 
the Pectoral Muscle shd. be cleanly dissected 
away with it- it in general proves destructive
in exausting the P. by its wonderful 
Secretion- The Vessels are much enlarged-
Irritable Tumor- of is marked by
its occuring in Females of a Sanguine Temparament
before Marriage from 17 to 20 yrs. of Age
& in those married not having children, is 
a Tumor not having any observable Limits,
being gradually & insensibly lost in the Surrounding
Substance & extremely tender to 
the Touch, being two Symptoms that fully
distinguish it from Cancer or the Pulpy Tumor.
Treatment Apply to the part stimulating 
Plasters at the Emplast. Ammon. e Hydrag
& give Steel & nation as in the following 
formula, By Ferri præcip grs v patron ppt grs. x4

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235
or the prist & Ferro e my vrh with petram, the 
Breast shd. also be kept warm with Flannel
or Fur, & much Advantage has been derived 
from wearing a Bladder half filled with Warm 
Water-
Removal of the Breast, consists in 
making two semicircular Incisions from 
the Top to the bottom of the Tumor meeting 
each other at both extremities & dissecting 
out the whole of the Diseased part, even then 
Fascia covering the Pectoral Muscle shd. it 
be affected, then secure the Vessels bring the
Edges together by Sutures & unite by Adhesion 
Apply what Bandages around the Chest that 
may be necessary-
Stone in the Male
Calculi are formed in five Different Situations,
but are most commonly formed primarily 
in the Kidneys- Situations are first 
in the Kidney 2nd. in the Ureter 3rd. in the Bladder- 
4th. in the prostrate Gland & 5th. in the 
Urethra-
1st. in the Kidney. The Symptoms are a dull
uneasy Sensation in the Loin of the Kidney
affected, especially in stooping, but after
when the Calculus is only of small size, this 
Sensation is felt only upon rubbing the Loin,
the P. is sometimes seized with Exacerbation 
of Pain, paleness, profuse perspiration, frequent

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frequent Vomiting with Flatulence & a benumbing 
Sensation in the loin, beginning at the Kidney
& extending across the Abdomen to the Umbilicus,
& when violent to the opposite Loin, the Quantity 
of Urine discharged in Scanty & whey ey, often 
mixed with Blood, the latter the Cause of Exertion 
being made too freely or violently, Abscesses have 
been known to form in the Kidney & the Calculus
been expelled by the Loins- tho rare- also 
Suppuration will take place in the Pelvis & 
communication form between it & the Colon, &
the Calculus pass off by these means- The Calculi
are first formed in the Tubili Urinifer pass on 
to the Infundibuli where they often rest & attain 
their exact [size] shape, as also in the Pelvis 
their existence will produce the Absorption 
of the [crossed out] Medullary part of the Kidney, Calculi 
when in the Kidney are chiefly composed of Uric Acid.
2nd. in the Ureter, it is rare for Calculi to remain
in this situation- Symptoms are Pain being 
felt at the Ant. sup. Spinous process of the Ilium,
as it passes down it is felt more in the Thigh
in the Direction of the Ant. Crural. Nerve & upon 
further descent the Testicle becomes affected by 
the Spasmodic Contraction of the Cremaster Muscle 
accompanied with a tingling Sensation at 
the Extremity of the Urethra, the Urine is scanty
& Vomiting is often produced, just before 
the Ureter enters the Bladder it is much contracted
so that the Stone meets with some resistance 
in passing thro' & if large cannot till by long

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forcing it becomes dilated- in this situation a 
Sac becomes formed around & Cases are related where
it has suppurated, & the Calculus has passed out 
thro the Integuments covering the fore part of
the Abdomen-
Treatment during the passage of Stones
thro the Ureter is the Warm Bath, applying
hot Flannels or what is more proper a Bag of 
Camomile Flowers frequently dipped in Hot Water,
giving opium in small & frequent Doses,
Soda Water & Aperients- 
3rd. in the Bladder when the Stone enters
this Viscus the Symptoms become suddenly 
changed (the same precisely attend when they 
are formed in the Bladder,) viz - a smarting, acute
& burning sensation is felt in the Urethra opposite 
the Frænum as if is was cut with a red 
hot Iron, it is rare for the Bladder itself to be 
in pain except when its mucous membrane is 
diseased, this pain is increased by Agitation of the 
Body & when the Bladder is very irritable by change
of Posture, accompanied with bearing Down of the 
Rectum, not infrequently causing Piles & Prolapses
Ani- during the existence of Stones in the 
Bladder the P. is Unable to void his Urine without
relaxing the Abdominal Muscles, bending forwards,
& will find relief sometimes making it keeling
with his Knees apart or upon his Elbows or even
in the recumbent posture, the Effort will often

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cause the Fæces to be voided at the same time
in common the Urine does not denote the existence 
of the Disease, being generally clear & limpid,
but upon taking violent or much exercise 
is mixed with Blood; the pain in general is greatest
in making the last drops of Water from 
the contraction of the Bladder upon the Stone
which does not appear to be increased in proportion 
to the size or the vary roughness of the Stone but 
upon the irritability of the Bladder, whilst in 
irritable Bladders arising from other Causes it is felt
prior to & during the Discharge of Urine, being 
sufficient to distinguish the two diseases, & passes
frequently more in alternate Jerks than in a full 
stream, which towards the Conclusion of the disease
becomes mixed with broken portions of Coagulable
Lymph, resembling Whey or stringy Mucus,
the Muscles of the Abdomen take on a spasmodic
Action, hollowing the Abdomen & causing great 
pain, when the Disease has been of long standing 
the P. will become affected with Rigors succeeded 
by heat as in the Intermittent Fever, whilst 
the Bladder ceasing to be capable of containing 
much Urine, causes frequent desires to make 
Water & sometimes a complete incontinence ensues-
The Bladder at length becomes lessened in size
& contracts around the Stone but the Operation
is still adviseable, Ulceration of this Viscus is sometimes
the Consequence accompanied with a similar disease 
of the Kidney, when a Bloody Mucus is discharged 
the Operation in this Case is not be be attempted, it cannot 
succeed-

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Structure of Urinary Calculi
They are commonly laminated Substances connected
together by Fibres, not of a very dense Nature, having 
in their Centre a Nucleus formed by a small portion
of Coagulated Blood, Mucus, a small piece 
of Gravel or any other extraneous Body, pieces of 
Bougie breaking off in the Bladder is not unfrequent 
Cause of the Formation of Stone, the Lamina 
are differing in thickness Color & Composition in 
different Stones & will grow to an enormous size
the largest taken away by Mr. C weighed 4 1/2 oz,
the largest taken from the dead Body was by Sir 
James Earle weighing 44 oz its Circumference
was 15 Inches by 14 Inches, largest diameter was
5 1/2 In. shortest 4 1/2 In. the weight is not always 
proportioned to the size, A stone of 8 oz is as 
large as can be extracted, many Stones are sometimes
formed in the same Bladder, Mr. C extracted 
142 or moderate size not long since
when he was obliged to introduce the forceps 
70 times-
Medical Treatment. Alkalies appear 
of great service, perhaps by no peculiar Action or 
the Stone but upon the Nerves deadening the Coats
of the Bladder- Half a dram of Soda Carbonary
be taken three or four times a day or oftener
if necessary or Soda in any form is of equal
Benefit- Acids have but very little effect either
taken inwardly or used as Injections- Opium 
alone or combined with Soda in small doses

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of great Benefit- When Mr. C is called to a Child 
to operate upon who has a discharge of Mucus 
with pain & irritation in making Water, he always 
gives Lig. Potass gtt x or xv c t opii 2 or 3 times
a day for some time previous & is always attended 
with good Effects-
Operation. The Existence of a Stone having 
been ascertained clearly by sounding the P. before 
determining upon the Operation it is necessary 
to take into consideration the State of his Constitution,
advanced Age does not in the least 
appear an objection, but will often do best it
is much better than the middle period, the 
youngest at which it ought to be performed is 
two years old, never before- if the Child be subject 
to any Visceral Disease, or Mesenteric Glands
then it shd. not be performed, so also in Adults
if any chronic disease shd. exist - as Astma,
Hæmoptesis &c- which I may here lay down 
as a general rule in all Surgical Operations- 
When attended with diseased Kidneys is generally 
known by the P. experiencing much pain in 
his Loins with a Discharge of Matter in his 
Urine, Ulceration of his Bladder &c c- shd 
deter you from operating- The Sound shd 
be always in proportion to the size of the Urethra
in old People large & very long but all shd. 
be sounded both in the Erect & recumbent Posture
with a full & empty Bladder & that pretty

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often so as to accustom the Bladder to it's Stimullus
& render it less irritable- if the P. is 
Young & of full Habit Blood shd. be taken from
him & purged freely one shd. always be given 
the Evening previous to operating & a Glyster
in the Morning to empty the Rectum of it's
Contents, & thus prevent any Liability of it's
being wounded- The P. being confined by 3 
Bandages, two to the Hands & Feet & the other 
Confining the Neck to the Knees, is to be placed
upon a Table three Feet in Height or varying 
it if Circumstances require, with his posteriors
placed close to its Edge upone a pillow & 
held by proper Assistants- This being duly & 
properly arranged the Staff is to be introduced & 
help by a proper Assistant in close contact 
with the Stone inclining it a little to the left
side & a good deal forwards towards the Abdomen 
The first Incision is then to be made with a 
double Edged Scalpel, commencing it just opposite
the under part of the Arch of the Pubis
& extending in an Oblique direction externally
about 1 In in length this the Integuments 
& Cellular Membrane, which exposes the bulb
of the Penis & Accellerator [Juind] Muscles,
the first of which is to be pushed to one
side & the Transverse Muscles divided, this Cut
divides the Artery giving to the Bulb, feel now
for the Staff & cut thro the Membranous

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part of the Urethra into the Groove of the 
Staff, & then thro' the prostrate Gland into 
the Bladder, at the same time raising the 
Staff having first previously taken it into 
[your] [away] Hand, withdraw the Knife & introduce 
the Forceps, taking out afterwards the Sound-
& having a secure hold of the Stone withdraw
it in a gradual & gentle Manner- shd. the Stone
be soft a [Stone] scoop may be used it was formerly 
the Custom in these Cases to syringe the Bladder,
but it rarely succeeded, it is now to introduce 
a piece of Sponge into the wound & keep it 
open for some time & it will rarely fail-
every Atom shd. be removed if possible for the least 
particle is sufficient to form the nucleus of another 
Stone- When the Gorget is used it shd. be 
introduced as soon as you have cut into the Groove 
of the Staff- But Mr. C always makes use of the 
Knife & has entirely abandoned the Use of the 
Gorget, as it is apt to slip between the Bladder
& Rectum instead of entering the [Rectum] former, as also 
to divide the Int. Pudenal Artery- he now uses
a probe pointed hooked Knife-
If the Prostate Gland shd. be enlarged & the 
Stone lay out of reach of the Forceps the finger
shd. be passed up the Rectum to raise it &
it will easily be accomplised, in this Case 
the Curved forceps may also be of service-

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The best common proportioned forceps are 
2/3 to the length of the Handles & 1/3 to the Blades-
After the Operation the P. shd. be put in Bed & an 
opiate given him, it is not adviseable to apply 
much Dressing but leave the wound quite open,
the Thighs also shd. not be kept close until Granulations
arise- the Wound will generally heal in 3 
Weeks & the Urine take it's natural course in 3 
Days even earlier in diseased prostate- If Peritoneal 
Inflam. shd. arise the Antiphogistic Regimen
shd. be smooth strictly followed up- Bleeding,
Warm Bath, & Camomile Fomentations to the 
Abdomen-
4th. in the Prostrate Gland, are of 
2 kinds-1st.-those originally forming there & 2nd. 
those lodging there when passing from the Bladder
to the Urethra, are commonly of small size
& situated between the Folds of the Gland, & sometimes
in a Sac & capable of being felt per Rectum
5th in the Urethra, when in the Membranes 
part are easily discovered by passing a Catheter
for retention of Urine which it generally occasions
which shd. never be pushed back into the Bladder
as it may eventually lead to the operation of 
Lithotamy & is easily removed here, introduce
into the Urethra a Bougie (as large as the Urethra coming bear)
as far as the stone, & let it remain till the P. has
a strong desire to make Water, when upon removing 
the Bougie the Stone will very commonly

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follow, but if this does not succeed it must be cut
down upon & extracted- When situated opposite
the Scrotum, the same Attempts may be made with 
the Bougie, as also in any other part of the Urethra
but when in the Situation just mentioned ought
not to be cut upon there but pushed forwards, Always
remembering to make the External Opening 
much larger than the Internal to prevent 
Extravasation of Urine-
Stone in the Female-
Females are much less subject to Stone then Males
not from any peculiar disposition but from the 
Shortness & Capacity of the Urethra allowing them 
in their smallest State to pass off without Difficulty-
The Symptoms are excessive pain 
at the extremity of the Meatus, after discharging 
the Urine, great bearing down of the Uterus with 
frequent inclination to go to Stool, but as this 
Symptom is attendant on other Diseases, to ascertain
the fact the P. shd. be sounded & for this 
purpose a Male Sound is best-
Operation. The P. is to be bound in the 
Same Manner as the Male, but a straight Staff
is to be used, introducing it with the Groove
turned downwards, & a little inclined to 
the left side, A Sharp pointed Bistoury or 
Phymosis Knife is then to be passed into 
the Bladder along the Groove first taking 
hold of the latter in your left hand & making 
a Cut in the Direction of the Groove
downwards, withdraw the Instrument & 

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extract the Stone with forceps, depressing them 
rather with your left hand & the Operation is done
if any difficulty arises in reaching the Stone the 
fingers shd. be introduced up the Vagina to elevate
it- The same after Treatment is required as in 
the Male- If the Gorget is used the Incision is 
to be made in the same Direction as recommended
with the Bistoury- It has been found by 
late Observation that is is not necessary in 
general to perform the Operation, but that the 
Stone can be extracted by means of the Sponge
Tent, Calculi in this Manner have passed thro'
the Vagina of 17 ℈ in weight in a Child only of
6 years [only] of Age, which is be far the most 
preferable, it shd. often be removed to allow 
the Urine to pass off-
Gonorrhæa Virulenta.
The first Symptoms denoting the Presence
of this Disease are an itching Sensation or titulation 
at the Extremity of the Urethra after making 
Water as if a drop remained inducing
the P. to examine the part, from which a little 
Mucus will be perceived to issue with redness
& Heat of the the Glans & præpuce, in 24 Hours 
the Discharge puts on more of the purulent 
[Matter] Nature, being of a Yellow Colour, & as the 
Inflam increases becomes green & often mixed 
with Blood, when in a high active State much 

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of both is discharged- after existing some time 
flakes of Coagulable Lymph will pass off, with 
the Urine & Matter like threads denoting much 
Inflam. being present- The Irritation first 
felt amounts now to considerable pain & 
upon making Water produces that heat called 
Ardor Urind, is diminished much by making 
it guttation- & arises from two Causes- first from 
the stoppage of the natural Secretion of the Urethra
& secondly from the Extention of the inflamed
Urethra during the Discharge- When the Lips of 
the Urethra are examined they will be found to 
be turned of a cherry redness, prominent & 
Tense, from this part the Inflam extends
downwards into the Urethra about 2 Inches being 
just opposite the [Fræum] which is the chief
seat of the pain- The Inflam, in Gonorrhæa,
will take two Courses, an external & an 
internal- in the first a general redness is spread 
over the Glands & Prapuce, causing the latter
to become adamatus which conjointly produces 
Phimosis, the Absorbents become enlarged an 
the Dorsum of the Penis & in bad Habits Abscesses
will be found requiring to be opened with a 
Lancet, if they are not they will break inwards
& become extremely troublesome, when they are 
opened a Discharge of Mucus will often remain
as long as the Gorrorhaa continues- Enlargement
of the Glands of the Groin is not also an unfrequent

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Accompaniment & commonly turned Sympathetic 
Bubo, which name however is not correct,
(Anatomically speaking) as it arises in Consequence 
of the Extension of the Inflam not from Sympathy-
Internal Course, in Consequence of 
the Subsidence of the External- the P. flatters
himself of a Cure or that he is about to recover
shortly, but in walking or taking other Exercise,
he feels an Uneasy Sensation in Perindo & in a 
few hours after will be affected with Spasms about 
the Urethra amounting often to Spasmodic Stricture,
or Inflam may first attack the Corpus Spongosium
causing coagulable Lymph to be thrown
out producing Chordea, or it may affect the Lacunæ,
when little hard Substances may be felt along 
the Urethra, in which Matter will sometimes 
form & burst discharging themselves by the 
Urethra, next that part of the Urethra covered
by the Accelerator Urinæ Muscles & the Sphincter 
Ani are affected with Spasms & often accompanied 
with Inflammatory Stricture, this Spasm 
will not unfrequently occur in Paroxysms & 
many times in the Course of an hour forming 
some of the most severe part of Gonorrhæa, this 
Inflam. keeps extending backwards even till it 
reaches the Membranous part of the Urethra & 
still further passing by the vas deferens to the Testicle
causing what is absurdly called Hernia
Hemoralis, in all cases of Gonorrhæa a Bag Truss
shd. be worn, but when this organ becomes affected

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it is indispensibly necessary- If the Man 
is advanced in Years the Prostrate Gland will become
affected causing retention of Urine & 
Abscesses in Perindo- The time at which Gonorrhæal
Inflam. takes place after the Application 
of the Poison is extremely various, usually from 
the 4th. to the 7th. Day, in Persons who have had 
it frequently in 24 Hours, in those of an Indolent
Habit it will be protracted to a usual 
longer period, perhaps 5 Weeks. The Chief Seat 
of the Disease is in the Lacunæ Mag. of the 
Urethra, but is capable of extending much 
further as just specified above the Mucous
Membrane if it does not sometimes escape-
No Ulcer is formed in the Urethra, but merely 
a new Discharge is set up in Consequence of 
the Stoppage of its usual Secretion by the Inflam.
Is very capable of being communicated 
by Inoculation, therefore great care shd. be 
taken in the lens of Bougies & Catheters- The 
Discharge is always stopped by the Presence 
of any other Disease as Typhus Fever &c.
or any other sudden change in the Constitution,
but as readily returns after it has ceased 
& often even with much more Violence-
from the debilitated State it may have 
left him in- In healthy Persons it may 
be cured in 3 Weeks, but in scrofulous will

262

[illegible]
be protracted to a much larger period after degenerating 
into Gleet, it does not attack them 
so violently at first but steals gradually upon 
them- Ablution after Coition does not in the 
least prevent Gonorrhæa but it may [Cham??]
Treatment- This disease requires no 
Mercury for it's Cure, but rather proves pernicious
when given as a Mercl., it has no power 
over the Disease, it excites additional Irritation
& Inflam, which is our Duty to suppress subjects
him to take Cold, producing Rheumatism
&c- Those who give it in Gonorrhæa are reprehensible 
for the Consequences- shd. be treated as common 
Inflam by purging & depleting as ꝶ 
Magnes Sulph ʒii- Potassa Nitras 2i Gum Acaciæ 
vel Fragacant C ʒss M sumat bis die- &
occasionally in the Morning a dose of Calomel
with Cathartic Extract- at the same time 
fomenting the Penis in Let Water two or 
three times a day & when the Urine requires
to be discharged let it be done in the same 
if the Ardor [??ind] shd. be severe give Liquor
Potassa gtt xv Ext Cornii grs iii- Mist Camphor 
q & qk Hearst pro re nata sumend and as a Potion
Soda Carbon ʒss in 8 oz of Milk & Water or Barley
Waters if these means do not prove successful 
the P. may be put into the Warm Bath, going 
to Bed afterwards between the Blankets- taking
at the same time large Quantities of Diluents-
Half a pint of Soda Water 3 times a day-

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if the Inflam still remains very high a Leech 
or two may be applied to the Penis or open one
of the Veins- Sometimes an Injection of Opium 
is recommended but it never attended with Benefit
neither shd. they be used, if the pain shd. 
be excessive extending down the Urethra an 
Opiate Glyster may be of Service- The Inflam
being got rid of the next Indication is to remove
the Discharge, for this purpose give the powder
as before recommended twice a day & the Draught
once in 48 Hours, & after the Discharge has almost
ceased an Injection may be used as ꝶ 
Acid Sulph gtt Aquæ Rosæ ℈i P. Opii gri which 
does not stimulate so much as Zinc Suplh-
if the P. is very irritable may use a Weak
Solution of Acetate of Lead- but this has an 
Objection being likely to render a person 
liable to Stricture, or a good Injection is
Zinc- Acetat grs 6 Aquæ Rosæ ℈iiii- the Zinc
Sulph shd. be used in the same proportion 
& never stronger, & if one kind does not
succeed the other shd. be tried, or if none do, leave
them off for a time & begin them again, shd. 
never increase their Strength when they prove 
to be of no Service in this Way- The best 
way of Injecting the Penis is with the Elastic 
Bottle which may be carried in the Pocket & 
used as often as is necessary, Shd. never be 
suffered to pass in further than 2 Inches, as it is 

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267
apt to produce swelled Testicle, suffered to remain
no longer than half a Minute & not the 
least force shd. be exerted; shd. always be used 
the last thing at going to bed & the first in the 
Morning-Other injections are recommended 
at the Hyd. Oxymur, but is too irritating- Aqua
Calcis c Calomel will be preferable but all are 
inferior to the Zinc Acct- their efficacy will 
be much increased by the use of Bougies, & 
will remove stricture shd. there be any that may 
Cause the Discharge-
The Bals Capivi is a good Medicine in Gonorrhæa 
but is objected because as soon as it is left 
off the Discharge is apt to return, so shd. be made 
use of some time after it has disappeared, it 
also Causes a Rash, of easy removal with purgatives- 
the following form makes it more 
agreeable to the Palate- ꝶ Bals Capivi ℈i
Gum Acaciæ pulv ℈ss. Aquæ Cinnam ℈iss M-
Strictures
Are of 3 kinds- 1st- permanent arising from 
the constitution of the Canal from the thickening 
of its Membranes Coat 2nd. Spasmodic 
from the Contraction of the Muscular Fibres
surrounding the urethra near the Bladder,
3rd. the Inflam accompanied with Considerable 
pain & retention of Urine-
First of the Permanent. The Symptoms
attending this species of Stricture are the P. having

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269
a frequent Desire to make Water, (more particularly 
during the night) & the Stream being 
forked, but sometimes passes out in aspioral 
Direction, owing to part of the Canal only being 
affected- this Changes of the Stream does not always
precede Stricture-When it has existed sometime
the Urine passes off only Guttatim, & 
frequent attempts are often made used to make 
it without being able to pass more than ℈ss or 
℈i-at length Incontinence of Urine is the 
Consequence- the Water in its Commencement 
retains its natural Appearance, but in the latter
Stages becomes much altered, sometimes resembling 
Whey, arising from a mixture of 
Coagulable Lymph with it, which denotes
the Existence of Inflam- of the Mucous Membrane 
of the Bladder, in which Case the P. frequently 
becomes afflicted with intermittent Fever, that 
will not yield to Bark, but Opium & relieving 
the Stricture- Patients labouring under stricture
also will have a violent pain in the region of 
the Bladder, over the Pubes & the Loins, & whenever
these occur be ought to be examined, other 
Symptoms occasionally accompany stricture
which would not be expected from apparently 
so trivial a cause, as great Derangement of the 
Stomach, & Bowels, Dejection of Spirits, Flatulence 
&c- & frequently great constitutional 
Irritation, & are most common by attended with 
a Gleety Discharge, which if irritated by riding, drinking
&c- will become purulent & Bloody & retention 
of Urine be the Consequence, This Discharge

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271
which attends it is not infectious, but will irritate
the Person on whom it is applied-
Upon Dissection of the Urethra where strictures
have existed in them for a long period, you will
find the affection not confined to that part of the 
Urethra behind it which is considerably enlarged,
but all the Lacunæ in the same State, these by the 
Irritation of the Urine in the Ulcerated, & thus 
Fistulæ are formed in Perindo, when Matter is 
formed in them it shd. nor be suffered to break of 
itself but be opened with a Lancet- The Bladder
also takes on part of the Disease, becoming much 
thickened & also a Ulcerates, when much ropy
Matter is discharged with the Urine, it is called 
Catarrhus Vesciæ- The Kidney also becomes 
inflamed & ulcerates & the whole of the Glandular 
Substance absorbed-
The Usual Seat of Stricture is generally about 
4 Inches within the Urethra, near that part
where the Membranous part joins the Bulb-
this part being naturally smaller than any other, 
A Circumstance to be remembered in passing Bougies,
when one Stricture is seated here, it is 
sometimes found that another is placed in
that part of the Urethra within the Prostrate
Gland, but most commonly they are situated 
anterior to the Membranous part, where
the Scrotum joins the Penis, but the Seat is 
very variable, & there is no part but what is 
liable to be affected by it, for frequently two 
or three will exist at the same time in different 
Situations-
Strictures are of various Kinds 1st as if a narrow

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273
Cord was tied around the Urethra & is the most 
Common, when a Bougie is introduced it appears
as tho' it has been cut, from which Circumstance
the State of the Stricture may be ascertained-
Second as if a wide Ribband was tied around 
the Urethra, & is very different in the Cure
from the foregoing-The Caustic is seldom or 
ever of Service-
Third Membranous Bands formed by Coagulable 
Lymph being thrown out, shooting 
across the Urethra & generally situated near
the Membranous part-
Fourth Projections of Flesh resembling 
Polypi called Carunculæ arising from the Vena 
Montanum, & warts arising near the Lips 
of the Urethra, may be cured by Caustic-
Fifth an Elastic Contraction of the Urethra,
preventing the Discharge of Urine & allowing 
the introduction of a Bougie, it may be remidied 
but not cured by Caustic-
The most common cause of Stricture
is Gonorrhæa, if less was done for it would 
not occur so frequently- Injections, Intemperance
& Exercise when under Gonorrhæa 
are most Common Causes-
Bougies shd. never be introduced straight,
but the Penis drawn out as much as possible 
to prevent its getting into Folds-

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275
The following Notes are copied 
from those of Mr. B Coschane
Irritable Testicle
This sometimes occurs without 
any obvious cause, when there is no 
disease of the Urethra & no injury has 
been recd. in the Testle their organ becomes
so irritable that the Pt.. cannot walk 
without great pain, The disease usually
exists in persons from 18 to 22 yrs. 
of age, but it sometimes happens at 
at later period- The removal of the disease
is very difficult- Mr. C [recoursing] 
the application of the Ext Opii round 
the Scrotum covering this wth. [crossed out] oil skin
giving the Ext Corsii on Hyoscyan internally 
& making use of the warm Salt
Water Bath, When we wish to keep up 
an equable perspiration on this or any 
other part the application of the oiled 
skin is the best means of effecting it-



276
Fistula in Ano-
By this is meant an abscess succeeded
by a sinus by the side of the Rectum,
when it bursts into the Rectum a long 
continued discharge of Matter takes 
place from the Rectum, when it busts
externally the cure is much more easy.
sometimes the complaint is connected 
with a disease of the Os Coccygis- Sometimes
but not often the abscess bursts in the 
groin, The Complaint often arises from 
Piles or obstinate costiveness or from riding
much, & when the P. does not void
his fæces regularly, Diseases of the Viscera
particularly of the Liver & also of the Lungs
often produce this complaint, And it 
is often arising in the last stages of Pthisis
Pulmonalis a very short time before death
sometimes not more than a few days
When the sinus extends by the side of 
the Anus into the Rectum, it is seldom
cured without an operation because the
Sphincter muscle prevents the adhæsion 
of the Sinus. The operation consists in 
putting a probe into the Rectum thro' the 
Sinus & then a director & the probe pointed

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Bistoury into it, we must then draw 
the knife out, the smaller the Bistoury the 
better, it is necessary to divide the Fistula 
to its very extremity for if we leave
the smallest pouch this will still form
a new Sinus, the whole of the Sinus must
be dilated whatever their Course & the operation 
shd. not be performed till the abscess
has gone on to form a sinus. When it is 
connected with diseased Viscera we must 
give remedies adapted to these, When the 
Operation has been performed, Lint shd. 
be applied to the opening to prevent bleeding.
This shd. be removed the next Day 
& poultices applied of 3 or 4 Days, when 
the suppurative process is complete an 
extraneous Body must be introduced to 
bring an adhesive Inflamatiary- 
Wards's Paste is much used in this 
disease ℈ss of Pulv R Elecan ℈ss of Piper long
ʒii of Pulv Shum Fæmical & Long sufficient
to make it into a fast a piece about 
the size of a muting to be taken morning 
noon & night, drinking after it a glass 
of wine & water, & the Ointment of Hyd. 
Int. Rub. when the Granulations are [compound]
shd. be externally applied-

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Hæmorrhois is of two kinds external 
& internal, is an enlargement of the Hemorrhoidal
Veins, They appear by the 
side of the Anus, we may give relief
to patients in these cases by making 
a puncture in them with the point
of a Lancet & squeezing the clotted 
blood out & applying Lint to the part
When they are inflamed we shd. apply 
Lig. Plumb. Acct. dilut. & keep the body
open, When they do not yield to these 
remedies, the excrescences resulting from
the external piles are to be removed-
by a pair of Scissors or a knife, The 
internal Piles generally require different 
treatment, Large piles are generally 
combined with Prolapsus Ani.
The Rectum is then of a florid hue & 
the disease of a dark Color, when they 
come down often & inflame much 
they become mortified & thus a natural 
Cure is performed, The Rectum sometimes
descends during walking exposing 
the Patient to much inconvenience

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to obviate which a Truss consisting of a 
Band to go round the Abdomen & another 
to go between the legs with a pad 
opposite the Anus, Fomentations & Leeches
will be proper with Opium when they 
are much inflamed to allay irritation 
& prevent their having motions very often
Purgatives shd. be given at the End of 3 
or 4 Days- The Fomentations shd. be of 
Spt Vin dilut. when they are to be removed 
by first passing a Tenaculum 
thro' the pile & then removing it with 
a blunt pointed pair of Scissors, Ligatures
shd. not be put round piles as 
they occasion intolerable pain-
Amputation of Fingers & Toes
at the second & third Joints, is performed 
by making a circular incision below 
the Joint, & a longitutinal one on each 
side, the Knife is then to be passed thro'
the Joint, the Incision being made 
first on each side to divide the lateral 
Ligaments- at the first Joint
by first separating the fingers very considerably
then making an incision on 
each side down to the Joint, these incisions 

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must be crossed by one above & another
below, The Tendons must be then divided 
a little above the joint & this in order
to prevent their projection afterwards
The two arteries in this case require to be 
secured by small ligatures, The two fingers 
must then be brought together on each 
side & secured by adhesive plaster
Amputation thro' the middle 
of the foot is sometimes performed in
consequence of Mortification, a circular
incision must first be made as near the 
disease as possible, as there is very little integument 
remaining unless it be, An incision
is then to be made on each side
does to the Tarsal bones, in order to allow 
the Saw to pass readily thro' these, An incision 
is there to be made on each side
so that the integuments be dissected back in
the same way as in Amputation of the fingers,
It is necessary to cut very deep in the sole 
of the foot to divide all Tendons, The 
Saw must then be used to divide the 
Tarsal bones & the Flaps then brought 
together

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Amputation below the Knee
When this Operation is to be performed
the Tourniquet is to be applied about midway
between the Spine of the Illeum
& the knee, it is done by making the 
first incision six inches below the knee
Two inches of inlegements shd. be left where 
the patient is of a spare habit & three
where he is very muscular, we shd.
never leave any muscle wth. the Integuments
After the Integ. has been divided the muscles
shd. be cut thro' with one incision & 
the interosseous ligament be then divided 
with the Cataline, The Bone is then to be 
divided- Here we must secure by Ligature
the Anterior & Posterior Fibial Artery & sometimes
the Interosseous- In some Cases the 
Interosseous is given off below the place
of Amputation. Nothing shd. be applied to 
the parts afterwards but adhesive plaster
to bring the Edges together-
In Amputating above the Knee we shd.
be careful to cut above the Sacculus Mucous
of the Rectus Muscle, the incision 
shd. be made 2 inches & a half above the 
Joint- Three Incisions are required in

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this operation, after the outer Muscles
have been divided by a circular Incision
the third shd. be made & while doing this 
the Muscles which have been divided shd.
be drawn up by the hand-
Amputation at the Hip Joint here
the first Incision is made on the anterior
& posterior part of the thigh, This 
divides the Femoral & Arteria profunda
wh. must be secured before this the femoral 
Artery must secured by the Thumb
The next incision divides the Muscles 
& the capsular Ligament of the Joint 
In the case of a Soldier at Plymouth 
the recovery took place in six weeks- 
Amputation at the wrist must 
be performed by making the first incision
at the root of the Thumb, observing 
the Styloid process of the Kadius, The 
next Incision finishes the Operation 
the Kadial & Ielmar Arteries require to
be [removed] secured- 
Amputation of the Fore Arm performed 
in the same way at the legs, This has sometimes
proved fatal a long time after the Operation
from Mattery forming between the 
thecæ of the Tendons

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Amputation of the Upper Arm is 
performed in the same way as that 
of the Thigh-
Amputation at the Shoulder Joint
is performed by first making an incision 
down to the Artery in the Axilla
& securing it, it is covered by the 
Nerves of the Axillary Plexus, Then 
making a flap of the Deltoid Muscle 
by making an incision from the Coracoid 
process of the Scapula to the 
Acronious, then making a circular 
incision from angle of the this 
flap to the other to divide the other
muscles, The best place is to divide 
the Capsular Ligt. at the under part first
raising the Arm, & the head of the bone
immediately slips out of it's place
Diseases of the Prostrate Gland
The Prostrate Gland infrequently becoming 
diseased in old Men, & when its
midde lobe becomes enlarged it projects 
into the Termination of the Urethra, & thus 
becomes a cause of Stricture, When the two

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lateral lobes are enlarged it may be 
distinctly felt by introducing the finger
in [illegible], it is never necessary to puncture 
the Bladder in cases of disease of this Gland
& that a Catheter may always be passed if 
we take care to have one of a proper size
& to depress the handle very much in introducing 
it-
Matter forming in the Urethra is
sometimes the cause of stricture & in such
cases an opening shd. be made into it to allow 
of it's discharge-
Fistula in Perinco are sometimes 
the consequence of strictures in the Urethra
the Water then passes thro' the fistulous 
Opening & prevents it's healing, The disease
may sometimes be removed by passing 
a Catheter three times a day so as to 
prevent the water passing thro' the new 
opening, & thus to admit of it's healing 
Or it may be effected by passing a Flexible
Gum or Metallic Catheter & allowing this 
to remain in the Bladder & then compelling
the urine to take it's proper
Course, The Pt. can wear a short Catheter 
with great comfort & it is a very common 
practice in the limited Hospitals

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Compound Fractures
A Fracture is said to be compound where 
there is a wound that communicates 
with the extremities of the Bone, but if 
there be a wound that does not communicate
with the extremities the fracture
is not considered a compound one 
[Union] takes place in the following way
Infn. takes place in the inner surface
of the Periosteum by which cartilaginous
matter is effused, Infn. & Granulation from 
at the same time from the external
surface of the Periu.m Granuln. also from 
the [estructure]. of the Bones, These Granns. have 
their vessels inosculating & thus union 
is produced, The Granns. in these case are
Cartilaginous- In compound as well as in 
simple fractures a large portion of 
bone may be separated & yet afterwards 
unite, but when a small portion it produces
great irritation & comes away
When called to a compound fracture in 
which there is nothing particular we must 
first place it in a bent position to relax
the muscles, as the reduce. is more easily 
effected when the muscles are relaxed

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If there be not an actual bleedg. after the 
redn. we must place dry lint on the wound
& if there be much contusion the appln.
of a poultice will be proper. The many
tailed bandage is then to be applied over
the Lint when there is no contusion. 
In fracture of the Thigh the limb [heel] must be
placed with the head hanging over a pillow
In the leg the bent position is proper as 
also in the Arm, When there is much irritation 
of the constitution we must not 
bleed unless the Pt. be of a very plethoric
habit, & even then very small Quantitities 
must be drawn, Pergatives are not eligible 
in these cases, if it be absolutely necessary 
that they shd. be given the Pt. must
not be moved during their operation,
but a cloth must be placed under him 
to receive the evacuations, he must not 
be placed on any vessel for this purpose 
Opium & Antimony must be given where 
there is much constitutional irritation to 
produce a determination to the Skin 
as this secretion is the principal one to 
be depended on these cases- When we can 
effect union by the first intention in 
compd. Fracts. we shd. by all means as we not 
only reduce it to the state of a simple

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Fracture, but also produce a cure in 
less than half the time- The best mode of 
effecting this is not by adhesive Plaster
(as it always irritates) but it is by dry
Lint on a piece of Linen being placed 
on it, This becomes glued to the wound 
by means of the blood becoming coagulated,
& when this is removed in two or three
days afterwards the wound is found in 
some cases as to have united, when there
is much contusion it is useless to attempt
union by adhesion, as there is no chance
of it, & the presure we make for the purpose
is increasing infln. Three Months at 
least are required for the union of 
compound Fractures when they are to 
be united by the Granulating process
Simple Fractures will unite in six weeks.
Peculiar Difficulties
When there is much difficulty attending 
the reduction of the Bones we shd. first 
enlarge the wound & if the reduction 
cannot be then effected, we must saw 
off the extrems. of the Bones. It is proper
to saw off the ends of the Bones when the 
Fracture is not an even one, & when the

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300
Periosteum is separated to a considerable 
extent as when this is the case if union 
by adhesion cannot be produced that 
portion of Bone which has been denuded
of its Beriosteum will certainly 
exfoliate & thus produce a tedious cure,
When the Bones are much communicated 
as many portions of such bones must 
be removed as can be & the wound must 
even be dilated for the purpose, When 
a simple fracte. is attended with much 
comminution of the Bone the separated 
portions are afterwards rendering the 
fracture a compound one, When the 
Anterl. Tibial artery is wounded in cases
of Compound fract. such artery may frequently
be tied & the Pt. do well, When the 
Interosseal artery is divided Mr. C would cut
down on it & take it up, Mr. Hey of Leeds
in one Case sawed thro' the Fibula & secured 
this, When the postl. Fibial Arter. is wounded 
Mr. C recommends the Limb to be amputated
unless it be wounded low down & then it can
be secured easily & without causing so much 
irritation, When the Feml. Arter is wounded 
it is absolutely necessary to amputate, When 
the Brachl. Artery is wounded, the Limb mortifies

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& it subsequently becomes necessary to 
amputate- In three cases Mr. C has seen
this take place, But he mentions also 
another in which the Pt. recovered without 
amputation, This therefore shews the necessity 
there is for waiting, as if mortifn. 
shd. not follow of course no operation shd.
be performed, In compd. fracts. of the fore Arm
accompd. wth. a wound of the Radl. or Ulnar 
artery the best practice is to amputate
as in all the cases whch. Mr. C has seen Mortn.
has eventually taken place 
Sometimes a few Days after acompd fracture [this accident]
there is a very considerable tension of the 
Limb, & in other cases the imfln. extends
up the inside of the Thigh & legs, In the 
first of these cases poultices wth. Leeches
& evaporating Latives must be had recourse
to V the best evaporating Latives 
are spt Vin keet c Aqua- or Spt Vim
c Aqua Ammon. Acct. but when the 
latter kind of Infn. occurs we must 
not deplete but must give Wine & 
Bark with Opium, taking care that the 
Bark does not bring on a Diarrhæa
as this sort of Infn. no attended with great

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Debility- When a Fracture extends into 
a Joint if the Bones be not much comminuted 
& can be tolerably replaced 
it is best not to amputate immediately 
as if the bone will not unite & if 
creat ulceration shd. take place the 
Limb can then be amputated & the 
operation can then be born much 
better by the Pt. after the constitutn.
has been accustomed to much irritition.
In cases where the ends of the 
Bones of a Joint protrude, it is always
highly proper to saw off the cartilagnosis 
ends- as if we do not they will be obliged
to be separated by the ulcerative process
(which they always must before a granulating 
process can take place in a 
Bone.) this process will require a 
very long time for it's completion 
Compound Fractures of the Patella 
& also of those extending into the knee
Joint always require amputn. in Town
but not always in the Country, where
these accidents take place in the Elbow

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306
Joint they very seldom require amputation
but the pt. can only recover 
by an Anchylosis of the Joint, therefore
it is always proper to reduce this in 
a bent state of the Limb- In most 
cases where there is a compd. fracture of the Elbow
Joint there is so much sloughing that 
in most cases it becomes necessary 
to perform amputn. Mr. C has never 
seen a case of this accident in the Hip
or Shoulder Joint- When Amputn. is 
performed in any of those Cases the 
Operatn. is rendered much more successful
by loss of Blood, which the Pt. experiences
& when we amputate immediately 
after the Accident it is very proper
[I] to loosen the Tourniquet [at] little to 
allow of a tolerably free Bleeding-
sometimes an exfoliating portion of 
Bone will get between the sides of the 
Fractured Bone, & thus preventing 
produces a necessity for 
Amputation-

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308
Purriters Ani
This Disease is an extremely prevalent 
one & particularly in females, It is 
very difficult to remove & is sometimes 
resisting every remedy we can employ
It commences round the Anus, the part 
can experience no case while warm
in bed or while in any warm situation,
even when in a cold one the
Disease is extremely distressing, the 
Pt.. scratches herself until the parts
become excoviated, The Disease spread 
over the Labia of female & the 
Scrotum of the Male & frequently 
down to the insides of the Thighs
The remedies Mr. C has found most 
effecual are Decoct Nicotian 
ʒi and ℈viii & grs viii Hyd Oxymur
or oxy Hydrar gzi Agnd Calcis 
℈is M ft Latia continue applicand

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310
Gunshot Wounds
are of two kinds those in we. the ball passes
thro' the limb, & those in wh. it is lodged 
in it, when the former it is a very simple
accident, & the first circumstance that strikes 
our attention, is that the opening thro' which
the Bale has passed is so very small, After 
a few Days the Limb becomes much swollen
& after six days suppurn. begins, as this 
takes place in these much later than in 
incised wounds, after a time a sloughing 
takes place, on the surface of the wound
this slough extending thro' all the contused
parts, & separating in about fourteen days
& causing a great deal of irritation, When 
the Ball has only passed thro' the soft parts
the Pt. in many cases falls without knowing
that he has been wounded, But when 
the Ball has struck a Bone there is a sensation
similar to Electrical Shock, when 
the wound is merely of the simple kind
Paultices must be applied also evaporating 
Lotions, & the tension at a distance 
must be removed by evaporating Lotions

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312
& Leeches if they can be procured, & when 
they cannot scarifications on the sides
of the wound will be proper, Bleeding 
from the Arm is not proper unless
the Pt. be of a very vigorous & Plethoric
constitution, opium is given with much 
Advantage in these cases, also purges & the 
Secretion of the Skin must be promoted
by Antimonials, when the first symptoms
have been combated & there is a sinus remaining
we must lay it open, This stimulates 
the internal surfaces & in most 
cases produces union, when it does not
we must pass in Caustic bougies to 
stimulate them, & if the sinus be in 
apart where an incision cannot be 
made, or if its lying very deeply prevents
its being made the injection of stimulating 
fluids will be proper such as the 
Ka Lyft or a solution of Hyd Muriat 
When a Bale Las been lodged in a body
there are three reasons why it shd. not 
be much searched for, if it cannot be 
extracted without difficulty as it is absurd 
to attempt to find a Bale when it cannot

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be seen or easily detected as it is impossible
to say in what a remarkable way a 
Ball might take its course The Second 
reason why no attempts shd. be made to 
extract it is that the Ball excites adhesvs., 
Infln. in the cellular Membrane, wh. 
forms a cyst round it, & it is ever after 
lying in the part without exciting pain
The third reason is that the Ball by its 
weight producing an ulcerative process
by it's gravitation will be discharged,
(if it be discharged at all) by a much 
easier process than any the Surgeon
can put in practice, wounds of arteries 
from Gunshot wounds do not bleed
much at first, as the cellular membrane
being then much extruded, catches 
the Blood wh. coagulates & forms this coagulum
round the opening of the Artery
The Danger in these cases is not immediate,
but when an artery has been woundd.
fifteen or sixteen Days a fatal hemorrhage
ensues wh. is produced by the sloughing 
process taking place, When a Gunshot 
wound has been recd. in the Abdomen

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316
the part seldom recovers as there are generally
two or three convolutions of intestines 
wounded, Mr. Bligh who was
murdered has four convolutions woundd. 
in them, a remarkable circumstance was
proved/viz/that adhesive infln. will 
take place as early as seventeen hours
after the infn. commences, for when 
Mr. C opened him (he having died in 
less than seventen hours after seeing 
the injury) The Peritoneum had taken
on the adhesive infn. in several 
places
a natural cure takes place-
The Disease sometimes is fatal, but when 
it is situated in the large Intestines is 
sometimes cured by throwing up large
quantities of fluids by injection
When Gunshot wounds have been recd. in 
the Thorax recoveries are very frequent

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318
& even so when Balls have penetrated the 
Lungs when the latter circumstance has 
taken place it is known by there being 
an immediate discharge of blood & a
great difficulty of breathing, This accident 
is very different from that where an 
incised wound has been recd in the 
Lungs, in such a case there is an
immediate great discharge of Blood
& the Pt. immediately expires, Gunshot
wounds of the Head are to be treated 
exactly the same as injuries of the head
from any other Cause, Compd. Fractres.
which arise is consequence of Gunshot
Wounds are worse than those from other 
Causes, as in such cases the bones are 
not only fractured but also much 
comminuted, & thus a number of 
pieces of Bone is obliged to be removed 
Compd. Fracs. of the Hip from a Gunshot 
are very dangerous as in consequence 
of the depth of the bone the splinters
cannot be removed & thus they keep 
a great & long continued suppuration

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320
Stricture of the Intestines
Is a prevalent disease being chiefly confined 
to the large Intestines as the Rectum 
Sigmoid Flexure of the Colon &c. It is 
known by the great irregularity of the 
Bowels, The Pt. being never able to
have evacuations without taking purgatives-
The best purgative is Ol Ricin
the Pt. shd. never go a day without a motion,
When the Disease is situated either
in the Rectum or the Sigmoid Flexure of 
the Colon, relief may be obtained by 
making the Pt. throw up large Inantities
of fluid, Teaching him to throw them 
up himself- In this Disease there are 
never motions of any size passed, but they
are either not larger than a quil or the 
Pt. goes many days without having a 
motion & then Diarrhæa taking place
the contents are discharged, The intention 
of passing large quantities of fluids by 
injection is to render the contents of the 
bowels soluble, When the Disease is situated 
near the verge of the Anus, a Speculum

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322
Ani must be used by the Pt. himself so 
as to dilate the opening very often, sometimes
dilating the Opening with a probe
pointed Bistoury has afforded relief,
sometimes vomiting is produced in consequence
of no fæces being permitted to 
pass by the smallness of the Stricture, a 
female Catheter must then be used, & subsequently 
something layer as a Bougie
When the Stricture is malignant it afterwards
ulcerates- Narcotic Injecns. & giving
Opium Cicuta &c internally are all that 
can be done- When there is an opening
of the Intestine into the Bladder the first
symptom of the Disesase is a discharge of 
Air with Urine, the next is the Urine 
having an offensive smell in consequence
of becoming mixed with the fæces- In a 
little more advanced period the discharge
of the Urine is accompanied by that of portions 
of fæces from the Urethra- The most
approved mode of treating this Disease is 
be giving Opium in pretty large doses, so 
as to produce Costiveness & thus preventing 
the passage of the fæces thro' the urinatural 

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324
unnatural opening & then giving some purgative 
to carry them off by the Rectum thus
preventing the passage of the fæces thro' the 
unnatural aperture is sometimes heals
Cutaneous Swellings sometimes 
the Skin is becoming enormously enlarged
& thickened, producing a Tumor
of a large size, A case of this kind existed 
on the arm of a pt. in Guy's Hospl.
& which Mr. C removed- These swellings
are of different growth from the 
natural Structure of the Body-
Sometimes a wart forming on a pact
& becoming irritated by any thing 
will ulcerate, & this ulceration will discharge
a matter wh is capable of producing 
the disease in other parts & thus it is 
often mistaken for cancer- These Warts 
frequently form on the Faces of old 
People & also on the Nose & under the 
orbits in young People- They may
be cured by frequent Arsenical-

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326
Wounds of the Abdomen
These are of two kinds viz where the 
Intestines have been wounded & where
they have not, a very large wound may
be made without any intestines protruding 
& yet in some Cases where the external 
wound is small some portion of the Viscera
is protruding- Sometimes when the intestine 
is protruding thro' a small aperture
it becomes strangulated & it is then necessary
to dilate the opening & return 
the Intestine- The Intes. are then to brought 
together by the Loop Suture- Wounds where 
the Viscera have been [crossed out] injured- When the
Stomach has been wounded Syncope is 
immediately produced & subsequently vomiting 
the Pt. must be put into a recumbent
posture & kept very quiet & the 
wound closed by a suture, he must not be 
allowed to swallow any thing, but must 
have jellies & Broths injected at the Rectum
for the first week, then he may take small
portions of Jelly, from Jelly he may venture 
on Broth & subsequently on small Quantities

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328
of Animal Food, as there is much thirst 
in these Cases the Pt. may be allowed to 
suck the corner of a handkerf. dipped in 
water or vinegar but must not 
be allowed to swallow the fluid, The danger 
in the cases depends much on the distension 
of the Stomach at the time the injury 
is recd.
Wounds of the Intestines
When the intestine has been divided or 
in other words opened for a great length
The Edges shd. be brought together by sutures 
But when the wound is longitudinal it 
is absolutely necessary to unite it by the 
uninterrupted suture, otherwise the Fæces
will escape into the Cavity of the Abdomen
& infln. of the Perritoneum will be produced
In all such wounds the ligature must be
left laying but_Mr. C says that he would 
always have the intestines returned & that 
he wound have them glued to the Parietes 
of the Abdomen for the Artificial Anus 
would afterwards granulate & become 
united-

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330
Wounds of the Abdomen without wounds 
of the Intestines-
Here is is only necessary to bring the 
Edges together & keep the Pt. perfectly quiet
& to allow him a light Diet-
Wounds of the large Intestines 
In these it is absolutely necessary to keep
the Pt. on Jellies & Broths as well as all 
those light things which can be taken 
up by the absorbents of the Intestines
without producing any faculent matter 
in the large Intestines
Wounds of the Liver
These are sometimes recovered from & 
Mr. C mentions a case in Guys Hospl.
where the Bile was for sometime discharged 
thro' the wound & yet the Pt. did well
The treatment was that of an antiphlogistic
regimen wth. perfect Quietude-
Wounds of the Spleen
are frequently proving fatal that they 
shd. do so appears wonderful because this Viscus
has been often removed from the Body without

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332
without any bad symptoms being produced-
It has often been separated from its attachment
to the Diaphragm by Blows &c
& then of course the accident soon proves 
fatal- when this accident has occurred
the Treatment can only be palliative, If 
the spleen has been punctured the antiphlogistic
plan must be rigorous by [crossed out]
pressured & perfect rest enjoined-
Wounds of the Gall Bladder-
Are soon proving fatal as the Bile becomes 
extravasted into the Cavity of the 
Abdomen & thus causes a high degree 
of Infn. of the Peritoneum- No Medicines
appear to afford any relief If any be
used they shd. be antiphlogistic-
Wounds of the Thorax
These may be divided into two kinds viz
those in which there is no wound in any 
Viscus, & secondly those in wh. there is a 
wound in the Heart or Lungs, this may 
take place, & get the Pt. recover- Mr C mentions 
a case where the Lung had been injured

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334
and a portion of it protruded at every expiration 
& was again drawn into the Thorax
at every inspiration- The Edges of the Wound 
were brought together by Suture little interstices
being left for the Discharge of pus-
This P.t was under Mr Birch & he recovered 
in a Month The Internal Mammary Artery 
is sometimes wounded in Wounds of the 
Thorax, Mr. C knew one case of this where the 
Hemorrhage was stopped by the pressure of 
Dossils of Lint. Incised Wounds of the Lungs
are attended by much Danger Lacerated ones 
by comparitively little- When a Lung has been
wounded blood of a frothy colour & mixed 
with air is thrown up by coughing. Blood
unmixed with air is also discharged from the 
external wound- For the purpose of putting 
a stop to the Bleeding & also of diminishing 
the discharge of Blood from the external Wound
large Quantities of Blood must be drawn from 
the Arm, the external wound must not be 
closed, till the Bleeding from the Wound & 
also that from the Month have stopped, If 
it be the Blood extravasates into the cavity
of the Thorax produces infln. of the Pleura
& subsequent ulceration, a person who 
has met with this accident must be bled
very frequently & after these Bleedings purgatives
must be given & Blisters applied to 

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the Chest, sometimes a long time after a 
Pt. has met with this Accident, he has symptoms
of Hydrothorax & dies from a effusion 
of Matter into the cavity of the Chest, & a large
quantity of coagulated blood floating in this 
Pus. A person in this state can only be 
saved by making an opening into the 
cavity of the Chest. This opening must be 
made at the lower part of the Chest, & in 
making it two circumstances are to be 
observed, viz to draw a side the Integts. before 
we make the puncture, & then to 
form a value over the opening when the 
Skin is relaxed, & thus to allow the wound 
to close more readily, & the second circumstance 
to be attended to is to pass the 
Instrument as near as possible to the 
Rib below that the intercostal artery may
not be wounded. Mr. C has only seen 
one case of a punctured wound in the 
Chest. This Pt. died of Locked Jaw three
weeks afterwards- Wounds of the Heart
are not always fatal. Mr. C mentions 
a case here & shows a preparation where 
the Pt. had need a layanet wound in the 
heart. This Pt. died in 49 hours after

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he had recd. the injury, it is inferred that 
death did not proceed from the puncture 
entirely as the Pt. was so very imprudent
as to walk to a water closet, & to strain 
violenty to procure a motion in consequence
of which fatal Hemorrhage took 
place. Immediate Death in these cases is 
prevented by the Edges of the toward countracting,
another case occurred under Dr. Baburyton
in which the Pt. lived nine hours
Wounds of Nerves
The Symptoms of wounded nerves are 
a loss of sensation in the part, The powers
or involuntary parts not being suspended
& this is the reason that in fractures of 
the vertebræ when the spinal marrow 
is torn thro' tho' the sensation in the 
part is lost there is still circulation 
going on, The part not having the [illegible] power
of resisting cold is another symptom
of this accident. This was proved in a 
case by a Gentleman who consulted 
Mr. C. who had divided the Median 
Nerve. The Suspension of secretion is 
another symptom of this Accident, & 

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when the Par Vagum is divided the mucus
which the Stomach in a healthy state secrets 
is not formed-Nerves will unite a very 
small in two Months, a tingling sensation 
is felt when the nervous influence is beginning 
to be renewed. Mr. C says the 
radial Nerve will unite in there 
& then Sciatic in Six Months. The diseased
function of a nerve will return after
division before the sensation & union 
in the Nerve are complete-This has often
been proved in cases where the pain 
of Tic Doloreaux has returned before the 
Union of the Nerve which had been divided 
had taken place, A Nerve becomes united 
by an enlargement of the part, where 
it has been divided, the part exibiting the 
appearance of a ganglion. In division 
of Nerves all that Surgery can effect 
is bringing the divided ends as near as 
possible together & then closing the Edges
of the Wound. when a Nerve has been
partially divided or lacerated the most
[distressing] symptoms sometimes take place.
Mr. C however does not think that Tetanus 

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so frequently follows a wound of a Nerve 
as that of a tendon, when a finger is punctured
it inflames & becomes very painful 
& as the infn. extends up the fore Arm
constitutional Irritation takes place & 
the Pt. frequently becomes delirious
All that can be done is to sooth the pt. as
much a possible by warm fomentns. & 
poultices as well as anodyne ones, & giving 
Anodyne mednes. internally. All stimulating 
application must be strictly avoided
including a nerve in a ligature with an
artery has been known to produce these 
symptoms-Another ill consequence arising 
from the inclusion of a nerve in a ligature
is that the latter is then so much longer 
coming away
Rupture & laceration of Tendons
The Tendo Achillis is sometimes ruptured
by violent exertions as jumping dancing 
&c The treatment consists in bringing 
the ruptured ends in contact again wch. 
may be accomplished by putting the Pt. in 
bed & placing the knee in a bent position 
wth. the heel up to the hates to relax the 

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Gastrosnemic Muscles. In cases where there 
is not much swelling & infn. a high heeled
shoe will be all that will be necessary. to subdue
infn. evaporating Lotions must be applied 
If spasms occur in the Gastrosnemic Muscles
a roller must be applied round them & if 
the infn. run very high leeches will be beneficial.
If the Tendon be cut thro' we 
must bring the integts. together by suture
but by no means apply any adhesive plaster
for if we were we shd. press the divided portions
of Tendon against the lower part of 
the Tibia by which union would take place
between them-The occurrence of this circumstance
would destroy the action of 
the Gastrosnemic Muscles & thus the pt.
would be ever afterwards be rendered lame 
If Spasms shd. make it necessary to apply 
a roller round Gastrosi. Mus. must 
be particulaly careful not to let it go on
the Tendon below the the Muscle. In injuries 
of the Tendons of the fingers or back of the 
Hand nothing more is necessary than to keep 
the fingers extended & to prevent subsequent 
Infn. by using evaporating Lotions-

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Wounds of the Throat-
When a cut had been made high up in the 
Throat. The tongue being on the fore part &
the Pharynx behind, four ligatures must 
be applied if the wound be from side to 
side taking care not to include anything 
in the ligature but integt. The Head must 
then be brought forwards & a [hand] by tied 
as tightly round the neck as can be done without 
occasioning inconvenience, let the 
Pt. have solid food well moistured & to 
relieve the thirst let him keep the corner
of a handkerchief moistened with Vinegar in his 
mouth, for when fluids are swallowed 
they penetrate the wound & occasion much
irritation. Cuts Lower down where the Larynx
is wounded require that sutures shd.
be applied- These must include the Perichondrium 
of the Cartilage but not the 
Cartilage itself for if the membrane
wh. lines it were to be included very great 
irritation wd. be produced. In every 
wound of the [crossed out] Throat our object must 
be to restore the situation & function of 
the part, & to approximate the Edges 
of the Wound-

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Wounds of Joints
These are very dangerous much more so than 
those in any other parts. The reason of this 
is two fold-Joints are parts wh. unite wth.
much difficulty & the Synovia escapes 
& prevents union. Which induces a second
infn. to unite the parts. the second 
reason is that suppuration is very generally
taking place & this suppuration goes on
to great extent, Before any Granulations
in Joints can form the Cartilaginous ends 
of the Bones must exfoliate, & this being 
a very tedious process very great constitional 
irritation is produced. The 
other Reason is that wounds of Joints there 
is a very large surface exposed, for if the 
parts of any Joints could be spread out 
they would be found to be very extensive
The Criterion of a wound having extended 
into a Joint is there being a few drops of 
Synovia found floating in the Blood that 
is discharged. This Synovia tho' it is of a 
mucilaginous nature is appearing like a 
few drops of Oil in the Blood- The

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Treatment is immediately applying adhesive
Plaster to unite the edges of the wound
as quickly as possible, when the wound is very
extensive it is necessary to apply sutures
but care must be taken that these pass 
merely thro' the Integts. & do not wound 
the capsular ligament- A Splint shd. 
be applied behind the Joint to prevent 
any motion of it & evaporating Lotions shd. 
be applied very frequently- If we have 
not been called early to the case suppuration 
will have taken place. High Constitutional 
Irritation, Fever, profuse sweats & even 
delirium are sometimes produced-
Sometimes way (often a finger shoots from 
the wound & this must not be destroyed
for if close the external wound) if the 
Cartilages of the extremities of the Bones
have not been previously destroyed)
the matter will be absorbed & the pt. will 
ultimately recover the use of his limb
wth. however a small degree of Analylosis 
at first- If the Cartilages have been destroyed
continual Abscesses will form & 
the pt. be ultimately destroyed 

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352
The only local remedies are Fomentating 
& Poultices & in this & every other case of 
high irritation the best internal Medcne.
is the Lig. Ammon Acct. c Ka opii, most
cases of this kind in old people that Mr. C
has seen have proved fatal while those 
in the young have recovered, therefore
he would amputate in the former & 
not in the latter-Partial Anchylosis 
is sometimes produced in cases of recovery,
by adhesive infn. gluing the Edges 
of the Synovial Membrane together-
When complete Anchylosis has taken place
from the union of the ends of the Bones
by granulations, we shd. if possible make
it take place by the limb being a little 
bent, as the Pt. then walks much better
When then if Anchylosis is from Adhesive Infn.
friction wth passive motion will much 
assist the Cure-
Disease of the Hip
When a Child's hip is diseased the first symptoms 
of it is pain in the knee, The Cause of 
the pain here is the Sciatic Nerve (which 
in this Course) becoming affected-The Limb

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is becoming apparently longer & the reason 
of this is the Pt.'s resting on the other Limb & this
producing a necessity of his bending the diseased
one in standing, but when the disease 
has been standing some time there is a real 
shortening of the Limb in consequence of the 
cartilage of the Acetabulum becoming absorbed
& also from the Head of the Os Femoris 
being diminished, Sometimes 
in very inveterate case the Head of the Bone
slips out of the Acetabulum & forms a 
new socket above the old one. The means 
of distinguishing Hip cases from other 
diseases are desiring the Pt. to bend the 
knee up to the body & observing that he 
cannot do this also that he cannot turn
his Toe much either inwards or outwards
also that when the Pt. is placed on his face the 
limb is seen to be larger than the healthy
one & also that on the diseased side the pats is 
lower than it's fellow- There is also a great
depression seen at Poupart's Ligt. on the 
diseased side. When Matter forms in a diseased 
Hip it sometimes passes into the 
Vagina sometimes into the Bladder & 
at other into the Rectum-

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Treatment
Is very similar to that in disease of other 
Joints- The frequent exhibition of minute 
doses of Calomel wth. Tonics such as Infus 
Nose c Acid Sulph & Ka Cort Aurautii
Children who have disease of the Hip shd. be
allowed to walk on Crutches, as [?ast] to the limb
in proper, & necessary exercise for the Body
is indespensibly necessary to allow the Pt. 
to a suppurative process- Counter Irritation 
shd. be made use of & it found that in 
hip cases their irritation can be excited
over the very part-Issues setons wth. the 
Iny Anterior Tart & Blisters kept open 
by means of the Savine Ointments
When there is much pain Leeches & the 
Warm Bath are proper, Whenever we 
find matter is formed we shd. not open
the abscess (in any cases of Diseased Joints)
till the skin has become very thin & is 
evidently on the point of bursting, & by 
these means we shall prevent very great 
Inflammation of the Joint-



Index
Constitutional Irritation 1 
Inflammation 5 
Chronic Do. 11
Adhæsive Do. 13 
Suppurative Do. 15 
Nature of Matter & Mode of Formation 16 
Ulveration 17 
Abscesses 18
Union by Granulation 21
Cicatrization 22
Ulcers 23 
Impediments to Healing 24
Nail growing into the Toe 25 
Death of the Cellular Membrane 27 
Gangrene 28 
Carbuncle 31
Injuries of the Head 32
Fractures of the Cranium 37
Formation of Matter on ye Brain 39
Trephining 40 
Hydrocele 41
Aneurism 55
Cataract 71 
Hernia 83 
Oblique 89 
Inguinal 91
Direct 99
Reducible 99
Irreducible 103
Strangulated 105 
Index 
Appearances after Dissection 
& Seat of Stricture 111
Operation for Strangulated 119 
Omental 131
Very large irreducible 135
Bubonocele 137
Direct Inguinal 137 
Operation for 139
Hernia in the Female 139
- Congenita 141
Femoral 145
Distinguishing Marks 147
from Bubo 147 
- Inguinal 147 
- Psoas Abscess 149 
Irreducible Femoral 149 
Taxis 151 
Umbilical 153 
Ventral 159 
Burns & Scalds 161 
Tumors 165 
Fungus Hæmatodes 171 
Hydatids 175 
Ganglions 177
Nævi Materni 179 
Ossific Tumors 179
Warts 181 
Poisons 181 
-Animal 183
Bite of Mad Dogs 185
Vegitable Poisons 189

Index
Mineral Poisons 191 
Sublimate 193 
Lead 195 
Oil of Bitter Almonds 195 
Ticunas 195 
Morbid 195
Fistul Lachymalis 195 
Causse of 197 
Removal of the Eye 201 
Polypi of the Nose 205 
-Hydatid 207 
Cancerous 207 
Removal of ye. Tonsil Gland 207 
Paracentisis Abdominis 209 
-Ovaria 211
Hare lip 211
Tic Douleureux 215 
Aura Epileptica 219 
Diseases of ye. Testicle 221 
-Breast 227 
Pulpy Tremors or 
Fungus Hæmatodes} 231
Irritable Tumors 233
Removal of ye. Breast 235
Stone in ye. Male 235 
-Kidney 235 
-Ureter 237 
-Bladder 239 
Structure of Urinary Calculi 243 
Index 
Medical Treatment of 243 
Operation 245
In the Postrate Gland 251
-Urethra 251 
Stone in ye. Female 253 
Operation 253 
Gonnorrhæa Virulenta 255
Internal Course 259 
Treatment 263 
Strictures 267 
Irritable Testicle 275 
Fistul in Ano 275 
Hæmorrhois 280 
Amputations from 282 to 290 
Diseased Prostrate 291 
Matter in Urethra 
Fist in Petinco} 292 
Compd. Fractures 294 
Pruritus Ani 303 
Gunshot Wounds 310 
Intestine Stricture of 320 
Swellings Cutaneous 324 
Wounds Abdominal 326
Thorax Wounds of 332
Tendon rupture of 362
Throat wounds of 366
Joints- 368
Hip Diseased 352