Thomas Windsor
Manchester
?-1745
(1845)
A gift for the library of the Surgeon-General, Washington
T. Windsor
July 18, 1885.
LECTURES
on the
RATIONALE of SURGERY
by
JOHN HUNTER.
VOL.I.






1
Introduction.
In the course of these Lectures I shall differ very much
from what is taught in Books on the subject of Surgery. The Ideas
I have to communicate are mostly my own, & not drawn from Books
I have reason to suppose them true because they are founded upon
facts. –
I shall consider first the Animal Œconemy. I shall mention
chiefly the actions of the body on a diseased state, with their recoveries
& natural functions in health. I have it not in view to
give a full course of Practical Surgery, but to teach the principles
of the Art.
I will be unnecessary to treat of the Operations & of every
particular disease; these are taught by Anatomists & others, the
principles are most necessary & those only shall be the subject of
our enquiry.
Every Art has its principles, from which we are enabled
to establish old facts, and account for new ones, the same holds
good in Surgery.
Effects are what strike the senses more forcibly even
while the cause is unknown, but as these are only consequences we
should endeavour to discover the Causes.
We know the causes of Inflammation, Suppuration
and Mortification, hence we are enabled to check their progress.
We find it necessary sometimes to increase the violence





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violence of a disease, before we can effect a Cure, as in indolen Inflammations
&ca. –
Sometimes it is necessary to change one disease into
another, - in Venereal Inflammation, by exciting a common Inflammation
we cure the disease.
If the Animal was always equal to the task it has
to perform, surgery would be unnecessary, but the powers of restoration
which arise out of the Animal, being not always sufficient, it
is our business to increase the action where too weak & vice versa.
It becomes often necessary to introduce Chemical means
in the Cure of diseases, these failing we have recourse to Mechanical
ones, as the different Operations.
As the Operations (tho the necessity for them is the
defect of Surgery) become sometimes indispensibly necessary, it is
right to know how to perform them.
A compleat knowledge of the parts of the Animal
Body should be strictly attended to, as this will lead us to their
uses, we should know the different Functions and consider the
dependence one action has upon another.
With regard to operations we should know when
they will relieve, & when nothing but an operation will relieve &  
also know when the Habit will bear an operation (this is sometimes
almost impossible to ascertain)
The facility with which a Man thinks gives him
a superiority over others, few have observed nature with more attention
than myself, yet even now, I think myself scarcely equal to the
task I have undertaken. A man will be ignorant of the knowledge




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he possesses until he arranges his Ideas.
The principles of Diseases which are the objects of
Surgery, have not been sufficiently attended to, these we intend
chiefly to consider.
We shall begin with Physiology, so far as it is necessary
to understand the principles of diseases.
Disease may be called a perversion of the natural
Actions of the Animal Œconomy.
I will first consider those diseases, that arise from
accident. Secondly those that are similar to them, then
the Union of divided Parts by the first intention, next Inflammations
which will throw a light on various subjects, as adhesions,
The Cure of the Hydrocele, Indurated Tumors &ca. Then the
union of Parts not cured by the first Intention, as Compound Fractures.
&ca.
Lastly we shall treat of some specific Diseases as
Scrophula, Cancer, &ca. –
J. Hunter.

Notes
🜹 3. So also the properties of matter act upon our senses, the sensation
of sweet or sour, are not matter, but the properties of matter
acting upon the Tongue.
Touch arises from resistance in matter. –
+ 5. By attraction of cohesion bodies of similar properties tend to
come in contact with one another & to remain so when this is effected,
this attraction is very slight in fluidity, in this however the stronger
it is the more globular or spherical the particles appear & vice versa.
Elective attraction disposes bodies, to join with various other [cross out] stances,
forming together one homogeneous mass. – of this we
have an instance in the combination of an air with an Alkali; there
are so many different Elective attractions, as there are methods of mixing
matter. – Elective attraction operates only when fluidity & vapour
are present, the compounds may however become solid afterwards
by the attraction of Cohesion. – The increased attraction of
Cohesion found in solid Bodies may be called the attraction of solidity.
 
        
 


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Rationale of Surgery.
Matter. –
1st. – By matter we mean that substance of which this Globe or
Earth is composed.  
2. By the impressions of matter alone, we are led to the knowledge
of our senses, & by our senses only we judge of the existence
of matter.
3. But our sensations are excited not by the impressions of matter
itself, but by the impressions of the effects of matter; - thus
when we hear a Drum beat, our sensation is not excited by the
Drum, but by the vibrations of the Air produced by the strokes on
the Instruments. 🜹.
4. Matter is found in one of the following states, Solidity, Fluidity
or Vapour.
5. The general kinds & properties of matter are few but different
modifications, & combinations of those kinds & properties of
matter produce great varieties in appearance.
6. The following properties are common to matter, attraction of
cohesion, chemical or elective attractions, & attraction of Gravitation. +
7. Repulsion is also a property of matter but it seems doubtful
whether it is so universal a property as that of attraction, nevertheless
the action of repulsion seems to be in a great measure

🜔 10. Heat seems to destroy all attractions. – Mechanics depend
upon the external figure & magnitude of bodies & upon the properties
of gravitation, attraction, &ca. –
     
        
 


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the cause of Fluidity & Vapour.
8. Magnetism seems to belong to attraction of gravitation, by the
attraction of gravitation the different parts of matter are kept together,
so as to form one great whole.
9. Each mass of matter though never so minute has in itself
a Centre of Attraction.
10. Heat also seems a generally necessary Agent to Fluidity & Vapor. 🜔 
11. The operations arising from changes in matter are regular &
determined according to certain & fix’d Laws.
12. We have been considering & speaking of the properties & modification
of common matter, but considerations on matter may be
carried much higher, & modifications of, or kinds of matter may
be found entirely different in every respect from common matter.
These are the matter of Animals & Vegetables.
13. The first principles of Animal & Vegetable matter are perhaps
the same, but they have many properties totally distinct
& different from one another.
14. It is observed (13) that the properties of Vegetable & Animal
matter are perfectly distinct, although their first principles may
be similar; & indeed so perfectly & entirely distinct are Vegetables
& Animals in many properties, & in the modification of
matter, as observed in their production & formation that no connection
between them has ever been traced.
15. They differ totally from common matter in that they have
each of them a power of acting, & performing various operations
within themselves & of producing or generating matter of their
own Genus from themselves. –

♂. 17. The circumstances of worms &ca. which feed upon Earth
would seem to afford an exception to this position, it is likely
however that the Earth they take in is only useful so far as it contains
Animal or Vegetable Matter. – In order to determine this
we should combine an Alkaline Salt with Earth, which will destroy
whatever Animal or Vegetable matter it contains, the wash it thoroughly
& try if a Worm will live in it.

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16. Vegetables & Animals especially differ from each other, both
Indeed have a power of performing operations within themselves
& of generating from themselves new matter, but in other respects
they very essentially differ.
17. The operations of Animals are attended with waste of their
component parts, this waste is recruited by a supply from common
matter, but common matter cannot be immediately converted
into Animal substance, nor can the decay of Animal substance
be supplied from common matter until it has by certain [degrees]
changes been already altered into Animal or Vegetable matter.
Vegetables can immediately convert common matter into their own
substance & be supplied from it, but Animals cannot, which proves
that Animal matter is still farther removed from common Matter,
than the Vegetable. ♂.
18. Animals & Vegetable Matter may be viewed in two states, as
living or dead; - when living it has in itself a power both of
continuance & generating new living Animal matter, but when
dead it loses these powers.
19. Animal & Vegetable Matter after death is capable of being
acted upon by the operations of chemistry., & by those of spontaneous
dissolution, by which latter it is at length reduced to
common matter, out of which probably it is at first formed the
presence of life is an antidote to, and resists both one & the other
20. Animal Matter submitted to Chemical enquiring & the operation
of Fire, yields certain substances peculiar to itself, as
the Volatile Alkali, Empyreumatic Oil, Calcareous Earth [&ca.]
& a kind of Water, other substances as Iron &ca. are also found

 


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which are superadded & do not constitute its natural component
parts. –
21. Animal Matter may receive a supply of its waste from
Vegetable Matter. –
Fermentation in Animals.
22. Many changes taking place during Life in Animal and
Vegetable matter have been attributed to a certain operation called
Fermentation, for it is known fermentation will alter powerfully
all substances which are subject to its action, & even changes them
into new & totally different substances, to this the secretions of
Animal Bodies have been supposed to be owing, to this the
change of the Water into the Juices of the different Plants nourished
solely by it has been imputed, to this Digestion &ca. –
23. But the Animal & the Vegetable Bodies are the subjects of
fermentation, no change wrought in them during Life can possibly
arise from this cause, for the presence of Life resists fermentation,
it is impossible it can only take place after the destruction
of Life, which is the preserving principle, we here speak of Fermentation
in the same sense the Chemists use it.
Principles of Life.
24. The changes arising in the Animal & Vegetable matter during
the presence of Life, are produced alone, by the peculiar power of
the principle of Life, to its operations we refer all the Secretions

♁ 28. Some experiments to elucidate – 28.
Expt. 1st. Mr. Hunter found that a new laid Egg tho kept by incubation
in an heat of 120° until it was hatched in 2 or 3 weeks,
when the Chicken was excluded, shewed not the least sign of Putrefaction; -
another Egg which was not hatched & of course died,
became in the same circumstances highly Putrid. –
Expt. 2nd. – A new laid Egg was exposed to heat between 17°.
& 15°. Farht. in which situation it was kept half an hour, its Life
being then destroyed by freezing it was thawed by Heat, being
then exposed to 25°. It then froze in half the time it before required,
that is in 15 minutes, while alive it had the power of resisting
Cold & consequently the destruction of its Life, a considerable
time, but when once killed it had no longer the property of resisting
the freezing power of cold. – Mr. Hunter made a number of
other Experiments on Animals & parts of Animals, he attempted to
freeze 2 Carp but without success, he found that for a long time
they generated heat & resisted the destruction of their Life by freezing
at length that power was exhausted & they died; the power
of resisting death almost every thing possessed of Life enjoys.
Mr Hunter found living Vegetables would endure Cold & resist being
frozen much longer than Plants whose vegetable life had been
destroy’d. – Experiments were tried on Dormice &ca. and all
had the same result. –
Experiment 3d. A dead Egg froze in the degree of 32 & a living
one gradually sunk to 29, it then continued stationary for
sometime, after which it rose to 32 & then became frozen, to

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all the new productions, the digestion of other substances &ca.
25. The Operations of the Principle of Life cannot be referred to
Mechanical powers.
26. Life is totally distinct from any property of Mechanics, we see
indeed the movement & construction of all the Bones are regulated
by Mechanical Laws, but the actions of the Muscles which puts
the Bones into motion are not owing to any Mechanical Power or
Principle, nor by Mechanical principle can they possibly be explained.
27. From an examination & survey of Animal Matter when dead,
we gain an Idea of living Animal Matter, as from Life only we
can gain an Idea of death, so vice versa. –
28. The functions of & changes in an Animal body during Life
are all to be referred to the operation of the principle of Life. – The
properties of the principle of Life consist in preservation of Animal
matter in the living state & in action, Life may exist without
matter being in a state of action, & the property of self preservation
may be alone present, Life at the same time being present in
full force. – Thus a new laid Egg, is truly & really alive, tho
no kind of action is known to be possessed by it. ♁. –
29. Life does not consist in any modification of matter, it either
is something superadded to matter, or it consists in a peculiar
Arrangement of certain fine particles of matter which being
thus disposed acquire the properties of Life. ♂
30. Life has been compared to the spring of a Watch, as that
Spring gives motion to all the Wheels, so Life gives action to the

same Experiment was made on Snails, Snakes, Eels & others of the
colder & imperfect Animals, which proves that the fresh Egg is as
truly alive as the Animals just spoken of, tho’ it has only the property
of resisting death, or self preservation & not any kind of action.
♂. 29. I enquired of Mr. Hunter if this did not make for the
exploded doctrine of Equivocal generation, he told me perhaps it did,
and that as to Equivocal generation, all we could have was negative
proofs of its not taking place, he did not deny that equivocal generation
happened, there were neither positive proofs for or against
its taking place.
🜔🜹 33. The doctrine of colours will tend to the same purpose,
we see by different arrangements the same colours will produce
different Shades. –
☿ 35. Tho’ Organization is not necessary to Life, yet it is to action.

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several parts of the Body, but this Idea is not just, no one part
of Body is dependent for action on any other part, but the several
parts, each possess life & action in themselves. –
31. Life in a living Animal is as much the property of every
individual part, as Gravity is of every particle of matter, every
one part is as much alive as the whole. –
32. Every action in the Animal body is produced by the living
principle, the secondary actions of Parts are as truly produced
by it as the primary. –
33. Magnetism will truly elucidate what is said of Life being
superadded to Matter, or arising from a particular arrangement
of certain particles of matter, a Bar of Iron placed for a long time
in an upright posture will acquire a magnetic Virtue, so perhaps
the particles of matter arranged & long continued in a
certain Position at length acquire the power of Life. 🜔🜹
34. Two, three, or four, or any number of Particles of Matter thus
animated may form a muscular Fibre, a certain number of
these Fibres collected form a Muscle.
35 Life does not consist in any Organization of matter, for
matter will remain as organized as ever after the destruction of
its life. ☿.
36 As from an observation of matter in its inanimate state we
gain an Idea of living matter, so from an observation of the functions
& actions of parts in a state of disease, we gain a knowledge
of or correct our opinions of the natural actions & functions
of parts in a state of Health.



                      


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37. Solidity in matter is necessary for its action, it is the fixed
point from which its actions must proceed, & on which they must
depend, therefore we find the parts of Animals destined for action
solid, these Animal Solids are kept together by Cohesion.
38. The Muscular parts of an Animal are active, - of an Animal
scarcely any parts are purely passive, almost all parts
have somewhat of the Muscle in them, and have some kind of
or degree of Action. –
Actions of Animals.
39. The actions of an Animal are two fold, the primary actions
or those which every part hath in itself (as to nutrition
growth & support) without regard to any Operation, for the benefit
of, or for producing some change in the general System,
as the actions of the stomach, Brain &ca. – The first are
the true Animal movements, the second are what are called Operations
of the Animal Œconemy, as most secondary actions
are employed for the ends of the first, having a necessary relation
to the first; - so those secondary actions are in general permanent
and constant. In diseases all these secondary actions
may be suspended for a season, the primary ones are never interrupted
for the least portion of time so long as the parts live.
40. Those are besides the muscular parts (38) which are the
active powers, other parts also which, have a kind of secondary motion,
(that is, a motion communicated to them the Elastic Parts)

    

                      


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but to the operation of these life is not necessary, their powers
are equal after the death of the Animal to what they were
during life. –
41. There are other parts also in the Animal Body that have
in themselves no kind of action, but whose use is merely
Passive, which are different in strength & density, some for Union,
as the Cellular substance, others for strength, as the
Tendons & Ligaments. –
42. It is said (40) that it is not necessary to parts being
possessed of Elasticity, that life should be present. – Elasticity
is indeed a property of many species of matter besides Animal. –
43. The actions of the living body are simple & compound
The powers of action distinguish living Animals & Vegetables
from dead & common matter.
The Stomach.
44. The operations of an Animal (17) are attended with a
waste of its substance; - supply is therefore necessary to
the continuance, this supply is performed by means of
which tho small in comparison to the bulk of the other parts
of some Animals, is the most important part of all. – This
is the Stomach. – The stomach is the principle distinction
between Animals & Vegetables, all Animals have a stomach, no
Vegetable is possessed of anything like one.; - to many Animl.
the Heart, Brain & Nervous System & many of the Viscera are

the stomach of plants may be said to be, the ground & air in which the
grow, as it furnishes a supply. So living animals which change the
situation of course it is necessary there should be supplied by some
with them, with stomach. HS
          

                      


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wanting, but no Animal is without a Stomach, it is the Stomach
only which is necessary for the support of a simple Animal,
& organs of generation for the propagation of its species therefore
some Animals consist of little more than a Stomach & Genitals.
45. This Stomach may be called the true & primary Animal;
all other parts may be considered as superadded, according to
the functions of the Animal, to which some or more is given, is
to perform on the Stage of Life, for one Animal that possesses a
Heart, there are millions that want it. –
46. The Stomach by means of its hidden powers, converts
various Substances into one common kind of matter, which is
taken into & forms part of the Animal, this very curious kind
of Operation is called digestion.
47. This Viscus in the most complicated Animal, as in Man,
is intimately connected with the general Æconomy, it is as much
the seat of Irritability as the Brain is of sensibility, it is highly
affected by many external influences, which in themselves have
nothing to do with the Operation of digestion, as Wounds &ca. –
It is more affected by morbid operations produced in Tendons,
Ligaments & other parts of small natural sensibility than by
the same taking place in the Muscles, it is chiefly affected
by changes produced in the internal parts, as the Brain is
by those in the external parts. – It is intimately connected
with affections of the mind, whether produced from injuries
of the Brain or from horrid stories or sights, to which a Vomiting

🜖. 50. Experiments have excluded the Veins from the Theory of
Absorbing, even in the Erection of the Penis the Veins do not absorb,
I consider the Corpora Cavernosa as Veins, through which the Blood
is constantly flowing from the Arteries & that there are a number
of Veins, opening into the Corpora Cavernosa, and that the Blood
is flowing into them, that in the Erection there is a spasm upon
the Veins, which prevents the Blood flowing thro’ them, hence an
accumulation and distention, in the Penis, which ceases with the
spasm. – I found that by tying the Veins of a Dogs Penis an Erection
was produced. – 

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vomiting or puking has been known to succeed, especially the last.
48. non est inventus.
The Vascular System. –
49. In compound Animals, as Man, the Vascular System
(or that by which fluids are carried to & taken from different parts
of the body, by means of which growth & nutrition are afforded
to parts, & to the whole) becomes an importent subject of enquiry. –
This is divided into, the Arterious, the Venous,
and the Absorbent System. –
50 The animal body is considered as an Hydraulic Machine
by those three sets of Vessels its course of fluids is conducted. 🜖.
51. Arteries. The arteries carry the blood from the Heart
to every other part of the body, consequently they convey the materials,
for the growth, nourishment & support of parts, for the
regeneration of them when lost, and the support or supply of
them when wasted, also for the different secretory Organs to
separate liquors for any further purposes in the Animal Œconomy,
or to diminish anything superfluous or noxious.
52. Veins. The Veins return to the Heart the blood wch
remained of what the Arteries had carried from it, after the
different purposes (51) have been effected, they are also said to
carry blood from certain parts to the Liver for the production of
Bile.
53. Absorbents. The Absorbents take up fluids & also solids
from [many] every part of the Body, which they pour (by means
of a peculiar duct) into the Blood, by this property they become

🜋 53. Also the Gubernaculum, & Membrane Pupillaris &ca.
When a Limb is removed, we know the end of the Bone is sawed
through in a circular figure, with hard edges, if examined
at some length of time after the Operation we find the end of the
stump approaching the section of a sphere.
Aphorism 59 continued. By this property also when their
actions are much excited, they take up the solid parts whether
soft or hard, these producing what has been called Ulceration,
this may be called Ulcerative Absorption.
They also diminish the bulk or density of parts without
ulceration, to this species of absorption no particular name
has yet been given, but it may be called Intersticial Absorption.

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the means of supplying the system of circulation with nutritive
particles, also of conveying disease into the habit. – Thus being both
the instruments of Health & destruction; by this property of absorbing
solids as well as Fluids, they become the modellers of the
shape, Form & structure of different parts; they prevent parts
from growing into irregular & inconvenient figures; in this light
they may be considered, as the builders of the Animal fabric,
whilst the Arteries are the labours bringing & laying before them
the materials for the work, or as the polishers of the rougher workmanship,
of the arterial vessels; by this property they take up and remove
parts, which though useful in one part of life, becomes useless
in another, as the Thymus Gland &ca. - 🜋
54. The action of this system of Vessels (53) being considered
with regard to the ultimate effects may be divided into two
kinds
1st. Absorption of extraneous bodies.
2d. Absorption of the Animal itself.
55. The absorption of extraneous substances as observed (53) introduces
both the particles of nourishment into the system, & the
particles of Disease.
56. Final use of Absorption. The Absorption of the Animal
itself is employed either for the nutrition of the Animal
when either absorption of extraneous nutrition cannot take place,
or when the mind, is unmindful of directing nutriment to be
taken in, & yet nourishment is still necessary to the life of the
Animal, or when an useless & inconvenient part is to be removed.

                                   


15.
57. The mind is frequently unmindful of taking in food in
fevers, no disease of it being perceived by her, but nourishment being
necessary for the sustenance of the Animal, the fat and other substances
are taken up by the absorbents and carried into circulation for the necessary
purposes of affording nutriment to the different parts of the
system. Thus the Animal is for sometime enabled to feed on itself.
58. every part of the body may be subjected by disease to the second
kind (54-56) of Absorption – Absorption will either take up from
parts portions of their intesticial substance, as Earth from bone &ca. or it
will take whole Parts, as an entire bone. –
59. When a stimulus of any kind is about to excite the process of
Absorption, two circumstances will take place, a consciousness in the
Lymphatics of the propriety or necessity to begin absorption but when
the part to be absorbed is dead the state of consciousness is incompatible
with an inanimate state of matter.
60. to the removal of dead parts by internal process, this System
of Absorbents seems alone to be equal, no chemical process can perform
it.
Ulcerative Absorption. 61. The process of Ulceration, or
Ulcerative Absorption is always the same, different causes may indeed
produce it, & different circumstances may be present with it.
62. The state of consciousness (59) may be induced by different
kinds of stimuli but the mode of impression will always be the same
63. The absorbents have a power of taking up both Solids & Fluids.


 
     
                                    


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64. The mode of their action is not clearly ascertained, it has
been imagined that they are Capillary Tubes, but capillary Tubes
can only absorb fluids & the absorbents take up solids. (63). –
65. The opinion of their absorbing matter in a fluid state alone
(which would shew, that the solids if to be absorbed, must undergo
solution by means of some fluid which acts upon them as a solvent)
is to be doubted of. –
66. It is equally & more probable that the absorbents have like entire
Animals, mouths & teeth, that the form of their mouths & teeth
in different Absorbents, essentially differ according to the parts they are
to act upon, so that perhaps could we obtain an accurate [class] survey
of them, we might be enabled to class them according to these differences. –
67. It is doubtful whether substances when mixed with the Blood
are essentially altered or not, the indefatigable parts of vegetables, as the
colouring part of Rhubarb pass off by Urine, or by some other secretion
unchanged; the variolus matter is not altered by the Blood the Venereal
matter when taken into the habit is certainly much altered, it is very
different from what it was before it was absorbed, this is the only matter
that we know undergoes a change.
68. The power of living Animal matter to consume itself is equally
probable, with the property of living matter to produce fresh living
matter from itself. –

🜔🜹 69. The existence of the Brain & Nervous System is not necessary
to simple Life, millions of animals want both, but they are necessary
to the performance of certain functions of Life, & without them in
those classes of Animals to which they are given, active Life cannot go
on if the perfect Animal, as Man, there have been instances of Monsters
born without a head; but not being able to support the functions
of Life, necessary to be performed from the time of birth, they die soon
after they come into the World, but they were truly & virtually alive
while in Utero.

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Brain and Nerves. &ca. –
69. From a peculiar arrangement of the particles of Animal matter,
muscles are produced, a different arrangement of those particles
forms other organs, so from a particular disposition of these particles in
perfect Animals, the Brain & Nerves are fashioned, which being acted
upon by various impressions, various sensations arise, the effects of wch
are the mind & will. 🜔🜹.
Senses. 70. The impressive given by external objects are considered
as of five kinds, of these one is touch or feel, of which every part
of the Body which is sensible is the seat, the other four kinds several
affect the Organs peculiarly adapted to them.
Idea. 71. The sensation raised by an impression is two folds
first its effects on the part to which it is applied, secondly the change
produced in the brain, in consequence of that effect, the first is simply
passive, the second state is active, for then action is produced in the
brain & an Idea is formed.
72. According to the kind of change effected in the Brain the idea
will be agreable or disagreable.
73. As from habit we gain a power of judging & distinguishing
what is advantageous or useful, from what is inconvenient & pernicious,
when an idea respecting an external objects is executed in
the mind, & that idea is followed by an inclination to possess or obtain
that object, we should be irresistibly inclined to gratify that inclination
when arising did not our power of judging of ill consequences that


  
 
 
 
     
                                    


18.
might arise from gratifying the inclination in question (acquired as
before said, from habit, or from reapeted observation) determine us to the
contrary, this weighing an inclination in the mind we call Reason.
Will 74. a determination of the mind whether produced by inclination
or reason (73) is called will. –
Voluntary Action. 75. In consequence of any changes produced
in the brain, as concomitant on the Actions of the will, an action
in any moving part of the body is excited. this is voluntary
motion or action, thus different parts of the body receiving impression,
have a power of acting on, or exciting a change in the brain, & a change
in the brain however produced has a power of producing a change
in other parts of the body. –
76. The vital principle of simple Life & that principle on which
The powers of sansation depend by this connection (75) act mutually
on each other.
77. It seems as if we had no simple sensation, but that every
sensation of which the mind is sensible is compounded of two
states as (71).
78. The Operations of the Brain & Nervous System (64) are not
so extensive as some have imagined, they can neither supply a
part with nourishment, nor preserve a part from dissolution.
79. Every living body has an intelligence of its own feeling after
an impression has been given to it, previous to and exclusive of
any Idea existing in the Brain. Thus every living part has in itself
a consciousness of any impression given to it whether of Pleasure

83. Many fishes have abundance of nerves with a very small
quantity of brain, Fœtuses to whom the Brain has been wanting
Acephilous Monsters have still their Nerves.
85. In Man & the perfect Animals; sensation is intimately connected
with life. if the powers of sensation are constantly kept exercised,
the sensative principle becomes fatigued, & the principle of Life
also suffers with it, Sleep therefore by giving relief to the sensitive
principle, prevents violence being done to the principle. –

19
or of pain & as it were a power of the Mind determining to action,
independent of the powers of the mind.
80. The power of the nerves is purely passive hence previous to any
action being excited in them a impression must necessarily be given 
to them. –
81. The different sensative Organs are appointed to receive the
several kinds of impression given to the body & which impressions
are of five kinds. Yet every Nerve is subject to receive the impression
of touch & pressure.
82. The living principle is coeval in all living Animal Matter wth
the Animal matter itself, & may long exist without sensation. Thus
a Child in Utero has no sensation until it is born. –
83. The Nerves are not indebted to the brain for their existence,
there may be Nerves tho’ there is no brain, but the existence of the
brain is necessary for the formation of Ideas.
84. Parts intended for strong sensations have always a great quantity
of Nerves distributed to them
85. This principle of sensation regulates all our External action
as the principle of Life does our internal ones.
86 When an impression is given it must continue a certain time
in order to produce a sensation. if it lasts but a short space of
time, no sensation will be produced, if an impression continues too
long a distant sensation will be yielded, it will then only produce a
disturbed state of the Nerves. –
87. Sleep is to the sensitive principle, what rest or the state of inaction
is to the living principle as the living principle may exist

89 – here is no notice taken of the eyes being required to be shut
when sleeping, & the absence of the eyelid preventing it. H.I.S.
🝄.
90. A loud noise produces the same effect upon the Ear in lieu   
of distinguishing sounds the idea of pain will be excited, even the Tympanum
of the Ear, has been burst or broken by this Violence. –
91. Ingenuity often gives reasons for things, rather than
not account for them, but their reason unless they have some shads
of probality, or even when they have, may not be the truth. HiS –
does a blow on the ear produce a gretter sensation of sound, than the real ble
occasion.? HiS.

20
tho no action is going on, so the Existence of the sensation is not incompatible
with the abscence of sensations.
88. Thinking is the effect of particular changes in the mind, accompanying
changes in the Brain, tho’ with respect to ourselves, or a consciousness
of action or sensation, we are in a state of non Existence, &
although we have then no sensation, yet the Effect of sensations are not
lost, the mind will be thinking (which is the effect of sensation) while
we are asleep as in dreams, we seem indeed then to have sensations
but our seeming perfections are fallacious. –
89. We often dream when awake, having a seeming perfection
of things & objects which do not exist.
90. Sensation excited in a certain degree is agreable, in a greater
degree painful, & then the natural sensation will not take place, but
the sensation of pain will be produced, Thus are excessively glaring
light applied to the Retina, pain not vision will be produced. 🝄.
91. An impression different from that which is the One, for the perception
of which any Organ is naturally & particularly adapted may
produce in the given organ the same sensation as would have taken
place, had the natural impression been given, thus a smart blow
on the Eye will excite the same sensation as a flash of light, the same
blow on the Ear will produce sensation of sound. –
92 Uneasy sensations may in many respects be similar to a natural
appetite, they rather warn the Animal to the avoiding somewhat
injurious to him, or the removing something unsalutary.

♁ 94. Sensation is not necessary to simple Life, a child in Utero
has no sensations & yet lives. –
♎︎ 95. A Muscle when its action is suspended by the communication
with the brain being interrupted or by any other means it
wastes. It is a law in the Animal Œconemy that the size of a Muscle
will be in proportion to the frequency of its use of this we have a variety
of instances in the legs of chairman, the Arms of Watermen, & the thickness
of the Muscular coat of the bladder when it has been long used to
frequent contractions from Irritations as there from a stone &ca. as will
be hereafter taken notice of when we are considering the diseases of the
Urinary parts &ca. so also Muscles waste if the joint they serve is rendered
useless because their action can be no longer performed.

21
93. During sleep whatever actions are derived from the Brain, whether
consequent on disease or health cease; so St. Vitus’s Dance does
not affect the Patient while he slumbers.
94. The living principle in any part of the body will continue
to exist after the Nerves leading to any part is divided. ♁
95 When a part intended for motion, loses its power of motion, it wastes;
for being now no longer useful to the Animal, as a moving part, it becomes
open to intesticial absorption; (53) the will can no longer influence
it. ♎︎.
96. The more distant any part is from the Centre of its energy, the less
fit will it be, or certain actions, as indeed it will receive less Energy
therefore all the Vital parts are near the heart. All the parts intended
for acute sensation are near the brain. So mortification from debility
more frequently attacks the extreme Vessels, especially if the Patient is
tall, perhaps one reason may be that the blood loses somewhat of its
nutritive powers before it arrives at them.
97. In the Animal Body there are actions which proceed from certain
fixed principles in the Animal Œconemy & are regulated by certain
fixed Laws; these are only actions which arise in consequence of the
other actions which we call sympathy. Sympathy. –
98. There is also another kind of action which we call Habit,
actions frequently repeated in any part induce a custom of acting
in a given manner in any certain part, & from this accustoming
a part to any such action Habit arises. –
99. Habit is a kind of force or violence done, or superadded to the

4
🜔 103. When stimuli are often repeated they lose the power of producing
sensation; hence the mind is at last insensible of the
change hence habit of Disease arise (189) & parts get into & go on
without the mind perceiving it a diseased action, hence also parts
become insensible even to noxious stimuli, to the frequent repetition
of which they have been accustomed hence whilst in strangers
the bites of the Bug & Mushito produce disagreable Effects
those who have been much subject to the application of their poison
have their skin at last insensible to it; as in the Body so it is in
the mind, horrid sights &ca. at first produce in it the greatest
changes but by frequent repetitions of them the mind becomes reconciled
to them & at length scarcely an idea is excited by their impressions
(148). –

22
first principle, parts from habit acquire a power of acting in a more
forcible, or in a different manner from that which primarily took place
in them.
100. This habit may be called a species of Memory, as Memory consists
in a Repetition of Ideas once taking place in the mind. So
habit consists in a frequent repetition of action in any moving part
of the body.
101. Habit is similar to a body, once put in motion which will
not cease from motion unless some new cause for obstructing motion
arises.
102. Habit becomes a cause not only of motion in parts accustomed
to that kind of motion, but also may be a cause of rest at that time
in other parts, like a body once put in motion it does not require
a renewal of the same & equal degree of force which first gave it
motion, but the addition of a small quantity of fresh force is sufficient
to keep up the motion.
103 Habit will even become a cause of action in the will, it will
make these actions of it voluntary which were involuntary & also the
reverse; the strength of habit will be much or little, in proportion
to the violence of the impression which gave rise to it. 🜔
104. As in the Memory it is not necessary that in order to the recollection
or renewal of an idea, the impression which gave rise to it
should be repeated with its full force, so with respect to habit in parts
but it is not necessary in order to excite them to an equal action;
the impression or stimulus should be equally Violent with
wat it was when it first produced the action in the part. Habit


                 

             
 
 
 
 
     
                                    


23.
is always gaining on us and little force is necessary to keep it up.
105. As in the Mind the remembrance of impressions which
were of little force wears off, unless the impression is repeated before
the effect of the first impression ceases, & consequently memory
of the impression will not remain, so neither will the power of
habit remain, if second impressions are not repeated before the
first ceases. –
106. In accustoming parts to habits, or impressions, two circumstances
will arise.
1st. If the impressions are slight & often repeated, or if the
force of the impression be each time gradually augmented, the
parts accustomed to them will become by degrees insensible to
them, so that here the cause may remain though the effect diminishes
or ceases.
2dly. The effect may remain though the cause ceases,
as violent impressions will continue to produce their effects, long
after they themselves have been removed, according to the kinds
of habit complied with, health or sickness will be induced.
107. All stimuli will not produce the same effect when applied
to different parts, hunger will be a stimulus to the stomach alone
light to the Eyes, sound to the Ears &ca..
108. Dispositions of the mind will arise from Ideas produced from
certain impressions given to the brain, a disposition taking place
[from its] may be compared to the state of an elastic body when altered
from its pristine to some other figure, the disposition of the

🜖 110. 111. 112. In inflammation though the Blood coagulates more
slowly, yet there is a greater disposition in the parts to separate one
from the other. The separation will often be so perfect, that if you
dip your finger into the fluid at the top during coagulation, it will
not be couloured at all red. this inflamed blood will sometimes be
half an hour before it is compleatly coagulated. –

24
Elastic body to recover its pristine state is destroyed, by its action in recovering
that state, so when the disposition has produced such a state
of the will as to excite the moving powers to any action, the disposition
no longer remains, with this difference however that the
elastic body loses its disposition instantaneously, the Animal by
degrees.
109. When an action is excited by the powers of the will in consequence
of a particular disposition in the mind taking place, the
brain for the seat of the disposition, which might before be considered,
as in an uneasy or stretched state, now returns with respect to the
consideration of the disposition to a state of rest.
110. The Blood which is the fluid circulating in the Arteries & Veins
is not a passive inanimate matter, but is endowed with a principle of
life in itself equally with the solid parts.
111. A particular a permanent figure of parts in a losing animal is only
necessary to mechanical action. action is not necessary to [illegible] presence of simple Life.
the Blood perhaps has not motion in itself, but motion is not necessary
to Animal life.
112. The blood is not only alive itself, but it also by circulating thro’
every part of the body, becomes the means of & carries life to other parts,
thus being the living support of every part of the Fabric, even the Nerves
themselves are supported by it, they do not convey life to the parts, but
only direct the motion of parts, & without the blood will themselves become
dead. 🜖.
113. Whilst the Blood is circulating in the Vessels, it is always fluid,
but it is not always alive whilst fluidity remains. If by any means

Φ 113. If the life of the Blood is suddenly destroyed &ca.
Cases in support of this.
A Gentleman died suddenly in a violent fit of passion his Blood
did not coagulate. – Two Deers were hunted to death the
Blood of neither would coagulate – The blood of Animals
killed by lightning or Electricity will not coagulate sometimes, but
this will depend upon the manner in which the Electric matter
was applied, if so as to pervade at once the greatest part of both the
fluids & solids, it may produce this Effect.
🜔 116. Though the Blood when in its fluid state has not sensation
yet when formed into solids may acquire sensation. before Blood is
capable of gaining Life & support to parts, it must have circulated
through the Lungs, where it undergoes some Essential change perhaps
it then first is compleatly in its second state or verification. –
🜔vuss 🜖 117. As the Blood acquires an inflammatory disposition when
circulating through inflamed solids so it may lose Quel?

25
the life of the Blood is suddenly & entirely destroyed, after its death
it will still remain in a fluid state. Φ.
114. Whilst alive it is always fluid, if its life is not suddenly & entirely
taken away, it coagulates as it does & the seeming component
parts recede one from another.
115. Long rest out of the Course of Circulation & Exposure to the air
of the atmosphere occasions the Coagulation of the blood, if unexposed
to air, blood will remain long at rest in the living body without
Coagulation.
116. Organization is not necessary to Life, an Egg is not Organized, &
Yet an Egg is alive (28.) so blood is not organized, & yet is possessed of
Life. 🜔.
117. There is a perfect harmony in a state of health between the fluids
& solids of an Animal Body, so also between the Blood, & its containing
Vessels. There is also a consent between them in disease, & when the
solids are affected the blood also puts on a diseased state, thus the Blood
is as capable of disease as the solid parts are so also the blood becoming
diseased the Solid parts also suffer. 🜔vuss 🜖.
118. As the blood conveys to parts the means of nutrition & growth,
so from the blood, new solids are formed, when in consequence of a disease
or violence, there has been a loss of the former ones, or when those
arises a necessity for their production.
119. Where there is a disposition to union in parts naturally distinct
from each other. Inflammation will arise which Inflammation
will be in proportion to the strength of that disposition. The

 
 
 
             
 
 
 
 
     
                                    


26
Blood passing through inflamed parts undergoes a change according
to circumstances, & from the change wrought in this, coagulable Lymph
is fitted to be formed into solids, by the solid parts formed from this
Lymph parts violently separated from each other are again united, &
parts before naturally severed from each other are blended together.
120 The living parts of the Animal, both the blood & the solids
being continually wasting, supply is necessary, this supply is obtained
by means of fluid prepared by the stomach (44) but before the food
taken into the stomach can furnish the desired supply, it must undergo
two process.
1st. Animalization
2d. Verification.
from living matter only, living parts can be made.
121. Sensation is not necessary to life the Blood may therefore be
alive though it wants sensation.
122. Heat. A certain degree of heat is necessary to the preservation
of Animal life whether existing in fluid or solid matter.
123. A certain degree of heat is necessary to Animal Life (122) but a
greater degree of heat is necessary to Animal Action, before the former
the Animal cannot retain simple Life, below the latter, though it
may retain simple life it will not retain the power of action.
124. Almost every order of Animals require a degree of heat peculiar
to itself, some Animals will not endure their heat to vary much
from a common standard without abolition of the actions of Life. A
Bee requires its heat to keep, to go, a Wasp will suffer its heat to vary
with the heat of the Atmosphere.

🜔vmss. 🜔. 126. An explanation of the power Animals have of generating
heat was attempted – 1st. by supposing it to arise from friction
but between the particles [there] of a fluid there can be no friction, nor between
the particles of solids can heat be produced by friction, if a fluid
is interposed. Thus the Wheels of a Coach are prevented from generating
heat by means of greasing them.
2d. By Fermentation (by Dr. Stephenson) but the fermentation of
Animal substances does not produce heat.
3d. From inspiring Atmosphere Air, this seems to be contradicted
by the following Case.
A man had a contusion of his brain, his respiration was exceedingly
Slow, breathing not above 5 times in 2 minutes, yet he had a
General warmth upon his skin, though in the month of February, & the
cloathing was but thin, the power of generating heat & cold depends simply
on the principles of Life, independent of circulation, the influence of the Nerve &c.
This is finely illustrated in the case of a Gentleman who was seized with
an apoplectic fit, whilst he lay insensible in bed, & covered with Blankets
his whole body would in an instant become extremely cold, in ever part, &
continue for sometime, & in as short time become Extremely hot, this was
going on for some hours alternately yet there was no alteration in the state
of his pulse, or in the excitibility of his sensations. X
🜋 128. Animals which are in a state of in action during the Winter,
as sleeping Animals the heat will vary with the seasons. The state
of the Hedge hog in summer is from 91 to 97 in the Winter when the
Atmosphere was 44 the heat of the same Animal was 45, the Experiment

27.
125. In the state (121) digestion & generation with other faculties
will be suspended, & the Animal remain in a torpid in active state.
126. All Animals in themselves have a power of generating heat,
when the actions of the external Cold are so great as to endanger the
preservation of life, this power arises wholly from the principles of life,
this power arises wholly from the principles of life, for dead Animal
matter, posseses no power of resisting cold, this generation of heat
is truly life, operating against its destruction. 🜔vmss 🜔.
x Animal heat is kept up by the circulation of the
blood, which receives oxigen in the lungs from the
atmosphere. The venus blood which has entered, is of a
dark colour, but receiving oxigen the iron in the blood unites
with it, & forms the bright red arterial blood. distributing
this in the required quantity. Perspiration is evaporation
which produces much a degree of cold, to restore the
equilibrium when from violent exercise we induce
too rapid a circulation, or in glass houses when
the beat is too great. HiS
127. The heat of all Animals is diminished during sleep, whilst
in a state of torpor, but more or less in different Animals. –
128. Variations of heat in the Atmosphere, will produce different
changes of the heat of different species of Animals, some animals
as Men, & those which are constantly in action have their heat
little changed by this variation. 🜋. –

Experiment was made on its pelvis.
🜍 132. Animals who suffer their heat to be diminished
with that of the atmosphere, suffer it to be as readily increased to a
certain degree as that of dead matter – A living & a dead Carp
were both placed in a mixture of snow & water, which was gradually
heated, & both received heat one as fast as the other. – different
parts of the same body will have different degrees of heat, and different
powers of generating it, the projecting parts of the body in
Man as the Nose & Penis will be colder than other parts, the urethra
will be colder than the Rectum, than the abdominal Cavity, the Standard
of heat in the Centre of the human body is about 99°. –
🜍 132. Animals have two powers of resisting heat, tho’ only one of
producing it. One by the Evaporation of fluids, but as when fluids
become condensed on the surface, instead of being evaporated they will
not answer the purpose they have which is of actually destroying heat
As the Extremities or projecting parts are more subjected to be influence
by cold, so they [are] more readily allow their heat to be increased than
the central parts. From Dr. Fordyces Experiment in an heated Room
it appears that the human body will for sometime bear heat with
impunity, & such heat as is sufficient to boil Eggs, or roast beef stakes
The Gentlemen present in it found that when they moved from one
place to another in the latter they found the heat also more intense than
that they had been sometime standing in seemed to be when they left it
so also in the hot Bath the Bathers find the water immediately in
Contact with their bodies Cool, & they must either have the water agitated

28.
129. Animals will suffer their heat to sink below the freezing
point before they will be frozen ( ) Expn. on Eggs. –
130. The stonger & more healthy the internal powers of the Animals
the more powerfully will it generate heat.
131. Cold applied to animals in a certain degree proves a sedative
to the powers of Life, but applied beyond that degree it proves a stimulant,
& the faculty of generating heat is excited in an extraordinary
degree.
132. Excess of heat may prove destructive to Animal life as well
as too great a diminution of it, the principle of Life is therefore endowed
with the property of generating Cold, when the external heat
endangers the life of the Animal. 🜍.–
The principle of life serves here as the nectary
in botany, which is Linneus's term for all indescribable
parts HiS
Though the effects of origin in circulation is but
a recent discovery, yet the living princible is
here placed for it, may not this living princible
be as enormous as when it is given to describe
muscular action. page 18, or apts. 34 & 35 p 9.

agitated or move into another part of the Bath to preserve the first
sense of warmth. –
133. The Operation of generating cold seems to weaken an Animal
much more than that of generating heat, before an Animal
perishes in consequence of Cold sleep is induced, an irresistible disposition 
to which always comes on when the powers of action for the generation
of heat are exhausted. The case of Dr. Solander & the people
with him at the Terra del Fuego is a manifest & melancholy illustration
of this, after bearing for a long time an excess of cold several of the
Doctors attendants found this disposition to sleep. In spite of his remonstrance.
who was aware of the event to which it was prelude,
they lay down & slept & presently died. At length Dr. Solander felt &
gave way to the same disposition he had not been asleep above 5
minutes before his Feet became so contracted that his shoes fell off
them & he lost the use of his limbs, he was however found brot away
to the fire & relieved. –
🜍 135. The best Atmosphere for the human subject seems to be
63 to 60. Bear & Fox 50. – Lion & Monkey 70 – The Animals
inhabiting Cold Climates have stronger powers of generating heat
than the human, preserving every part of their bodies free from injury
in Countries where Men are losing their feet, hands &ca. from Cold.
Cold causes the hair of the Bear &ca. to grow much faster & finer,
hence they are better defended.

29
133. Nether excess of heat, nor excess of Cold will destroy the life
of an Animal, until its powers of generating Cold or heat are exhausted,
then the Animal must necessarily Perish. –
134. All the perfect Animals carry on their actions, in an Atmosphere
considerably below the temperature of the body, for it seems
a natural & healthful action, for an Animal to be constantly exerting
itself moderately in the generation of heat. –
135. Different Animals as above mentioned either preserve a standard
heat or have their heat increased or diminished with that of
the atmosphere, yet all animals require a certain degree of heat for the
standard in which their functions are best Performed, many Animals
are obliged to the atmosphere for a Standard heat whilst Man & many
of the perfect Animals, have from their faculty of Generation of heat
& Cold a power of giving a standard heat to themselves. 🜍.
136. The effects of a climate will correspond in a great measure
with the influence of the Sun in that climate, so that as the
Climate is exposed in a different manner to, & is differently acted

♂. 136. Between the Tropics the heat is greatest in Islands the
heat or Cold, is always more moderate than in Continents. Some 
Vegetables have a power of living in both extremes of Climate Some
Animals seem also to have this power, perhaps Animals of Passage
as Birds & Fish change their residence more from want of
proper Food, than from the inconvenience they feel from a given
Climate. Some Animals which have no power of getting their food
in the Winter, Nature has given a power of remaining during that
season in a torpid state, as the power of generating heat is not equal
to the degree of Cold nature has taken another method of preserving
Animals of the very frigid Climates [which] with down, fur, &ca. wch
are bad conductors of heat, so also whatever Animals have their
bodies will covered with hard fat, which is also (as Oils are) a bad
conductor of heat. –
Too much external heat produces diseases of the liver,
spasms, diseases of the Bowels, Tetanic &ca. diseases of Climates
are more slow in their action, & many of them depend on debility
as Chilblains &ca. Cold Climates also increase disease They are
not the causes of, as Venereal disease. &ca.

30.
upon by that body it will be hot or cold; moist or dry; or it will
hot & moist; or hot & dry. ♂. –
137 The effects of heat & cold will be greater according to the
degree of the surface of the Climate. A small surface will be less
hot or less cold than a larger.
138. The effects of Climate will be very great in Animal bodies
the imperfect Animals bear changes of Climate very badly. Man
& many Quadrupeds can accommodate themselves to almost any
Climate, yet great changes of Climate prove the causes of diseases
& destruction both to man & those Quadrupeds especially to the former
139. Besides our being influenced by heat & cold our bodies are surrounded
by & subjected to the influence of the atmosphere, which
will always be of the same temperature as the Climate we live in
140. This atmosphere having a power of dissolving a Variety of bodies,
will be a compound of many heterogeneous particles.
141. The Atmospherical fluids having a constant & powerful influence
on the Animal body, according to the nature of the particles
of which it consists, it will materially affect the health of Animals.
142. All Bodies which the atmospherical fluids take up & dissolve
are to be considered in a state & Volatilization to render
substances Volatile, some degree of heat is required, (perhaps the
lowest degree is sufficient thus to Operate on some bodies) according
to the degree of heat the atmospherical fluid, or the Air will
be enabled to take up a greater variety & a greater or less quantity

☿ 145. Thus the Plague jail fevers &ca are unknown within
the Tropics, another reason why hot climates are not so subject
to Putrid & Contagious diseases as might be expected is, as the Termites
described by Dr. Smeathman, eat up & destroy in a curious
manner amazing quantities of dead Animal & Vegetable substances
thus preventing them becoming putrid Enough to throw
off Volatile noxious Vapours to produce Contagion, it must be
highly Putrefied.
♃ 148. Habit & Custom &ca. -. Prisoners have carried the seeds
of the Jail Fever & communicated it to others by their cloaths,
though they themselves were free from it, of this we have had memorable
instances at the old Bailey & at Oxford Assizes. Again
persons who have never had the small pox themselves have nursed
others labouring under it with impunity, & have on visiting other
people who have never had the disease communicated it to them.

31.
quantity of bodies. –
143. The purity or impurity of the Air will depend upon the
quantity or quality of bodies dissolved in it, & its capacity of dissolving
them be according to its heat.
144. Cold Climate will for the reason given (139-140) be [cotens?]        
paribus, found the purest Air & best adopted to maintain health
nevertheless. –
145 Heat in warm & dry Climates has the property of causing
bodies taken up by & dissolved in the atmospherical fluid to be
decomposed & thus changing their nature renders them less 
noxious.
146. Heat & Moisture especially when dead Animal substances
are acted upon by the Air, produce the most unwholesome Atmosphere.
147. The Air will be injurious to the health of animals by affecting
them in three distinct manners. Viz+.
1st. By its being simply impure it lessens the fitness
of them for their several functions. –
2nd. By its containing specific particles of contagion.
3d. By its containing poisonous Vapour.
148. Habit & Custom are very powerful in enabling Animals to
endure without determent impure & unwholesome Atmospheres, to
some Atmospheres Animals cannot be brought to accustom themselves.
♃.
149. All irritating substances will not act in a state of vapour

♀. 150 Thus previous to a shower of rain we see the beast, running
to the Covert, the Birds flying to the Thicket, People with
corns are capable of presaging this decomposition of the Atmosphere
& also parts labouring under great debility.
“Hence doubtless people who have had Fractures have
the part where the Callus was formed sensibly affected on changes
of weather, is not this because new parts are weaker than Original
parts as will hereafter be shewn.
♄ 152. The Harmatan a Wind that blows from the interior Coast
of Africa, shews how much Winds may affect animal bodies, it
continues from 2 or 3 to 15 days; returning 3 or 4 times a Year, it
blows moderately, its accompanying Fog & Gloom are very considerable
surely this Fog & Gloom cannot be Animalculæ, as we do not find
anything produced by them, not the least moisture can be found in
this Wind, it makes the Lips & Fauces dry & chapped if it continues
3 or 4 days the Cuticle peels off, continuing a few days longer the
perspiration becomes Acrid & is so to the taste, it is yet highly Conducive
to health convalescents recover fast, also those labouring under
intermittents, Dysenteries, &ca. & are Cured, it checks Epidemics [but]
[the small pox did not appear] a number of people were innoculated 
at the accession of the Harmatan, but the small pox did not appear;
some inoculated after the Wind Ceased & recovered perfectly
except one Girl who died of a locked Jaw in consequence of a large
Ulcer from innoculation.

32
or are capable of Volatilization.
150. Water is in a greater or lesser quantity chemically combined
with Air, when a decomposition of this solution of parts in Air takes
place, Rain is produced, previous to this decomposition Animals
are sensibly affected. Brutes & Birds very much so, the human
subject unless unhealthy rarely perceives much difference. ♀.
151. The decomposition of substances in the atmosphere may be succeeded
by new compositions from which various effects may arise
hence to determine a priori the effects of Atmospheric Air is extremely
difficult.
152. Noxious particles taken up by the Air of one Climate may
be conveyed to another, thus Winds by bringing noxious particles
in their currant from distant places or Climates, may materially
affect [the] and alter the salubrity of any given Region. ♄
153. Matter will be found either in a state of perfection or imperfection
if in a state of perfection health is present, if in a state
of imperfection the reverse or diseases take place, this maxim is
universal, it will therefore hold good respecting Animals as well
as inanimate matter.
154. In order to Diseases being present three Circumstances must
take place
1st. Susceptibility of certain impressions
2d. Disposition arising from these impressions
3d. Action in consequence of a disposition
155 In respect to these requisites the body bears a perfect Analogy

☉ 158. Thus a strain gives occasion to Scrophula, a blow to
Cancer &ca. moreover different parts will be more or less liable to
disease, as they are more or less able to resist a diseased action,
this in general will be in proportion to their strength & weakness
the different parts of the body may have their natural actions very
dissimilar. Yet disease may produce similar actions in them, for
instance, the Lungs & the Liver have dissimilar natural actions in them 
yet disease produces a similarity of action when they are affected
with Scrophula a disease of which they are both susceptible, & which
is a specific affection.

33
Analogy to the mind, which must be susceptible of impressions, must
receive impressions, must have a disposition arising in it to which
an action of the proper kind must succeed. –
156. Susceptibility of impression is not sufficient alone to produce
disease but impressions of some kind must be received by
parts endowed with that susceptibility which, a disposition being
produced an Action naturally succeeds.
157. Disease bring a perversion of the regular laws of nature
observe less order, therefore their phenomena are less easily to be 
explained & accounted for than natural actions.
158. With respect to the changes taking place in the body we
know only the causes of them & their effects, we know not the manner
in which those causes, produce those effects. ☉.
159. We can judge only from the consequences of impressions of
the degree of susceptibility of the mind or body. The causes of actions
in the body, bears a strict analogy to the causes of Actions
in the mind.
160. As the human body is compounded of parts very Essentially
different the one from the other, the diseases of different parts will
vary very widely, so also the constitutions of different bodies greatly
vary & of course the susceptibilities of different impressions, in some
the susceptibility for particular diseased action is so strong as only
to require the habitual actions to be obstructed to run into disease
161. Constitutions will be either universally subject to the same
action as the indolent or irritable, or constitutions will be subject


             
 
 
 
 
     
                                    


34.
to some specific kind of Action whether local or general
162. Constitutions are both generally & locally subject to Particular
actions.
163. Constitutions are subject to particular kinds of both local
& general actions.
164. Constitutional Susceptibility may be three fold.
1st. Universal tendency for diseased actions of some kind
or other, where however the whole must be in action.
2d. Universal susceptibility of local action.
3d. Universal susceptibility to fall into an universal
disposition as though something was teizing the constitution as
an inflammatory fever &ca. –
165. Dispositions are natural, unnatural or diseased, of the
natural disposition of sensitive or irritable parts instances are
given in the secretion of Glands.
The unnatural are divided into three kinds Vizt.
1st. Disposition to restoration in parts Injured, as in
Fractures &ca. –
2d. Disposition from necessity as in Ulceration.
3d. Unnatural dispositions of all kinds, of which
great is the variety, the diseased disposition is that which
tends to the destruction of parts.
166. Every disposition to diseased action has a certain time
allowed to it, in which that action will be produced in some

🜔 167. A Girl in the West Indies had a disposition formed for Leprosy,
but it was sometime after she came to England that the
disease appeared; here there was a considerable space between
the disposition & action of the Disease. In some Specific Dispositions.
Years may intervene before the action Commences, as in Cancer.
We should be careful not to confound dispositions with
actions, dispositions are properly the disease, Actions the effect of
the disease, disease may exist for a time though its action is
superadded as in Ague.
🜖 168. Of the first we have instances in the small pox, Measles
Inflammations & Fevers, of the 2d. in Agues, where the disposition
to Action continues though the Action only commences & goes off at
stated Intervals. the disposition in the system for action remaining
undestroyed by the action, & until it has lost its power of conger exciting
the system to action the diseased disposition existing as much
between the fits, as during them: of the 3d. We have instances in
some specific diseases, as the Venereal (Gonorrhea excepted) Cancer
& others where the disposition notwithstanding the Action continues to
exist because it cannot produce its full effects hence it will go on
until it destroys, unless the disposition is removed by an immediate
increase of action. –

35.
sooner than others.
167. A disposition once formed will go on to action, and its ultimate
Action be produced, notwithstanding sometime intervenes
unless the disposition can be destroyed by some change affected in
the part or constitution where it has taken place. 🜔.
168. In Diseases, dispositions & their consequent Actions are of
three kinds.
1st. Where the disposition has its action frequently repeated,
without the disposition itself being destroyed by that action
taking place.
2nd. Where disposition is destroyed by action, & the Action
ceasing, the disease also ceases.
3rd. Where the different action continues to go on without
removing the disposition, until the progress of it is destroyed
by Medicine. 🜖.
169. Two different & opposite actions cannot go on at the same
time neither in a part nor in the whole, if by means of any disposition
a new action is produced, the first action ceases.
170. If two dispositions are excited not two different & neutral
actions will be produced at one time, but a third simple disposition
& consequent action will be generated, which will be entirely

170. Of this we have an instance in Dovers power which consisting
of Opium & Ipecacuanha, a narcotic & an Emetic, Sleep & Vomiting
should be the actions, but as two actions cannot take place at one time
a disposition to a third action arises which produces that third Action
& is called sweating.
☿. 172. Too little actions in any part produces weakness in it which
although not a disease itself becomes the cause of diseases it causes
irritability & thus gives rise to morbid or irregular affections as locked
Jaw &ca. Mr. Hunter says that if the Nerves are weak the Voluntary
parts suffer, if the stomach is weak the general system suffers.
🜍 173. Inflammation arises from too great a degree of Common
action, if a specific action accompanies it, a specific Inflammation
will take place.
☍ 174. By increased Actions in parts, we become sensible of their
actions which before we were insensible of, thus palpitation of the
heart makes us sensible of the hearts action, of this we have no perception
in a natural state of the Organ, the whole body being subject
to similar actions with those arising in parts as observed (7)
the first attack of a disease is probably intimated to the Mind by
the feel of health previous to the attack of some diseases, it is not
unusual for persons to be sensible of an uncommon degree of health
& spirits here the several powers are as it were summoned into
action, to resist & destroy disease.

36.
& altogether distinct from other two.
171. Of Susceptibilities for diseases there will be great variety as above
said ( ) for every disease there must first be a susceptibility, -
172 In diseases either too great or too little a degree of action
will take place & to these two general kinds of action all the Phenomena
of diseased Action may be referred. ☿.
173. Diseased Action will be common or specific, Specific Action
follow certain determined dispositions arising from peculiar kinds
of impressions. 🜍
174. When a part unused to a particular sensation has that
particular sensation, the first alarm or knowledge of Disease is
given to the mind, but the action of Disease is often so slow as not
to be sufficient for a long time to produce any sensation in a part. ☍
175. The whole Animal body will be subject to many actions &
degrees of action, similar to what arise in parts.
176. Whenever a part heretofore subject to the will takes on an
involuntary action the Disease is called Nervous.
177. Whenever the action of a part is [suspended] superior to the
strength a power of a part debility & perhaps the distinction of the
life of the will ensue. –
178. A Diseased action in one part may first produce a particular

♂ 178. Sympathy will hereafter be more fully Explained but an
example in illustration of the Text may be given in the pain in
the Knee being often the first Symptom of the disease in the hip
Joint, or again in Vomiting being excited sometimes by passing a
bougie through the Urethra though there is no pain. –
🜋 179. A variety of diseases have been considered as hereditary,
but it is only the susceptibility of any disease, so that the Child
shall be more susceptible of an impression producing that Disease
than other people, this is all that parents can communicate to their
offspring. Mania has been supposed hereditary, & in some it seems
to arise spontaneously without any apparent Exciting Cause, as impression,
an Explanation of this will be found ( ) where it is said
that in some, the susceptibility for a given disease is so strong
that they will run into it without any other exciting cause, than
simply [the] same obstructions to the natural actions, the small pox is equally,
hereditary with mania or scrophula, the Gout is also considered
hereditary but it is in general otherwise & brought on by irregularity
in living but it sometimes arises in persons under 18,
then it must be considered as hereditary in the same manner that
we have considered Mania to be hereditary, to originate from a strong
susceptibility of the given disease, ready to take it on without any
visible Cause, & only from some unseen one as the least obstruction
to the natural Actions. The Gout is a disease of the Constitution

37.
particular sensation in another part, thus the first knowledge of Disease
will often be conveyed to the mind by sympathy. ♂.
179. Actions [of] are not hereditary, but, susceptibility of impressions
the cause of disposition, the cause of action may be hereditary,
thus diseases are not hereditary but a susceptibility of impression
which is to produce a particular disease may be hereditary. 🜋
180. When the different specific impressions, naturally productive
of two distinct specific dispositions, are given to the system, two

until it falls upon a part & then the full action there being produced,
the local Affection relieves the Constitution. –
🜔🜹. 180. The small pox & measles cannot Exist in Action at
the same time, but one disease will be prevented from action until
the other has gone through its natural course.
Case 1 Mr. Pools was inoculated for the small Pox, in
a few days the redness round the punctures appeared but he was
attacked with measles which suspended for a considerable time
the Eruption of the small pox which however on the decline of the
Measles appeared & went through its usual Course.
Case 2d. A Lady was inoculated for the small pox,
the Measles appeared soon after & the further process of variolous
infection was suspended until the Measles was over.
Case 3d. A Boy was inoculated & the same Events
took place. –

38.
distinct dispositions to specific actions may be formed, but the action
of one will be suspended during action of the other, that being
finished the suspended disposition may produce its action. 🜔🜹.
181. Actions must always correspond with dispositions, if the dispositions
are simple, so will the actions also be.
182. Too great or too small a degree of natural action will cause
a disposition to disease.
183. In health there must be both a due degree of strength as
well as susceptibility of action, moreover the actions must be always
in proportion to the strength.
184. The human body is continually undergoing some changes.
it has been considered to be either in an increasing state, As
between Birth & Manhood when its parts are continually increasing
either in bulk or firmness; to be stationary, or preserving
with little alternation its strength & firmness during a certain
period or lastly to be decreasing, when it loses gradually its, Vigour
& firmness. but these three States or Conditions of the
human Body are not explained by Proofs, but it is difficult
to say, when the Body in all its parts is arrived at its perfect
state, & it is difficult to say that the body, as soon as it is
obtained to its perfect state, does not begin immediately to
suffer, though for sometime, indissensible yet a real & gradual
decay.
185. It is certain however that at different periods of Life

☽︎ 186. The diseases the first stage is particularly subject
to are scrophula consequently diseases of the Lungs, complaints
in bowels from Worms &ca. Hydrocephalus. The Young are
more disposed to local & especially universal sympathy.
The Middle Aged have few specific diseases, if we
Except Nervous & Hypochondriacal disorders they are however
accidentally attacked with the complaints of Youth & Age &
this lays the foundation for disease in a more advanced Age.
In the Aged we have a variety of disorders, here the
necessary actions are not well performed: proper to this Stage are
Cancer Calculi in the Urinary & Gall bladder & Ducts, Ossification    
of Arteries &ca. –
♂ 188. Climates. Climates are hot, Cold & temperate, in hot Climates
the involuntary actions are carried on with more violence
whilst the Voluntary Actions are more sluggishly performed.
So diseased Actions are carried on with more rapidity &
violence hence Diseases run through all their Stage in these Climates
faster than in others, when disease kills absolute, absolute
Death (that is putrefaction) quickly succeeds visible Death. Cold Climates
have not such variety of Diseases as hot ones, neither is the
progress of them so rapid. Cold invigorates the voluntary Actions
at the same time it lessens the violence of the involuntary Ones.
In Cold Climates, [from the irregularity of the] simple
Life is not destroyed until sometime after visible Life is departed, for

39.
the susceptibility of the body for different disposition will be very
different, hence different Ages will have diseases in some measure
peculiar to themselves & these may be divided into.
A. The Diseases of Youth
B. The Diseases of Manhood
C. The Diseases of Old Age.
186. The diseases of the first & last stages (185) are many those
of the second are fewer. ☽︎.
187. The Causes producing disposition to diseases are many
& various when impressions are given which are to produce
diseased dispositions, the dispositions will vary very much
according not only to the constitutional or natural susceptibility
of the body, but according to other circumstances.
188. Whatever can affect or alter the natural susceptibility
of the body, will produce variety of disease, therefore the difference
of Climate, Seasons. The Moon, the atmosphere will produce
differences of disease, & each absolute state of Climates
Atmosphere, Moon [&1/4?] Year will have disease or appearances in
disease peculiar to itself, moreover affections of the mind will
often produce diseased Actions, the weaker the natural powers
of Action in a part are the less able will that part be to resist
disease therefore tendons, bones &ca. have less power to resist disease
than Muscles &ca. ♂.

putrefaction does not so soon follow as in hot Climates.
Temperate Climates from the irregularity of the medium
between heat & Cold furnish us with a greater variety
of diseases than either of the others. Hence Scrophula, Cold, Agues
& such like disease abound.
Seasons. We may consider a change of Seasons as a
change of climate, & as in changes of climate dispositions formed
in one climate by a removal into another are retarded from coming
into action, so upon returning into one similar to the first go
through their action.
The spring at it were ripens Diseases & brings them into
a disposition, for a disposition may be found during a season
which has not sufficient influence to bring it into action, as
the Winter; but in a season more favourable to the forwarding
that disposition, as in the Spring that disease has been brought
into action, so also in hot climates.
The Moon becomes often the immediate cause of diseases,
especially those in which the mind is particularly concerned,
as in Madness; which is always more violent at certain times of
the Moon, the full of the Moon also affects people whose brains
have been contused by any External Violence, this was instanced
in a Lamp lighter who received a fracture of the Cranium with
concussion of the Brain, he was trepanned & recovered, but ever after
found himself much affected by the full of the Moon. The seasons
of the Year affect the influence of the Moon on the human body,

40.
Note Continued.
the lamp lighter was additionally affected in the Spring.
A person of very scrophulous habit was very subject to
deafness at the full of Moon except in Autumn. –
Affections of the mind. Every Action voluntary or involuntary
may be affected by changes in the Mind; by a peculiar
state of it blushing may be produced, other states of it Excite Vomiting,
sickness, irregularity of pulse, diarrhea, discharges of Urine
Spasms &ca.
The Diseases on which the mind has the greatest influence,
are those in which increase or diminution of Action takes
place without any alteration in the structure. Constitutions that are
called irritable have the active parts more under the direction of
the Mind & less under the command of the will. The state of the
mind greatly affects, the involuntary Actions, that have already
taken place in consequence of disease. Agues have been cured by
affections. of the Mind, local Affections are even altered by the same
means. Tumors have been cured by rubbing them with a dead
mans hand.
189. Diseases are
A. Local
B. Constitutional
or
C. Mixed. –
We judge of the presence & nature of Diseases by their [specific]


 
     
                                    


41.
Symptoms, a symptom is a sensible effect of a peculiar action
Symptoms are either to be referred to the mind or to the senses. The
former only known by the Patient as pain &ca. the latter Perceptible
to the Physician as the state of the Pulse &ca.
When the symptoms are not expressive of the disease we
call them Anomalous symptoms & are either local or universal.
190. In simply local diseases a part may suffer, the General
health of the Body still remaining unaffected, in the Mind both apart
& the constitution are affected. –
191. Diseases may be originally local, or originally constitutional,
& again they may be constitutionally universal or constitutionally
local, or lastly they may be originally local, & at length affecting the
General system become constitutional.
192. The originally local (191) & the Originally Constitutional may
arise in the same person at the same time independant one of the     
other.
193. Dispositions as above said must be formed previous to the
Existence of disease, so that there will be a disposition to produce
originally local effects, an universal disposition to produce local Effects
&ca. –
194. An originally local Disease may take on a part of the Constitutional
one when the former has only been common diseased action
but a local specific disease will not take on a part of a specific constitutional
disease unless the latter has superior powers, in which case
the former local action will be suspended during the presence of a new

10
195. This should seem to refer only to common diseased action
of this we have an instance in fevers curing or increasing an
Ulcer, or a sore increasing.
☿. 201. A – as in diseases of the hip, where it is no uncommon
thing to have the patient complaining of his Knee.
B – as when a stone in the Kidnies produces Sickness & vomiting
as an impression given to the Urethra produces often a
swelling of the Testicles though the Urethra at the time the Testicles become
swelled shall be free from Complaint.

42.
Specific Action.
195. A Constitutional disease may be the cause of increasing or
diminishing local disease & a local disease may be the cause of increasing
or diminishing constitutional disease.
196. It frequently happens that a local diseased appearing some
other will appear.
197. A diseased action once formed will go on increasing, until
either it is destroyed by a new action being induced in a part or
constitution, or until the parts to which it is spreading lose their
susceptibility of the disposition to that action or until it produces
an Abolition of Life.
198. Diseases will be either common or specific.
199. We cannot increase specific diseases, unless we can increase
the susceptibility of the constitution of these diseases. Every
specific Disease will have two modes of Action, the Specific & the Common.
200. If the constitution or a part is susceptible of impression
from a peculiar stimulus & a peculiar disposition is Excited then
a specific disease may be produced & that specific disease may be
either local or Constutional.
201. When A an Impression is given to any part susceptible
of action, & the action is not produced in the part to which the impression
was given but in some other part, or B when an Action
formed in one part produces an Action in another part, or when an
action is formed in one part & the sensation resulting from that action
is felt in another part, sympathy takes place. ☿.



   
     
                                    


43
202. the part (201) receiving the impression is the Sympathent, the
part in which the new consequent action, or the sensation arises,
is the Sympathizer.
203. A...Sympathy is simple or Compound.
B...Similar or dissimilar.
C...Regular or irregular
D...Natural or Unnatural.
E...Real or delusive.
F...Partial or universal.
G...Contiguous, continuous, or Remote.
H...Common or uncommon.
204. The more simple the structure of the being, which is the
subject of the operation of sympathy, the more simple will the
sympathy be found, even some Vegetables are susceptible of it,
as the sensative plant, whose leaves successively dropping on
approach of the hand arises from this simple sympathy between
the different leaves, in successive order sympathizing with one
another. –
205. In the more compound being as the perfect animals the
sympathy may be more complicated, for an impression being given
to one part becomes the cause of action in another part, the action
in the last part becomes a cause of action in the third part. & that
again in a fourth part, hence in many Animals sympathy may
become exceedingly complicate.

206. If one part is affected with pain & another part by
sympathy gives the same sensation then the sympathy is similar
& vice versa – A pain in the Testicles producing by
sympathy sickness in the stomach. the sensation & action in
the latter being different from those of the former the sympathy
is dissimilar.
♄. 207. We observe affections of the brain produce sickness and
Vomiting & this almost invariable here we have an example of
common or ordinary sympathy by attending to this division of
sympathy we learn a knowledge of the symptoms of diseases,
some common sympathies though but few arise in consequence of
disease only & are therefore unnatural, such is the sympathy between
the shoulder & the Liver between which in health there
seems to be no sympathy.
♂. 210. The Father of the great Lord Chancellor Clarendon, had
a stone in his bladder he was affected with it many years & it
was painful, it was always accompanied with a pain in his Arm.

44
206. When a part receiving an impression, an action is formed in
it, & a like action is consequently produced in another part the Sympathy
is similar, but when the action in the one or sympathizer is
different from the action in the other or symphathent, the sympathy
is dissimilar.
207. When an action of a peculiar kind in the Sympathiser has always
been observed to follow an impression & action of a peculiar
kind in the sympathent, such an action in the sympathiser arising
consequent in the impression & action in the sympathent, is called
common sympathy, as also where a particular part being the sympathent,
another particular part, has been observed, to be constantly
the sympathizer. ♄.
208. When an action of an unusual kind arises in a sympathiser,
or when the sympathiser is a part unused to action consequent on
an action in a given sympathent, uncommon sympathy is said
to arise.
209. Sympathy is natural when the sympathent receiving an
impression not productive of disease, & healthy consequent action is
induced in the sympathizer, thus the breasts of Women are affected
previous to coming on of Menstruation.
210. Unnatural or diseased sympathy is when an impression
given to the sympathent produces an affection of the sympathiser,
inconsistent with its healthy or natural action so scratching
an Issue in the Thigh which itched has produced a difficulty of
breathing & a pain in the breast. ♂. –

🜖 211. Delusive sympathy. A Man in a fever & delirium,
when he wanted to go to stool, always signified to the By standers
that some other Person whom he talked of or pointed out wanted to
Ease himself referring his sensations to some other individual. –

45
211. Sympathy is real when the mind refers to the affection or Sensation
produces to the proper sympathiser, & delusive where the mind
refers the Sensation, Action, or Affection, to a sympathiser between wch.
& the sympathent no possible connection can exist. Thus when a
Man under Idiotism or Delirium, has an impression given to any
part of his body, & his mind believes the sensation consequently
produced not to exist in himself but in some other person, he is
under a delusive sympathy. 🜖.
212. Sympathy is partial where one or more parts of the body
are sympathisers, some given part being also the sympathent.
It is universal when an impression, being given, or an action
Excited in any part, the whole constitution sympathizes with it
so a wound being made in the Knee, a fever which is the action of
the constitution sympathizing with a part will often arise. –
213. Sympathy is continued when a part receiving an impression
& a consequent action arising in it, the parts immediately joining
& connected with it are also thrown into action, thus when an Inflammation
arises in a part, as the Skin, & spreads wider & wider
the parts of the to which Inflammation spreads from the first point,
are suffering by continued sympathy.
214. Contiguous sympathy arise where an impression being given
to or an action excited in a part or parts contiguous to, but not
joined & immediately connected with the Sympathent, becomes the
sympathiser, thus an affection of the Integuments of the Abdomen
will produce consequent affection of the bowels.

☽︎. 219. I must remark on the text that the strength of partial & regular
sympathy will be in the Ratio of the powers of life. I think
here we must make a distinction between a readiness or susceptibility
of sympathy, & a strength of sympathizing action, perhaps debilitated
& most irritable persons & those in whom the powers of life are weakest
are the most ready to fall into sympathy of every kind, but the strength
of the sympathizing action in them will be but little, because the
sympathiser can have but little powers of Action.
♃. 220. The Brain Sympathizing with some other part, convulsions,
Epilepsy, or a sudden abolition of the visible Life, may be the
Event, the action in the sympathiser being here more violent than in
the sympathent.

46.
215. The sensitive principle the principle of Life & the Mind
mutually sympathize with each other so that affections of the one,
will produce affections of the other, or of both the others.
216. Remote sympathy is where the part which is the sympathiser,
is distant from the part which is the sympathent, as when a
diseased Testicle shall produce a sickness at the Stomach.
217. some parts are more particularly disposed to become sympathizers
than others, the stomach will sympathize with any part
of the body.
218. Particular habits are more disposed to universal sympathy
than others, the less determined in the disposition to partial sympathy,
the greater will be the disposition to irregularity & universality
of sympathy. Thus Infants are peculiarly subject to universal
sympathy, because when an impression is given to any part of
their body their partial sympathies, not being yet settled, or determined,
no particular part is disposed to become the sympathiser,
but the constitution takes up the sympathizing Action.
219. The strength of regular & partial sympathy will be greater
in proportion to the strength of the powers of Life & vice versa. ☽︎.
220 The affection of the sympathiser will often be more violent than
the affection of the sympathent, but this will depend on the number
& nature of the part & parts taking up the action of the sympathent
& thus becoming the sympathiser. ♃.
221. The vital parts are particularly disposed to partial sympathy
between one another, the further parts which are the sympathents

♀ 221. Thus in Diseases of Extremities, the Constitution is Exceedingly
ready to run into hectic Fever, as in white swellings of
the Knees, Arms or Ancles; but the latter part of the Text in this
Aphorism can only refer to the non vital parts for the constitution
is always most disposed to sympathize when a part necessary to
Vitality is affected. –
☉. 222. Instances of mutual sympathy are but few, the Stomach
will indeed sympathize with the head & the head with the stomach
but the liver is perhaps never the sympathizer when the Shoulder
is affected, though a Morbid change in the Liver produces very commonly
an unusual sensation in the Shoulder. –

47.
are removed from the heart, the greater will be the disposition of the
constitution to sympathize with them ♀.
222. Sympathy being only a secondary Action will cease when the
first part is destroyed, thus if a diseased & Ulcerated joint is attended
with hectic Fever, quick pulse, restless nights &ca. almost immediately
after its removal by amputation the pulse grows slow & calm
& the Patient recovers his sleep. ☉.
223. Sympathy is of many & important uses in the Operations of
life, it connects the principles of different parts, it enables one
part to assist another in the performances of its Operations possibly
when one part is affected with pain by enabling another part to take
on pain also, & thus diffusing the sensation it lessens its violence as
the same quantity of Pain concentrated in one part might be insupportable
to the Animal, but by its being diffused over other parts
the Animal is enabled to endure it with less injury.
224. Sympathy leads us to the knowledge of the causes, nature
& seat of diseases by observing in what manner one part becomes
affected from a prior indisposition of some other part, we learn frequently
from the sympathiser, the state situation & manner in wch.
the sympathent is affected.
225. But sympathy often leads us astray, & causes our judgement
to err, when the sympathiser is only sensibly affected we
refer too frequently the Disease to it entirely, over looking or not suspecting
the affection of the sympathent. (see the notes) We are moreover
often led to imagine from considering the Phenomena of Sympathy,

♂. 225. Thus a Man, having been used to fits of the Gravel if
seized either with a pain in the back or from any
other cause refers his pain to a Nephritic Affection (see symptoms)
228. How can it be proved that water is present in all
animal fluid, so as to act as water in the solution
of substances? for though in the analysis of animal [flu??]
water may be found, yet the process of that analysis
may be separated this water from combination in [wh?]
the nature of water was totally different. Consequently
water in this combination cannot act as it would other
do as a solvent.

48.
Sympathy, parts to be Sympathent, which are free from the action
in question, so also when the mind of the patient has been long
habituated to a particular Idea, it frequently but falsely refers
many sensations to the same cause, that had given rise to that
particular Idea, which sensations arise from the Causes. ♂.
226. When Medicine or Artificial means are employed for the removal
of Diseases, produce either a partial or universal effect,
it is to be considered as a kind of Violence done either to a part
or to the constitution. –
227. Before a Medicine can produce any, except Mechanical effects
upon the constitution, it must be reduced to a state of solution.
228 There is one property only in all the Juices of an Animal
body which is common also to one fluid out of the Body & by the
solubility of substances, in which fluid we can judge of their solubility
in the Animal juices, now all our juices are more or less
of a watery nature. Hence substances soluble in water will also
be soluble in the Animal juices.
229. But not only the substances (219) are soluble in the Animal
juices, almost all substances are so in a greater or lesser degree &
most of them are so in the mouth, as we know by their giving their
impression by the Taste, previous to their doing which they must
be in a state of solution, no substances having any but a Mechanical
action on a part which are insoluble in the juices of that part (228)

232 may not different degrees of galvanic action
be the cause of the separation of the various juices
for what[ever] other cause is so probable.

49
230. many substances are soluble in the Stomach though insensibly
as Earths, which are neither soluble in water, nor in the Saliva
& consequently are insipid. –
231. For a Medicine to produce universal Effects it must be dissolved
in ye Blood.
232. The Blood is a kind of Universal Menstruum for Substances
being found incapable of solution in it. Its properties
of retaining at once so many substances in a state of solution,
may arise from its heterogeneous nature, for it is well known
that a fluid that has dissolved one substance, tho’ it will perhaps
take up no more of that Substance, yet will even by means of that
substance be enabled to dissolve a second Substance for which it had
otherwise been an improper Menstruum; thus Water when pure
will difficulty dissolve Corrosive sublimate, but a saturated aqueous
solution of Sal Ammoniac will enable the water to dissolve abundantly
more of the sublimate, than in its Elementary state it
would have done, so also water impregnated with fixed Air to Saturation
will still dissolve other substances, & even such as unmix’d
it would not have acted upon.
233. Medicines dissolved in the Animal juices have a power
of influencing both the Nervous & Living principle.
234. Medicines perform their operations by their
(a) Stimulating
(b) Irritating or
(c) Sedative powers, & by the Animal body having

are not the stimulation the irritating & the sedate
all chemical.

50.
a susceptibility of that Operation but never produce any change
unless when they act as caustics by any Chemical Operation. –
235. The powers a.b. (234) are to be found in the same Medicine,
the quantity in which it is applied only making the difference.
236. Stimulating Medicines only produce natural action or
increase one already present; Irritating Medicines diminish action
whether natural or unnatural, each of these may produce
both partial & universal effects. –
237. The influence of stimulants, will be as the power of the stimulant,
& the nature, & powers of the part taken together. The same
will also be the influence of an irritation. –
238. The influence or operation of the same Medicine on different
parts will be extremely different, so also the action of Medicine on
a second part will differ from its action on the same part when
in a state of disease.
239. In order to understand aright, the influence of Medicine we
must consider parts as capable of suffering four actions Vizt.
1st. The Action of Health.
2d. The Action of irritation on health.
3d. The Action of Disease.
4th. The Action of irritation on Disease.
240. Irritation acting upon health produces diseased action, Irritation
acting upon disease produces or restores health.
241. As parts are susceptible of a variety of diseased actions the

🜔v 247. Friction can be applied to a larger surface than pressure.

51.
removal of one diseased action by medicine will not always produce
a return of health, a disposition to some other diseased action
may have been formed, & wait only for a removal of the present diseased
action, to go on to its proper Action. One action can only exist
at one time in one part ( ).
242. The irritation of medicine on disease, may although it removes
the present disease, even induce a disposition to some
other diseased action, which as soon as the first action ceases, may
go on to its action.
243. From (241-242) it is evident, we should be careful to discriminate
the consequence of disease, from the consequences of Cure,
we may otherwise persist too long in any mode of Cure.
244. The powers of the living Animal may also be affected by
mechanical means The operation of the application of mechanical
means may be reduced to two Species. Vizt.
A. That of Pressure
B. That of Friction.
245. Both A. & B. (244) produce the same ultimate Effects as
Medicines. –
246. Pressure seems to impede action, it is also of use as a stimulus,
if applied more forcibly it irritates.
247. Friction does not seem to impede but excite action, if
violently applied it irritates, if gently it stimulates. 🜔v.
248. Medicinal applications may produce their Effects either

  
         
     
                                    


52
simply by contact, or by exciting sympathy.
249. It is rarely Medicines act simply by contact, their influence
being carried by Sympathy generally much further than the
parts to which they are immediately applied. –
250. The effects of medicines acting by Sympathy, may be thrown
into the same divisions as the actions of Sympathy particularly
they will act by continued, contiguous, or remote sympathy.
251. In directing the administration of medicines it is necessary
to have respect to the strength & weakness of the part or constitution,
& to the too great or too little action of the part or constitution.
252. As in health the action of a part must be always in due
proportion to its strength ( ) so in your Endeavours to restore
health when impaired, we must always endeavour to proportion the
degree of Action to the strength.
We must never increase action when strength is deficient
without endeavouring to increase strength likewise.
253. A. Strength & Action may both be diminished or Increased
B. Action may be increased, & strength at the same time be
diminished.
In one case A., it must be our care to increase both
strength & Action.
In the other B., we must either reduce the action to the
strength, or increase the strength so as to level it with the action

at the moment of act of solution what change
takes place, does an electric action accompany the chemical
if it does the new solution may acquire new properties of
electric matter, & then modification may effect the animal
the modification too may effect growth of the different
vegetables for how can you account for the same plant
acquiring properties different from in another & the
same situation is then the effect of different organization
or different galvan action.

53.
254. Weakness & want of action are not the same, a part may
have Weakness, & yet too great action, we judge more readily of
too great or too little action than of strength & weakness, because
the former are effects, the latter are often causes.
255. Medicine may act by contact (249) or by Sympathy ( )
256. Medicine may also be absorbed (see absorption (1)) & when
absorbed will again exert their action by sympathy or by Contact,
by contact they may affect either the Lymphatics of the part, or
of as much of the Lymphatic system as they pass through, or again
when mixed with the Blood may by contact affect the constitution
in general.
257. There are also applications which penetrate beyond the surface
to which they are applied, as heat, cold, Electricity
258. Heat [sometimes] increases the Vital & involuntary actions
though it is considered as penetrating it cannot produce that
effect beyond a certain degree because the animal is incapable
either in a part or the whole of receiving or containing a certain portion
of heat.
259. With respect to cold, also the same reasoning will apply the
Animal powers whether in a part or in the whole, will neither
receive nor part with more than a certain quantity of heat, that
is without destruction of its principle of life.
260. Electricity indeed in every capacity of the Animal is Universally
penetrating, as no circumstance or difference in the capacity

more electricity than the natural quantity increases
action.

54.
of the Animal can obstruct its passage.
261. Cold, heat & Electricity are capable of powerfully Exciting Action,
we must therefore be extremely attentive to the circumstances
& degree in which they are applied, least we sometimes excite
an action superior to the strength.
262. Cold applied to the surface of the body may become a Stimulant
& Rouser, or a seadative & weakener.
263. In the first instance (262) it produces heat, in which it
agrees with the warm Bath, with this difference that the latter in
some measure gives heat to the Animal the former obliges the Animal
to produce its own heat, here the powers of generating heat
are increased the Pulse quickens the actions of health are in general
increased. these Effects show the Animal is in full
powers of restoration.
As the cause of these effects is instantaneous, so the Effects
will be but temporary therefore the cold applications must at due
intervals be repeated.
264. In the second instance (262) it proves a sedative & weakener
where the parts to which it is applied either can give no
Alarm to the constitution or the parts, or the constitution have its
power of generating heat diminished here all the consequent
actions will be the actions of weakness.
265. Cold may produce various effects by sympathy even local.
266. Heat is either absolute or sensible, the latter we shall here
notice.

♁. 269. For the general properties & effects of heat & cold, in Animal
Bodies, see the Text & Notes on heat, Cold & Climate. –

55
267. We judge of the sensible heat by our senses, or by
measurement, this sensible heat is either Native or Foreign.
268. Foreign heat in its application will produce different effects,
as it is applied simple, or compounded with  bodies capable
themselves of exciting action.
269. Foreign heat is applied with two intentions. Vizt.
1st. to increase the warmth of the Animal
2d. to act upon the principle of Life.
Heat has the general property of increasing the violence of the
involuntary actions. ♁.
270. According to the degree in which it is applied it will be
either irritating or sedative.
271. Substances compounded with that heat are applied either in a
dry or an humid state.
Heat in dry vapours can be medicated with Essential
Oils, Spirits, &ca. The warm bath is an example of humid bodies
compounded with heat.
272. The Bath ( ) is generally used with a degree of heat
something below that of the Animal, or in a degree above it, the
former is called the tepid Bath, the latter the hot Bath.
273. The former seems in general to soothe the Skin & by Sympathy
to affect other parts with an agreable sensation, hence it
rarely depresses nor does it in general Excite any increased action
further than simply freeing a part from disease.
274. The hot bath produces more powerful effects, by exciting

🜔. 276. Muscles heal or are restored to health more readily
than bones or ligamentous parts, the cellular substance will
take on the healing process more readily if placed about Muscles
than if placed about Tendons or bone &ca. taking on in general
the disposition of the parts it is subservient to.

56
an increased action on the surface it may produce relief to the
internal parts if continued for a length of time it produces weakness
but not commonly a permanent one.
275. It is observed above ( ) that different parts will be more
or less able to resist disease. In the same manner in different
parts when diseased there will be more speedy or slow advances
towards health, & this from the same Cause. Vizt. the difference
in strength or weakness.
276. Parts in which actions are excited with the greatest difficulty,
fall into diseases more slowly, & when diseased are more slowly
restored again to health. 🜔.
277. Touching the slowness or readiness with which parts diseased
recover their health much will depend on their situation in
the body.
278. The power of healing or the facility with which parts diseased
recover their strength or health will also be different during
different ages, other circumstances being similar.
279. This power (278) will be greater [more or less] or more active,
during the growth of the subject than after the growth is
stopped, during the middle age or that which is called stationary
( ) though this is not well ascertained / the power of healing
is less Active, but it will be the least active of all during the state of
decline when [Life] the System seems to take a retrograde motion
& nature begins to unbuild. ( ). –

🜔🜹. 282. A scrophulous Joint, an ill conditioned Ulcer, an
ulcer in the Lungs, or any other similar cause may produce
a constitutional affection & these existing in such a state the Constitutional
affection cannot be removed.
♎︎ 283. Thus the Cranium is at first membranous, it afterwards
in due time becomes bony, or its bones shoot in membranes
if by fracture or other violence a part of it is removed, in the
restoration first membrane is formed & afterwards bone so in
the cylindrical bones as they were at first cartilaginous, when
restoration in consequence of injury becomes necessary, the Union
is first by Cartilage afterwards by Bone.
☿ 284. If a part of a tendon is destroyed as by a Wound &ca.
the injury extending in other parts as Skin, Cellular Membrane
&ca. the Process of restoration being begun, the Union will not be
formed by means of a regeneration of Tendon.

57
280. It frequently happens that one disease will prove the cure
of another. –
281. One local disease being produced may remove a prior
local disease, a constitutional Disease arising may prove the
cure of a local disease ( ) & a local disease arising may
cure a constitutional one. ( )
282. Constitutional Diseases cannot be cured whilst parts are
continually adding to the constitutional affection. 🜔🜹.
283. When loss of substance happens in any part & that loss
is to be restored, the parts which restore the loss or which regenerate
the substance to fill up the loss, in their action for that
purpose [produce] preserve the same disposition with which they
were at first formed. ♎︎.
284. The law (283) does not however universally hold good
as circumstances being present may prevent its operation. ☿.
285. Inflammation, is an increased action in a
part, it is difficult to determine whether it differs from common
Action in a part except in degree.
286. Inflammation is the first principle in Surgery, it is the
cause of many local diseases, it is the means of preventing the
increase of many local diseases, & it is often a powerful instrument
in their Cure, it operation are chiefly performed by the small


  


 
   
    
                                  


58.
Vessels, the larger ones doing more than bringing the
blood to them.
287. It may be divided into
1. the Healthy
2. the Unhealthy.
The first that which is attendant on any healthy
state of a part of the constitution, the other that which attends
on an unhealthy state of the part or Constitution.
288. It may be divided into.
1. Single
2. Compound.
The first the Action of Inflammation alone
the second the Action of Inflammation with the modes of
action
289. It may be divided according to its Effects into
a. The adhesive.
b. The suppurative
c. The Ulcerative
290. The parts Subject to Inflammation are
a. The cellular membrane & circumscribed Cavities.
b. All the Canals & outlets of the body.
291. The three Stages or States of Inflammation may have
a fourth superadded. Vizt. that of a specific disposition to Scrophula

▽. 293. By the effusion of coagulable Lymph & its gluing
up the Cavity, or confining the extent of the inflammation
& in fact a Cyst is formed to contain the purulent matter
when formed, hence we see how matter is confined to one
spot instead of being widely diffused, by it also is formed
a Cyst round Musket Balls, pins, Glass & ca.

59.
Scrophula.
292. In the order (a. 290). The adhesive generally begins first
the suppurative & ulcerative are its sequels. In the order (b. 290) 
The suppurative begins & the ulcerative or adhesive follows.
293. In the adhesive inflammation coagulable Lymph as by
the increased action of the Vessels speedily thrown out between
the surfaces of the Cavities one to another, & thus entirely obliterates
them. ▽.
294. Inflammation is frequently carried no further than
the adhesive (293) & then it may terminate by what is
called Resolution.
295. The adhesive inflammation often prevents an increase
of local disease, it sets bounds to its own progress & it
prevents the diffusion or extent of the suppurative inflammation
when it takes place.
296. The coagulable Lymph thrown out in Inflammation
(293) always partakes of the nature of the solids, which seperate
it.
297. The termination (294) does not always take place when
it does not happen if in the violence of the action the
death of the parts does not ensue the suppurative stage
takes place.


 
 
  
  


 
   
    
                                  


60.
298. The suppurative stage will arise when the death of a
part has actually taken place, but the surrounding parts
have not suffered the same absolution of their vital principle
here indeed the dead part may be considered as a foreign
substance & as a Stimulus to inflammation to those that
surround them.
299. Particular circumstances arising in different parts
of an animal body, the parts may be disposed to absorb
themselves & so to produce a solution of continuity, the Inflammation
attendant on this action is the Ulcerative (289 c)
300. This is commonly the sequel of the suppurative Stage
& therefore may for the most part be rather considered as a
consequence of that stage than as the affection of an original
disposition in a part.
301. This (300) is however not always the Case, it sometimes
arising without a part previously undergoing suppurative
inflammation. –
302. The general order in which inflammation proceeds
in the cellular membrane (290 a) is
1st. Adhesive
2d.. Suppurative
3d.. Ulcerative.
303. But this order is not always observed. The suppurative

☽︎☉ 304. When inflammation attacks the canals, it rarely
goes beyond the suppurative affection as those parts do not
readily fall into Ulceration, adhesion will arise still more rarely
the ulcerative inflammation being in these parts so uncommon,
granulations of course will as seldom be found to take place.
309. This arises from a particular original disposition in the
part brought into action by the fever or by a part taking up an
Universal disposition.

61.
Inflammation will sometimes arise without the adhesive previously
taking place, here the Disease & the extravasated fluid
will be widely diffused this is the Case in all the Erysipelatous
suppuration.
304. In the Canals or outlets of the Body (290 b) the suppurative
generally begins, the ulcerative follows to which the
adhesive succeeds. ☽︎☉.
305. The Erysipelatous affection attacking the parts the order
is here also disturbed, the adhesive or Ulcerative arises
first & the suppuration succeeds.
306. Whatever can increase the violence of the action of parts
may be called a cause of common inflammation.
307. A part will take on the affection of the constitution,
that is an universal affection may become a local one, hence
therefore a cause of local inflammation may be traced.
308. The abscises arising after the termination of specific
febrile constitutional diseases, as Small pox, Measles &ca.        
have nothing specific in their nature, they only arise in consequence
of the common disturbance the constitution has suffered
from the fever if the disease.
309. Simple inflammatory fever may be followed by an Abscess
in a part (308).
310. The remote causes of Inflammation are four Vizt.

  
 
 
  
  


 
   
    
                                  


62
1st: From accidental Violence.
2d: From irritation applied to the part.
3d: From a particular disposition to the part itself.
4th: From a general state of the Constitution affecting
some particular part.
311. Many constitutions have a disposition to specific inflammation,
& will fall into it whenever any exciting cause shall
arise as in Scrophula & in habits subject to Erysipelas.
312. Many parts of the body have a greater tendency to specific
diseased action than others, so any constitutional Affection
arising these will readily take on a diseased specific action.
313. Specific inflammation may be.
a. Specific & healthy, or
b. Specific & unhealthy.
314. Different parts more or less readily take on different Inflammation.
External parts are more inclined to the suppurative,
internal parts take it on less readily suffering [them]
even the presence of foreign stimuli a longtime without going into
this Stage; Vital parts do not readily admit of the suppurative
Inflammation tho’ they willingly take on the first & most simple
inflammation.
315. When a part is inflamed that is not essential to Life the
Constitution does not necessarily sympathize with it, unless from

♀. 316: There are two powers which can produce a change in
the state of the pulse, that of the heart, & that of the Arteries,
the regularity or irregularity will depend upon the heart, the
hardness, fullness, softness & smallness will depend upon the Arteries.
🜔🜹. 317. The effects of Inflammation on different parts.
Stomach. Quick small & hard, sometimes low
pulse, nausea, dull heavy pain, depression of mind.
Small Intestines. nearly similar
Large Intestines: pain more acute, general depression
less nausea:
Liver. This procures besides its own peculiar
symptoms effects somewhat similar to inflammation of the Stomach.
Heart. Its motions are confused & irregular
the pulse quick & lower than common.
Uterus. Great oppression, nausea & obtuse pain.
Lungs the heart frequently sympathizes 

63
the long continuance & violence of the inflammation for here the
operation of inflammation may be carried on without interrupting
the functions of the Vital parts
316. But of the constitution of the patient is very irritable &
readily takes on sympathy nearly the same Phenomena will
arise as in inflammation of the Vital parts; the Pulse will
grow small quick & hard; blood drawn off will be sizy but loose
& its superficies flat, the violence of pain will however be greater
than in the inflammation of the vital parts. ♀.
317. All parts supplied with their Nerves from the intercostals
& par Vagum when attacked with inflammation give symptoms
of lowness, & depression. 🜔🜹.
318. The termination of Inflammation will take place the quicker
the nearer it is to the heart.
319. The pulse growing quick after the commencement of inflammation
is a proof of the constitution becoming affected on
sympathizing.
320. On the commencement of inflammation Rigor is frequently
felt, this is not simply from the debility induced into the constitution,
but also from the Novelty of the action which it performs
but weakly because it is not prepared for, nor accustomed to
it.
321. In Rigors & Syncope the blood is collected about the

preventing a full diastole; when the Muscles are inflamed the
pain is acute, the pulse full & strong. Inflammation of the
bones & Tendons produces a dull heavy pain & the Stomach generally
sympathizes.

64
internal parts, & the External are left in some measure empty.
322. Every new Action in the Constitution must tend to induce
weakness in it, its Effects will however vary in different constitutions,
in the strong it will excite the general powers of action &
an hot fit will soon succeed, in the weak the hot fit will not always
be produced but only a clammy sweat succeeds.
323. Rigors are not attendant on the commencement of Inflammation
alone every new action in the constitution may be accompanied
by them.
324. Life cannot go on always in the same state it must have
its stated seasons of rest & action, hence even in the most continued
diseases, & when the cause is unvaried there will be intervals of Alleviation
& exacerbation, nature observing her general Law rests even
in disease.
325. Exacerbation may be considered as the renewals of the commencement
of diseased action, & so a kin in some measure to
Rigor...
326. Disease may exist & yet the constitution may be insensible
to its action, it may want power of keeping the constitution in
action beyond a certain time in ague the disease exists as much
between as during the Paroxysms.
327. From ( ) it is evident that a change arising in the constitution,
a change in the Blood as partaking of and possessing
the living principle may take place also.


   

        
  
 
 
  
  


 
   
    
                                  


65
328. The appearance of the Blood will not be always the same
under given symptoms of constitutional affections, such as the
state of the pulse &ca.
329. Inflammation begins at a point at first, all the local
symptoms being confined within a small compass, afterwards
it spreads according to the state of the surrounding parts wch.
may be either local or constitutional, as the surrounding parts
are more or less in health they will be more or less disposed to
continued sympathy, at length the inflammation & redness will
be gradually lost in the surrounding parts.
330. Inflammation is attended with a swelling of the part
the more healthy the more the swelling will increase at a
point.
331. The swelling of a part arises from the Vessels of the part
being more distended with fluid than natural from the Extravasation
of coagulable Lymph, & of some serum, which is
known from the Oedema of the surrounding parts, the less extensive
the Oedema is & the firmer the Margin of the Inflammation
is the more healthy inflammation will be present for here
more coagulable Lymph & less serum is thrown out.
332. The colour of the inflamed parts (329) will also be altered
the nearer it approaches to a pale scarlet redness the more healthy
the inflammation will be, the less healthy the inflammation
is, the colour will be less of the scarlet & more of the darker red

♂. 337. Mr. Hunter threw Tartar Emetic qts. iij into the Veins of
a Bitch, it soon vomited her, she became Convulsed & died, she
was astonishingly Cold during Vomiting & upon opening her immediately
after Death the heart & lungs were found remarkably Cold. –

66.
inclining to purple & sometimes to a blueish hue
333. The changes of colour (332) will arise.
a. – from Vessels which naturally contained only Lymph
or Serum, carrying red Blood.
b. from either containing more blood than circulated
through the parts in its natural state according to the Law of
the Animal Oeconemy, the the more a part has to do, the more
blood will be given to it, the colour is that of Arterial blood.
c. from New Vessels being formed in that partly
coagulable Lymph becoming organized. –
334. When inflammation attacks parts near the surface of the
body, heat of the parts will be considerably increased.
335. But the heat of the inflamed part will not be increased
above the standard heat of the Animal, though compared wth.
the heat of other parts of the surface it will be greatly increased.
336. An increase of heat in a part does not always arise from
an increase of its power of action, it may arise from increased
action though attended with weakness. –
337. Coldness in a part is however in general arising from weakness
& want of power of action; but a part may have its degree
of heat lessened by its sympathizing with the affections of other
parts as the stomach, changes in the Mind &ca. ♂.
338. The source of heat is probably in the Stomach from whence

♃. 338. The Stomach sympathizing with any part of the constitution
is the probable cause of Rigors, Rigors are not only produced by
constitutional affections but even by local ones as the Pricking of a
finger, also by affections of the mind as fear, horrid sights &ca. the
absorption of any Contagions or putrid matters into the System is
attended with Rigor, Rigors probably do the same thing in the Constitution
as Vomiting, rousing the constitution to greater action, the
heat of the Blood cannot be altered by the Sympathetic Fever, a
constitutional affection can only produce a change in it. –

67.
by means of circulation it may be conveyed to every part of the
Body. ♃.
339. Inflammation is commonly attended with a painful sensation
communicated from the affected part to the mind, in the
adhesive state it is rather of a dull heavy kind, when proceeding
to suppuration it becomes more acute, when suppuration has taken
place it abates, when Ulceration begins it again increases,
but during the latter state it rather gives the idea of soreness.
340. Every time the Arteries dilate there is an increase of pain hence
the sense of throbbing, the cause of the pain is the distension of Nervous
& sensitive parts.
341. The disposition of inflammation, will sometimes cease before
even adhesions are produced, [& This], after a part has begun to swell,
[this] is called resolution.
342. As the increase of pain was a proof of the progress of Inflammation,
so its diminution is to be attributed to the cessation of the
inflammatory state, when the uneasy state is removed, the disturbing
cause is taken away, & the parts return to their state &
ordinary functions.
343. The Constitution will not only be differently affected by the
different situations & functions of parts inflamed & greater or lesser
extent of the Inflammation, but it will also be differently affected
by the different stages of the inflammation present, thus the suppurative
inflammation will affect it much more than the adhesive
or Ulcerative by where action in general the constitution is but little

♄. 348. Thus if small pox matter is applied, if the constitution
has a peculiar susceptibility of a putrid disposition, the disease will
partake of the constitutional disposition, as in the confluent small
pox. So Venereal matter shall in one person produce a Chancre
surrounded with common inflammation, in a person of a different
constitution it will be accompanied with an Erysipelatous Inflammation
which may spread to a wide Extent.

68.
disturbed.
344. The vital parts subject to inflammation may be divided into
a....Those which readily take in Sympathy. &
b. – Those which do not.
Of the latter, the Lungs, of the former the Stomach are instances.
The Pulse will generally be harder though smaller under
the affection of the former than the latter. –
345. Whatever can obstruct the natural circulation through the
minute Vessels will produce inflammation its causes therefore
may be very different & various. ( ).
346. When a part perceives an alteration in its structure or a
change in or obstruction to its natural functions the Stimulus of imperfection
arises.
347. The stimulus of perfection exists in parts new dispositions
where consequent actions are either processes of restoration or destruction
according to the strength of the parts & their facility in the art
of healing. (252).
348. Irritation of whatever kind being applied may produce inflammation
peculiar to the constitution or condition of parts.
(311-314). ♄.
349. The disposition for restoration of parts injured is the most
simple, (165), that from necessity is more complicated, but the disposition
for disease is the most complicated of any.
350. The stimulus of imperfection may arise in parts from different

🜔. 352. To the first may be referred bruises, strains simple, fractures
&ca. To the second, Wounds of all kinds opening Externally.

69.
different causes, as obstruction to their natural actions, or from an alteration
in their structure by external violence, the latter becomes
chiefly the object of surgery though the former may also fall within
its province.
351. The effects of external Violence will be different according
as that violence is applied to sound parts, or to parts diseased.
352. Mechanical injuries on sound parts may be divided into
two heads
1st. Those which do not communicate externally
2d. Those which do. 🜔.
353. The first division may by circumstance be changed into the
second, & the second may be brought back to the first.
354. The effects of the first division on the constitution will be
different according to the state of the constitution & the nature
of the parts injured & the power of healing in a part is strong,
the part injured not vital, & the constitution not highly disposed
to Sympathy, no material change will take place in the constitution
& the process of restoration will go on with only local effects.
355. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the
parts injured, the kind of violence inflected, & the degree of that
violence.
356. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the

🜔^. 359. When wounds are inflicted it is evident from the Text
that when the first mode of union is to be effected the Surgeon
should bring the lips of it in close contact & retain the blood in the
Wound, then defend the part from the action of the Air, no foreign
matter should be introduced, hence the suture must in general be
objected to.
Union will not only take place between divided parts of the
same body but also between parts of different bodies still retaining
their living principle when brought in contact with each other
Thus Mr. Hunter introduced the testicle of a living cock into the Abdomen
of a Hen, the testicle became united to the liver of the
latter, & sometime after the Hen was killed, Mr. Hunter injected
the Testicle from the body of the Animal.
Again he fixed a Tooth recently extracted on the Comb of
a Cock & on injecting the Animal the Membrane lining the tooth
was also injected.
Upon this Mode of union depends the cure of the hare
Lip from this arises the unnatural cohesion of fingers one to the
other when the Cuticle has been destroyed by burns &ca. from this arises
the union of the Chin to the breast when ulceration has
proceeded &ca.

70.
parts injured, the kind of violence inflicted, & the degree of
that violence.
356. Its effects on the constitution will be determined by the same
laws as those regulating the effects of the first class.
357. When vascular parts violently separated from each other is
accomplished either by
a. The extravasated blood being the Bond of Union
b. The adhesive inflammation, or
c. Granulation.
359. It has been already observed that the blood is a living fluid,
when extravasated it does not immediately lose its living
principle. In  the separation of parts by violence when the
blood is Effused. the first mode of reunion is effected by the red.
particles & Serum being absorbed, & the coagulable Lymph being
left. the Lymph becomes vascular & nervous, & thus readily reunites
the sides of the Wound together, this process is accomplished
with more ease in the first class of injuries than in the second
because the blood by coming in contact with atmospheric Air
the sooner loses its living principle. &ca. 🜔^
360 – But a variety of circumstances may prevent this mode
of union taking place. The second process or that by adhesive inflammation
is next excited – Coagulable Lymph being still the
necessary medium of reunion is supplied from the Vessels of the side

♀ 362. Hence when a Cavity is exposed & the Wound does
not unite by the first or second mode of Union the whole
Cavity still will often escape running into the suppuratory
process, the contact of the Edges, or the part near the Edges
of the wounds with some of the containing parts setting bounds
to the process of the new action.
The parts taking on Sympathy may however produce
an exception to the rule in the Text.
♄. 363. This is illustrated by dissections of Women dying
with the puerperal fever when Inflammation had produced
adhesion between the Peritoneum & some of the contained Viscera,
while the suppuration had generally diffused itself over
the parts of the Abdominal Cavity.

71
of the wound by the first or adhesive inflammation arising,
this becomes organized & again fills up the breach.
361. But many circumstances impede this process also such
as the death of the solid parts receiving the injury, hence their
becoming foreign bodies, the too great violence of the inflammation
(360) producing suppuration; the interposition of foreign bodies &ca.
& here the process of restoration cannot be accomplished without the
third mode of union (348) Granulation.
362. When an internal Cavity is exposed the whole of the cavity
would run into Inflammation unless some part of its surface is
in contact with some other living part, that simple contact will
set Bounds to the spreading of the Inflammation. ♀.
363. The adhesive inflammation is sometimes imperfect not answering
to the final intentions, & this is when the violence giving
rise to it has excited too rapid an Action to admit of the adhesive
process taking its full effect, this however seems rather to belong
to the Erysiplatous Inflammation. ♄.
364. The Cure of Inflammation is by resolution ( ) but before
we attempt the Cure of Inflammation artificially, we must enquire
into the constitution of the patient, as whether he is disposed
to irritability or indolence, his former habit, temper of
mind &ca. & also the situation & other circumstances of the affected
part.
365. The time for attempting the cure of inflammation by

    
      
  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


72
resolution is before the suppurative process has taken place
366. We must consider whether the inflammation is of the true
healthy kind, or has the Erysipelatous disposition, or any other
specific disease mixed with it, We must also consider whether
there is an increase of life or only an increased disposition to
make use of Life; a distinction very necessary to observe.
367. We have noticed (332) that a change of Colour in parts is
produced by inflammation, when inflammation is seated in
parts near the Skin & its action is violent, vesications will arise
the Cuticle being seperated from the Cutis, this arises from the action
producing death of the connecting Medium between the Cuticle
& the Cutis.
368. The Coagulable Lymph (319) fulfills not only the intentions
(290-359-360) but also when the third mode of Union, or as it takes
place becomes the basics of the future Granulations.
369. In the Cure if the Inflammation is of the true healthy kind
we have only to remove whatever cause keeps it up.
370. An increased disposition to make use of life (366) or too
great violence of circulation is to be lessened by weakening with
evacuations & the exciting of nausea, & by soothing or Anodyne remedies.
371. When there is both an increase of Life & powers & an increase
of action weakening the System becomes necessary.
372. The System is weakened by bleeding, if only increased action

🜺 373. Topical Bleedings however [considerable] desirable cannot
always be had recourse to, for instance in increased action of
the Vessels of any of the internal Organs.

73
action is present without increased powers bleeding is only to be had
recourse to from particular indications: Vizt.
a. When it is desired to lessen the present Action in order
to give the disposition time to wear itself out without destroying parts
by its violent action.
b. When the parts affected is a Vital one.
c. When it is near a vital part.
373.. Unless the powers of action are great or the exigency of present
circulations requires that blood should be drawn from
the System. Topical blood letting is to be preferred & that from
or as near to the inflamed part as possible. 🜺.
374. Topical bleeding should be particularly insisted on when
there is a disposition in the habit to form but little blood, & when the
part inflamed is distant from the source of Circulation.
375. When the action only & not the powers are increased it is to
be desired that the constitution should perceive the loss of blood as
little as possible. Topical bleeding give less Alarm to the constitution
than bleeding from the System.
376. In our choice of bleeding we are in a great measure to be regulated
by the Pulse, but as the pulse is differently affected by the inflammation
of different parts we cannot be absolutely determined for or
against bleeding by any one general state of the pulse, for the most
part however, it is to be considered a quick & hard pulse generally
indicates bleeding.
377. An other general indication of Blood letting is the state of the

♃. 381. In weakened habits a single stool frequently produces fainting
may it has even caused an Abolition of the powers of Life.

74.
Blood but this can be only an after proof.
378. If state of the Blood is [only] Sizy & the Coagulum flat & its
texture loose bleeding is contraindicated, or at least to be sparingly
employed.
379. Another general indication of bleeding, is Urine high in Colour
& small in quantity.
380. A comprehensive view of all the Symptoms of health & weakness,
present violence of action, the nature & situation of the parts
affected, can only enable us to decide on the rectitude of using or omitting
bleeding. –
381. Purging weakens universally, it is to be had recourse to
with the same Caution as bleeding & in irritable habits still greater
caution is necessary. ♃
382. Sudorific may be proper when the Constitution Sympathizes
much, because they do not so much diminish strength.
383. Nauseating medicines lessen universally the powers of Life.
Vomiting ones rouse the spirits & powers; for Vomiting seems an
action intended to relieve weakness. (338 note).
384. Soothing remedies. Opium is the principle. Opium will only
lessen actions not alter them, as the disease sometimes consists almost
entirely in increased irritability by lessening the latter it may
diminish the disease.
385. We also endeavour to promote the intention (370) by topical applications;
of these preparations of Lead appear to lessen the power
as well as lessen the action, they are not therefore universally to be

389. Upon this principle we use blister plasters to remove deep
seated pains, upon the same we apply sinapisms to the feet when
the Brain is affected. Vomits when the Testicle is inflamed.

75.
had recourse to (366).
386. Cold powerfully weakens action, from its use therefore great
effects may be expected, the degree & length of applications of Cold
is however to be considered (262). –
387. The effects of topical remedies will be either.
a. Immediate
b. by Repulsion
c. by Revulsion & derivation.
d. by Sympathy.
388. The first order (a) seems to require no Explanation, applications
acting by repulsion only produce their effect upon a part when
the Inflammation has arisen from a parts taking on the disease of the
Constitution, & the disease from a Constitutional has become a local one,
as Gout.
389. Revulsion & derivation are not well defined the distinction between
them is perhaps Ideal, by them we must understand a cessation
of action in one part produced by an increase of Action in another
part this does not depend upon the humours but upon a change in
the place of action, or irritation.
390. Repulsion is the cure of the part, be the consequences of the Cure
what they may.
391. Sympathy. the cure of a part by local Sympathy is when the
same effects arise in the part diseased from an application used to
some other part as if the application was made to the diseased part

☿ 391. Hence it is that Mercurial Ointment applied to the Skin Covering
a Node, will cause the node to disappear in the same manner
as though the Mercury had been applied to the Node itself without
the medium of the Integuments.
🜔vmss 392. Vomits curing inflammation of the Testicle after sedatives
&ca. had been used in Vain, Caustic behind the Ears curing
Ophthalmia which had resisted all applications to the Eyes, elucidate
the truth of the Text.
The Cure of the tooth ach by burning the Ear is to be referred
either to derivation or Sympathy.
Derivation seems to be the reverse of Sympathy We cannot
however always distinguish one effect from the other. The cure
shall often be effected by Sympathy, thus blistering one part will
remove pain existing in another part tho’ the action excited by the
Blister may be of a different kind.
☍ 398. Among the causes of this effect are wounds not uniting by
either of the two first modes of union & the 3d. or Granulation becoming
necessary for their cure, violence having produced the death of parts to
the removal of which suppuration becomes necessary. Violence having
Exposed internal surfaces.

76.
itself. ☿.
392. A cure of local inflammation by derivation or Sympathy
will often take place when sedative applications have proved ineffectual.
🜔vmss.
393. Topical applications may be divided into.
a. Fomentations.
b. Steams.
c. Lotions.
d. Poultices.
394. The order a. & b. are of shorter duration in their actions,
but may afford relief during the application, the order c. are
more lasting in their actions & are only substitutes for the order
d. which of all application produce the most permanent action
395. Poultices will be either.
a. Simply warm & Moist, or
b. Medicated.
396. The effects of a Poultice will be immediate on the parts
to which it is applied, but by sympathy they will be extended
further.
397. Medicated Poultices will be formed according to circumstances;
[of] with Lead, Opium, Mercury &ca.
398. When Inflammation however excited exceeds the adhesive
state, & gets beyond the point of resolution, Suppuration is produced ☍
399. The cause of a parts running into Suppuration is, its

🜍 400. The application of Air to internal surfaces as the Cavities
of the Thorax, Abdomen & Joints, has been considered as the cause of
suppuration but this is evidently not the case, suppuration would
take place even in vacuo. In Emphysema where Air is diffused all
over the body we have no such effect until an Opening is made, but
in case of suppuration from an Opening the stimulus of imperfection
takes place the Cavity being an improper one to prevent this
imperfection as much as possible we observe in a Wound of the Abdomen
of a fowl that adhesion takes place between some of the Intestines
& the edges of the Wound, if this does not happen general
suppuration succeeds, another proof that Air in internal Cavities
is not the Cause of suppuration is that in some Animals the Air
has a free communication from their Lungs into the cells of their
bones & into the Abdominal Cavity without producing suppuration
as in the Case of many Birds.
🜖 404. This we readily account for, knowing that suppuration
is the first ordinary process in inflamed Canals, whereas adhesive
Inflammation is the prior action in the Cavities.

77
perceiving the stimulus of imperfection, & being thence necessitated
to begin a new & unusual process.
400. Communication with the atmospheric Air is not necessary
to suppuration. 🜍.
401. Great violence of action is not necessary to suppuration
it is rather productive of gangrene, suppuration is sometimes
produced in a part without any visible violence of action in the
part which takes it on.
402. Although it sometimes arises without any visible violence of
action in a part, yet in healthy constitutions it is generally found
that the inflammation is considerable.
403. The action producing it is most violent when it arises
spontaneously. –
404. Suppuration takes place more readily in internal Canals
than in internal Cavities. 🜖.
405. It is not necessary to forward Suppuration even in Inflammations
arising from the constitution, the constitutional disposition
seeming to have produced its full action in the Inflammation
or inflammation is to be considered as the disease taken on by the
part from the constitution, & so curing the latter & suppuration is
only the sequel of the disease. –
406. The adhesive inflammation going on to the suppurative,
in the latter stage, the general symptoms increase, the pain becomes
more acute, the sensation arising from it is as much as possible


 
 
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


78
that of simple pain, the redness is more intense, new Vessels being
formed & old ones more dilated, hence a more violent throbbing
from an increased dilatation of the Arteries the swelling of the
parts increases from a still greater effusion of coagulable Lymph
& Serum, the surrounding parts become Oedematous.
407. One, two, or more parts lose the power of resolution & take
on a similar state to Cavities exposed ( ) a Cavity is formed in wch.
pus is secreted, at first mixed with coagulable Lymph.
408. A return of the adhesive inflammation checks the progress
of suppuration.
409. When the progress of suppuration is not stopped, the matter
will be carried onwards to the Skin, the parts between the
cavity & the surface of the body are gradually absorbed the Cavity
becomes daily enlarged, the Skin becomes thinner & thinner, at
length Ulceration from pressure takes place & the abscess bursting
a natural Exit is given to the contained matter.
410. When the suppurative inflammation is going on Rigors
frequently Occur, a common attendant on new actions of the constitution.
411. When suppuration cannot be stopped the progress of the
matter is to be carried as towards the skin, hence the utility of
stimulating plasters &ca. Poultices can do little until the Inflammation
has invaded the Skin, they then keep the surface moist
& soft. –

☍ 415. to 423. Observations on Pus.
Pus cannot be formed from the melting down or waste of
the Solids, otherwise how could the human penis in the virulent
Gonorrhea furnish pus many times exceeding in quantity
the substance of that Organ, some have denied the discharge
from the Urethra & certain other canals to be purulent & affirmed
that it was only Mucus, but it has every characteristic
of Pus, no injury arises from the absorption of pus into the Circulation
otherwise how may those fare who have large sores, as patients
undergoing Amputation whose health is often disturbed
through the whole of their cure, Pus may become offensive by
being mixed with other fluids as putrified Blood & hence its factor
when its discharge attends a diseased Bone. Pus is a bland
unirritating fluid we see it makes its way in psoas & Hip Cases
from the Loins & Hip low down into the thigh without producing
the least sense of pain unless merely from its weight & distention
of the parts amongst which it is seated. Pus cannot
change Animal [matter] Solids into own nature by any fermenting
process. Chemistry cannot irritate the process of nature in
forming pus in the Animal body any more than any of

79.
412. Suppuration sometimes goes on without previous inflammation.
here parts suddenly fall into it without allowing the previous
action of the adhesive inflammation as in the Erysipelatous
suppuration, or it goes on slowly without pain as in some
scrophulous Cases.
413. When an healthy Abscess is opened, [& its cavity become exposed]
the parts readily take on a disposition to heal, but in the
collection of matter (412) when the abscess is opened & its cavity becomes
exposed a general inflammation takes place & a perfect suppuration
is formed; but the constitution is generally much affected by
this process, for here the Inflammation is to arise in a part already
in the habit of disease.
414. The matter contained in the Abscess formed without inflammation
will be different from that in the common Inflammatory
Abscess, in the former it will be a curd like substance mixed
with a thin purulent fluid..
415. The fluid produced by the healthy suppuration is Called
pus, which is quickly & readily formed on the surface of Canals ☍
416. To the formation of pus a particular organization of
parts seems necessary though we do not exactly know in
what the nature of that organization consists, any more
than we do that which is necessary for the different secretions.

the other secretions, nor can Chemistry decide on the nature of
Pus the conclusion drawn from the precipitations of it from
Vitriolic Acid &ca. are irrational & unsatisfactory; the precipitate
from any other Animal Substance so dissolved will give equally
the same appearances.

80.
417. Pus is to be considered as a secretion & the parts secreting it
to be glandular, it does not arise from a destruction or dissolution
of the Solids by fermentation &ca. the solid parts may die, slough
& be found in it, nor is it a mere straining of a matter from the
Blood.
418. Pus is a fluid which in its perfect state has certain peculiar
qualities as Colour & consistence, it is somewhat sweet and
mawkish to the taste. it consists of a number of large whitish
Globules swimming in a fluid resembling serum, of which Globules
it will have a greater or lesser proportion according to the
health of the body that produced it, like serum the fluid is Coagulable
by heat.
419. It is perfectly mild & inoffensive in its natural state incapable
of irritating the most sensible sore.
420. Pus when absorbed into the habit & mixed with the blood is
productive of no ill effects unless it is the vehicle of specific Poison
421. Pus is less disposed to Putrefy than other Animal fluid wn.
in certain situations & in contact with Air, it readily takes on
putrefaction & becomes offensive, but this is probably from other
substances as blood &ca. being mixed with it.
422. When an Abscess is first opened portions of Coagulable Lymph
mixed with pus are commonly found. These are parts of that Lymph
which had been employed in making the Cyst to contain the matter.
becoming loosened from the internal surface of the Abscess & being

🜔vuss. 🜖. 426 Pus may be of use to Sores to keep them Moist &ca.
but this does not explain why it is formed in natural Cavities it
may also be useful as a vehicle in the removal of extraneous substances,
this however can be only a secondary intention with its
final use we are still unacquainted.

81.
blended with Pus. –
423. Chemical experiments cannot explain the nature or manner
of the formation of Pus. (see last note).
424. The formation of Pus is to be considered though a New, yet as
a Process of Health, parts taking on a diseased action, the secretion
of Pus is interrupted, & it is no longer generated pure & possessed of
its peculiar properties.
425. Pus like all other fluids thrown off from Solid Parts will
always partake of the nature & properties of the parts from which
it is secreted & according will have occasionally the specific properties
of the Lues, the Cancer, the Small Pox &ca. –
426. The final use of Pus, or intention of nature in producing it
is not known. 🜔vuss 🜖.
427. Ulcerative Inflammation is that action into which a part
falls from a disposition to absorb itself Even to the solution of continuity.
428. The cause of this Ulcerative absorption will be an inability of
parts to support themselves under present circumstances, these
circumstances will be
a. Irritation.
b. Weakness.
429. These Circumstances give rise to
1st. a consciousness in the parts of the necessity to be
absorbed. 2d. a consciousness in the Absorbents of the necessity of
commencing the absorbing process.

🜔vuss. Φ. 436. When a collection of pus makes its way to the Skin
we find the cellular substance adipose membrane & even Muscles to
a considerable extent ulcerated while the Skin ulcerates only so as to
form a hole for the exit of the matter.

82.
430. Irritation will be given by
a. Pressure (246)
b. Contact with dead or foreign matter.
431. Weakness or a want of power in parts to carry on their natural
functions may be a cause of the ulcerative Absorption.
432. pressure considered as irritating is of two kinds.
a. pressure from the surface inwards.
b. pressure from within outwards.
433. parts strongly resist the action of the pressure (a) but readily
yield to the action of the pressure (b. 432).
434. From the above then we may infer that when the irritation
of the pressure, (a. 432) is applied to produce ulcerative Absorption it
must be very violent in proportion to the strength of the parts, for it
is not sufficient to destroy the power of resistence in the parts pressed
it only produces a thickening of them.
435. Nature resisting the entrance of foreign matters into the
body thickens & thus as it were strengthens the parts to give them
a greater power of resisting the admission of what would prove
injurious to them.
436. In pressure from within outwards (b. 433) the internal parts
as cellular Membrane &ca. fall more readily into the ulcerative absorption
from the Skin. – in irritation from external pressure & from
contact with foreign matter the Skin falls more freely into it than the
other substances. 🜔vuss. Φ

🜔vmss. 🜔. 437. [(When a collection of pus makes its way to the 
Skin we find the cellular substance adipose membrane & even
Muscles to a considerable extent ulcerated while the Skin ulcerates
only so)] If Inflammation attacks the external coat of an intestine
adhesions are produced between it & the peritoneum, & if the
inflammatory action goes on an abscess is formed in the middle of
the adhesion after which the matter contained acts as an Extraneous
body; Ulceration takes place only in the side next the Skin, between
which & the matter (even in the most corpulent person) the
Muscles, fatty Membrane & Cellular substance will be dissected by
the Pressure of the Matter & that fluid eliminated before by so thin an
interior substance as the Intestine will fall into Ulceration (Sidran
gives several cases of this kind but does not explain them).
🜔vuss. 🜖. 439. When living tumors are brought to the Skin, in their
progress the intersticial absorption only goes on until there arises a
necessity for the ulceration in the Skin, many other substances also
are brought to the skin without producing the ulcerative Absorption.
440. Suppuration very commonly & in some parts always attends
on the Ulcerative absorption, of this we have abundant instances
in the Muscles, Cellular substance & skin, we have also instances
of its proceeding without producing pus, in bones when sustaining the
pressure of aneurisms &ca. in the absorption of the alveolar processes after
removing a Tooth & in the removal of Callus after fractures. In Jordansons
Voyage we find that several of his Crew who had been severely

83
437. When the pressure is from within outwards, tho’ all sides are
Equally in contact with & compressed by the body making the
pressure yet that side only will accept of ulceration which is the
nearest to the Surface of the Body. 🜔vmss. 🜔..
438. When bodies making pressure from within outwards are
to be carried to the surface in the natural process the adhesive inflammation
of the neighbouring parts precedes the ulceration of the
Skin, for nature finding exposure must take place by the former
process provides against that inconvenience & renders its extent as
small as possible. (439 🜔vuss. 🜖.
439. When absorption is to take place of the parts between a surface
lodged within & the surface, in order to the removal of that substance
there is always a mixture of the ulcerative & intersticial Absorption.
440. Ulcerative Absorption goes on either with or without Suppuration.
441. Bones as well as soft parts become open to the Ulcerative
Absorption from pressure & irritation but the cuticle is incapable
of irritation & of the ulcerative Absorption.
442. An exception to (437) will arise, when the irritation from
the pressure is violent, & the adhesive inflammation has not duly
taken place in the parts behind, within or on one side of the irritating
substance. 🜔^
443 The difficulty with which the Cuticle (441) is removed for

affected with the Scurvy which occasioned the spontaneous dissolution
of old Cicatrices & even of the Callus formed after Fractures.
442. Hence it is that matter sometimes bursts into the Air
cells of the Lungs when a suppuratory inflammation of the Pleura
& Lungs had happened instead of making its way thro’ the intercostals
Muscles to the Skin; for the same reason pus sometimes in
Abscesses of the Liver makes its way internally, bursting into the
Intestinal Tube or the Abdominal Cavity.
444. A change in the constitution will often occasion a sore
to spread more in one nights time than we can procure in a fortnight.

.84
the expulsion of matter is the cause of the pain in suppurations
where the cuticle is very thick, as in the whitloe, abscess in the sole
of the Foot &ca..
444. The Ulcerative Absorption but little affects the constitution
although the constitution has powerful effects on the ulcerative absorption.
445
As ulceration consists in the division of parts naturally united,
or in a particular made of solution of continuity, so its cure is effected
by a reunion of them either by adhesion (358) or by Granulation,
the third mode of union (358) when the first & second modes of
Union will not take place in parts violently separated the third mode
is preferred or pursued in the process of restoration, this is by means
of Granulation.
446. Granulations are formed by coagulable Lymph, effused from
the surface of the Ulcer becoming vascular, Vessels from the original
parts pass to the basis, & also to the surface of the granulations
& would almost seem to terminate there.
447. Granulations are always of the same nature as the Parts
they arise from.
448. Granulations will be healthy or unhealthy, the more Convex
they are seen, & the smaller their points, & the more florid red
colour they are of the more healthy. The flatter their surface, the
paler or the more they approach to a livid hue the less will they be
found healthy, & the more slowly will they admit of the parts

🜔🜹. 448. By attending to the appearance of a sore, we may judge
whether it is healing or disposed to ulcerate farther, if the latter the
edge will be irregular, inverted, or hanging over the ulcerated surface,
the discharge is in general thin, the surface in the whole or in many
parts concave whereas, when there is a disposition to healing they are
convex, the margin purple covered with a whitish semitransparent
membrane.
☉. 449. In the irritable constitution mostly, the Granulations will
be large & flabby.
☽︎. 450. Mr. Hunter saw two granulations one from the scalp, the
other from the Dura mater arising after trepanning united so firmly
together that they could not be seperated without an hemorrhage.
♂. 451. A Man aged 50, broke his Thigh bone & the attempt of
a reunion both by the first & second intention failed; for the fracture
(which was simple) did not unite after being bound up for a considerable
time, at length the Man died, Upon examination it was
found that Granulation between the ends of the fractured bones though
without suppuration had taken place. Scratches & slight wounds in
the Skin though they unite by the first intention do not always require
suppuration, they heal frequently under a scab.
☿ 456. The contraction of granulations perhaps goes on in some
degree until the cure is compleated, but after a certain time they
contract not sufficiently to oblige the Skin to stretch itself & hence there
must be a necessity for the formation of New Teguments. +

85.
being healed. 🜔🜹.
449. By the appearances of Granulation we may judge in some
measure of the state of the constitution. ☉.
450. When Granulations are healthy they have a strong disposition
to unite one with another. ☽︎.
451. Granulations are in general the consequence of suppuration,
but granulation may sometimes take place without suppuration preceding.
♂.
452. To perfect the Cure of an Ulcer it is necessary that the Granulations
receive a covering, or that the process of Cicatrization takes
place.
453. Cicatrization is performed partly by the elongation of the original
Skin, & partly by the formation of a new Skin.
454. The Original Skin is necessitated to Elongate or stretch itself
by the contraction of the Granulations.
455. Cicatrization is always in view when granulations are formed,
when the Granulations have been carried to a sufficient degree, the
Contraction of the Granulation begins at every point as the contracting
process goes on the Skin on all sides is drawn nearer to the center of
the Sore.
456. When the contraction of the Granulations has been carried
so far as circumstances will admit of; & the consequent elongation
of the Skin has been carried to its greatest point, from the
Margin of the original Skin, the new skin shoots. ☿.
457. The contractions of the granulations or their effect in + elongating

+ When the original is unfit or cannot give the disposition for the
new one to form then there is sometimes a disposition in the Centre
of the Sore to produce it hence it is why we sometimes see sores
begin to cicatrize in the middle.
♃ 457. We see that if the Wound or Ulcer takes place on soft parts
as the Buttocks &ca. & when the Skin is loose, the quantity of new
Skin formed in the healing is very little, but in ulcer in had parts
as on the head; the skin is enabled to stretch but little hence in
Wounds of the scalp, the new formed Skin is nearly of equal extent
to that of the lost Substance.
♀. 458. Hence it is evident that Surgeons cannot be too cautious
in saving Skin, when it becomes necessary for them to remove parts
as in amputation of the Leg &ca. & especially where the wound is to
be inflicted on bone, the natural covering of which is little binds
the Skin, as in the Tibia &ca.
♄. 459. From part of this aphorism it must be evident of how
much utility motion & friction must be to a part stiffened from
having undergone granulation & cicatrization, Mercurial Unction
& Electricity both conduce to this End & seem very properly indicated.
🜍. 461. As in the Negroes who when they are burned or blistered the
Cicatrix formed after healing wants the black tint.
“But even in Negroes the Rete Mucosum is formed as I have
found on examining the Cicatrix of a Negroe adult from which by maceration
I turned off the Cuticle & found the Rete Mucosum perfect”.

86.
elongating the original Skin is impeded by being seated on hard
parts as bone, & where the Sore is circular instead of having considerable
length in proportion to its breadth. ♃.
458. The formation of new Skin is a process nature forms with
difficulty & with more difficulty in the lower Extremities than in the
other parts of the body. ♀.
459. The new skin is a very different substance from the old,
whether it consists of the granulation altered in their structure
or is a new and distinct substance from them is not to be ascertained.
It is less moveable than the original Skin, appears to be
on the stretch, as if a small piece of Skin was stretched & sewed
into a larger hole, so that the sides of the old Skin seem puckered
it gradually however is subjected to Mechanical motion & becomes
[less] more lose & flexible. The young Cutis when first formed is
very full of Vessels, but these are either afterwards taken away
or changed into absorbents until at length the part becomes
quite white. ♄.
460. Whenever a New Cutis is formed a cuticle is found also
the Cutis forming it, more readily than the granulations forms
Cutis, every point of Cutis is forming Cuticle.
461. The Rete Mucosum is always late in forming Cicatrices
between the Cuticle & Cutis, sometimes it is never formed at all. 🜍.
462. The Cicatrization is sometimes materially affected during
the giving on of the processes of restoration above described by certain

🜁. 467 & 468. Thus we see affections of the ligamentous parts
more readily bring on hectic than those of the muscular parts.
Disease of the joints very frequently produces this constitutional
Sympathy, & the larger the joint the Earlier this effect will
take place, An affection of the Knee or Elbow brings on Hectic
speedier than a disease of the Wrist or Ancle, again backwardness
of parts to heal depends much on their situation in the
body (277). In the lower extremities the power of healing
will be less than in the upper, & we see a disease in the Knee or
Hip produce hectic sooner than a disease of the Elbow or Shoulder.
Hectic will arise from Affections of parts whose natural  
powers of healing are not weak, as in large abscess in the
Muscular parts, but it still depends upon the same principle,
a Disease which the Constitution can neither conquer nor get rid
of. (464).
∇. 469. It will arise in affections of the Vital Parts & Joints
even before suppuration has taken place. Did it arise from the
absorption of Pus it should take place in one large Ulcer as well
as another, for it does not appear that there is a greater disposition
for absorption in one ulcerated surface than in another it
should arise from Venereal buboes where the matter is often even
poisonous.
In large Abscesses the Hectic disposition comes on after

87.
Actions.
463. The most ordinary actions are.
a. Hectic
b. The action of dissolution.
c. Spasms.
464. Hectic is a remote constitutional sympathetic affection
taking place in a constitution weakened by a long continued local
disease, which it can neither get rid of nor cure.
465. It will be caused either by an affection of a vital or a
non vital part.
466. It is produced earlier by the affections of a vital than of
a non vital part.
467. In the Non Vital it most frequently arises from affections
of those parts which have a backwardness to, & small powers of
healing. (275-276-277).
468. The more extensive the seat of the diseased Action in
parts of equal powers of healing, the earlier will the Hectic be induced
in the constitution. 🜁.
469. Hectic does not arise from the absorption of Purulent
matter into the System. ∇.
470. Hectic then depends on a part being irritated beyond
its powers of acting for restoration & beyond the power of the Constitution
to overcome the Disease: 🜺.

opening & when the Matter has been discharged.
If the Constitution can heal up these Abscesses, no hectic
arises large suppurations have taken place & the matter been
absorbed again without opening yet without the rise of hectic.
We readily conceive why it should take place sooner in vital
than in non Vital parts because the former gives the alarm
sooner to the constitution (22. Note) Hectic commonly arises from
Lumbar or Psoas abscesses, Scrophulous Joints, white swellings
&ca.
🜺 470. Whatever then will long & Obstinately teize the Constitution
may become the cause of Hectic.
🜔🜹 476. The action of dissolution seems different from Hectic,
it is infinitely more rapid in its progress it is incidental
to opposite Constitutions it is uncurable by the removal of any
part, & therefore seems to be an act of the constitution.

88.
471. It is however sometimes doubtful whether the hectic is
not an original disease of the constitution, we see that it arises
when there is a sore in a part which has no impediment to
healing, & here the Hectic must in general be cured before the
sore will heal.
472. Hectic is a kind of slow diminution of Animal Life, even
to gradual dissolution, its Symptoms are in general slow fever
with great debility, & languor, want of appetite, paleness of the
Skin. Sweats easily provoked, & indeed arising spontaneously
frequent sickness & vomitings, in habitual purging, clear Urine.
473. The administration of internal Medicines can only be useful
in order to the cure of hectic by somewhat strengthening
the constitution & enabling it to support its struggle longer than
it could do unaided.
474. Its cure can only be affected by the removal of the local
Disease either by taking away the part or by inducing in it
a disposition to heal.
475. The constitutions most disposed to Hectic are the weak
& irritable.
476. The action of Dissolution is different from Hectic when the
constitution seems to have every thing in its power having gone
through & supported the processes of inflammation & suppuration
its powers will suddenly sink & the destruction of Animal Life
be readily accomplished. 🜔🜹.

🜖. 481. If a limb has its bone or bones fractured the Muscles
will no longer act in obedience to the Will, the same in the Case
when a joint is rendered useless, if the patella is fractured the
patient cannot voluntary act with the Rectus Muscle.
It is extremly curious to observe that voluntary Muscles,
when the final use of their being no longer exists, become
no longer the Instruments of the will, & they then waste in
bulk, strength & firmness & become soft flabby. -

89.
477. The Symptoms are an universal affection of the Stomach
shivering, Nausea, & frequent vomiting, small quick pulse
Hemorrhage from the surface of the Ulcer, excessive spontaneous
sweatings soon succeeded by Death.
478. The Habits most disposed to it are the Robust & full.
479. For its Cure nothing seems to be effectual.
480. Muscles lose their power of action not only when the
Nerves leading to them or which are their immediate Instruments
of motion, are compressed or destroyed, but also, when
there is no longer a necessity for their propriety in their acting
(53) & here they become though naturally voluntary inobedient
to the Will.
481. They also become open to Intersticial Absorption & waste
in size & firmness. 🜖.
End of the first Part. –






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


90.
Illustration of the Doctrines contained in
Part the First. –
482. In the circumscribed Cavities when taking on inflammation,
the adhesive it is observed ( ) is first to take place
if the progress of the complaint is not checked, or put a stop
to by the adhesion, the suppurative or the ulcerative stages
are the necessary sequels. ( ).
483. In cavities containing Vital parts, the Ulcerative stage
is seldom produced for before the complaint proceeds thus far
it generally kills, to produce adhesions between contained & containing
parts it is not necessary that the surfaces of both
should be inflamed.
484. According to the degree or extent of the adhesions the suppuration
in a circumscribed Cavity will be greater or less, if suppuration
comes on in a Cavity where no adhesions have previously
taken place the whole surface of the Cavity will become the






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


91.
seat of the suppuration.
485. The contents of an inflamed Cavity will not always partake
of the Inflammation of the containing parts, for the
Lungs, or the Intestines may remain uninflamed, though a
Pleuritis or Peritonitis may be present.
486. The preceding doctrines will be illustrated by observations
on the inflammation of the following Cavities.
1st. The Thoracic Cavity or Inflammation of the Pleura.
2d. Inflammation of the Pericardium.
3 --- of the Peritoneum, as contain of the Abdominal
Viscera. 4 --- of the Bladder
5 --- of the Joints & Sacculi Mucosi.
6 --- of the Eye.
7 --- of the Veins.
8 --- of the Encephalon.
9 --- of the Tunica Vaginalis.
also by injuries & diseases of bones, by Wounds in soft parts
& lastly by common & specific diseases of the constitution and
parts.
487. The pleura is more subject to Inflammation than any
other membrane lining [the] a cavity in the body not far from
its particular nature, but from its particular circumstances,
as being much exposed to the action of Cold &ca.
488. The pleura becoming inflamed adhesions are formed,








    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


92
between that Membrane & the Lungs sometimes with but
little pain if any. Sometimes the adhesion is throughout the
whole of their surfaces, sometimes in parts only, these adhesions
frequently terminate the Complaint.
489. But it frequently happens that the Inflammatory Action
goes on to suppuration if the whole Cavity becomes the seat of it
then the true Empyema takes place, if the suppuration is by
means of the adhesions confined to certain parts, then the spurious Empyema
or collection of matter not communicating with the
general Cavity of the Thorax is produced.
490. The Empyema will be preceded by violent pains in the
Thorax, difficult respiration, quick pulse, rigors, &ca. –
491. The Empyema when present will have symptoms peculiar
to itself together with the common Symptoms, & Symptoms from
Sympathy of a Fluid contained in the cavity of the Thorax.
492. The common Symptoms of a Fluid Extravasated in the
chest are difficulty & frequency of Respiration.
Breathing easiest in some particular situations. If the
fluid be in one lateral Cavity only, the Patient lies chiefly & most
easily on the affected side, if in both cavities, then he will only
lie on his back & that not horizontally, the head & chest will be elevated,
otherwise he feels a sense of impending suffocation, there
is a sense of weight in the Diaphragm, there are patients who
perceive the fluctuation within them; frequently Anasarca, & 

🜋 496. Emphysema will often remain a considerable time,
Interior parts do not fall so readily into the adhesive Inflammation
as the more external parts, hence the wound continues
open so long & admits of the egress of ye Air.
I believe the presence of pus, or water extravasated in
the Thoracic Cavity will be alone accompanied with the anasarcous
Symptoms, blood or Air, not producing there appearances.

93.
sometimes Ascites is present.
493. The peculiar Symptoms of the true Empyema are a
great difficulty & uneasiness in expanding the Chest, great
lowness & depression of Spirits, frequent sense of seemingly impending
dissolution, the fluid accumulating Gradually.
494. The Sympathetic Symptoms are great irregularity of the
Pulse, palpitation of the heart &ca..
495. Water may be Extravasated in the Cavity of the Thorax
& the Disease then becomes Dropsy of the Chest, to the common
Symptoms (492) & the Sympathetic (494) may be added the circumstance,
that the fluid is so suddenly collected.
496. Air may be extravasated in the Cavity of the Thorax by
a wound in the Lungs from the end of a fractured Rib, here the
Pleura being also wounded the Air will escape into the Cellular Membrane
& produce a partial or general Emphysema.
497. Blood may be extravasated in the Cavity of the Thorax [by a]
[wound in the Lungs] & will occasion the common & probably several
of the other Symptoms.
498. For the discharge of Extravasated Fluid from the Thoracic
Cavities, the operation for the Empyema or the Paracentesis of the
Chest becomes requisite.
499. This should be performed as rarely as possible because its sequel
(as being an Exposure of & rendering the Thoracic Cavity

🜔. 499. [Emphysema will often remains] When Pus is present
in the Cavity of the Thorax, no objection to the operation
can arise for the part is already in a state of suppuration.
☿. 502. If you make the incision upon or near to the fractured
Rib, with respect to the bone you place it in the state of a compound
fracture & may induce all its consequences, besides rendering
the Chest an Exposed Cavity, the sequels of a compound
fracture will be hereafter shewn.
♁. 503. This must be obvious from considering the text (502) the
scarification need not be more than half an inch long (501) but sufficiently
deep to make exposure of the cavities of the cellular substance,
when much blood is extravasated (497) the Paracentesis of
the Thorax must be generally necessary, from the great danger of
suffocation that must attend its continuance in the Cavity.
Mr. Hunter has sometimes seen patients recover from injuries     
of the thorax, even when suppuration has taken place (as
after Gunshot of Wounds) he finds it difficult to Account for the means
of the Recovery, but thinks it must be by a kind of Resolution for
the Lungs in exposure of the chest are generally collapsed, so that
adhesions between this membrane & the Lungs in those cases cannot
be effected. –
Φ. 506. To such symptoms [for] the name of Angina Pectoris
has been given. –

94
imperfect) is an universal suppuration generally ending in
death. 🜔.
500. When Emphysema (496) in consequence of a wounded
lung arises & extends to a considerable degree the cellular membrane
may be scarified to discharge the offending Air.
501. The scarification should be made at some distance from
the seat of the fracture of the Rib.
502. The Lung on the Opposite side (if only one is wounded) should
not have its action confined nor should the escape of the Air from
the Cavity of the Thorax into the cellular substance be impeded. ☿.
503. In the case before as tight bandage applied on the Thorax
& compressing the parts which received the injury is improper.
♁.
504. It will be difficult to distinguish the Inflammation &
Suppuration of the Pericardium, from that of the Pleura, or Thoracic
lateral cavities, the heart sympathizing with affections
of the latter & the latter with those of the Pericardium.
505 If adhesion takes place between the heart & pericardium,
the Patient generally recovers, if the Inflammation goes on to
suppuration, the patient always is destroyed.
506. The adhesion of the Pericardium to the heart is attended
with palpitations of the heart, irregularity of the Pulse, frequent
& difficult & oppressive breathing, pain in the Sternum, frequent
syncope, debility &ca. Φ.

🜔v 507. By spontaneous inflammation is signified an Inflammation
arising without any visible cause.

95
507. The Peritoneum is the largest inverting membrane in
the body, it is subject both to Spontaneous inflammation & to
inflammation from external injuries. 🜔v
508. The Peritoneum taking on inflammation Runs through
its actions sooner than any membrane or Cavity in the body.
509. The Inflammation may be either Common or Erysipelatous
(303) at the onset it is difficult to determine its nature.
510. Whether it is of the common or erysipelatous kind it will
at first be accompanied with a violence of action of the constitution,
which is powerfully roused, but if of the Erysipelatous kind
the strength of the patient will soon sink.
511. The peculiar symptoms will be a pain in the abdomen not
of the cholicy or spasmodic kind with a sense of soreness of the
abdominal Region, greatly increased by pressure or by stretching
the peritoneum.
512. The Intestines will also from Sympathy take on an unnatural
action, Costiveness in some cases, in others a Diarrhea
will be induced.
513. The inflammation of it does not go off by resolution, or
unless adhesions taking place prove its cure will produce suppuration.
514. The suppuration will be
A. partial of adhesions taking place, limit the extent of it
B. universal if the adhesive inflammation is insufficient 

♂. 520. The Uterus on dissection is generally found sound
& free from inflammation, the disease does not arise then from
an inflammation of the Uterus. But the Uterus conscious of
some change effected in its nature will give the same stimulus
to the Peritoneal Cavity as would arise were the Uterus removed &
thus the abdomen be made an imperfect Cavity, parts may retain
their life & yet give a stimulus productive of death to
other parts.
“This seems to be the action of the Sympathiser becoming
more violent than that of the Sympathent.”
The dissection of Women dying of this disease proves
in general the fatal affection to be a suppuration of the Peritoneal
Cavity.

96.
sufficient either in the time of its duration or degree, to produce
adhesions of the membrane to the contained parts.
515. If the Suppuration is universal it always destroys the patient,
the prevention of this state is therefore to be diligently
prevented.
516. Bleeding seems the only means we have of preventing
suppuration, & therefore should be had recourse to, it should seem
to be improper in the Erysipelatous Species, but even there we
know of no other means of warding off suppuration.
517. When universal suppuration of the Cavity happens,
trial might be made of opening the Cavity with a Trochar
evacuating – the fluid as much as can be, & washing the part
well by injecting warm water.
518. When the suppuration is partial (a. 513. 482. 362) the
matter frequently points outwardly, like any other abscess, either
ulceration takes place, & it bursts, or it is opened & the patient
does well, here is a striking proof of the utility of the
adhesive Inflammation
519. The lying in or puerperal fever is a Sympathy of the
constitution with an inflammation of the Peritoneum.
520. The Cause of the Puerperal [fever] Inflamn. of the Peritoneum arises as
well as every other Inflammation of this part from a stimulus of
imperfection, which in this case is given by the Uterus. ♂.

Δ. 521. [Here] Mr. Hunter supposes the broad & round ligaments
of the womb most affected.
522. This most commonly takes place in Patients with
unsound viscera & Peritoneum, & in whom the disease has been of
long standing, rarely the first time of tapping, but not uncommonly
the 3d. or 4th. time. Mr. Hunter has seen on the second day
after tapping, the inflammation spread over the whole cavity of the
abdomen yet proceed no further, in which case it does not kill,
hence we should be cautious in our Prognosis of the event of tapping.
On dissecting Patients who have died after tapping
the same morbid appearances have occurred to the Examiner, as in
Women dying of puerperal fever & the Symptoms have been the
same during their illness. Mr. Hunter mentioned the Cases of
two men who died after tapping & the appearances on examination
after Death.
🜔🜹. 524. The suppuration of the Peritoneum after the operation
of the Bubonocele & Femoral hernia do not happen because
the sides of the Sac are brought together & closed before the alarm
is given to the Cavity. In the umbilical Hernia, after the operation
the external parts do not adhere, [to the] but the Union must
be formed by suppuration & Granulation.
Here the Omentum should be made the basis of the Granulation
that uniting with the external parts it may prevent

97.
521. Sometimes after lying in the adhesive inflammation will
prevent the suppuration from extending itself far, & an abscess
will form at the lower part of the belly & do well. Δ.
522. The Peritoneal Suppuration will sometimes succeed to
tapping or the common operation of the Paracentesis of the Abdomen.
523. From what has been said it must appear that whatever
can produce in the Peritoneal Cavity the stimulus of imperfection,
whether the death of one of its contained Parts, external violence
or penetrating wounds not healing by the first intention,
or by adhesion formed near the opening between the membrane
& some Viscus, may occasion the Peritoneal suppuration.
524. The Operation for the Bubonocele & Femoral Hernia, the
Cesarean operation, may all be productive of the Peritoneal Suppuration,
because they all occasion an Exposure of the Cavity, to
which suppuration must succeed, if the exposure continues long
enough [after] for the Cavity to take Alarm. 🜔🜹.
525. After the Cesarean Operation & other cases of Wounds into
the Abdomen, care should be taken to bring the Lips of the Wounds
in Contact, but not to pass Ligatures (if suture is used) so deep
as to penetrate the peritoneum. 🜔^

prevent the general inflammation of the abdominal Cavity.
🜔^. 525. A.B. A Crooked Woman was with Child & went her
full time, her pelvis was so narrow & deformed that she could
not have been delivered even by the Crotchets. Mr. Hunter delivered
her of a living healthy Child by the Cesarean Section immediately
on its contents being removed, the Uterus contracted strongly, the
Lips of the Wound was brought together by the uninterrupted
suture, the Woman died soon after, on dissection the small intestines
were found adhering about the Wound, the Uterus was
very much contracted, there was a quantity of extravasated blood
likewise in the abdomen, it should seem from this latter circumstance
that in similar Cases the wound should not be closed until
the bleeding ceases.
☉. 526. Of this we have abundant Evidence in observing what happens
during the cure of Patients, who have undergone Lithotomy
☽︎. 528. Joints as consisting of Ligamentous & membranous
parts have their processes carried on slowly, we see the worst consequences
follow suppuration of the Joints, the loss of limb & even
the Life of the Patient, is no unusual sequel, if a cure is effected
it is by granulation, & the granulation afterwards for the most
part, becomes bony & thus the Joint is rendered motionless.

98.
526. The internal coat of the bladder is liable to Suppuration
on exposure, though not very susceptible of it. ☉.
527. The Doctrines (482-483). are further illustrated by the common
consequences of the Exposure of Cavities of Joints by Penetrating
Wounds, which if they heal not by the first mode of union
( ) a general suppuration takes place, for here there being no
Contained solids, as in the abdominal & Thoracic Cavities, where adhesion
forming might prevent the general action of suppuration
an universal suppuration of the Cavity must be the Event.
528. Joints becoming diseased have a great backwardness in recovering
health (275-277) hence when suppuration has taken
place & the third mode of union ( ) becomes necessary, granulation
goes on with difficulty & slowness, hence also agreeably to what
is observed (427) we are enabled to understand, why Hectic is no unusual
consequence of joints falling into Suppuration. ☽︎.
529. Granulations forming though they effect a Cure, alter the        
structure of the part hence its Utility as a Joint is lost, motion is
destroyed, an anchylosis takes place.
530. Hence it is Evident that Surgeons when they intentionally
cut into a Joint, for the purpose of removing an extraneous body
as a loose bone or

🜖. 530. Therefore Sutures penetrating the Cavity of the
Joint should be avoided.
♀. 531 & 532. The Sacculi Mucosi are found between bone & Tendon,
between Cartilage & Tendon, between Bone & Skin, or between ligament
& Skin. So between the Patella & Skin, the Olecranon
& Skin, the Annular Ligaments of the Fingers & the Skin, &ca. &ca.
(532) Obliterating their Cavity &ca. this is done by opening them
preventing the Lips of the Wound uniting by the first intention, &
so making suppuration & granulation necessary, on the same
principle is the dropsy of these parts to be cured, as that of the
Tunica Vaginalis, or Hydrocele which will hereafter be explaind.

99.
531. The Sacculi Mucosi are similar in their nature & use to
joints & contain a fluid to facilitate motion, the consequences of
injuries done to them will be similar to those inflicted on the Cavities
of Joints.
532. They are subject to dropsy, & when affected with it are to
be cured by obliterating their cavity, this is generally followed by
a weakness & stiffness of the parts to which they belong but this
is soon relieved by giving them motion. ♀.
533. The Chambers of the Eye are subject to the suppurative inflammation,
which may have its seat in one chamber (as the
Anterior) only.
534. The causes of this may be whatever can give the stimulus
of imperfection to the Cavity, whether spontaneous inflammation not
terminating by resolution, or a wound not healing by the first
mode of union, hence it may follow the extraction of the Cataract.
&ca. –
535. By inflammation of the chambers of the Eye the Iris may be
made to adhere to the Chrystalline Lens.
536. The formation of pus in the anterior chamber of the Eye
will obstruct the passage of the Rays of light, similar to an opacity
of the Cornea.        


♀. 541. A Gentleman had an inflammation of the Sclerotica,
but the Cornea, remained clear, he had darting pains in the
back part of his head, with lassitude &ca. A white speck appeared
on the Cornea, which being a collection of pus gradually
increased, at Angth the suppuration filled the whole anterior
chamber & the matter was let out by an incision similar to
that for a Cataract. 5th. day the Eye appeared flat, the Iris &
Pupil could hardly be seen 6th. day the cornea was rendered

100
537. It will produce an appearance of an opake cornea with
which indeed it may be complicated, or it may be single, no
opacity of the Cornea being present.
538. When single it may be distinguished from an opacity of
the cornea by the pus forming in the Anterior chamber, in a section
of a Circle, a straight line forming its superior side, as the accumulation
of pus encreases its figure approached nearer & nearer to a
perfect Circle, till at length it entirely covers the pupil, however when
fully confirmed it is not to be ascertained whether it is complicated
with an opacity of the Cornea or not.
539. In general if the Disease is of long standing, the cornea
is opake.
540. The Removal of the Pus is obtained.
A. by absorption into the System
B. by Ulceration of the Cornea Evacuating it.
C. by an artificial opening.
541. (a. 540) is the most desireable mode of Cure, as if the Cornea
is not opake, Vision is readily restored.
(B) is the worst mode of all being invariably followed
by blindness from the cavity becoming obliterated (as in other
Abscesses) from the injury it may do to the Chrystalline Lens & from
the sprinkling or washing of the Eye – Therefore

full by a thinner & more transparent fluid 8th. day matter
was visible at the bottom of the Cornea in the End his
Eye was lost as to its vision & diminished in Size.
🜍. 543. The internal coat of a Vein may inflame from
the Puncture made in bleeding should it not heal by the first
intention.
Therefore in bleeding the Surgeon should always be careful that
his Launcet is very sharp & that after stopping the Blood he will
closes the orifice. When the Arm bleeds a second time after Venesection
from the same orifice, a sore arm is no unusual Consequence,
this arises from the Orifice not healing a second time without inflammation,
Linnen or Lint is a better application after bleeding
than sticking plaister for obvious reasons, there are more sore arms
after bleeding where sticking plaister is used than where lint.
Sore Arms after bleeding have been commonly attributed to the wound
of a Nerve, but Mr. Hunter thinks they more commonly arise from
an inflammation attacking the internal Coat of the Vein, if when
Horses are bled the Farrier is not careful to produce union between
the edge of the Wound a suppuration not unfrequently
attacks the internal surface of the Vein & if it extends as it sometimes
does to the Heart the Animal dies, adhesion, suppuration
& ulceration may all be going on, in a Vein at the same time

101.
(C) is to be preferred though even from this mode
small hopes of restoring vision can be Entertained. ♀.
542. The Veins are not to be considered as Canals but as Cavities
& like other cavities the internal Coat is liable to
the adhesive as well as the suppurative & ulcerative inflammations.
543. The Causes of the Inflammation of Veins will be the same
as those of inflammations of other Cavities whatever can
produce the Stimulus of imperfection in them will bring on
inflammation. 🜍.
544. If the adhesive Inflammation takes place in any part
of a Vein its Cavity is obliterated & a cure is performed.

as mr Hunter found in Examining the body of a Man in St Georges
Hospital who died after bleeding, we sometimes observe a chain
of Abscesses in the Course of Veins after bleeding in the Saphena
when suppuration takes place a compression on the Vein, above
the seat of the suppuration both to produce contact between the
sides of the Vessel & obliteration of its Cavity & to prevent the blood
from carrying Pus onward to the heart.
♁. 547. This we see by observing the effects of a Ligature put
round an Artery. Mr. Hunter has never seen an Artery suppurate
except once & that was the immediate consequence of mortification. –
🜁. 549. This being the case it is to be observed that when the
cure is attempted by Seton the water being suddenly evacuated,
the Tunic collapses, now though the Seton as a foreign body
may excite inflammation, Yet the Tunic at the time of producing
the Inflammation being in partial contact with the
testicle, it is not certain that the inflammation will extend over
the whole cavity, but it must in general have its progress bounded
by the contact of membranes. (362).

102
545 Suppuration arising, if the means of adhesions taking
Place above the point suppurating a simple abscess will be formed
& no ill consequences arise, but (546)
546. The inflammation & consequent suppuration may Extend
(in default of the adhesive inflammation setting bounds to it)
throughout the whole course even to the right Auricle of the heart,
or pus may be formed & Carried with the blood to the heart; either
of which circumstances taking place, kills the patient.
547. The internal coat of the Arteries is not liable to suppuration
they will however take on the adhesive inflammation.
♁.
548. Brain. We should be extremely cautious how at any
time we open or wound the dura mater, as the exposure of the
pia mater & brain is in general productive of fatal consequences,
the brain will inflame, swell & protrude through the openings
of the dura Mater, as the Cutis throws out a fungus
through the opening of the Cuticle in the whitloe, suppuration
will take place, but the Patient will be destroyed before
a Cure can be effected.
549. Hydrocele.. The Tunica Vaginalis is a circumscribed
Cavity, when exposed the same local circumstances, as
in the exposure of other circumscribed Cavities takes place (362) 🜁
550. It is necessary we should carry this idea (549) in our

🜖. 552. Mr Hunter in his Lectures took notice of the Anasarcous
Hydrocele, but as that is a mere Symptome of Anasarca
& has nothing to do with the doctrines we are now illustrating,
it becomes not an object of our present attention.
A diseased Testicle is frequently the Cause of the first
kind of Hydrocele, we shall have occasion to speak of the diseased
Testis hereafter.
554. Whichever mode of Operation is chosen, Suppuration
is to be expected, since we cannot promise to ourselves
a certain Cure by adhesion only, no one can have any great superiority
in point of utility over the other, different Men will
have different opinions in making their choice.

103.
Minds, when we prepare for the radical Cure of the Hydrocele
or proper dropsy of the Tunica Vaginalis.
551. The Hydrocele is of two kinds.
1. Where the fluid is collected between the Vaginal
Coat & the testicle.
2. Where the fluid is contained in an Hydatid adhering
to the Tunica Vaginalis.
552. We know little of the cause of the first kind if Hydrocele
& of the cause of the second we are totally ignorant. 🜖.
553. The Radical Cure of the Hydrocele is to be obtained by
no other means than the obliteration of the Cavity which is
the seat of it - this obliteration is accomplished by.
A. Inflammation by which the surfaces of the
Tunica Vaginalis & Testicle must be omitted, so that the Cavity
between them shall no longer exist, or
B. A total removal of the membrane of forming
the Cavity, that is the Tunica Vaginalis.
554. The first purpose is fulfilled by one of three operations.
a. Caustic
b. Seton & Tent.
c. Incision.
555. The second (B./554) by the excision or dissecting out of the
whole Tunica Vaginalis except where it adheres at the back

🜔. 555. This must be a certain mode of Cure for it is not
only removing the disease but taking away the very seat of it.
The seventy of the operation however together with its being
follows by more violent Inflammation & greater danger has
brought it generally into disrepute.
Φ. 556. 557. / Mr. Hunter experienced the truth of these aphorisms
in a Patient upon whom he performed the operation for the Radical
cure by Seton, soon as he evacuated the Water, the tunic Collapsed,
the Inflammation excited by the Exposure was not general,
consequently the Cavity was not obliterated, within two
Years the disease returned, stimulating injections have been
practised to bring on the adhesive inflammation & thus obtain a
Cure, but here we shall be too frequently foiled, & on this mode
we can depend but little.
🜔🜹. 559. It has been usual to divide the Cure into the Palliative
& the Radical, of the former unless when it accidentally becomes
the cause of the latter we have little to say since it teaches
nothing respecting the exposure & inflammation of Cavities, it
is needful only to observe that the palliative Cure consists in
Puncturing the Tumor with a launcet, or small trochar & thus
evacuating the fluid but it is rarely that this mode does not
require repetition throughout the Life of the Patient.
The palliative Cure should not be attempted unless the

104.
part of the testicle. 🜔.
556. No certain cure can be performed unless the whole cavity
is obliterated, if any part of the Tunica should not adhere to the
Testicle the disease will return. For
557. In this as in all other circumscribed Cavities the adhesive
inflammation may take place only in a few points & thus the
Perfection of the cavity may still be preserved & consequently the
stimulus of imperfection will not be given to the internal surface
of the Cavity. Φ.
558. The adhesive inflammation will rarely affect the Cure, in
general an universal suppuration must take place before the
purpose of the Surgeon will be accomplished.
559. Tapping for the Hydrocele, the wound not healing by the
first intention may also accomplish the desired effect, the same
circumstances here take place as in the Peritoneal Cavity, after
tapping for the ascites, or accident, as a bruise producing a Rupture
of the Vaginal Coat, & a diffusion of its contents throughout
the cellular substance of the adjacent parts if followed by inflammation
of the Tunic may also effect a Cure. 🜔🜹.
560. It is to be remembered that the operation for the Hydrocele
is not necessary for the preservation of the life of the Patient,
or the support of his health, but only for the removal of
an inconveniency, therefore the danger of the operation is to

Patient can lie by for sometime because sometimes Inflammation
succeeds & the Radical Cure with all its Circumstances
take place when the palliative was only intended.
🜔^ 563. Inflammation arising in Consequence of any Operation
is no unusual circumstance for a considerable quantity
of Coagulable Lymph to be thrown out, surround & give the appearance
of enlargement to the Testicle, this effusion of coagulable
Lymph also forms the sloughs that are thrown off in the processes
when suppuration takes place, & which were by the Author
of a late Publication considered as sloughings of the Vaginal
coat, to which he imputed the Cure by caustic, but the Vaginal
Coat rarely sloughs, the slough discharged being in general
false membranes made from coagulable Lymph now & then
however when the Tunica Vaginalis is in a diseased state a
partial sloughing of it may take place.
The Circumstance which may give an appearance of
an enlarged & diseased testicle deserve particularly to be attended
to as otherwise a surgeon may be induced to remove it
shirrous & incurable, the testicles requiring no such operation.
Case. A Man laboured under an Hydrocele, the tumor inflamed,
suppurated & at last ulcerated, the Surgeon enlarged
the opening & finding the Testis apparently enlarged & supposing
it schirrous was about to remove it Mr. Hunter was desired

105.
be ballanced against the extrication of the Patient from present
trouble.
561. If a Radical Cure for an Hydrocele is resolved upon we are
then to consider in our choice of a mode of performing the Operation
1st. The Comparitive danger of the different methods.
2d. The Comparitive certainty of success of the difft. Methods.
3d. The State of the Testicle.
562. The greatest Comparitive degree of danger attends the Operation
by Excision ( ) which is therefore perhaps never to be advised,
this danger will arise from the Sympathy of other parts
& of the Constitution with the Testicle in this mode of Operating
so rudely handled & so entirely & suddenly exposed.
563. The mode by excision is most certain of success, next to
that the mode by incision, the Caustic & Seton are less sure
in their Effects. 🜔^.
564. All the modes of operating give us an opportunity of
examining into the state of the Testicle, that by Caustic alone excepted,
the mode by excision gives the best opportunity.
565. The mode by incision being the most simple of all, more

to attend the operation, he found the suppuration of the Tunica
Vaginalis too general, for the complaint (in his opinion) to be
Cancerous, the history of the case confirmed this Opinion, the
Patient being extremely timid, there was no difficulty in getting
the Operation put by, it was deferred & he recovered from his ailment
by very simple means.
Further respecting the state of the Testicle it becomes
necessary particularly to attend to it, that if the disease requires
it may be extirpated without the necessity of a second operation,
care should be taken to distinguish a swelled Testicle from a
dropsy of the Tunica Vaginalis, if the tumor consists of the latter
it will be mostly pyriform, if the former it will be flatted,
this attention to the appearance added to the assistance of the
feel, will mostly preserve the Surgeon from an Error.
Again in the Hydrocele the situation of the Testis should
be ascertained, that we may not if we have Occasion to tap the
tumor be in danger of wounding it.
Mr. Hunter by accident wounded a testicle four times & yet
no ill consequence supervened which is somewhat singular
as so much mischief frequently follows the slightest bruise
of this Gland.
A pulpy Testicle will be very apt to be mistaken for an
Hydrocele.

196
certain, yet not more dangerous than either caustic or Seton
& more safe & easy than that by Excision is probably to be with
justice preferred, it is performed by making an incision three
inches in length, or throughout the length of the tumor into
the Cavity containing the water, which being evacuated. Poultice
or Crumb of Bread is to be introduced every where between the
two Tunics & kept in by means of Lint stuffed into the mouth
of the wound. Rags welled in Brandy or Spirits of Wine should
be kept on the Scrotum & often renewed to prevent the too sudden
coming on of Inflammation & the Scrotum should be suspended
in a Bag truss.
566. The advantages of knowing whether a testis is diseased or
not is that if found so in a considerable degree it may be removed
without the patient undergoing a second operation.
567. We cannot perhaps a priori determine whether the disease
be a Hydrocele of the Tunica Vaginalis, or the Water be contained
in an Hydatid, nor is this knowledge of consequence in
the Cure, as in both the same mode of treatment is to be observed,
but the consequences of an opening into the tunica
vaginalis will be different from those of wounding an hydatid.
568. In the former (567) the sympathetic affection usually following
an exposure & inflammation of the Testicle, will come on
such as Rigors, Nausea, vomiting dull pain in the back & Loins

Again respecting the state of the Testicle, we should take care
to distinguish, a Scrophulous Testicle from a cancerous one
Mr. Hunter never saw a Cancer of the Testis follow the Radical
cure of the Hydrocele.
The best means of ascertaining the situation of the
Testicle, & whether this Gland forms the Tumor, is the Sensation
the patients experience in squeezing the Tumor, if it be a diseased
Testis the pain is the same in every part, if only an
Hydrocele, pain is felt on pressing that part alone in which
the Testis is situated. –
∇. 568. In cases where the Hydrocele has been tapped we
should be led to suspect that the Cicatrix left after the Puncture
would be the proper part to perform an operation again, either
for the Palliative or Radical Cure, but this is not always the
Case for the Testis sometimes adheres to the Cicatrix & if this Rule
is observed would be wounded in consequence after the Symptoms
following the radical Cure abate, an enlargement of the parts
always remains, which is not an enlargement of the Testicle
but only a thickening of the Tunica Vaginalis &ca. this gradually
subsides & the parts return almost to their natural size
which diminution may be forwarded by Rubbing in the Mercurial
Ointment.
Hœmatocele is an Extravasation of Blood into the Tunica

107.
great sense of lassitude, swelling of the Testis &ca. these
will generally come in twenty four hours after the operation
but when an hydatid is opened as the body of the Testicle is not
exposed, these will not arise but only the common circumstances
of inflammation as heat, soreness of the Scrotum &ca. ∇.
569. The treatment of both (568) will be the same as in Inflammations
in General, but the Scrotum must necessarily be suspended ☍.
Note Continued.
Tunica Vaginalis, it is not of much consequence to distinguish
it from the Hydrocele as the same treatment is advisable
but it should be carefully distinguished from an enlarged Testis,
sometimes the contents is only Coagulated Blood, & sometimes
coagulated Blood, mixed with Serum, & sometimes the Coagulum
will be found to have become Vascular.
☍. 569. Farther Remarks on the Cure of Hydrocele
by Seton or Tent & by Caustics.
If the Seton is used Care should be taken that the Skain of Silk
or thread be large enough to fill up the Wound made by the
lancet or Seton needle, & thus plugging it up, prevent the Escape
of the water until a general inflammation has taken
place for the water keeping the Tunic every where distended
partial adhesions will be prevented & the influence of the operation
become general (566-567). The Seton should be passed

in the perpendicular Axis of the Tumor, but the Tent about midway
the water should not be suffered to escape before the tent is
introduced for the same reasons as the confinement of that
fluid is recommended where the Seton is used Sponge Tent
is preferable.
Caustic. There is an uncertainty how deep the Caustic will
act, should it not penetrate so as to include the Tunica Vaginalis
in the Eschar, we shall be under the necessity of
making a Puncture through that membrane & so shall gain
no advantage from the use of the Caustic.
When the Eschar is sufficiently deep the inflammation
of the Cavity takes place before the Water is discharged which
here also prevents partial adhesions & an Imperfect Cure, but
the uncertainty of the action of the Caustic is an objection to its
use. It may happen that the Testicle may lie in
the fore part of the Tunic & its situation not be known, or not
attended to by the operation, if in performing the radical cure by
incision he finds that he is cutting into the body of the Testicle
he should carry his Knife more to the lower & outer part of
the Tumor in finishing his incision for fear of wounding the
Spermatic Artery, an accident That has occasioned

108.
570. Fractures. The bones as well as the soft parts
are subject to every stage of Inflammation either arising spontaneous
or being induced by external violence when their continuity
is divided they are reunited by processes somewhat similar to
those which we observe to take place in the soft Parts.
571. Bones are liable to Solution of Continuity from external violence,
solution of continuity in bone is called fracture.
572. Fractures in bones are either
A. Simple
B. Compound. [simple]
C. Compound Simple
D. Simple Compound.
By a simple fracture is meant a solution of continuity
in a bone without a wound communicating Externally.
573. By a compound fracture is meant a solution of continuity
in a bone, with a wound communicating Externally which does
not heal without suppuration & granulation.
574. By a Compound simple fracture is to be understood a fracture
which has a wound communicating Externally but which
Wound heals either by the 1st. or 2d. Mode of union & without Suppuration.
575 The Simple Compound fracture takes place where originally

♄. 578. It has been usual to distinguish all unnatural
states of the Bones, by the name of Caries. Caries was divided
into moist & dry; moist seemed to imply a diseased state of
the Bone, dry the bone becoming dead. By converting the
moist into the dry state a cure was frequently accomplished,
why this happened will appear from (587. 597. 632).
The term caries signifies a Rottenness in the bones it is
evident this was improperly applied to bones becoming [diseased]
dead, because a dead bone is generally thrown off without the
least appearance of Rottenness, indeed it is much more firm &
solid than the margin of suppuration in the living bone which
had thrown it off.

109.
there was no Wound communicating externally, but where in
consequence of some parts losing their living Principle from any    
cause Ulceration of the Integuments is rendered necessary & the circumstances
of a Compound fracture induced.
576. Previous to our entering upon diseases, or mode of restoration
in bones it is necessary to consider the five following aphorisms.
577. Bones consist of an inanimate earthy matter attached to
a living organized substance.
578. Bones may either be in a dead or a diseased state, between
the death & disease of a bone it becomes necessary carefully to
distinguish. ♄.     
579. Bones fall into disease more slowly than soft parts, &
when they become diseased are proportionally slower in the act
of Restoration for all processes go on more slowly & difficultly in
bones, than in soft parts.
580. It will be necessary also to consider the doctrines advanced
in (352. 358. 359. 361. 362. 482.).
581. Also that bones receive their Nutrition & means of support
chiefly from the Periosteum or membrane covering the
bones (382) different Bones varying much in their structure
(577) their diseases will vary, as well as the readiness with wch.
they undergo the process of restoration.
582. When a solution of continuity happens in a bone by External

     

  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


110
External violence, productive of simple fracture (572) the cure may
be effected by the first mode of union ( ) without either Inflammation
or Suppuration. In simple fractures though accident
produces a Rupture of several blood Vessels & an immediate effusion
of Blood into the Cavity made by the division of the bone
if the Œconomy of the Parts is not very much disturbed by this
violence, the bloods retaining the living principle, the red part
& serum, are soon absorbed & the coagulable Lymph alone remaining
becomes Vascular the Cure is accomplished with little
pain & without disturbance of the General System.
583. If so much injury is done to the parts, that a considerable
& unusual action is necessarily Excited in them, the first
& most simple mode of union will not take place, but the Ossific
Inflammation or that which is perfectly similar to the adhesive
Inflammation in soft parts arises. Coagulable Lymph
is poured out into the Cavity (now similar in its nature to any
natural circumscribed cavity) which is to form the callus this
becomes vascular at length Cartilaginous & lastly ossific matter,
as in the first formation is deposited ( ) & thus the cure is accomplished,
here pain, tumefaction of the circumjacent parts
& the common symptoms of the adhesive inflammation takes
place.
584. In the compound fracture ( ) the Cavity made by the division
of the ends of the bone becomes an Exposed one, from the


    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


111
fracture being complicated with a communicating Wound, the
blood effused does not as in (582) retain its living principle, the
stimulus of imperfection obligates the Cavity to set up a new process
suppuration takes place & the only means of reunion left are
those of granulation.
585. As in wounds made into circumscribed Cavities, if the
lips of the wound come in contact & unite either by the first or
second mode of Union, before the Stimulus of imperfection gives
the Alarm to the cavity, a suppuration of the whole Cavity does
not necessarily take place, so in the Compound simple fracture
if the external wound is thus made to unite before the blood effused
into the Cavity has lost its living principle & the stimulus
of imperfection has given rise to a new process, the Cure may be
accomplished, with the same case as in the simple fracture.
586. But it may occur that either a splinter of Bone being
detached & dying, or the extravasated blood losing its living
principle, or from a misplaced end of the bone producing ulceration
of the integuments, or an irrecoverable injury being done
to the parts covering the bone, that Ulceration even to the Exposure
of the Cavity is produced, in this case which we term a
simple Compound Fracture the same circumstances will take
place as in the Compound Fracture (584).
587. When a part of a Bone becomes dead, Exfoliation or the throwing
off the dead part from the living must take place, In what

🜖 588. It can rarely happen that any large portion of Periosteum
shall be destroyed, or become dead without a consequent
death of [the] a portion of the subjacent Bone, if only a small extent
of Periosteum is destroyed, exfoliation of the Bone does not always
follow, because its Life will be still supported by means of its
Vessels anastomosing with those that pass from the Periosteum
nearest to the exposed part.
♀. 592. Of this we have instances in Anchylosis of the Vertebræ of
the Spine especially in Horses, between two or more of the Vertebræ
of these Animals it is Common to have an Anchylosis formed.

112.
the Process of exfoliation consists we will hereafter shew.
588. When a surface of a Bone is exposed, it is very common for
a portion of it to become dead & a necessity for the Process of Exfoliation
to take place. For the Bone receiving its nutrition from the
surrounding periosteum, that being destroyed or becoming
dead a part of the Bone must lose its means of support. 🜖.
589. The Union of broken bones is more slowly accomplished than
that of the soft parts, because in the former two processes are to be accomplished
Viz the formation of soft parts & then the formation of
bone.
590. The Ossific Inflammation arises when there is an increased
disposition in a part to form Bone.
591. It consists in the Vessels of the Bone, or the parts covering
the Bone, taking on the same action as the Vessels of the soft parts do
in the adhesive inflammation.
592. The consequence will be similar, for it will produce tumefaction
& enlargement of the Bone, if extending from one Bone to
another between which & the other there is a natural motion it
will produce Anchyloses, like as the adhesive Inflammation produces
immobility in the soft parts to which it extends, it will
be followed occasionally by suppuration & ulceration. ♀.
593. The Causes also of the Ossific Inflammation will be similar
to those of the adhesive; External Violence, as exposure & pressure,
a necessity for action in the Vessels of the bone or its membrane &ca.

♃. 593. Pressure will not uncommonly occasion ulceration &
absorption of Bone, but it may also Excite the Ossific Inflammation
& a thickening of the Bone.

113.
may give rise to it. ♃.
594. The final intentions for which the ossific Inflammation
may be employed, are first to produce restoration of parts & reunion
in a diseased Bone, & secondly to strengthen weak parts.
595. The seat of disease in bone can only be in its living part.
596. The more spongy & soft the Bone is, or the more living matter
it contains the more liable it is to disease, the harder the Bone
the less ready it is to fall into disease, but a death of some of its
parts is more easily Induced.
597. When a bone becomes diseased it is our business to endeavor
to get the better of the disease, but when a Bone becomes dead nothing
can be done but to produce exfoliation.
598. The treatment of diseased bone is rendered difficult by
the impossibility in general of discerning the extent of the disease
599. The inflammation & suppuration may have its seat either
in the surface of the bone, or within the substance of the
bone, or in the medullary substance.
600. Hard bones becoming diseased are more difficult of cure
than soft One’s, & when cured are more liable to fall again into
a diseased state.
601. Bone is liable both to ulceration & intersticial absorption.
602. When a portion of bone becomes [diseased] dead the process of
exfoliation is performed by the dead Bone giving a stimulus to
the living Bone in contact with it & to which it adheres by the attraction
of Cohesion, the living parts immediately in Contact with
the dead bone are absorbed, & a Cavity between the dead – living

🜔vmss. 🜔. 602. The first appearance of separation in order for exfoliation
is a springiness in the living bone now becoming more vascular,
then a Grove is formed in the direction of the fibres that surround
the dead Bone, the living Bone becomes softened & more porous, part
of the dead Bone seems to be sometimes absorbed for it has the appearance
of having undergone ulceration, it is certain that absorbents have
a power of taking up dead bone. The absorption begins at the circumference
& is continued to the Centre. In the Skull they become first
membranous, nature observing the same order in the repair of bone
as in its first formation, a pulsation in the Granulations often attends
the exfoliation of bone. Granulations will sometimes arise
shoot over the edges of the bone to be exfoliated, & prevent it being
thrown off so soon as it otherwise would be in this case it excites
new Inflammation & Ulceration.
🜔vmss. 🜖. 603. The Granulations forming bone irregularly become
often a considerable obstacle, to the cicatrization of the Ulcer after the process
of Ossification &ca. is finished.

114.
surface is formed, the former now being a mere extraneous body
is according to a law in the Animal Œconemy ( ) carried from within
outwards, & at length thrown off from the body, ulceration of
the integuments having made way for its exit, the cavity is filled
up with Granulations which become New bone. 🜔vmss. 🜔.
603. Granulations will arise from the Surface of bone without Suppuration
having preceded, but this only where that surface has
not been exposed by a penetrating Wound. 🜔vmss. 🜖.
604. A thickening of the Periosteum & integuments has often been
mistaken for an enlargement of a bone.
605. A Bone may be enlarged without any alteration in its original
structure, by bony matter being formed in its natural surface,
this laying on of new Bone will arise from the Ossific inflammation
taking place in the periosteum, or on the surface of the bone, we
call this adventitious Bone.
606. Or a Bone may be increased by the Ossific inflammation taking
place in its substance, which causes an alteration in its
structure & enlargement of its dimensions.
607. A Bone may be increased in size at the same time that
there is an absorption going on in its substance, for the ossific
Inflammation may be laying on New Bone on its surface at
the same time that absorption is removing portions of its more
internal substance thus a bone may at the same time be increasing
in its dimensions & losing in its Quantity.
608. Suppuration may take place either on the surface or in the

  
   
   

        
  
 
 
  
  


 
   
    
                                  


115.
substance of a bone.
609. Matter when formed may be confined, if in the substance of
the Bone, by the natural bone remaining unulcerated through its
substance, & thereby preventing its exit, or if on the surface of the bone
by the ossific Inflammation forming a Case round it of new or adventitious
bone, but in the latter Case the progress of the suppuration
must be rapid, otherwise there will not be time for the bony case to be
constructed & the matter will make its way to the Skin as in a common
deep seated Abscess.
610. Matter may be also confined on the Surface of the bone for a considerable
time, simply by the thickening of the Periosteum just as it
is confined by a fascia in the whitloe.
611. The periosteum & the cellular substance connected with it may
take on the Ossific Inflammation.
612. Suppuration taking place in the substance of a bone, & the Ossific
Inflammation being also taken on by the surface of the bone & the
parts covering it, the matter will produce a disposition to the ulcerative
absorption which will be continually removing large portions of the internal
surface of the bone, the ossific Inflammation at the same time
depositing new bone on the outside, thus the Bone may be enlarged
to any size & there two processes, absorption within & Ossific disposition
without going on together the dimensions of the Bone shall be wonderfully
increased at the same time that perhaps the original
bone shall be entirely removed, & even some of the internal parts of the
New bone shall be taken away & at last instead of a Solid bone only


          
   
   

        
  
 
 
  
  


 
   
    
                                  


116.
a large bony Case shall remain from which at length the matter
shall be evacuated. Ulceration within may however go on even after
the matter has made its escape.
613. Ulceration is the Sequel of suppuration it removes the Effects
of the Ossific Inflammation, when ulceration has gone through the
surface of a bone it affects. 1st. the periosteum next the Muscles and
lastly the cellular substance & Skin.
614. Bones when the first & second modes of Union fail are, as heretofore
observed / cured by the formation of Granulations & those taking
on the [diseased] ossific disposition.
615. But it sometimes happens that the ossific disposition shall
not be taken on by the granulations between the Ends of the bone,
so that there shall be no union by bone, the restorative process going
no further than the production of granulations or the change of them
into Cartilage.
616. It sometimes happens that no union at all is formed between
the separate ends of the Bone even after a simple fracture in
this Case, a New Joint is formed, the ends of the Bones become covered
with a Cartilage, & as in all other Articular Cavities a power of
secretion Synovia is given to it, & it is in every respect similar to any
other Joint Except the want of the proper moving powers, that is
corresponding Muscles, these not being generated the new joint becomes
Extremely inconvenient.
617. Ossific Inflammation may terminate in a Suppuration, or the

☿. 620. Here nature seems to be counteracting her own Ends, but
the final intention of this bony case seems to be an hasty attempt
to obviate the weakness in the limb that might spring from the
extent of death in the bone.

117.
bone may remain swollen, but Indolent.
618. Exfoliation of Bone is of three kinds. Vizt.
A. External.
B. Internal.
C. Mixed Exfoliations.
619. The process of Simple external exfoliation has been already
considered (602) It happens also that an internal part of a bone
shall become dead, becoming dead it gives a stimulus to the surrounding
living parts, as an Extraneous Body, it must ultimately
be thrown off, for all parts, / as has been shewn ( ) admit readily of
the passage of foreign substances from within outwards, hence from
its stimulus & the ulcerative absorption is finally produced in the
surrounding parts & a passage is given at last to the dead bone,
In consequence of the stimulus Granulations also arise & fill up
the loss occasioned by the seperation of a part of the bone & these Granulations
becoming bony the Case is accomplished.
620. The mixed is when the External Exfoliation becomes an internal
one which is accomplished as follows.
At the same time that the process of absorption goes on for
removing the dead bone from its Contact with the living parts, the
parts in the neighbourhood take on  the ossific Inflammation & in
the End forms a bony Case round the dead piece & prevents its Exit. ☿.
621. Bones commonly become painful before a swelling of them
is perceived.

622. This happens 1st. because it is the matter of diseased
parts. 2d. because the Continual irritation of the
bone like other irritation induces a flow of matter.
3d. because there is commonly some Blood
mixed with it, which soon becomes putrid.
♂. 626. The quantity of Mercury to be used may be somewhat
less than that fitted to Cure a Pox.

118.
622. The matter discharged from diseased Bone, or where the process
of exfoliation is going on is seldom laudable pus & is extremely disposed
to putrefy, tinging the probe of various colours.
623. When the Skin is affected, that is when the Inflammation
of the bone is communicated to the Skin, suppuration commonly
takes place.
624. The periosteum becoming inflamed & its internal surface
taking on suppuration, a disease or death of the more external
parts of the bone may be induced.
625. The hard bones having fewest living parts, & of Course fewest
Vessels have their life soonest destroyed by any destructive
cause whatever, it is scarcely possible to lay them bare to any considerable
extent without death & exfoliation being the consequence.
626. Where the ossific Inflammation, or the Inflammation of a bone
requires the assistance of Art it is to be treated by antiphlogistic
remedies & by limiting upon rest being given to the part affected,
& if the lower extremities that the Patient lie in an horizontal
position.
When the swelling of the bone becomes indolent, the parts
are to be rouzed into action, & if possible intersticial Absorption excited
by the administration of Mercury both internally & Externally.
The Mozeron Root has been much recommended as
a specific in the Enlargement of Bones. ♂.
627. If the seat of suppuration is the surface of the bone, or the
internal surface of the Periosteum the matter should be evacuated












 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


119.
as early as possible & this by simple incision through all the integuments
down to the bone, but without removing them & more
especially in case the Cranium is the object of our consideration.
628. sometimes in this Superficial suppuration bones are so
much diseased that they have not a disposition for restoration
& the bone will not exfoliate unless the actual Cautery be used.
629. In case of suppuration in the substance or medullary substance
of the bone, (which is the worst case by far) the matter is
to be evacuated by the actual or potential Cautery, or by the trepan.
630. Bones which have undergone external Ulceration often fall into
an indolent state in which Case stimulating dressings are to be used.
631. When the actual Cautery is applied we must [not] use an Iron
of a thickness sufficient to give a degree of heat in proportion to the
depth of the bone. The time of continuing its application must be
also directed by the same Rule.
632. Cauteries may produce a Cure of diseased bones by inducing
a Death of the diseased parts & so render the process of exfoliation
necessary, but in order to have this effect their action must produce
the Death of the whole diseased Part.
633. The [whole] Actual Cautery induces not only the death of
the diseased parts but an inflammation in the sound parts &
this hastens the seperation of the part to be exfoliated. The potential
Cautery rarely does more than producing the death of
the diseased bone.

☍. 637. Mr. Hunter has seen patients who have fractured their
legs in whom firm union would not take place until they were
set upon their Legs, the fractured bones being well supported & defended
by splints &ca. 

120.
634. However [an] a natural or spontaneous exfoliation is much more
to be desired than an exfoliation produced by Art because of the
uncertainly of our endeavours to extend our operation to the whole
of the diseased bone.
635. Of Specific diseases producing disease in bone & consequent
exfoliation, the exfoliation goes on more readily & kindly from the
venereal disease than from Scrophula or others. In Scrophula the
extent of the disease is more considerable, whereas the venereal is
more partial & confined to a narrower Limit.
636. When after a solution of continuity in a bone the cure proceeds
no further than the soft union, the rest of the Limb should
be discontinued to excite if possible a further disposition to the act
of restoration in the parts.
637. When the fracture with the circumstances (636) is in the lower
extremity care must be taken by means of splints & Iron work,
that the whole weight of the body does not rest on the fractured bone ☍
638. When a new joint is formed (616) the observation & Precautions
are also to be attended to.
639. But it may sometimes be desirrable to attempt the destruction
of the new formed joint & procure firm union between the Ends
of the formerly divided bone, in this Case we are to consider the doctrine
of Inflammation of Cavities & particularly that of the Cavities
of Joints (528) &ca. –
640. The mode of accomplishing this purpose will consist in producing

🜍. 640. It must be evident that the less time has elapsed since
the formation of the New Joint the more readily its destruction
will be accomplished.

121.
producing in the new articular Cavity the stimulus of imperfection
by making an opening into the Joints & introducing some foreign
body to prevent healing of the Wound by the first or second mode
of union & excite universal suppurative Inflammation which
being followed by Granulations & those Granulations becoming
bony, the ends of the bone will be immoveably united. 🜍.
641. Diseases of bone may have powerful influence on the constitution,
we may readily conceive the effects of a constant & long
continued pain, want of Rest &ca. which are their attendants we
also know they will bring on hectic & this is accounted for by considering
what is advanced on hectic (479 & ).
642. When ulceration has removed so large a portion of the bone,
that the remainder on account of its weakness shall be unable to
support its necessary actions, or where disease extends through a
greater part of the substance of the bone, than art can restore to
health, or procure a seperation from the sound parts, or where there
is an inability of the constitution to support the disease, or the
processes necessary to healing.
Amputation becomes indispensable.
643. In simple fracture if the patient be healthy the union
of the Bones will be generally accomplished in about three Weeks
but something sooner in the upper than in the lower extremity.
644. Rest – retention of the bones in their natural position,
freedom from pain, & the prevention of Inflammation are the general

   










 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


122
general indication in all fractures of the Extremities, whatever
position of the limb best fulfills these indications is the position
to be recommended.
645 To prevent the displacement of the Ends of the bone we
use splints & bandages.
646. Of the different species of fractures enumerated (572) the
Compound is the most dangerous, & frequently attended with
troublesome, if not fatal Symptoms, as Fever, Symptoms of
dissolution, Gangrene &ca.
647. We can rarely keep the bones perfectly at rest, in bad
compound fractures, hence constant irritation, pain, &ca.
648. The same indications are to be fulfilled in the compound
as in the simple fracture (582) we should move the Limb as
rarely as possible. Poultices though they should otherwise seem
desirrable applications in Compound fractures, become injurious
by their admitting of motion in the ends of the fractured bones.
649. The simple compound Fracture is attended with less danger
than the compound fracture, although the former also may
produce troublesome & dangerous symptoms.
650. The treatment of the constitution when affected by the
consequences of compound Fracture will be but understood
by recurring to (462 od 479.)
651. From what has been said it must be evident that when
a fracture of a bone is complicated with a communicating

   









 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


123.
wound of parts that cover it, as Muscles, Cellular substance
& Skin, it must be always the duty of the Surgeon to endeavour
to render the Case a simple of a compound Fracture,
to which End he will be careful to remove extraneous bodies wch.
may hereafter produce the Stimulus of imperfection, to place
& retain the bones in their natural site & prevent their irritating
the soft parts, to bring the soft parts into contact
one with the other, in short to observe the rules laid down
in cases of Wounds into Cavities & the doctrine (682).
652. In bones as in soft parts the observation that all new
formed are weaker than original parts holds equally good.
653. In bones as well as in soft parts, the process of restoration
goes on more readily in the upper than in the lower extremities
Compound fractures therefore considered as injuries done both to
the bones & to the soft parts are more dangerous in the leg and
thigh, than in the Arm or fore Arm.
654. Fracture of bones, which communicate with Cavities of
joints, whether simple or Compound require peculiar attention
& peculiar treatment, as
1st. the fractured Patella
2d. --- Olecranon
3 --- either Ancle
655. Also when a fracture happens near a Joint, the bone may











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


124.
be so splintered as to communication with it.
656. In case it be a fracture attended with a wound of the Joint
communicating externally, the Wound must be healed if possible
without suppuration, which arising, will occupy the whole
Cavity of the Joint & too often produce a necessity for amputation.
657. If a simple fracture communicate with a joints cavity
the Bond of Union will escape into the Cavity of the Joint
& form a Case similar to Compound fracture.
658. The fracture of the bone will be here united by the third
mode of union or granulation. (the first & second being lost
by the escape of the Bond of Union into the Cavity of the Joint)
except that here there will be granulation without suppuration
preceding (603) In case of fracture communicating with a
joint, it is apt in the cure to produce a stiffness & loss of action
in the joint from the blood escaping into the Cavity & becoming
organized, in this Case as soon as the fractured bones are united
by the Callus it is necessary to give passive motions to the joint
often repeated them & when the callus is confirmed the patient
should diligently exercise the part affected by constant motion
of the proper Muscles.
659. When the Patella is fractured the union of the fractured
parts will be either by bone or ligament.











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


125.
660. If the fractured parts, remain in contact or very near to
each other, the Union may take place by bone as in the fractures
of other bones; but if the fractured portions are at a distance from
each other, Union by the formation of Ligament will be the mode
adopted.
661. For the Patella being employed in the formation of a Joint
a Union by lengthening the bone two or three inches must have
been extremely inconvenient to the patient & incompatible with
the future motions of the Knee.
662. The Patella being the point to which the principle extensor
Muscle of the Leg is inserted, when fractured transversely the
Muscle being now no longer confined contracts itself & draws the
superior portion of the fractured bone to a considerable distance
from the inferior.
663. When the union is formed by ligament as is always the
case, when the fractured portions remain at a considerable distance,
asunder, the patella is very much lengthened & the two
points of attachment of the Rectus Muscle being therefore brought
much nearer together, the Muscle must be considerably shortened.
664. As the original length of the Muscle is diminished its power
of contraction must be diminished in proportion, for the two
ends of the Muscle have in consequence of the accident approximated

♀. 668. Lady B. broke both her Patellæ, they were reunited by ligament
& she lost entirely the use of her Legs, consequently was [n??]
able to walk, she has been in this state 2 Years when Mr. [H?a?] 
her: conformable to the principle laid down in the Text, he set
upon a Table with her Legs hanging inflected over it, he desired her
think attentively of extending her leg & try by the powers if the will
to raise it forward, at first her mind had not the least [influe??]
on the Leg by repeatedly determining the influence of the will to 
the Muscles & repeating this endeavour several times for two
three days she gained a trifling power of Extending her Legs, by persisting
in the same means she increased that power so as to
be able to extend them compleatly, she was then directed to raise
he Leg with a small weight affixed to the Toe, this weight was
gradually increased, at length she was set upon her feet & obliged
by an attempt to walk to Exert a greater force, by daily exercising
the Muscles in this manner & gradually increasing their labours she
was at last restored to the use of her legs, which were formerly considered
as irrecoverably lost.

126
approximated themselves nearly entirely as much to each other as
they were accustomed to do in voluntary action, hence it is evident
the powers of extending the limb must remain lost unless the
Muscle acquires a new action, thus accommodating itself to the
present Circumstances.     
665. The Muscle will acquire however a new action in time &
moreover will in time be enabled to shorten itself, so that by its
contraction the power of extending the Limb shall return to the
patient.
666. This power will be the sooner restored if the Surgeon & the
patient join their endeavours to induce in the Muscle an habit
of Acting.
667. This is to be done first by giving passive motion to the limb
& then by the Patients exerting attentively the influence of the
will upon the part.
668. For the Muscle being originally under the influence of
the will, if the powers of volition are resolutely [& powerfully] & industriously
exerted, will in time recover its pristine action & voluntary
motion of it will be restored. ♀.
669. If the Union is formed by bone from the irregular formation
of the Callus, a bony ridge may be raised on the internal
surface of the Patella which may impede the future actions of the
Joint.
670. It must be evident that the knee should be kept straight

☍. 673. The Triceps Extensor Cubiti being fixed to the Olecranon
when a fracture of that process happens, the superior portion
of the bone will be drawn upwards by the involuntary contraction
of the Muscle, in the Cure the superior is to be brought
downwards, the Arm for sometime kept extended until Union begins
to take place & the action of the triceps is to be checked by
Bandages, when Union is partly formed, as after a fortnight it
mostly will be, then passive motion is to be given to Prevent stiffness
of the Joint, & lastly when union is compleated a voluntary
motion as in the Case of the Patella.
It is remarkable that in general the luxuriant Callus
of a bone is on the outside if its internal surface is exposed to the
action of Moving parts. Thus a ridge from a callus of a fractured
Rib, is never on the inside of the Rib.
After Muscles have acquired a new action the next step
is to give them strength, which must be done by frequent Exercise
It is to be observed that the greatest possible Contraction of a muscle
is somewhat more than a motion of the Joint which it serves admits
of, hence when the Patella or Oleacranon is fractured – the Extensor
Muscles will be shortened more than they were in voluntary
action.

127.
X that in order to the retention of the bones in their approximate
state we must apply a bandage rolling the thigh from above downwards
to prevent the involuntary Contraction of the Rectus Femoris
also that rest should be insisted on, the Surgeon should repeat his
motion of the Limb once in two or three days, afterwards more frequently,
until at length the proper time comes for the Patient to
Exert self-motion (Sec Lady B's case 667).
671. The union of the Bone will be much sooner accomplished
by bringing the seperated portions of bone near together & retaining
them in that situation, for by this means the Muscle will not lose
its original Length & of course its power of contraction, consequently
less difficulty will hereafter arise to the patient in Extending his
Limb & the Evils of irregularity of Callus & Stiffness of the Joint may
be prevented by the attention of the Surgeon
672. When the Cure has been attempted, as soon as reunion has
begun to take place a slight degree of passive motion should be
given to the Limb, & as soon as Union is perfected, Voluntary or self-motion
should be insisted on.
673. The Olecranon is to be considered as a fixed Patella & the same
principles allowing for that difference will apply to a fracture of it.
674. When the Ancle bones are fractured they are only to be considered
as bones making Joints, & not as liable to be influenced by the action
of Muscles, none of which are inserted into them, they are therefore
to be returned if any displacement has happened to their natural

🌕︎+. 679. Mr. Hunter has once seen a Cartilage die become black
& be thrown off with a portion of bone lying under it, this is also
the Case in White Swellings the Cartilaginous Ends of bones being
observed, the bones are removed together with the Cartilage.
Mr. Bromfield Amputated the Arm of a young Woman
at the shoulder joint, she recovered several years afterwards she came
into St. Georges Hospital where she died on dissecting the shoulder on
which the operation had been performed it appeared that the Granulations
& soft parts were not the least adherent to the subject Cartilage
which they covered loosely like a purse, the same thing happens
when fingers are amputated at Joints. Mr. H has seen the Cartilages
of the Larynx & ribs exfoliate but they have previously ossified & become
a spongy bony substance

128.
natural situation & retained in it by bandage &ca. & when union
has begun to take place between the divided portions of bone passive
motion should be given to the Joint, (675).
675. Cartilage is an animal substance intermediate between the hard
& soft parts, approaching very much in its nature & properties to horn
It has very few Vessels is insensible; has little or no power of absorption,
does not swell from pressure, is not liable to exfoliate even when
exposed & scraped, never goes into the suppurative Inflammation, nor
ever becomes the basis of Granulations.
676. Cartilages may be divided into two kinds.
A. the permanent
B. the changeable.
677. The order A are such as remained unaltered during Life
such are those of the Nose & Ear.
678. The order B. (676) are two fold.
1st. Those which at a certain time become bone for which
before they served as a substitute, such are the Epiphyses of bones wch.
in the Infant are Cartilaginous, in the Adult are bony.
2d. Those whose change into bone to her place at an uncertain
time of Life, & sometimes are never changed into bone, as the
Cartilages of the Ribs, & the ends of the Cylindrical bones.
679. When Cartilages are exposed they do not exfoliate; like bones       
nor do Granulations arise from them, but granulations arising from
the circumjacent soft parts on all sides shoot out & meet over them,
thus losely covering them without adhesion. 🌕︎+.

🜖. 607. The lower Jaw seems an exception to this, the depressors
are always attempting to dislocate the Jaw, but the Elevators keeping
it firm in its socket, opening the Mouth does not give firmness
to the Joint; We see in immoderate Yawning the Jaw will be sometimes
dislocated the Elevators here either for a time losing the power
of action or being over come by the power of the depressors, the latter
are not inserted near the Centre of motion.

129.
680. When the permanent Cartilages are divided the Reunion is
formed by Cartilage, but when the changeable Cartilages undergo
solution of continuity, they are consolidated by bony union.
681. When the changeable Cartilages inflame they take on the ossific
disposition , when they fall into disease they also become bony.
682. Cartilages seldom admit of the ulcerative process, they are
however liable to undergo Contiguous absorption from the Lymphatics
of the surrounding parts.
683. Joints. If we judge of them by the Laws of Mechanics are
in general very ill formed, but this deviation from mechanical
principles, fits them for a vanity of actions, which had the Rules of
Mechanics been strictly adhered to would have required a greater
number of additional Joints.
684. In considering the structure & properties of Joints we are
also to take into account the ligaments & Muscles
685. The Ligaments in general serve as Pivots.
686. The Ligaments of some joints regulate the motion of the
Joint, but there are only such as are moved in one direction only as
the two upper Joints of each finger, others they only serve to sustain
& support.
687. The powers that give force & firmness & direct the Actions of Joints
are the Muscles, the Muscles support the joints in the motions they
have to perform. 🜖.
688. From knowing that the strength & weakness of a joint depends

🜔. 688. 689. These aphorisms require considerable attention
it is observed (48) that the voluntary Muscles may occasionally act
of themselves & independent of the will, & this may be either from disease,
or in spasms, or from a kind of consciousness in themselves of
the necessity of acting when a Man is descending from an eminence
as when he is descending down stairs, the Muscles are all prepared to
support the Joints of the Knee & Ancle, so as to prevent their giving
way, & of course being strained, or any Jarring between the bones
that compose them, & this without any direction from the will, but
seemingly from a kind of attention in the Muscles to the security of
the Joint, but if a Man in walking a longer plane suddenly steps
down a descent which he is not aware of the muscles being unprepared
for the exertion & off their guard do not give firmness to the
Joints, & in this sudden action a jarring & strain of the parts composing
the Joint takes place, hence why strains so often accompany
falls – When a Man falls from an eminence it being uncertain
what part shall immediately receive the shock no particular
set of Muscles can prepare themselves to support a Joint against
Injury.
We gain much information on this Subject from considering
the Cooperation of Muscles. This will enable as to learn why a
Man shall jump from a considerable eminence to the Ground with
out injury, yet from a slight fall shall violently strain the parts
subservient to some of the Joints of his body if we but eagerly clench

130.
depends in a great measure on its muscles we are enabled to account
for several Circumstances otherwise inexplicable.
689. Joints are capable of motion either passive or Active by the
former we mean motion given to a joint by external force, by the
latter that motion derived solely from its proper Muscles. 🜔.
690.
Note continued.
our fist we find not only the Muscles of the hand in motion, but a degree
of rigidity pervades the whole body, the general System of Muscles
cooperating so as to give additional strength to the primary ones
or those immediately concerned in the action of the hand, this is a familiar
instance of the Cooperation of Muscles, so when a Man is about
to jump from an Eminence not only the Muscles of the Legs prepare
themselves to give firmness to the Joint & resist violence but all the Muscles
of the body Exert themselves likewise to give general firmness &
by their general cooperation to assist the Muscles of the legs, in overcoming
the violence of the Jar.. if we suddenly raise an Animal
(as a Cat) upwards the body being elevated its muscles are relaxed, but
the moment we begin to let its body sink towrds the earth the whole
Muscular System becomes in action & a degree of rigidity is sensible
throughout its body, the same holds good with a Child: if in playing
with an Infant (though ever so young) we toss its body tow’rds the
heavens its Muscles whilst it is going upwards remain lax & at
rest, but as it descends towards the Earth they all become Rigid &
firm, prepared as we may say to receive the shock of violence
If

If a Man intentionally Jumps from a considerable Eminence
to the Ground as from an house loss his Knees or Ancle Joints are
injured because the power of the Muscles although prepared to resist
violence & give firmness to the Joints is less than the force with which
his body comes to the Ground & the greater overcomes the lesser.
If a Man jumps out of a Carriage in quick motion he generally
injures his Knee or Ancle Joints from the same cause, for although
he does not in this case jump from any great height, yet the projectile
force of the Carriage (out of which he is thrown as a Stone from a
sling) added to the weight of his body combine to give a greater shock
than the resting power of the Muscles can support, in these cases the
degree of violence, forcing the Joint to passive motion & that perhaps
in an unnatural direction is superior to the power of the muscles to
give firmness & resistence to the Joint.

131
690. Strains always arise from a weakness of the Muscles in
question, or from an intention in them to the task they have to
[ex??ite], being then taken by surprize.
691. If the force of passive motion given to a Joint be greater than
the power in the Muscles to give firmness to that Joint then a Strain
or some other injury to the Joint will ensue (687/689).
692. The Muscles themselves as well as the Joint suffer from strains,
& this from the Causes, being obliged to act unprepared, or being obliged
to resist a force superior to their powers.
693. Dislocations arise from the same Causes as Strains & it is not
impossible but fractures of bones may also be produced by them.
694. Crookedness of the Spine may also originate in a deficiency
of muscular powers, the Muscles of the back not being able to sustain
the trunk in its erect posture.
695. The same Cause likewise, probably gives occasion to Knocked
Knees, we rarely see very muscular People fall into these states.
696. The power of the Muscles in preserving joints being overcome
by the Violence of the external force applied, the joint gives way to
this violence as far as its ligaments will allow, there are stretched to
that side to which the Joint bends & these Ligaments are not unusually 
torn.
697. The joint being thus injured the following circumstances may
arise Vizt. Tumefaction of the Joint & this almost instantaneously.
Ecchymosis.

🜍. 701. When Joints after an injury recover their health it is Probably
the ligaments are injured & not the Cartilages.
702. If dislocations are not easily reduced the parts receiving
the dislocated bone adapt themselves to it.
☿. 703. In speaking of dislocations we say the bone farthest from
the trunk is dislocated, thus when there is a dislocation at the Elbow,
we say the ulna is dislocated not the humerus.

132
Heavy dull pain in the part ( )
Sickness ( ).
698. The tumefaction arises from an increased Secretion of Synovia
added to the other Common Causes of tumefaction from external injuries.
699. The parts which are the seat of pain though in their natural
state insensible now acquire great sensibility, this sensibility
leads to a natural Cure by incapacitating the patient for motion
& so necessitating him to remain in a state of rest.
700. In the treatment of strains & injuries of the ligamentous parts
of Joints, the indications are
Rest.
Topical bleeding, as by leeches.
The application of cold water, Vinegar, Spint; [Oari?]
&ca, or Fomentations.
701. But, the powers of restoration here being weak, the cure will
in general be tedious & too often imperfect, the joint sometimes never
recovering its original health. 🜍.
702 the common causes of Strains (690) will be also the causes of
Dislocations.
703. When a bone is dislocated, its end is thrown beyond the Articular
surface of the bone with which it is naturally conjoined. ☿.
704. The bone being thus displaced the action of the Muscles inserted
into it draws it upwards, so that the limb (if one of the Extremities
is concerned) appears generally shorter than its fellow & if

♁. 705. Here then retrograde motion is to be observed, & the last actions
in the dislocation is the first to be overcome, the last action is that of
the Muscles drawing up the dislocated bone & their force being overcome
by distension, in a proper direction & by it the Head of the bone being
brought to the edge of its receiving articular Surface is then by lateral
pressure to be forced into its place. The humerus is the bone that is
most frequently displaced & its reduction is rendered difficult among
other causes by the Scapula being a moveable bone, it is of the last
consequence sometimes to make the Scapula steadily fixed, a great
variety of motion & a great degree of mobility is incompatible with great
strength, this is a cause why dislocation of the humerus so frequently
occur how far the Ligaments are lacerated in dislocations is not yet
ascertained.
☉. 706. This happens most commonly in irreducible dislocations
of the thigh bone, for its head comes in contact with the Os Illium 
this may also take place in certain dislocations of the Os Humisi
where its head happens to be placed against the Scapula, these necessitous
joints are very similar, to simple fractures not uniting (616).
♂. 708. When a joint inflames it swells & becomes Extremely Painful;
Inflammation of a Joint always requires great attention.
Inflammation arising spontaneously is in general more dangerous
than Inflammation produced by external injuries.

133.
suffered to remain long so the reduction is frequently impossible.
705. In attempting the reduction of a dislocated bone the indications
are.
1st. to make the naturally most immoveable
part a fixed point.
2d. to overcome the action of the Muscles
which draw up the dislocated bone & resist its recovering its natural
situation. –
3d. then by making lateral pressure to force
the head of the dislocated bone in its proper place. ♁.
706. If a dislocated bone remains in its unnatural state a considerable
time & in contact with a bony surface by degrees it forms
to itself a new socket, the bone against which it presses undergoes
absorption, & the adhesive inflammation Arising in the parts around
a new joint is formed, these may be called necessitous joints. ☉.
707. Joints are more subject to fall into diseased habits than
any of the other circumscribed cavities & this from the nature of
the materials of which they are composed, some Joints are more
frequently the subjects of disease than others from being more exposed
to Injury as the Knee.
708. Joints are subject to the adhesive, suppurative & ulcerative
inflammations & to specific diseases as scrophula. ♂.
709. Scrophula may be brought into action in Joints having
a disposition to it by any external violence.



  
       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


134.
710. The adhesive Inflammation is not carried to the same extent
in Cavities of Joints, as in other circumscribed Cavities, because
adhesions being produced, would render a joint useless, but the Inflammation
runs into suppuration, or the Inflammation becomes
of the Scrophulous kind.
711. Inflammation of Joints whether arising spontaneously or
from violence requires.
Rest. Topical Bleeding, sometimes Blistering & general
Antiphlogistic Regimen but as soon as the disease becomes Stationary
it is to be considered as falling into a Scrophulous state &
the treatment of scrophula had recourse to.
712. If a joint takes on Suppuration every point of its Cavity falls
into it, Abscesses in the Joints should always be prevented if possible,
as they are productive of the greatest Evils.   
713. The suppuration here rarely goes on kindly, it is a mixture
of the adhesive & suppurative inflammations, the parts want power
to carry on readily any process, even ulceration goes on very slowly &
a considerable time is taken up, in bringing the matter to the Skin.
714. The ends of the bones forming the joint here become ulcerated,
indeed the bones seem to accept of the ulcerative Absorption more
readily than the other parts employed in forming the joint.
715. From the backwardness or inability of the parts to commence
the process of restoration & the constitution being long teized by an incurable
local Disease Hectic ( ) is produced & the patient is destroyed, unless

719. As between two ribs, this is seldom inconvenient but may
if it is taking place between the Radius & ulna, hinder the pronation
& supination of the hand, it happens when two Bones are within the
reach of ossific Inflammation arising in either of them.
Φ. 719. Here circumstances are similar to a fractured bone being
united by Granulation as in Compound fracture.

135.
saved by a timely Amputation which in general is best performed
early.
716. Diseases of the joints more readily produce Hectic than diseases
of the Bones in which joints are not affected, should circumstances
more kindly arise, & the suppuration & ulceration go on quickly,
it may happen that granulations may arise & a cure be obtained
without the loss of the limb & only with Abolition of motion in the joint.
717. If when motion is lost in a Joint, Anchyloses is said to have
taken place.
718. Anchyloses is produced by two Causes Vizt.
1st. By an immobility of the bones produced by a
change in the soft parts forming or surrounding the Joint.
2d. By an immediate Union between the Bones
themselves.
719. Anchyloses are of five kinds. Vizt.
1 Lateral Anchyloses.
2 Surrounding parts becoming bone.
3. The Capsular Ligaments of Joints taking on the
ossific Inflammation & becoming bony.
4 Granulation arising from the Soft parts in
a joint & afterwards becoming bone.
5. The ends of bones forming a Joint becoming
ulcerated & Granulations taking place, these granulations renting
becoming bony & in fact forming the two bones into one. Φ.


  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


136.
720. When in consequence of proceeding inflammation, or any
other cause, a stiffness & partial loss of motion in a Joint takes place
the Joint [persevering] preserving its original structure or at least
with little alteration, we can often restore its use by giving it a
passive motion frequently repeating it as advised after fracture of
bones communicating with Joints. (658).
721. The powers of Flexion are more easily restored to a limb than
the powers of extension.
722. When joints communicate or are in contact with each other,
as those of the Tarsus & Carpus. Suppuration beginning in one
joint will generally extend itself throughout the whole & all of them
will equally fall into disease.
723. A loose Cartilaginous or bony substance is sometimes found
in the Cavity of the knee Joint this may be formed in the following
manner, some blood being extravasated into the cavity of a
Joint may become organized & at length Cartilaginous or bony, not
being an original formed part, it may in the motions of the Knee
[be] broken off, from the part on which it had been formed, & thus
be found loose in the Cavity of the Joint.
724. Gun shot wounds, are to be considered in general as
wounds accompanied with contusion, they are followed by the same
effects & require the same mode of treatment.
725. These wounds being made by a projectile body driven wth.


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


137.
violence against a part, the extent & degree of the injury will
be in proportion to the magnitude of the projectile body & the Velocity
with which it is driven against a part.
726. The danger of Gun Shot Wounds is to be estimated according
to the nature of the part or parts injured & the degree & Extent
of the part injured.
727. Many circumstances will depend on the degree of velocity
with which the projectile body is driven against a part, as
1st. The greater the Velocity of the projectile body as
a Ball the more the Wound will be made in a straight line.
2d. The greater the Velocity of the ball the more the
Wound will approach to the nature of an incised Wound.
3d. The greater the Velocity of the ball, the greater
will be the danger of Hemorrhage.
4th. The Velocity of the Ball will decrease in invers’d
proportion to the obstruction given to it.
728. Gunshot wounds as all other Contused wounds are attended
in general with less hemorrhage than Wounds from incision
& gun shot wounds are in general slow in taking inflammation.
729. These wounds being attending with a destruction of the life
of several parts, cannot heal by the first or second intention, the dead parts
must slough & be thrown off, so that the process of suppuration
is necessary.


   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


138
730. The slough will be larger where the Ball enters than where
it goes out.
731. We divide Gunshot Wounds into Simple & Compound.
732. By simple we mean where the Ball passes into or through
soft parts only as Muscles & Integuments & which are not attended
with the effects enumerated in the following Aphorism.
733. The Compound [we] subdivide into
1st. Those in which a bone is fractured.
2d. Those attended with the division of some large
Artery. 
3d. Those penetrating some Cavity.
734. The penetrating wounds (733 3d) are either
A. simple penetrating or
B. Those also wounding some contained Viscus.
735. When a Ball passes through a part the most depending
orifice will heal sooner than the superior one.
736. The healing of Gunshot Wounds is always more slowly
performed than the healing of incised Wounds.
737. The degree of mischief done by Gunshot wounds is not
always Early to be ascertained, because parts may suffer violence
without any proof of the kind of injury appearing until sometime
after the accident for.
738. An Artery may be so injured that a portion of it shall become
dead, yet the seperation of the dead portion shall not

🜖. 741. As when a Ball, Bone, or any extravasated fluid presses
on the brain we may remove a portion of scalp to prepare for
the Trephine. As when the intestines come out through the
wound & cannot be returned without dilating it.

139.
take place at the time of the accident, but sometime afterwards,
so that though some hemorrhage happens when the injury is
received, yet a violent one may come on when the dead portion
of the Artery sloughs away – or.
739. A Ball penetrating the abdominal Cavity may bruise
even to death some portion of some Gut, yet the Canal shall
for the present remain entire, nor the exit of faces through its
side take place, until the seperation of the dead from the living
parts is affected.
740. Dilation of Gunshot wounds is not in general necessary
& therefore not to be practised, however the same indications
which require the dilations of other contused Wounds may also
direct us to enlarge these.
741. Dilatation of the Wound, or even the removal of a portion
of soft parts may be necessary when a Ball or other foreign
substance presses in any vital part, a large Artery, or a Nerve,
likewise in case a large Artery is wounded or can be taken up
also when a part is displaced & can be restored by dilating in all
these Cases it is right to enlarge the Wound. 🜖.
742. When a ball is lodged in a part where its continuance may
be the Cause of danger, if we can extract it, it is right to
make dilatation.
743. It is wrong to dilate simply, because a Ball is lodged

🜁. 743. Balls we know, often remain in parts for years
without producing any inconvenience & sometimes they are
never found, with regard then simply to the ball being
lodged in the body, the Surgeon need be under but little concern,
he has only to take into consideration, the other circumstances
present, as the seat of the Ball, the nature of the Part
injured &ca. –
♂. 745. Four Frenchmen were badly wounded by gun shots at
Belisle, two through the Chest, one through the Elbow & one
through the Deltoid Muscles, Scapula &ca. All the Patients did
well without dilatation of their wounds. If the surgeon makes
dilatation, the consequence is that the cure will remain unaccomplished
equally as long as if nothing had been done, The superficial
parts will heal to a very small hole & the deep seated
ones remain open, so that a fistula will remain, incurable untill
all the dead or foreign matter is come away, as exfoliation
of bone &ca. Again in gun shot wounds where the Ball cannot
be followed, as when it has entered the bones of the face, dilatation
must be entirely useless. A Reason given for dilatation
has been the preventing or taking off inflammation & tension,
but has not the incision made in dilating rather a tendency

140
in a fleshy part, or with a view to Extract a Ball, where the
circumstances similar to these (741-742) do not indicate the dilation
of the wound. 🜁.
744. In simple gun shot wounds no advantage is gained by
their dilatation, for the wound made by the knife of the Surgeon
will heal much sooner than the wound made by the Ball
so that dilating will not alter the nature of the Wound or
hasten the Cure.
745. Moreover if an Extraneous body, as a Ball splinter of a
bone &ca. is to be thrown off, the wound though dilated or treated
in any other manner will not heal until the foreign matter
is thrown off, so that, all attempts tow’rds a Cure must be fruitless,
until that Event takes place, the wound will heal so as to
leave a small hole only, open, which will remain unhealed until
all the Extraneous matters, which are to be thrown off
are come away. ♂.
746. In examining Gun shot wounds the probe should never
be used where the finger can be admitted, & forceps &ca is never
to be introduced but when the Ball &ca. is within our reach.
747. If a Ball passes some way under the Skin, & again
passes out at a considerable distance, an opening should be
made midway between the two orifices to prevent the formation
of an Abscess.

to induce these affections.
🜔vmss. 🜔. 751. Balls that do not go through & through are
generally Spent balls, unless it happens that a ball strikes
against a bone; a Ball shall sometimes enter the breast obliquely
& afterwards go almost round the whole body & be directed
by a rib until it pier as the Skin & makes its way outwards.
The Course of some balls is really surprising, Mr. H has seen
a ball enter on one side the Shin bone, go across it & raise up
the Skin from the Periosteum & make its exit on the opposite side
without doing any injury to the bone, now had the Ball struck
the part with great velocity it must have gone directly across the
bone & carried away a Portion of it. A Soldier had a Ball
enter the Biceps Muscle of the Arm & pass out under the Scapula
close to the Spine.
🜔vmss. 🜖. 752. It is difficult to say on what this red line depends,
it seems to be neither the effect of Inflammation nor
of Extravasation.

141.
748. If a Ball passes through & through immediately under
the Skin, the orifices not being far asunder, it might be right
to open the sinuous wound it has made through its whole
length, for the Skin does not so readily unite with the parts
underneath, as muscular parts do with each other.
749. If a Ball is lodged under the Skin & can be felt & the
integuments are bruised & threaten to slough away, it may
be right to incise the Skin & Extract it, for the mischief will
not be increased by taking it out, & it will be giving satisfaction
to the patients mind.
750. If the Skin appears to remain quite sound & free from inflammation
or disposition to slough the immediate extraction
of the ball is by no means necessary.
751. The Course of the ball will be ever extremely irregular it
will vary from the perpendicular or Horizontal direction to Oblique
or tortuous & sometimes its Course will make a considerable
section of a Circle. 🜔vmss. 🜔.
752. A red line appearing on the Skin will in general merk
the Course of the ball. 🜔vmss. 🜖.
753. It is unnecessary to dilate a Wound penetrating a Cavity,
as the Abdomen, or Thorax unless, some other Object requires
the attention of the Surgeon than the simple penetration of the
Cavity.

     

 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


142.
754. Compound Gunshot wounds in which an Artery is divided,
or a bone fractured, as there is nothing specific in their nature
so the general principles of Surgery will apply to their
treatment.
755. Penetrating Wounds (733 3d) are divided into
a. Simply penetrating wounds.
b. Wounds penetrating some contained Viscus.
The containing Cavities will be the abdomen, the thorax & the Cranium.
756. Wounds simply penetrating the Abdomen will in general
do well, provided the first or second mode of union takes place, so
as to exclude the Stimulus of imperfection from giving a general
alarm to the whole Cavity.
757. Compound penetrating wounds of the abdomen will again
divide themselves into two kinds
1st. Those which penetrate some containing Viscus
as the Stomach, small intestines, large intestines, Bladder &ca
2d. Those which penetrate some non containing
Viscus as the liver, spleen &ca.
758. The Compound penetrating Wounds (757 1st.) will have different
Symptoms according to the part receiving the Injury.
759. The Symptoms of wounded Viscera will be either
1. Immediate or
2. Secondary.

🜔vuss. 🜖. 760. A Young Gentleman received two or three Shots
in his abdomen, one of which went through his body, entering
before & coming out near the Spine, his stools were natural, from
which Mr. Hunter pronounced his bowels unhurt, his urine was
bloody, which shewed either his Kidney or his Bladder to be wounded,
he recovered.

143
By the first is meant peculiar Symptoms arising immediately
from the injury done to the Viscus.
By the second, those which arise from the consequences of that injury
& not from the injury itself.
760. The immediate Symptoms of wounded Stomach will be
sickness, Vomiting, great depression of Mind &ca.
Wounded Intestines --- Bloody Stools.
--- Liver --- Pain in the right or left Shoulder,
according as the right or left lobe of the Liver is wounded, discharge
of pure Blood by stool.
Kidneys or Bladder --- Bloody Urine, & here the Ball if it
remains unextracted may prove a nucleus for a future Stone,
a wound of the Spleen will give no particular symptoms, it is
in general followed by a profuse extravasation of blood into the Cavity
of the Abdomen.
In general wounds of the Liver & Spleen will have none but immediate
Symptoms. 🜔vuss. 🜖.
761. It will however be very different in Wounded containing
Viscera or those which naturally contain quantities of foreign secreted
matter, as the Stomach, the Intestinal Canal, the Bladder
the Gall Bladder &ca. the Intestinal Canal being wounded, considerable
time may be elapsed before the seperation of a Slough
gives an opportunity for the fœces to escape, these getting into the
common Cavity of the abdomen, at what distance of time soever from

🜔vuss. Φ. 762. A Gentleman in Duel had a Ball passed through
his Belly, he had no particular Symptoms for 13 days, on the 14th
fœces came through the Wound nothing further indicating mischief
Mr. H pronounced him, out of danger forming his prognosis
on the principles laid down in the text.

144
the injury, will become the cause of general inflammation
of the whole Cavity with all its consequences, as suppuration,
Gangrene & Death. A Wound of the Gall Bladder, ductus Coliducus,
Parceaticus, or Urinary Bladder, if communicating with
the common cavity, may produce the same affects though probably,
more slowly, see ( ).
762. In general Wounds of the containing Viscera will destroy
the Patient, but it sometimes happens that previous to the
appearance of any secondary Symptoms adhesions shall take
place between the Wound in the intestines & the wound in the
peritoneum & common integuments, so that when the slough comes
away the fœces &ca. will escape, not into the Cavity of the Abdomen
but through the artificial Canal formed by the adhesive inflammation,
& which as an artificial Anus or Urethra, will
give an exit to the Substances to be evacuated, when this circumstance
takes place no other ill Symptom forbidding us, we may
offer a favorable prognostic. 🜔vuss. Φ.
763. The time which may elapse before the secondary symptoms
appear may be, 10-12, or 14 days (762 Note).
764. The Artificial Canal (762) will sometimes close & heal up.
765. Wounds simply penetrating the Cavity of the Thorax will
be only so far dangerous, as they may produce exposure of the thoracic
Cavity, if the first or second mode of union takes place before



 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


145.
before the alarm is given to the Cavity no mischief arises.
766. Wounds of the Lungs are not always fatal, those made
by a Shot are less frequently destructive than those made by
a sharp instrument, as a Sword or Bayonet, for
767. One great cause of the Mortality of Wounds in the Lungs
being excessive hemorrhage into the Cavity of the Thorax, the
hemorrhage following a Gun shot wound will be much less than
that produced by a cutting instrument.
768. Symptoms of a wounded Lung will be Bleeding from the
Larynx, Cough, pain, in the side, fainting difficulty of breathing.
Diminution of motion in the muscles of the Thorax because
the Muscles of one side cannot act without those of the other
side acting likewise.
769. The Wound being in a Vital part the pulse will grow quite
hard.
770. The Patient will not lie in an horizontal posture but is
desirous of sitting Erect that his Diaphragm may be as freely
expanded as possible.
771. A profuse Extravasation of blood in the Thoracic Cavity may
be judged of from the sense of weight complain’d of by the patient,
from the lowness & faintness which must attend so sudden & copious
evacuation from the Lungs, & the common Symptoms of a sudden
accumulation of fluid in the Thorax. ( ). –

🜔🜹. 773. Penetrating wounds of the cavity of the head will be
considered among the diseases of the Encephalon (785).

146.
772. A Gun shot wound penetrating the Lungs, the wounded
Lung, commonly collapses & therefore an adhesive of the
wounded part to the pleura cannot take place
773. Gunshot wounds not healing without suppuration soon
will be left for the matter, which may be collected in the Chest
to drain off, but this will be attended with the inconvenience of
making the Thorax an exposed & imperfect Cavity, if the quantity
of Blood Extravasated is small it may be absorbed, but if there
are Symptoms of a large quantity being collected in that Cavity the
operation for the Empyema should be performed as early as possible,
because if the Blood coagulates it will adhere to the sides
of the Cavity & not be got out without the greatest difficulty, or in
some cases it may suffice, or be best to enlarge the original
Wound. 🜔🜹.
774. Gunshot Wounds may so far injure a part, that the process
of restoration cannot take place in it, & therefore the Wound
is rendered incurable, in this case the removal of the part becomes
necessary, & when a part, as are upper or lower limb has been
so much injured that its removal is necessary, we must determine
in what case Amputation should be immediately performed or
in what it may be deferred to some future Period.
775. Should a part, (as an upper or lower extremity) be so far       
nearly seperated from the body, as only to hang by a small Portion


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


147.
Portion of soft parts, it may be immediately removed.
776. Should an hemorrhage from some Vessel, which cannot
be restrained endanger the Life of the Patient, amputation of
the Limb should be immediately performed.
777. But in most other cases, it is adviseable to defer the Amputation
until the Inflammation is gone off.
778. If a Cavity is wounded & any of the contained Viscera protruded
they should be immediately replaced.
779. Bleeding is not indiscriminately to be had recourse to in
Gun shot wounds
780. We are always to be directed in our opinion with respect to
this Evacuation, by the nature & situation of the part injured, & its
powers of action, & the general strength of the patient in proportion
to the general action of the Vessels.
781. Excessive bleedings having been employed, Patients have
sunk suddenly.
782. The use of the bark becomes highly proper after Inflammation
has subsided, & even during the presence of Inflammation if
attended with weakness of the System, it is however necessary sometimes
to accompany its use with small bleedings.
783. After the sloughs occasioned by Gun shot Wounds have been
thrown off, though the Ball or other Extraneous matter remains
in the body, the ulcer will granulate & continue to heal so long

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


148.
as the extraneous matter remains quiet & does not stimulate
784. When an Extraneous body remains unremoved, the ulcer
may become fistulous, or a fistula may even be formed when the
foreign body has been extracted, in which case it is to be treated
as another fistula.
785. Tents are however always improper.
786. Diseases of the Brain are of two kinds, Vizt.
a. Where the imagination is affected, from various
causes as in Mania &ca.
b. from Mechanical Injuries.
787. Mechanichal Injuries (.786.b.) may be either. 1st. concussion
2d. Compression, 3d. Wound or loss of substance 4th want of due compression.
788. The three first may exist seperately, or any two, or all three
together, their Symptoms will be nearly similar, there are as cessation
of sensation, & voluntary actions, the Muscles of the mouth &
throat becoming flaccid, froth being discharged from the mouth
with the appearance of fullness of the Vessels, the Symptoms
of the 4th. will be restlessness & insensibility.
789. Vomiting accompanies all these affections of the brain & arises
from Sympathy.
790. Vomiting however never takes place during the time of perfect
insensibility. –

  
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
791. Injuries done to the Brain diminish sensibility, Injuries
of other parts increase it to a certain degree.
792. Concussion (787) may depend upon a displacement of parts
of the brain, the degree of concussion will be in proportion to the
violence with which the blow is given, whether the head falls
against any Body, or any hard body is driven against it.
793. Compression ( ) may follow accidental Violence immediately
or arise sometime after.
794. Compressions may be owing to any of the following causes
Vizt.
1st. To a depression of the Scull from Fracture
2d. to pressure of some part of the Cranium from the
thickening of a diseased Bone.
3d. To water in the Ventricles
4th. To distention of the Blood Vessels.
5th. To Inflammation.
6th. To the formation of Pus
7th. To the extravasation of Blood.
8th. To a Tumor in the substance of the Brain itself.
The causes of Wounds or loss of substance in the Brain must be
sufficiently obvious.
795. Concussion will be either.
a – Simple – b – Compound immediately or
c – Compound secondarily.
796. Simple Concussion is where there is no fracture, compression

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
or Extravasation, we must endeavour to distinguish between Concussion
& the effects of intoxication. The effects of simple concussion
will soon be carried off by plentiful bleeding &ca. but if it is
Complicated with Compression the effects will not be diminished by
time, but rather increased, Compression may instantaneously follow
Concussion, in which case it is said to be compounded immediately,
or Compression may arise when the effects of Concussion would
be naturally going in which case is said to be compounded
Secondarily.
797. Fractures of the Scull may always be considered as compound
Fractures, they are either made so intentionally by the Surgeon,
or are found by him in that state.
798. Fractures of the Skull are of three kinds. Vizt.
1st. Fracture of the Outer plate
2d. Fissure
3d. Bone broken in several places
These may be complicated with each other.
799. The 1st & 2d. (798) may be the remote Cause of Compression (793)
& the third may in itself become the immediately Cause of Pressure on
the Brain.
800. Bleeding from the Nostrils or Ears, is a common though an equivocal
Symptom of a fracture of the Cranium
801. The concussion will be in general less, where the Bone is much
shattered than when otherwise, for the force being spent upon the Skull
less shock is given to the Brain.

       
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


150.
802. Gun shot Wounds of the Head & those made by other Bodies
moving with great Velocity do not produce for the most part great
concussion.
803. Fissures of the Scull will run in very different directions along
the Cranium, across it, & even across the Sutures. –
804. If the Scull is soft & yielding there will be often depression of the
bone without fracture.
805. When there is fracture & depression of both tables, if the fracture
detaches an entire piece of bone from the undepressed Cranium & that
whole piece is driven downwards, then the fracture of the internal table
will always be larger than that of the External.
806. If the fractured bone is depressed on one Edge only, & through
both Tables, the inner table will still go shelving off beyond the outer.
807. hence (805-806) will appear the difficulty of elevating depressed
portions of bone, so as to make the seperated pieces, fit themselves
to the undepressed Cranium perfectly smooth, hence also the utility
when a portion of bone is to be removed, to make the margin of the depressed
piece a part of it.
808. The indication in all fractures of the Scull, is to prevent or remove
pressure on a Vital part, that is the Encephalon, therefore it is
necessary whenever there is a fraction with depression, when a piece
is detached & driven inward to remove it entirely, or if one edge only
is depressed to take care to elevate it properly, the operation employed
for the purpose of elevating or removing depressed Bone, or for making

🜔vmss 🜖. 814. The situation of the extravasated fluid will be very
different in different Cases & hence the great uncertainty of our Release
the Patient, who labours under compression from some cause independent
of depressed bone, it may be between the dura mater of the Scull,
between the dura & pia mater, between the pia mater & the brain,
or it may be in the Ventricles, & even in the substance of the brain itself.

151.
an opening for any necessary purpose into the Cranium is called
trepanning & the instrument used by Surgeons for that end is called
the Trephine.
809. When a fracture is discovered it should in general be traced as
far as possible throughout its extent, & therefore we are sometimes Obliged
to remove the Scalp freely.
810. Fractures of the Scull are so often complicated with the immediate
or secondary symptoms of Injured brain, that few cases will
offer in which the trephine will not be necessary.
811. It is never necessary to apply the Trephine either in Cases of
fissure or fracture of the outer table only, unless there are also Symptoms
of an injured brain, & those not of Simple concussion alone.
812. In all cases of Compression either immediate or Secondary of Concussion,
complicated with compression, & in all wounds of the brain
it is necessary to apply the Trephine.
813. It may sometimes be impossible to ascertain the exact situation
of the Compressing matter, yet here, as the patient must undoubtedly
die if not relieved, it is justifiable to operate at Random.
814. The situation of extravasated fluid will sometimes be opposite
to the part where the blow was received. 🜔vmss 🜖.
815. The dura mater should never be divided unless from the
greatest & most evident necessity (as when matter or blood is visibly
lodged beneath it) for penetrating Wounds of the dura mater (which
exposes & renders imperfect a Cavity containing the Brain) will in general

♀. 815. Mr. Hunter computes that not more than one in 20 persons in head
would recover from a penetrating wound of the dura mater.
♂. 819. In health we know the Strength is always greater than
the actions.

152.
general be mortal. ♀.
816. The Trephine must be applied (one, twice) or as many times
as the Extent of the Injury shall require.
817. The Trephine may be applied in any part of the arch of the
Cranium where an accident may render it necessary, or eligible, if the
fracture is circular it will be right to repeat the application of the Trephine
until it is surrounded by the perforations.
818. As life consists in the properties of preservation & Action, so
Death is the loss of both.
819. The immediate Cause of death in a part would appear in most
cases to arise from a total loss of Circulation, but this must be the
effect of some remote Cause. ♂.
820. Mortification of a part differs much from common universal
Death, in the latter case the Vessels can be injected & the Structure [cross out]
of the parts examined, but this is not the case with the former its
Vessels cannot be injected, its structure is changed, is destroyed.
821. The immediate cause of mortification, will be whatever can
excite the actions of a part so as to render them superior to its strength,
or reduce the strength of a part so as to be unequal to its actions.
822. Debility Can be only the predisposing Cause of mortification it
cannot immediately produce it, if a part is ever so weak while its
actions, do not exceed its strength it will retain life.
823. From (813) it is evident that a part may fall into mortification
either with or without previous inflammation, in the former Case the

∇. 824. The greater the distance from the heart the more liable are
parts to mortification.

153.
inflammation is the immediate cause of death.
824. Heat should always be in proportion to the living principle otherwise
it produces a necessity of Exertion, which the strength of a
part is not equal to, the exciting of heat then in a part where powers
are very weak may induce mortification.
825. When parts are extremly weakened as to their principle of Life,
by Cold (as when people are frost bitten) the application of heat must be
gradual & Slow, otherwise it will necessarily induce mortification ( ) as
the principle of Life increases the heat may be increased.
826. from (819) we are enabled to discover why scarifications in the
legs of anasarcous patients, or wounds made in their extremities,
either by Art or Accident, why Blisters applied to persons in whose
Systems there is great debility & a disposition to putrefaction should be
followed by [Putrefaction] Mortification.
827. Also why Persons who have suffered severe famine, long exposure
to intense cold, are in extreme old Age, or who have the Circulation
obstructed through a part, or those of tall stature are subject
to Mortification, especially of the feet & Toes.
828. In the Cure of mortification, or restoring parts falling into mortification,
it must be evident that as the cause is a diminution of
powers in proportion to the actions of a part whether common or increased
so the Cure must consist in lessening Actions & in increasing the
powers of the part.
829. Whatever then stimulates a part to action without increasing its

☽︎. 830. The temperature of the atmosphere in which patients to
be cured of Mortification are best placed, should be neither very
hot, nor very Cold, that the natural actions may neither be impeded,
nor hurried on too fast. –

154
strength & powers, must be contraindicated.
830. Hence also it is evident why bark should have so much power
in checking some inflammations, & that opium may prove a very
useful remedy. ☽︎.
831. The Causes will be either (819).
a. Mechanical, as a Blow, or
b. Chemical as a Caustic
832. The less vascular a part is the more readily its Life, is destroyed.
833. Also the weaker the powers of Life in a part are, the more easily
will they be acted on by Caustics.
834. No substance can act chemically but in solution, in order for
the Caustic to act chemically it must be moistened, this is effected
by the serum produced from the vesication which arises from the irritation
caused, by the application of the caustic substance, which Serum mostens
the Substance & thus after the Life of the part is unable to Acts for its
preservation, Operates chemically on the Skin &ca.
835. The action of a caustic when applied to a part produces an
abolition of Life & then the Caustic acts chemically upon its substance
coagulating its Mucilaginous parts & changing its texture.
836. Mortification on the death of a part is often induced with
a view to destroy a diseased or even a sound part (in order to enable
us to make application to some diseased part otherwise out of our
reach) or to give an exit to some foreign substance retained under

 



 
   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


155.
the Skin, as pus &ca.
837. The Effects (834 &ca.) will be produced by a variety of substances
artificially & intentionally applied of these the principal are
Caustic Alkalies
Concentrated Acids & Metallic Salts.
838. Of the Metallic Salts Arsenic is the most powerful, whose action
is different in some measure from that of the other Caustics,
as it produces mortification simply by its exciting violent actions in
parts which they cannot support, & not by any chemical process.
839. The application of these substances to sentient parts is attended
with violent pain, that is to be diminished
1st. By the administration of Opium by the Stomach.
2d. By mixing opium with the substance to be applied
3d. By applying plaisters of Opium to the part for some
hours previous to the application of the Caustic.
840. The natural sequel of mortification is a sloughing of the
mortified part, or the process by which it is thrown off from the living
parts immediately in Contact with the dead & the ulcerative absorption
of them is necessary (449).
842. As in the Exfoliation of Bones, so in the sloughing of soft parts
the absorption begins at the external edges of the dead parts, the dead
part becomes dark Coloured & dry, the ulcerative absorption beginning
at the Edges & going through the whole surface of Contact of the living
with then dead parts, the slough is ultimately thrown off like any

☿. 846. We know with some certainly, how far the parts of the body
the Brain excepted & with what comparitive facility they go through
the process of Sloughing, the nearer the heart Cotises Paribus the
more readily the process of seperation will go on, the common integuments
& Muscles will throw off a dead part sooner than a Tendon
Ligament or Bone, as to the Brain it has not been ascertained
whether it will slough or not, for before the seperation of the dead
part can possibly take place, the Patient in general dies.
🜔^. 847. Thus if a Limb is mortified throughout its substance
we may cut off a portion of the dead parts to lessen the Stench
arising from so large a mass of Putrid matter, & render the patients
situation more comfortable, but we must not proceed to amtating
in the living Parts until a compleat seperation has taken
place.

156.
other extraneous Body.
843. As the weaker the part is the more easily is it Acted upon by Caustic,
so the greater the strength of a part, the more readily the seperation
of the slough will go on.
844. New formed, being weaker than original parts it is evident
they will suffer their Life to be much sooner destroyed by Caustics.
845. From (844) we are enabled to learn, why in new formed parts, Mortification
is so Easily induced, as in larger cicatrices &ca.
846. Also why Caustics so easily destroy the fungous Excrescenous
of Ulcers &ca. ☿.
847. In a mortification no incision or wound is ever to be made,
into living parts, at least until the process of seperation is begun,
a portion of the parts quite dead, may however be removed at pleasure.
🜔^.
End of Volume the First.

INDEX
Aphorism Page
A
Animal actions of---39---10 
Arteries---51---13
Absorbents---53---13
Absorption the final end of---56---14
___ulcerative----61, 440---15, 83
Actions voluntary---75---18
___two different cannot exist &ca.---169---35
Air affecting animals---147---31
Anchyloses---718---135
B
Brain and Nerves &ca---69---17
Blood living principle of---110---24
Bladder inflammation of---526---98
Brain inflammation of---548---102
Bones disease in---595---113
Brain disease of---786---148
C
Cicatrization---452---85
Cesarian Operation---525---97
Cartilage---675---128
D
Disease---154---32
Diseases division of---185---38
___local---190---41
___Constitutional---195---42
Dissolution the action of---476---88
Dislocations---693---131
E
Empyema---493---93
Emphysema---500---94
Eye inflammation of the Chambers of---533---99
Exfoliation---618---117
F
Fermentation in Animals---22---7
Fractures---570---108
___communicating with Joints---654---123

G
Granulation---445---84.
H
Habit---98---21
Heat---122---26
Hectic---464---87
Hydrocele---549---102
I
Ideas---71---17
Inflammation---285---57
___Cure---364---71. 
___Topical applications to---387---75
___ulcerative---427---81
Joints---683---129
___& Sacculi Mucosa exposure of---527---98
Joint Cartilage in---723---136
L
Life principle of---24---7
M
Matter---1---4
Medicines---226---48
___their mode of acting---234---49
Mortification---818---152
P
Part the actions of---239---50
Pus---415---79
Pleura Inflammation of---487---91
Pericardium Inflammation of---504---94
Peritoneum Inflammation of---507---95
Puerperal Fever---519---96
Patella fractures of---659---124
S
Stomach---44---11
Senses---70---17
Sympathy---201---42
Suppuration---398---76
Strains---690---131
Scull Fractures of---797---149
V
Vascular System---49---13
Veins---52---13
___Inflammation of---542---101

Aphorism Page
V
Viscera Wounded---759---142
W
Will---74---18.
Wounds Gunshot---724---136
___Penetrating---755---142.


   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  

























Thomas Windsor
Manchester
?-1745
(1845)
A gift for the library of the Surgeon-General, Washington
T. Windsor
July 18, 1885.
LECTURES
on the
RATIONALE of SURGERY
by
JOHN HUNTER.
VOL.I.






1
Introduction.
In the course of these Lectures I shall differ very much
from what is taught in Books on the subject of Surgery. The Ideas
I have to communicate are mostly my own, & not drawn from Books
I have reason to suppose them true because they are founded upon
facts. –
I shall consider first the Animal Œconemy. I shall mention
chiefly the actions of the body on a diseased state, with their recoveries
& natural functions in health. I have it not in view to
give a full course of Practical Surgery, but to teach the principles
of the Art.
I will be unnecessary to treat of the Operations & of every
particular disease; these are taught by Anatomists & others, the
principles are most necessary & those only shall be the subject of
our enquiry.
Every Art has its principles, from which we are enabled
to establish old facts, and account for new ones, the same holds
good in Surgery.
Effects are what strike the senses more forcibly even
while the cause is unknown, but as these are only consequences we
should endeavour to discover the Causes.
We know the causes of Inflammation, Suppuration
and Mortification, hence we are enabled to check their progress.
We find it necessary sometimes to increase the violence





2
violence of a disease, before we can effect a Cure, as in indolen Inflammations
&ca. –
Sometimes it is necessary to change one disease into
another, - in Venereal Inflammation, by exciting a common Inflammation
we cure the disease.
If the Animal was always equal to the task it has
to perform, surgery would be unnecessary, but the powers of restoration
which arise out of the Animal, being not always sufficient, it
is our business to increase the action where too weak & vice versa.
It becomes often necessary to introduce Chemical means
in the Cure of diseases, these failing we have recourse to Mechanical
ones, as the different Operations.
As the Operations (tho the necessity for them is the
defect of Surgery) become sometimes indispensibly necessary, it is
right to know how to perform them.
A compleat knowledge of the parts of the Animal
Body should be strictly attended to, as this will lead us to their
uses, we should know the different Functions and consider the
dependence one action has upon another.
With regard to operations we should know when
they will relieve, & when nothing but an operation will relieve &  
also know when the Habit will bear an operation (this is sometimes
almost impossible to ascertain)
The facility with which a Man thinks gives him
a superiority over others, few have observed nature with more attention
than myself, yet even now, I think myself scarcely equal to the
task I have undertaken. A man will be ignorant of the knowledge




3
he possesses until he arranges his Ideas.
The principles of Diseases which are the objects of
Surgery, have not been sufficiently attended to, these we intend
chiefly to consider.
We shall begin with Physiology, so far as it is necessary
to understand the principles of diseases.
Disease may be called a perversion of the natural
Actions of the Animal Œconomy.
I will first consider those diseases, that arise from
accident. Secondly those that are similar to them, then
the Union of divided Parts by the first intention, next Inflammations
which will throw a light on various subjects, as adhesions,
The Cure of the Hydrocele, Indurated Tumors &ca. Then the
union of Parts not cured by the first Intention, as Compound Fractures.
&ca.
Lastly we shall treat of some specific Diseases as
Scrophula, Cancer, &ca. –
J. Hunter.

Notes
🜹 3. So also the properties of matter act upon our senses, the sensation
of sweet or sour, are not matter, but the properties of matter
acting upon the Tongue.
Touch arises from resistance in matter. –
+ 5. By attraction of cohesion bodies of similar properties tend to
come in contact with one another & to remain so when this is effected,
this attraction is very slight in fluidity, in this however the stronger
it is the more globular or spherical the particles appear & vice versa.
Elective attraction disposes bodies, to join with various other [cross out] stances,
forming together one homogeneous mass. – of this we
have an instance in the combination of an air with an Alkali; there
are so many different Elective attractions, as there are methods of mixing
matter. – Elective attraction operates only when fluidity & vapour
are present, the compounds may however become solid afterwards
by the attraction of Cohesion. – The increased attraction of
Cohesion found in solid Bodies may be called the attraction of solidity.
 
        
 


4
Rationale of Surgery.
Matter. –
1st. – By matter we mean that substance of which this Globe or
Earth is composed.  
2. By the impressions of matter alone, we are led to the knowledge
of our senses, & by our senses only we judge of the existence
of matter.
3. But our sensations are excited not by the impressions of matter
itself, but by the impressions of the effects of matter; - thus
when we hear a Drum beat, our sensation is not excited by the
Drum, but by the vibrations of the Air produced by the strokes on
the Instruments. 🜹.
4. Matter is found in one of the following states, Solidity, Fluidity
or Vapour.
5. The general kinds & properties of matter are few but different
modifications, & combinations of those kinds & properties of
matter produce great varieties in appearance.
6. The following properties are common to matter, attraction of
cohesion, chemical or elective attractions, & attraction of Gravitation. +
7. Repulsion is also a property of matter but it seems doubtful
whether it is so universal a property as that of attraction, nevertheless
the action of repulsion seems to be in a great measure

🜔 10. Heat seems to destroy all attractions. – Mechanics depend
upon the external figure & magnitude of bodies & upon the properties
of gravitation, attraction, &ca. –
     
        
 


5
the cause of Fluidity & Vapour.
8. Magnetism seems to belong to attraction of gravitation, by the
attraction of gravitation the different parts of matter are kept together,
so as to form one great whole.
9. Each mass of matter though never so minute has in itself
a Centre of Attraction.
10. Heat also seems a generally necessary Agent to Fluidity & Vapor. 🜔 
11. The operations arising from changes in matter are regular &
determined according to certain & fix’d Laws.
12. We have been considering & speaking of the properties & modification
of common matter, but considerations on matter may be
carried much higher, & modifications of, or kinds of matter may
be found entirely different in every respect from common matter.
These are the matter of Animals & Vegetables.
13. The first principles of Animal & Vegetable matter are perhaps
the same, but they have many properties totally distinct
& different from one another.
14. It is observed (13) that the properties of Vegetable & Animal
matter are perfectly distinct, although their first principles may
be similar; & indeed so perfectly & entirely distinct are Vegetables
& Animals in many properties, & in the modification of
matter, as observed in their production & formation that no connection
between them has ever been traced.
15. They differ totally from common matter in that they have
each of them a power of acting, & performing various operations
within themselves & of producing or generating matter of their
own Genus from themselves. –

♂. 17. The circumstances of worms &ca. which feed upon Earth
would seem to afford an exception to this position, it is likely
however that the Earth they take in is only useful so far as it contains
Animal or Vegetable Matter. – In order to determine this
we should combine an Alkaline Salt with Earth, which will destroy
whatever Animal or Vegetable matter it contains, the wash it thoroughly
& try if a Worm will live in it.

6
16. Vegetables & Animals especially differ from each other, both
Indeed have a power of performing operations within themselves
& of generating from themselves new matter, but in other respects
they very essentially differ.
17. The operations of Animals are attended with waste of their
component parts, this waste is recruited by a supply from common
matter, but common matter cannot be immediately converted
into Animal substance, nor can the decay of Animal substance
be supplied from common matter until it has by certain [degrees]
changes been already altered into Animal or Vegetable matter.
Vegetables can immediately convert common matter into their own
substance & be supplied from it, but Animals cannot, which proves
that Animal matter is still farther removed from common Matter,
than the Vegetable. ♂.
18. Animals & Vegetable Matter may be viewed in two states, as
living or dead; - when living it has in itself a power both of
continuance & generating new living Animal matter, but when
dead it loses these powers.
19. Animal & Vegetable Matter after death is capable of being
acted upon by the operations of chemistry., & by those of spontaneous
dissolution, by which latter it is at length reduced to
common matter, out of which probably it is at first formed the
presence of life is an antidote to, and resists both one & the other
20. Animal Matter submitted to Chemical enquiring & the operation
of Fire, yields certain substances peculiar to itself, as
the Volatile Alkali, Empyreumatic Oil, Calcareous Earth [&ca.]
& a kind of Water, other substances as Iron &ca. are also found

 


7
which are superadded & do not constitute its natural component
parts. –
21. Animal Matter may receive a supply of its waste from
Vegetable Matter. –
Fermentation in Animals.
22. Many changes taking place during Life in Animal and
Vegetable matter have been attributed to a certain operation called
Fermentation, for it is known fermentation will alter powerfully
all substances which are subject to its action, & even changes them
into new & totally different substances, to this the secretions of
Animal Bodies have been supposed to be owing, to this the
change of the Water into the Juices of the different Plants nourished
solely by it has been imputed, to this Digestion &ca. –
23. But the Animal & the Vegetable Bodies are the subjects of
fermentation, no change wrought in them during Life can possibly
arise from this cause, for the presence of Life resists fermentation,
it is impossible it can only take place after the destruction
of Life, which is the preserving principle, we here speak of Fermentation
in the same sense the Chemists use it.
Principles of Life.
24. The changes arising in the Animal & Vegetable matter during
the presence of Life, are produced alone, by the peculiar power of
the principle of Life, to its operations we refer all the Secretions

♁ 28. Some experiments to elucidate – 28.
Expt. 1st. Mr. Hunter found that a new laid Egg tho kept by incubation
in an heat of 120° until it was hatched in 2 or 3 weeks,
when the Chicken was excluded, shewed not the least sign of Putrefaction; -
another Egg which was not hatched & of course died,
became in the same circumstances highly Putrid. –
Expt. 2nd. – A new laid Egg was exposed to heat between 17°.
& 15°. Farht. in which situation it was kept half an hour, its Life
being then destroyed by freezing it was thawed by Heat, being
then exposed to 25°. It then froze in half the time it before required,
that is in 15 minutes, while alive it had the power of resisting
Cold & consequently the destruction of its Life, a considerable
time, but when once killed it had no longer the property of resisting
the freezing power of cold. – Mr. Hunter made a number of
other Experiments on Animals & parts of Animals, he attempted to
freeze 2 Carp but without success, he found that for a long time
they generated heat & resisted the destruction of their Life by freezing
at length that power was exhausted & they died; the power
of resisting death almost every thing possessed of Life enjoys.
Mr Hunter found living Vegetables would endure Cold & resist being
frozen much longer than Plants whose vegetable life had been
destroy’d. – Experiments were tried on Dormice &ca. and all
had the same result. –
Experiment 3d. A dead Egg froze in the degree of 32 & a living
one gradually sunk to 29, it then continued stationary for
sometime, after which it rose to 32 & then became frozen, to

8
all the new productions, the digestion of other substances &ca.
25. The Operations of the Principle of Life cannot be referred to
Mechanical powers.
26. Life is totally distinct from any property of Mechanics, we see
indeed the movement & construction of all the Bones are regulated
by Mechanical Laws, but the actions of the Muscles which puts
the Bones into motion are not owing to any Mechanical Power or
Principle, nor by Mechanical principle can they possibly be explained.
27. From an examination & survey of Animal Matter when dead,
we gain an Idea of living Animal Matter, as from Life only we
can gain an Idea of death, so vice versa. –
28. The functions of & changes in an Animal body during Life
are all to be referred to the operation of the principle of Life. – The
properties of the principle of Life consist in preservation of Animal
matter in the living state & in action, Life may exist without
matter being in a state of action, & the property of self preservation
may be alone present, Life at the same time being present in
full force. – Thus a new laid Egg, is truly & really alive, tho
no kind of action is known to be possessed by it. ♁. –
29. Life does not consist in any modification of matter, it either
is something superadded to matter, or it consists in a peculiar
Arrangement of certain fine particles of matter which being
thus disposed acquire the properties of Life. ♂
30. Life has been compared to the spring of a Watch, as that
Spring gives motion to all the Wheels, so Life gives action to the

same Experiment was made on Snails, Snakes, Eels & others of the
colder & imperfect Animals, which proves that the fresh Egg is as
truly alive as the Animals just spoken of, tho’ it has only the property
of resisting death, or self preservation & not any kind of action.
♂. 29. I enquired of Mr. Hunter if this did not make for the
exploded doctrine of Equivocal generation, he told me perhaps it did,
and that as to Equivocal generation, all we could have was negative
proofs of its not taking place, he did not deny that equivocal generation
happened, there were neither positive proofs for or against
its taking place.
🜔🜹 33. The doctrine of colours will tend to the same purpose,
we see by different arrangements the same colours will produce
different Shades. –
☿ 35. Tho’ Organization is not necessary to Life, yet it is to action.

9
several parts of the Body, but this Idea is not just, no one part
of Body is dependent for action on any other part, but the several
parts, each possess life & action in themselves. –
31. Life in a living Animal is as much the property of every
individual part, as Gravity is of every particle of matter, every
one part is as much alive as the whole. –
32. Every action in the Animal body is produced by the living
principle, the secondary actions of Parts are as truly produced
by it as the primary. –
33. Magnetism will truly elucidate what is said of Life being
superadded to Matter, or arising from a particular arrangement
of certain particles of matter, a Bar of Iron placed for a long time
in an upright posture will acquire a magnetic Virtue, so perhaps
the particles of matter arranged & long continued in a
certain Position at length acquire the power of Life. 🜔🜹
34. Two, three, or four, or any number of Particles of Matter thus
animated may form a muscular Fibre, a certain number of
these Fibres collected form a Muscle.
35 Life does not consist in any Organization of matter, for
matter will remain as organized as ever after the destruction of
its life. ☿.
36 As from an observation of matter in its inanimate state we
gain an Idea of living matter, so from an observation of the functions
& actions of parts in a state of disease, we gain a knowledge
of or correct our opinions of the natural actions & functions
of parts in a state of Health.



                      


10
37. Solidity in matter is necessary for its action, it is the fixed
point from which its actions must proceed, & on which they must
depend, therefore we find the parts of Animals destined for action
solid, these Animal Solids are kept together by Cohesion.
38. The Muscular parts of an Animal are active, - of an Animal
scarcely any parts are purely passive, almost all parts
have somewhat of the Muscle in them, and have some kind of
or degree of Action. –
Actions of Animals.
39. The actions of an Animal are two fold, the primary actions
or those which every part hath in itself (as to nutrition
growth & support) without regard to any Operation, for the benefit
of, or for producing some change in the general System,
as the actions of the stomach, Brain &ca. – The first are
the true Animal movements, the second are what are called Operations
of the Animal Œconemy, as most secondary actions
are employed for the ends of the first, having a necessary relation
to the first; - so those secondary actions are in general permanent
and constant. In diseases all these secondary actions
may be suspended for a season, the primary ones are never interrupted
for the least portion of time so long as the parts live.
40. Those are besides the muscular parts (38) which are the
active powers, other parts also which, have a kind of secondary motion,
(that is, a motion communicated to them the Elastic Parts)

    

                      


11
but to the operation of these life is not necessary, their powers
are equal after the death of the Animal to what they were
during life. –
41. There are other parts also in the Animal Body that have
in themselves no kind of action, but whose use is merely
Passive, which are different in strength & density, some for Union,
as the Cellular substance, others for strength, as the
Tendons & Ligaments. –
42. It is said (40) that it is not necessary to parts being
possessed of Elasticity, that life should be present. – Elasticity
is indeed a property of many species of matter besides Animal. –
43. The actions of the living body are simple & compound
The powers of action distinguish living Animals & Vegetables
from dead & common matter.
The Stomach.
44. The operations of an Animal (17) are attended with a
waste of its substance; - supply is therefore necessary to
the continuance, this supply is performed by means of
which tho small in comparison to the bulk of the other parts
of some Animals, is the most important part of all. – This
is the Stomach. – The stomach is the principle distinction
between Animals & Vegetables, all Animals have a stomach, no
Vegetable is possessed of anything like one.; - to many Animl.
the Heart, Brain & Nervous System & many of the Viscera are

the stomach of plants may be said to be, the ground & air in which the
grow, as it furnishes a supply. So living animals which change the
situation of course it is necessary there should be supplied by some
with them, with stomach. HS
          

                      


12
wanting, but no Animal is without a Stomach, it is the Stomach
only which is necessary for the support of a simple Animal,
& organs of generation for the propagation of its species therefore
some Animals consist of little more than a Stomach & Genitals.
45. This Stomach may be called the true & primary Animal;
all other parts may be considered as superadded, according to
the functions of the Animal, to which some or more is given, is
to perform on the Stage of Life, for one Animal that possesses a
Heart, there are millions that want it. –
46. The Stomach by means of its hidden powers, converts
various Substances into one common kind of matter, which is
taken into & forms part of the Animal, this very curious kind
of Operation is called digestion.
47. This Viscus in the most complicated Animal, as in Man,
is intimately connected with the general Æconomy, it is as much
the seat of Irritability as the Brain is of sensibility, it is highly
affected by many external influences, which in themselves have
nothing to do with the Operation of digestion, as Wounds &ca. –
It is more affected by morbid operations produced in Tendons,
Ligaments & other parts of small natural sensibility than by
the same taking place in the Muscles, it is chiefly affected
by changes produced in the internal parts, as the Brain is
by those in the external parts. – It is intimately connected
with affections of the mind, whether produced from injuries
of the Brain or from horrid stories or sights, to which a Vomiting

🜖. 50. Experiments have excluded the Veins from the Theory of
Absorbing, even in the Erection of the Penis the Veins do not absorb,
I consider the Corpora Cavernosa as Veins, through which the Blood
is constantly flowing from the Arteries & that there are a number
of Veins, opening into the Corpora Cavernosa, and that the Blood
is flowing into them, that in the Erection there is a spasm upon
the Veins, which prevents the Blood flowing thro’ them, hence an
accumulation and distention, in the Penis, which ceases with the
spasm. – I found that by tying the Veins of a Dogs Penis an Erection
was produced. – 

13
vomiting or puking has been known to succeed, especially the last.
48. non est inventus.
The Vascular System. –
49. In compound Animals, as Man, the Vascular System
(or that by which fluids are carried to & taken from different parts
of the body, by means of which growth & nutrition are afforded
to parts, & to the whole) becomes an importent subject of enquiry. –
This is divided into, the Arterious, the Venous,
and the Absorbent System. –
50 The animal body is considered as an Hydraulic Machine
by those three sets of Vessels its course of fluids is conducted. 🜖.
51. Arteries. The arteries carry the blood from the Heart
to every other part of the body, consequently they convey the materials,
for the growth, nourishment & support of parts, for the
regeneration of them when lost, and the support or supply of
them when wasted, also for the different secretory Organs to
separate liquors for any further purposes in the Animal Œconomy,
or to diminish anything superfluous or noxious.
52. Veins. The Veins return to the Heart the blood wch
remained of what the Arteries had carried from it, after the
different purposes (51) have been effected, they are also said to
carry blood from certain parts to the Liver for the production of
Bile.
53. Absorbents. The Absorbents take up fluids & also solids
from [many] every part of the Body, which they pour (by means
of a peculiar duct) into the Blood, by this property they become

🜋 53. Also the Gubernaculum, & Membrane Pupillaris &ca.
When a Limb is removed, we know the end of the Bone is sawed
through in a circular figure, with hard edges, if examined
at some length of time after the Operation we find the end of the
stump approaching the section of a sphere.
Aphorism 59 continued. By this property also when their
actions are much excited, they take up the solid parts whether
soft or hard, these producing what has been called Ulceration,
this may be called Ulcerative Absorption.
They also diminish the bulk or density of parts without
ulceration, to this species of absorption no particular name
has yet been given, but it may be called Intersticial Absorption.

14
the means of supplying the system of circulation with nutritive
particles, also of conveying disease into the habit. – Thus being both
the instruments of Health & destruction; by this property of absorbing
solids as well as Fluids, they become the modellers of the
shape, Form & structure of different parts; they prevent parts
from growing into irregular & inconvenient figures; in this light
they may be considered, as the builders of the Animal fabric,
whilst the Arteries are the labours bringing & laying before them
the materials for the work, or as the polishers of the rougher workmanship,
of the arterial vessels; by this property they take up and remove
parts, which though useful in one part of life, becomes useless
in another, as the Thymus Gland &ca. - 🜋
54. The action of this system of Vessels (53) being considered
with regard to the ultimate effects may be divided into two
kinds
1st. Absorption of extraneous bodies.
2d. Absorption of the Animal itself.
55. The absorption of extraneous substances as observed (53) introduces
both the particles of nourishment into the system, & the
particles of Disease.
56. Final use of Absorption. The Absorption of the Animal
itself is employed either for the nutrition of the Animal
when either absorption of extraneous nutrition cannot take place,
or when the mind, is unmindful of directing nutriment to be
taken in, & yet nourishment is still necessary to the life of the
Animal, or when an useless & inconvenient part is to be removed.

                                   


15.
57. The mind is frequently unmindful of taking in food in
fevers, no disease of it being perceived by her, but nourishment being
necessary for the sustenance of the Animal, the fat and other substances
are taken up by the absorbents and carried into circulation for the necessary
purposes of affording nutriment to the different parts of the
system. Thus the Animal is for sometime enabled to feed on itself.
58. every part of the body may be subjected by disease to the second
kind (54-56) of Absorption – Absorption will either take up from
parts portions of their intesticial substance, as Earth from bone &ca. or it
will take whole Parts, as an entire bone. –
59. When a stimulus of any kind is about to excite the process of
Absorption, two circumstances will take place, a consciousness in the
Lymphatics of the propriety or necessity to begin absorption but when
the part to be absorbed is dead the state of consciousness is incompatible
with an inanimate state of matter.
60. to the removal of dead parts by internal process, this System
of Absorbents seems alone to be equal, no chemical process can perform
it.
Ulcerative Absorption. 61. The process of Ulceration, or
Ulcerative Absorption is always the same, different causes may indeed
produce it, & different circumstances may be present with it.
62. The state of consciousness (59) may be induced by different
kinds of stimuli but the mode of impression will always be the same
63. The absorbents have a power of taking up both Solids & Fluids.


 
     
                                    


16
64. The mode of their action is not clearly ascertained, it has
been imagined that they are Capillary Tubes, but capillary Tubes
can only absorb fluids & the absorbents take up solids. (63). –
65. The opinion of their absorbing matter in a fluid state alone
(which would shew, that the solids if to be absorbed, must undergo
solution by means of some fluid which acts upon them as a solvent)
is to be doubted of. –
66. It is equally & more probable that the absorbents have like entire
Animals, mouths & teeth, that the form of their mouths & teeth
in different Absorbents, essentially differ according to the parts they are
to act upon, so that perhaps could we obtain an accurate [class] survey
of them, we might be enabled to class them according to these differences. –
67. It is doubtful whether substances when mixed with the Blood
are essentially altered or not, the indefatigable parts of vegetables, as the
colouring part of Rhubarb pass off by Urine, or by some other secretion
unchanged; the variolus matter is not altered by the Blood the Venereal
matter when taken into the habit is certainly much altered, it is very
different from what it was before it was absorbed, this is the only matter
that we know undergoes a change.
68. The power of living Animal matter to consume itself is equally
probable, with the property of living matter to produce fresh living
matter from itself. –

🜔🜹 69. The existence of the Brain & Nervous System is not necessary
to simple Life, millions of animals want both, but they are necessary
to the performance of certain functions of Life, & without them in
those classes of Animals to which they are given, active Life cannot go
on if the perfect Animal, as Man, there have been instances of Monsters
born without a head; but not being able to support the functions
of Life, necessary to be performed from the time of birth, they die soon
after they come into the World, but they were truly & virtually alive
while in Utero.

17
Brain and Nerves. &ca. –
69. From a peculiar arrangement of the particles of Animal matter,
muscles are produced, a different arrangement of those particles
forms other organs, so from a particular disposition of these particles in
perfect Animals, the Brain & Nerves are fashioned, which being acted
upon by various impressions, various sensations arise, the effects of wch
are the mind & will. 🜔🜹.
Senses. 70. The impressive given by external objects are considered
as of five kinds, of these one is touch or feel, of which every part
of the Body which is sensible is the seat, the other four kinds several
affect the Organs peculiarly adapted to them.
Idea. 71. The sensation raised by an impression is two folds
first its effects on the part to which it is applied, secondly the change
produced in the brain, in consequence of that effect, the first is simply
passive, the second state is active, for then action is produced in the
brain & an Idea is formed.
72. According to the kind of change effected in the Brain the idea
will be agreable or disagreable.
73. As from habit we gain a power of judging & distinguishing
what is advantageous or useful, from what is inconvenient & pernicious,
when an idea respecting an external objects is executed in
the mind, & that idea is followed by an inclination to possess or obtain
that object, we should be irresistibly inclined to gratify that inclination
when arising did not our power of judging of ill consequences that


  
 
 
 
     
                                    


18.
might arise from gratifying the inclination in question (acquired as
before said, from habit, or from reapeted observation) determine us to the
contrary, this weighing an inclination in the mind we call Reason.
Will 74. a determination of the mind whether produced by inclination
or reason (73) is called will. –
Voluntary Action. 75. In consequence of any changes produced
in the brain, as concomitant on the Actions of the will, an action
in any moving part of the body is excited. this is voluntary
motion or action, thus different parts of the body receiving impression,
have a power of acting on, or exciting a change in the brain, & a change
in the brain however produced has a power of producing a change
in other parts of the body. –
76. The vital principle of simple Life & that principle on which
The powers of sansation depend by this connection (75) act mutually
on each other.
77. It seems as if we had no simple sensation, but that every
sensation of which the mind is sensible is compounded of two
states as (71).
78. The Operations of the Brain & Nervous System (64) are not
so extensive as some have imagined, they can neither supply a
part with nourishment, nor preserve a part from dissolution.
79. Every living body has an intelligence of its own feeling after
an impression has been given to it, previous to and exclusive of
any Idea existing in the Brain. Thus every living part has in itself
a consciousness of any impression given to it whether of Pleasure

83. Many fishes have abundance of nerves with a very small
quantity of brain, Fœtuses to whom the Brain has been wanting
Acephilous Monsters have still their Nerves.
85. In Man & the perfect Animals; sensation is intimately connected
with life. if the powers of sensation are constantly kept exercised,
the sensative principle becomes fatigued, & the principle of Life
also suffers with it, Sleep therefore by giving relief to the sensitive
principle, prevents violence being done to the principle. –

19
or of pain & as it were a power of the Mind determining to action,
independent of the powers of the mind.
80. The power of the nerves is purely passive hence previous to any
action being excited in them a impression must necessarily be given 
to them. –
81. The different sensative Organs are appointed to receive the
several kinds of impression given to the body & which impressions
are of five kinds. Yet every Nerve is subject to receive the impression
of touch & pressure.
82. The living principle is coeval in all living Animal Matter wth
the Animal matter itself, & may long exist without sensation. Thus
a Child in Utero has no sensation until it is born. –
83. The Nerves are not indebted to the brain for their existence,
there may be Nerves tho’ there is no brain, but the existence of the
brain is necessary for the formation of Ideas.
84. Parts intended for strong sensations have always a great quantity
of Nerves distributed to them
85. This principle of sensation regulates all our External action
as the principle of Life does our internal ones.
86 When an impression is given it must continue a certain time
in order to produce a sensation. if it lasts but a short space of
time, no sensation will be produced, if an impression continues too
long a distant sensation will be yielded, it will then only produce a
disturbed state of the Nerves. –
87. Sleep is to the sensitive principle, what rest or the state of inaction
is to the living principle as the living principle may exist

89 – here is no notice taken of the eyes being required to be shut
when sleeping, & the absence of the eyelid preventing it. H.I.S.
🝄.
90. A loud noise produces the same effect upon the Ear in lieu   
of distinguishing sounds the idea of pain will be excited, even the Tympanum
of the Ear, has been burst or broken by this Violence. –
91. Ingenuity often gives reasons for things, rather than
not account for them, but their reason unless they have some shads
of probality, or even when they have, may not be the truth. HiS –
does a blow on the ear produce a gretter sensation of sound, than the real ble
occasion.? HiS.

20
tho no action is going on, so the Existence of the sensation is not incompatible
with the abscence of sensations.
88. Thinking is the effect of particular changes in the mind, accompanying
changes in the Brain, tho’ with respect to ourselves, or a consciousness
of action or sensation, we are in a state of non Existence, &
although we have then no sensation, yet the Effect of sensations are not
lost, the mind will be thinking (which is the effect of sensation) while
we are asleep as in dreams, we seem indeed then to have sensations
but our seeming perfections are fallacious. –
89. We often dream when awake, having a seeming perfection
of things & objects which do not exist.
90. Sensation excited in a certain degree is agreable, in a greater
degree painful, & then the natural sensation will not take place, but
the sensation of pain will be produced, Thus are excessively glaring
light applied to the Retina, pain not vision will be produced. 🝄.
91. An impression different from that which is the One, for the perception
of which any Organ is naturally & particularly adapted may
produce in the given organ the same sensation as would have taken
place, had the natural impression been given, thus a smart blow
on the Eye will excite the same sensation as a flash of light, the same
blow on the Ear will produce sensation of sound. –
92 Uneasy sensations may in many respects be similar to a natural
appetite, they rather warn the Animal to the avoiding somewhat
injurious to him, or the removing something unsalutary.

♁ 94. Sensation is not necessary to simple Life, a child in Utero
has no sensations & yet lives. –
♎︎ 95. A Muscle when its action is suspended by the communication
with the brain being interrupted or by any other means it
wastes. It is a law in the Animal Œconemy that the size of a Muscle
will be in proportion to the frequency of its use of this we have a variety
of instances in the legs of chairman, the Arms of Watermen, & the thickness
of the Muscular coat of the bladder when it has been long used to
frequent contractions from Irritations as there from a stone &ca. as will
be hereafter taken notice of when we are considering the diseases of the
Urinary parts &ca. so also Muscles waste if the joint they serve is rendered
useless because their action can be no longer performed.

21
93. During sleep whatever actions are derived from the Brain, whether
consequent on disease or health cease; so St. Vitus’s Dance does
not affect the Patient while he slumbers.
94. The living principle in any part of the body will continue
to exist after the Nerves leading to any part is divided. ♁
95 When a part intended for motion, loses its power of motion, it wastes;
for being now no longer useful to the Animal, as a moving part, it becomes
open to intesticial absorption; (53) the will can no longer influence
it. ♎︎.
96. The more distant any part is from the Centre of its energy, the less
fit will it be, or certain actions, as indeed it will receive less Energy
therefore all the Vital parts are near the heart. All the parts intended
for acute sensation are near the brain. So mortification from debility
more frequently attacks the extreme Vessels, especially if the Patient is
tall, perhaps one reason may be that the blood loses somewhat of its
nutritive powers before it arrives at them.
97. In the Animal Body there are actions which proceed from certain
fixed principles in the Animal Œconemy & are regulated by certain
fixed Laws; these are only actions which arise in consequence of the
other actions which we call sympathy. Sympathy. –
98. There is also another kind of action which we call Habit,
actions frequently repeated in any part induce a custom of acting
in a given manner in any certain part, & from this accustoming
a part to any such action Habit arises. –
99. Habit is a kind of force or violence done, or superadded to the

4
🜔 103. When stimuli are often repeated they lose the power of producing
sensation; hence the mind is at last insensible of the
change hence habit of Disease arise (189) & parts get into & go on
without the mind perceiving it a diseased action, hence also parts
become insensible even to noxious stimuli, to the frequent repetition
of which they have been accustomed hence whilst in strangers
the bites of the Bug & Mushito produce disagreable Effects
those who have been much subject to the application of their poison
have their skin at last insensible to it; as in the Body so it is in
the mind, horrid sights &ca. at first produce in it the greatest
changes but by frequent repetitions of them the mind becomes reconciled
to them & at length scarcely an idea is excited by their impressions
(148). –

22
first principle, parts from habit acquire a power of acting in a more
forcible, or in a different manner from that which primarily took place
in them.
100. This habit may be called a species of Memory, as Memory consists
in a Repetition of Ideas once taking place in the mind. So
habit consists in a frequent repetition of action in any moving part
of the body.
101. Habit is similar to a body, once put in motion which will
not cease from motion unless some new cause for obstructing motion
arises.
102. Habit becomes a cause not only of motion in parts accustomed
to that kind of motion, but also may be a cause of rest at that time
in other parts, like a body once put in motion it does not require
a renewal of the same & equal degree of force which first gave it
motion, but the addition of a small quantity of fresh force is sufficient
to keep up the motion.
103 Habit will even become a cause of action in the will, it will
make these actions of it voluntary which were involuntary & also the
reverse; the strength of habit will be much or little, in proportion
to the violence of the impression which gave rise to it. 🜔
104. As in the Memory it is not necessary that in order to the recollection
or renewal of an idea, the impression which gave rise to it
should be repeated with its full force, so with respect to habit in parts
but it is not necessary in order to excite them to an equal action;
the impression or stimulus should be equally Violent with
wat it was when it first produced the action in the part. Habit


                 

             
 
 
 
 
     
                                    


23.
is always gaining on us and little force is necessary to keep it up.
105. As in the Mind the remembrance of impressions which
were of little force wears off, unless the impression is repeated before
the effect of the first impression ceases, & consequently memory
of the impression will not remain, so neither will the power of
habit remain, if second impressions are not repeated before the
first ceases. –
106. In accustoming parts to habits, or impressions, two circumstances
will arise.
1st. If the impressions are slight & often repeated, or if the
force of the impression be each time gradually augmented, the
parts accustomed to them will become by degrees insensible to
them, so that here the cause may remain though the effect diminishes
or ceases.
2dly. The effect may remain though the cause ceases,
as violent impressions will continue to produce their effects, long
after they themselves have been removed, according to the kinds
of habit complied with, health or sickness will be induced.
107. All stimuli will not produce the same effect when applied
to different parts, hunger will be a stimulus to the stomach alone
light to the Eyes, sound to the Ears &ca..
108. Dispositions of the mind will arise from Ideas produced from
certain impressions given to the brain, a disposition taking place
[from its] may be compared to the state of an elastic body when altered
from its pristine to some other figure, the disposition of the

🜖 110. 111. 112. In inflammation though the Blood coagulates more
slowly, yet there is a greater disposition in the parts to separate one
from the other. The separation will often be so perfect, that if you
dip your finger into the fluid at the top during coagulation, it will
not be couloured at all red. this inflamed blood will sometimes be
half an hour before it is compleatly coagulated. –

24
Elastic body to recover its pristine state is destroyed, by its action in recovering
that state, so when the disposition has produced such a state
of the will as to excite the moving powers to any action, the disposition
no longer remains, with this difference however that the
elastic body loses its disposition instantaneously, the Animal by
degrees.
109. When an action is excited by the powers of the will in consequence
of a particular disposition in the mind taking place, the
brain for the seat of the disposition, which might before be considered,
as in an uneasy or stretched state, now returns with respect to the
consideration of the disposition to a state of rest.
110. The Blood which is the fluid circulating in the Arteries & Veins
is not a passive inanimate matter, but is endowed with a principle of
life in itself equally with the solid parts.
111. A particular a permanent figure of parts in a losing animal is only
necessary to mechanical action. action is not necessary to [illegible] presence of simple Life.
the Blood perhaps has not motion in itself, but motion is not necessary
to Animal life.
112. The blood is not only alive itself, but it also by circulating thro’
every part of the body, becomes the means of & carries life to other parts,
thus being the living support of every part of the Fabric, even the Nerves
themselves are supported by it, they do not convey life to the parts, but
only direct the motion of parts, & without the blood will themselves become
dead. 🜖.
113. Whilst the Blood is circulating in the Vessels, it is always fluid,
but it is not always alive whilst fluidity remains. If by any means

Φ 113. If the life of the Blood is suddenly destroyed &ca.
Cases in support of this.
A Gentleman died suddenly in a violent fit of passion his Blood
did not coagulate. – Two Deers were hunted to death the
Blood of neither would coagulate – The blood of Animals
killed by lightning or Electricity will not coagulate sometimes, but
this will depend upon the manner in which the Electric matter
was applied, if so as to pervade at once the greatest part of both the
fluids & solids, it may produce this Effect.
🜔 116. Though the Blood when in its fluid state has not sensation
yet when formed into solids may acquire sensation. before Blood is
capable of gaining Life & support to parts, it must have circulated
through the Lungs, where it undergoes some Essential change perhaps
it then first is compleatly in its second state or verification. –
🜔vuss 🜖 117. As the Blood acquires an inflammatory disposition when
circulating through inflamed solids so it may lose Quel?

25
the life of the Blood is suddenly & entirely destroyed, after its death
it will still remain in a fluid state. Φ.
114. Whilst alive it is always fluid, if its life is not suddenly & entirely
taken away, it coagulates as it does & the seeming component
parts recede one from another.
115. Long rest out of the Course of Circulation & Exposure to the air
of the atmosphere occasions the Coagulation of the blood, if unexposed
to air, blood will remain long at rest in the living body without
Coagulation.
116. Organization is not necessary to Life, an Egg is not Organized, &
Yet an Egg is alive (28.) so blood is not organized, & yet is possessed of
Life. 🜔.
117. There is a perfect harmony in a state of health between the fluids
& solids of an Animal Body, so also between the Blood, & its containing
Vessels. There is also a consent between them in disease, & when the
solids are affected the blood also puts on a diseased state, thus the Blood
is as capable of disease as the solid parts are so also the blood becoming
diseased the Solid parts also suffer. 🜔vuss 🜖.
118. As the blood conveys to parts the means of nutrition & growth,
so from the blood, new solids are formed, when in consequence of a disease
or violence, there has been a loss of the former ones, or when those
arises a necessity for their production.
119. Where there is a disposition to union in parts naturally distinct
from each other. Inflammation will arise which Inflammation
will be in proportion to the strength of that disposition. The

 
 
 
             
 
 
 
 
     
                                    


26
Blood passing through inflamed parts undergoes a change according
to circumstances, & from the change wrought in this, coagulable Lymph
is fitted to be formed into solids, by the solid parts formed from this
Lymph parts violently separated from each other are again united, &
parts before naturally severed from each other are blended together.
120 The living parts of the Animal, both the blood & the solids
being continually wasting, supply is necessary, this supply is obtained
by means of fluid prepared by the stomach (44) but before the food
taken into the stomach can furnish the desired supply, it must undergo
two process.
1st. Animalization
2d. Verification.
from living matter only, living parts can be made.
121. Sensation is not necessary to life the Blood may therefore be
alive though it wants sensation.
122. Heat. A certain degree of heat is necessary to the preservation
of Animal life whether existing in fluid or solid matter.
123. A certain degree of heat is necessary to Animal Life (122) but a
greater degree of heat is necessary to Animal Action, before the former
the Animal cannot retain simple Life, below the latter, though it
may retain simple life it will not retain the power of action.
124. Almost every order of Animals require a degree of heat peculiar
to itself, some Animals will not endure their heat to vary much
from a common standard without abolition of the actions of Life. A
Bee requires its heat to keep, to go, a Wasp will suffer its heat to vary
with the heat of the Atmosphere.

🜔vmss. 🜔. 126. An explanation of the power Animals have of generating
heat was attempted – 1st. by supposing it to arise from friction
but between the particles [there] of a fluid there can be no friction, nor between
the particles of solids can heat be produced by friction, if a fluid
is interposed. Thus the Wheels of a Coach are prevented from generating
heat by means of greasing them.
2d. By Fermentation (by Dr. Stephenson) but the fermentation of
Animal substances does not produce heat.
3d. From inspiring Atmosphere Air, this seems to be contradicted
by the following Case.
A man had a contusion of his brain, his respiration was exceedingly
Slow, breathing not above 5 times in 2 minutes, yet he had a
General warmth upon his skin, though in the month of February, & the
cloathing was but thin, the power of generating heat & cold depends simply
on the principles of Life, independent of circulation, the influence of the Nerve &c.
This is finely illustrated in the case of a Gentleman who was seized with
an apoplectic fit, whilst he lay insensible in bed, & covered with Blankets
his whole body would in an instant become extremely cold, in ever part, &
continue for sometime, & in as short time become Extremely hot, this was
going on for some hours alternately yet there was no alteration in the state
of his pulse, or in the excitibility of his sensations. X
🜋 128. Animals which are in a state of in action during the Winter,
as sleeping Animals the heat will vary with the seasons. The state
of the Hedge hog in summer is from 91 to 97 in the Winter when the
Atmosphere was 44 the heat of the same Animal was 45, the Experiment

27.
125. In the state (121) digestion & generation with other faculties
will be suspended, & the Animal remain in a torpid in active state.
126. All Animals in themselves have a power of generating heat,
when the actions of the external Cold are so great as to endanger the
preservation of life, this power arises wholly from the principles of life,
this power arises wholly from the principles of life, for dead Animal
matter, posseses no power of resisting cold, this generation of heat
is truly life, operating against its destruction. 🜔vmss 🜔.
x Animal heat is kept up by the circulation of the
blood, which receives oxigen in the lungs from the
atmosphere. The venus blood which has entered, is of a
dark colour, but receiving oxigen the iron in the blood unites
with it, & forms the bright red arterial blood. distributing
this in the required quantity. Perspiration is evaporation
which produces much a degree of cold, to restore the
equilibrium when from violent exercise we induce
too rapid a circulation, or in glass houses when
the beat is too great. HiS
127. The heat of all Animals is diminished during sleep, whilst
in a state of torpor, but more or less in different Animals. –
128. Variations of heat in the Atmosphere, will produce different
changes of the heat of different species of Animals, some animals
as Men, & those which are constantly in action have their heat
little changed by this variation. 🜋. –

Experiment was made on its pelvis.
🜍 132. Animals who suffer their heat to be diminished
with that of the atmosphere, suffer it to be as readily increased to a
certain degree as that of dead matter – A living & a dead Carp
were both placed in a mixture of snow & water, which was gradually
heated, & both received heat one as fast as the other. – different
parts of the same body will have different degrees of heat, and different
powers of generating it, the projecting parts of the body in
Man as the Nose & Penis will be colder than other parts, the urethra
will be colder than the Rectum, than the abdominal Cavity, the Standard
of heat in the Centre of the human body is about 99°. –
🜍 132. Animals have two powers of resisting heat, tho’ only one of
producing it. One by the Evaporation of fluids, but as when fluids
become condensed on the surface, instead of being evaporated they will
not answer the purpose they have which is of actually destroying heat
As the Extremities or projecting parts are more subjected to be influence
by cold, so they [are] more readily allow their heat to be increased than
the central parts. From Dr. Fordyces Experiment in an heated Room
it appears that the human body will for sometime bear heat with
impunity, & such heat as is sufficient to boil Eggs, or roast beef stakes
The Gentlemen present in it found that when they moved from one
place to another in the latter they found the heat also more intense than
that they had been sometime standing in seemed to be when they left it
so also in the hot Bath the Bathers find the water immediately in
Contact with their bodies Cool, & they must either have the water agitated

28.
129. Animals will suffer their heat to sink below the freezing
point before they will be frozen ( ) Expn. on Eggs. –
130. The stonger & more healthy the internal powers of the Animals
the more powerfully will it generate heat.
131. Cold applied to animals in a certain degree proves a sedative
to the powers of Life, but applied beyond that degree it proves a stimulant,
& the faculty of generating heat is excited in an extraordinary
degree.
132. Excess of heat may prove destructive to Animal life as well
as too great a diminution of it, the principle of Life is therefore endowed
with the property of generating Cold, when the external heat
endangers the life of the Animal. 🜍.–
The principle of life serves here as the nectary
in botany, which is Linneus's term for all indescribable
parts HiS
Though the effects of origin in circulation is but
a recent discovery, yet the living princible is
here placed for it, may not this living princible
be as enormous as when it is given to describe
muscular action. page 18, or apts. 34 & 35 p 9.

agitated or move into another part of the Bath to preserve the first
sense of warmth. –
133. The Operation of generating cold seems to weaken an Animal
much more than that of generating heat, before an Animal
perishes in consequence of Cold sleep is induced, an irresistible disposition 
to which always comes on when the powers of action for the generation
of heat are exhausted. The case of Dr. Solander & the people
with him at the Terra del Fuego is a manifest & melancholy illustration
of this, after bearing for a long time an excess of cold several of the
Doctors attendants found this disposition to sleep. In spite of his remonstrance.
who was aware of the event to which it was prelude,
they lay down & slept & presently died. At length Dr. Solander felt &
gave way to the same disposition he had not been asleep above 5
minutes before his Feet became so contracted that his shoes fell off
them & he lost the use of his limbs, he was however found brot away
to the fire & relieved. –
🜍 135. The best Atmosphere for the human subject seems to be
63 to 60. Bear & Fox 50. – Lion & Monkey 70 – The Animals
inhabiting Cold Climates have stronger powers of generating heat
than the human, preserving every part of their bodies free from injury
in Countries where Men are losing their feet, hands &ca. from Cold.
Cold causes the hair of the Bear &ca. to grow much faster & finer,
hence they are better defended.

29
133. Nether excess of heat, nor excess of Cold will destroy the life
of an Animal, until its powers of generating Cold or heat are exhausted,
then the Animal must necessarily Perish. –
134. All the perfect Animals carry on their actions, in an Atmosphere
considerably below the temperature of the body, for it seems
a natural & healthful action, for an Animal to be constantly exerting
itself moderately in the generation of heat. –
135. Different Animals as above mentioned either preserve a standard
heat or have their heat increased or diminished with that of
the atmosphere, yet all animals require a certain degree of heat for the
standard in which their functions are best Performed, many Animals
are obliged to the atmosphere for a Standard heat whilst Man & many
of the perfect Animals, have from their faculty of Generation of heat
& Cold a power of giving a standard heat to themselves. 🜍.
136. The effects of a climate will correspond in a great measure
with the influence of the Sun in that climate, so that as the
Climate is exposed in a different manner to, & is differently acted

♂. 136. Between the Tropics the heat is greatest in Islands the
heat or Cold, is always more moderate than in Continents. Some 
Vegetables have a power of living in both extremes of Climate Some
Animals seem also to have this power, perhaps Animals of Passage
as Birds & Fish change their residence more from want of
proper Food, than from the inconvenience they feel from a given
Climate. Some Animals which have no power of getting their food
in the Winter, Nature has given a power of remaining during that
season in a torpid state, as the power of generating heat is not equal
to the degree of Cold nature has taken another method of preserving
Animals of the very frigid Climates [which] with down, fur, &ca. wch
are bad conductors of heat, so also whatever Animals have their
bodies will covered with hard fat, which is also (as Oils are) a bad
conductor of heat. –
Too much external heat produces diseases of the liver,
spasms, diseases of the Bowels, Tetanic &ca. diseases of Climates
are more slow in their action, & many of them depend on debility
as Chilblains &ca. Cold Climates also increase disease They are
not the causes of, as Venereal disease. &ca.

30.
upon by that body it will be hot or cold; moist or dry; or it will
hot & moist; or hot & dry. ♂. –
137 The effects of heat & cold will be greater according to the
degree of the surface of the Climate. A small surface will be less
hot or less cold than a larger.
138. The effects of Climate will be very great in Animal bodies
the imperfect Animals bear changes of Climate very badly. Man
& many Quadrupeds can accommodate themselves to almost any
Climate, yet great changes of Climate prove the causes of diseases
& destruction both to man & those Quadrupeds especially to the former
139. Besides our being influenced by heat & cold our bodies are surrounded
by & subjected to the influence of the atmosphere, which
will always be of the same temperature as the Climate we live in
140. This atmosphere having a power of dissolving a Variety of bodies,
will be a compound of many heterogeneous particles.
141. The Atmospherical fluids having a constant & powerful influence
on the Animal body, according to the nature of the particles
of which it consists, it will materially affect the health of Animals.
142. All Bodies which the atmospherical fluids take up & dissolve
are to be considered in a state & Volatilization to render
substances Volatile, some degree of heat is required, (perhaps the
lowest degree is sufficient thus to Operate on some bodies) according
to the degree of heat the atmospherical fluid, or the Air will
be enabled to take up a greater variety & a greater or less quantity

☿ 145. Thus the Plague jail fevers &ca are unknown within
the Tropics, another reason why hot climates are not so subject
to Putrid & Contagious diseases as might be expected is, as the Termites
described by Dr. Smeathman, eat up & destroy in a curious
manner amazing quantities of dead Animal & Vegetable substances
thus preventing them becoming putrid Enough to throw
off Volatile noxious Vapours to produce Contagion, it must be
highly Putrefied.
♃ 148. Habit & Custom &ca. -. Prisoners have carried the seeds
of the Jail Fever & communicated it to others by their cloaths,
though they themselves were free from it, of this we have had memorable
instances at the old Bailey & at Oxford Assizes. Again
persons who have never had the small pox themselves have nursed
others labouring under it with impunity, & have on visiting other
people who have never had the disease communicated it to them.

31.
quantity of bodies. –
143. The purity or impurity of the Air will depend upon the
quantity or quality of bodies dissolved in it, & its capacity of dissolving
them be according to its heat.
144. Cold Climate will for the reason given (139-140) be [cotens?]        
paribus, found the purest Air & best adopted to maintain health
nevertheless. –
145 Heat in warm & dry Climates has the property of causing
bodies taken up by & dissolved in the atmospherical fluid to be
decomposed & thus changing their nature renders them less 
noxious.
146. Heat & Moisture especially when dead Animal substances
are acted upon by the Air, produce the most unwholesome Atmosphere.
147. The Air will be injurious to the health of animals by affecting
them in three distinct manners. Viz+.
1st. By its being simply impure it lessens the fitness
of them for their several functions. –
2nd. By its containing specific particles of contagion.
3d. By its containing poisonous Vapour.
148. Habit & Custom are very powerful in enabling Animals to
endure without determent impure & unwholesome Atmospheres, to
some Atmospheres Animals cannot be brought to accustom themselves.
♃.
149. All irritating substances will not act in a state of vapour

♀. 150 Thus previous to a shower of rain we see the beast, running
to the Covert, the Birds flying to the Thicket, People with
corns are capable of presaging this decomposition of the Atmosphere
& also parts labouring under great debility.
“Hence doubtless people who have had Fractures have
the part where the Callus was formed sensibly affected on changes
of weather, is not this because new parts are weaker than Original
parts as will hereafter be shewn.
♄ 152. The Harmatan a Wind that blows from the interior Coast
of Africa, shews how much Winds may affect animal bodies, it
continues from 2 or 3 to 15 days; returning 3 or 4 times a Year, it
blows moderately, its accompanying Fog & Gloom are very considerable
surely this Fog & Gloom cannot be Animalculæ, as we do not find
anything produced by them, not the least moisture can be found in
this Wind, it makes the Lips & Fauces dry & chapped if it continues
3 or 4 days the Cuticle peels off, continuing a few days longer the
perspiration becomes Acrid & is so to the taste, it is yet highly Conducive
to health convalescents recover fast, also those labouring under
intermittents, Dysenteries, &ca. & are Cured, it checks Epidemics [but]
[the small pox did not appear] a number of people were innoculated 
at the accession of the Harmatan, but the small pox did not appear;
some inoculated after the Wind Ceased & recovered perfectly
except one Girl who died of a locked Jaw in consequence of a large
Ulcer from innoculation.

32
or are capable of Volatilization.
150. Water is in a greater or lesser quantity chemically combined
with Air, when a decomposition of this solution of parts in Air takes
place, Rain is produced, previous to this decomposition Animals
are sensibly affected. Brutes & Birds very much so, the human
subject unless unhealthy rarely perceives much difference. ♀.
151. The decomposition of substances in the atmosphere may be succeeded
by new compositions from which various effects may arise
hence to determine a priori the effects of Atmospheric Air is extremely
difficult.
152. Noxious particles taken up by the Air of one Climate may
be conveyed to another, thus Winds by bringing noxious particles
in their currant from distant places or Climates, may materially
affect [the] and alter the salubrity of any given Region. ♄
153. Matter will be found either in a state of perfection or imperfection
if in a state of perfection health is present, if in a state
of imperfection the reverse or diseases take place, this maxim is
universal, it will therefore hold good respecting Animals as well
as inanimate matter.
154. In order to Diseases being present three Circumstances must
take place
1st. Susceptibility of certain impressions
2d. Disposition arising from these impressions
3d. Action in consequence of a disposition
155 In respect to these requisites the body bears a perfect Analogy

☉ 158. Thus a strain gives occasion to Scrophula, a blow to
Cancer &ca. moreover different parts will be more or less liable to
disease, as they are more or less able to resist a diseased action,
this in general will be in proportion to their strength & weakness
the different parts of the body may have their natural actions very
dissimilar. Yet disease may produce similar actions in them, for
instance, the Lungs & the Liver have dissimilar natural actions in them 
yet disease produces a similarity of action when they are affected
with Scrophula a disease of which they are both susceptible, & which
is a specific affection.

33
Analogy to the mind, which must be susceptible of impressions, must
receive impressions, must have a disposition arising in it to which
an action of the proper kind must succeed. –
156. Susceptibility of impression is not sufficient alone to produce
disease but impressions of some kind must be received by
parts endowed with that susceptibility which, a disposition being
produced an Action naturally succeeds.
157. Disease bring a perversion of the regular laws of nature
observe less order, therefore their phenomena are less easily to be 
explained & accounted for than natural actions.
158. With respect to the changes taking place in the body we
know only the causes of them & their effects, we know not the manner
in which those causes, produce those effects. ☉.
159. We can judge only from the consequences of impressions of
the degree of susceptibility of the mind or body. The causes of actions
in the body, bears a strict analogy to the causes of Actions
in the mind.
160. As the human body is compounded of parts very Essentially
different the one from the other, the diseases of different parts will
vary very widely, so also the constitutions of different bodies greatly
vary & of course the susceptibilities of different impressions, in some
the susceptibility for particular diseased action is so strong as only
to require the habitual actions to be obstructed to run into disease
161. Constitutions will be either universally subject to the same
action as the indolent or irritable, or constitutions will be subject


             
 
 
 
 
     
                                    


34.
to some specific kind of Action whether local or general
162. Constitutions are both generally & locally subject to Particular
actions.
163. Constitutions are subject to particular kinds of both local
& general actions.
164. Constitutional Susceptibility may be three fold.
1st. Universal tendency for diseased actions of some kind
or other, where however the whole must be in action.
2d. Universal susceptibility of local action.
3d. Universal susceptibility to fall into an universal
disposition as though something was teizing the constitution as
an inflammatory fever &ca. –
165. Dispositions are natural, unnatural or diseased, of the
natural disposition of sensitive or irritable parts instances are
given in the secretion of Glands.
The unnatural are divided into three kinds Vizt.
1st. Disposition to restoration in parts Injured, as in
Fractures &ca. –
2d. Disposition from necessity as in Ulceration.
3d. Unnatural dispositions of all kinds, of which
great is the variety, the diseased disposition is that which
tends to the destruction of parts.
166. Every disposition to diseased action has a certain time
allowed to it, in which that action will be produced in some

🜔 167. A Girl in the West Indies had a disposition formed for Leprosy,
but it was sometime after she came to England that the
disease appeared; here there was a considerable space between
the disposition & action of the Disease. In some Specific Dispositions.
Years may intervene before the action Commences, as in Cancer.
We should be careful not to confound dispositions with
actions, dispositions are properly the disease, Actions the effect of
the disease, disease may exist for a time though its action is
superadded as in Ague.
🜖 168. Of the first we have instances in the small pox, Measles
Inflammations & Fevers, of the 2d. in Agues, where the disposition
to Action continues though the Action only commences & goes off at
stated Intervals. the disposition in the system for action remaining
undestroyed by the action, & until it has lost its power of conger exciting
the system to action the diseased disposition existing as much
between the fits, as during them: of the 3d. We have instances in
some specific diseases, as the Venereal (Gonorrhea excepted) Cancer
& others where the disposition notwithstanding the Action continues to
exist because it cannot produce its full effects hence it will go on
until it destroys, unless the disposition is removed by an immediate
increase of action. –

35.
sooner than others.
167. A disposition once formed will go on to action, and its ultimate
Action be produced, notwithstanding sometime intervenes
unless the disposition can be destroyed by some change affected in
the part or constitution where it has taken place. 🜔.
168. In Diseases, dispositions & their consequent Actions are of
three kinds.
1st. Where the disposition has its action frequently repeated,
without the disposition itself being destroyed by that action
taking place.
2nd. Where disposition is destroyed by action, & the Action
ceasing, the disease also ceases.
3rd. Where the different action continues to go on without
removing the disposition, until the progress of it is destroyed
by Medicine. 🜖.
169. Two different & opposite actions cannot go on at the same
time neither in a part nor in the whole, if by means of any disposition
a new action is produced, the first action ceases.
170. If two dispositions are excited not two different & neutral
actions will be produced at one time, but a third simple disposition
& consequent action will be generated, which will be entirely

170. Of this we have an instance in Dovers power which consisting
of Opium & Ipecacuanha, a narcotic & an Emetic, Sleep & Vomiting
should be the actions, but as two actions cannot take place at one time
a disposition to a third action arises which produces that third Action
& is called sweating.
☿. 172. Too little actions in any part produces weakness in it which
although not a disease itself becomes the cause of diseases it causes
irritability & thus gives rise to morbid or irregular affections as locked
Jaw &ca. Mr. Hunter says that if the Nerves are weak the Voluntary
parts suffer, if the stomach is weak the general system suffers.
🜍 173. Inflammation arises from too great a degree of Common
action, if a specific action accompanies it, a specific Inflammation
will take place.
☍ 174. By increased Actions in parts, we become sensible of their
actions which before we were insensible of, thus palpitation of the
heart makes us sensible of the hearts action, of this we have no perception
in a natural state of the Organ, the whole body being subject
to similar actions with those arising in parts as observed (7)
the first attack of a disease is probably intimated to the Mind by
the feel of health previous to the attack of some diseases, it is not
unusual for persons to be sensible of an uncommon degree of health
& spirits here the several powers are as it were summoned into
action, to resist & destroy disease.

36.
& altogether distinct from other two.
171. Of Susceptibilities for diseases there will be great variety as above
said ( ) for every disease there must first be a susceptibility, -
172 In diseases either too great or too little a degree of action
will take place & to these two general kinds of action all the Phenomena
of diseased Action may be referred. ☿.
173. Diseased Action will be common or specific, Specific Action
follow certain determined dispositions arising from peculiar kinds
of impressions. 🜍
174. When a part unused to a particular sensation has that
particular sensation, the first alarm or knowledge of Disease is
given to the mind, but the action of Disease is often so slow as not
to be sufficient for a long time to produce any sensation in a part. ☍
175. The whole Animal body will be subject to many actions &
degrees of action, similar to what arise in parts.
176. Whenever a part heretofore subject to the will takes on an
involuntary action the Disease is called Nervous.
177. Whenever the action of a part is [suspended] superior to the
strength a power of a part debility & perhaps the distinction of the
life of the will ensue. –
178. A Diseased action in one part may first produce a particular

♂ 178. Sympathy will hereafter be more fully Explained but an
example in illustration of the Text may be given in the pain in
the Knee being often the first Symptom of the disease in the hip
Joint, or again in Vomiting being excited sometimes by passing a
bougie through the Urethra though there is no pain. –
🜋 179. A variety of diseases have been considered as hereditary,
but it is only the susceptibility of any disease, so that the Child
shall be more susceptible of an impression producing that Disease
than other people, this is all that parents can communicate to their
offspring. Mania has been supposed hereditary, & in some it seems
to arise spontaneously without any apparent Exciting Cause, as impression,
an Explanation of this will be found ( ) where it is said
that in some, the susceptibility for a given disease is so strong
that they will run into it without any other exciting cause, than
simply [the] same obstructions to the natural actions, the small pox is equally,
hereditary with mania or scrophula, the Gout is also considered
hereditary but it is in general otherwise & brought on by irregularity
in living but it sometimes arises in persons under 18,
then it must be considered as hereditary in the same manner that
we have considered Mania to be hereditary, to originate from a strong
susceptibility of the given disease, ready to take it on without any
visible Cause, & only from some unseen one as the least obstruction
to the natural Actions. The Gout is a disease of the Constitution

37.
particular sensation in another part, thus the first knowledge of Disease
will often be conveyed to the mind by sympathy. ♂.
179. Actions [of] are not hereditary, but, susceptibility of impressions
the cause of disposition, the cause of action may be hereditary,
thus diseases are not hereditary but a susceptibility of impression
which is to produce a particular disease may be hereditary. 🜋
180. When the different specific impressions, naturally productive
of two distinct specific dispositions, are given to the system, two

until it falls upon a part & then the full action there being produced,
the local Affection relieves the Constitution. –
🜔🜹. 180. The small pox & measles cannot Exist in Action at
the same time, but one disease will be prevented from action until
the other has gone through its natural course.
Case 1 Mr. Pools was inoculated for the small Pox, in
a few days the redness round the punctures appeared but he was
attacked with measles which suspended for a considerable time
the Eruption of the small pox which however on the decline of the
Measles appeared & went through its usual Course.
Case 2d. A Lady was inoculated for the small pox,
the Measles appeared soon after & the further process of variolous
infection was suspended until the Measles was over.
Case 3d. A Boy was inoculated & the same Events
took place. –

38.
distinct dispositions to specific actions may be formed, but the action
of one will be suspended during action of the other, that being
finished the suspended disposition may produce its action. 🜔🜹.
181. Actions must always correspond with dispositions, if the dispositions
are simple, so will the actions also be.
182. Too great or too small a degree of natural action will cause
a disposition to disease.
183. In health there must be both a due degree of strength as
well as susceptibility of action, moreover the actions must be always
in proportion to the strength.
184. The human body is continually undergoing some changes.
it has been considered to be either in an increasing state, As
between Birth & Manhood when its parts are continually increasing
either in bulk or firmness; to be stationary, or preserving
with little alternation its strength & firmness during a certain
period or lastly to be decreasing, when it loses gradually its, Vigour
& firmness. but these three States or Conditions of the
human Body are not explained by Proofs, but it is difficult
to say, when the Body in all its parts is arrived at its perfect
state, & it is difficult to say that the body, as soon as it is
obtained to its perfect state, does not begin immediately to
suffer, though for sometime, indissensible yet a real & gradual
decay.
185. It is certain however that at different periods of Life

☽︎ 186. The diseases the first stage is particularly subject
to are scrophula consequently diseases of the Lungs, complaints
in bowels from Worms &ca. Hydrocephalus. The Young are
more disposed to local & especially universal sympathy.
The Middle Aged have few specific diseases, if we
Except Nervous & Hypochondriacal disorders they are however
accidentally attacked with the complaints of Youth & Age &
this lays the foundation for disease in a more advanced Age.
In the Aged we have a variety of disorders, here the
necessary actions are not well performed: proper to this Stage are
Cancer Calculi in the Urinary & Gall bladder & Ducts, Ossification    
of Arteries &ca. –
♂ 188. Climates. Climates are hot, Cold & temperate, in hot Climates
the involuntary actions are carried on with more violence
whilst the Voluntary Actions are more sluggishly performed.
So diseased Actions are carried on with more rapidity &
violence hence Diseases run through all their Stage in these Climates
faster than in others, when disease kills absolute, absolute
Death (that is putrefaction) quickly succeeds visible Death. Cold Climates
have not such variety of Diseases as hot ones, neither is the
progress of them so rapid. Cold invigorates the voluntary Actions
at the same time it lessens the violence of the involuntary Ones.
In Cold Climates, [from the irregularity of the] simple
Life is not destroyed until sometime after visible Life is departed, for

39.
the susceptibility of the body for different disposition will be very
different, hence different Ages will have diseases in some measure
peculiar to themselves & these may be divided into.
A. The Diseases of Youth
B. The Diseases of Manhood
C. The Diseases of Old Age.
186. The diseases of the first & last stages (185) are many those
of the second are fewer. ☽︎.
187. The Causes producing disposition to diseases are many
& various when impressions are given which are to produce
diseased dispositions, the dispositions will vary very much
according not only to the constitutional or natural susceptibility
of the body, but according to other circumstances.
188. Whatever can affect or alter the natural susceptibility
of the body, will produce variety of disease, therefore the difference
of Climate, Seasons. The Moon, the atmosphere will produce
differences of disease, & each absolute state of Climates
Atmosphere, Moon [&1/4?] Year will have disease or appearances in
disease peculiar to itself, moreover affections of the mind will
often produce diseased Actions, the weaker the natural powers
of Action in a part are the less able will that part be to resist
disease therefore tendons, bones &ca. have less power to resist disease
than Muscles &ca. ♂.

putrefaction does not so soon follow as in hot Climates.
Temperate Climates from the irregularity of the medium
between heat & Cold furnish us with a greater variety
of diseases than either of the others. Hence Scrophula, Cold, Agues
& such like disease abound.
Seasons. We may consider a change of Seasons as a
change of climate, & as in changes of climate dispositions formed
in one climate by a removal into another are retarded from coming
into action, so upon returning into one similar to the first go
through their action.
The spring at it were ripens Diseases & brings them into
a disposition, for a disposition may be found during a season
which has not sufficient influence to bring it into action, as
the Winter; but in a season more favourable to the forwarding
that disposition, as in the Spring that disease has been brought
into action, so also in hot climates.
The Moon becomes often the immediate cause of diseases,
especially those in which the mind is particularly concerned,
as in Madness; which is always more violent at certain times of
the Moon, the full of the Moon also affects people whose brains
have been contused by any External Violence, this was instanced
in a Lamp lighter who received a fracture of the Cranium with
concussion of the Brain, he was trepanned & recovered, but ever after
found himself much affected by the full of the Moon. The seasons
of the Year affect the influence of the Moon on the human body,

40.
Note Continued.
the lamp lighter was additionally affected in the Spring.
A person of very scrophulous habit was very subject to
deafness at the full of Moon except in Autumn. –
Affections of the mind. Every Action voluntary or involuntary
may be affected by changes in the Mind; by a peculiar
state of it blushing may be produced, other states of it Excite Vomiting,
sickness, irregularity of pulse, diarrhea, discharges of Urine
Spasms &ca.
The Diseases on which the mind has the greatest influence,
are those in which increase or diminution of Action takes
place without any alteration in the structure. Constitutions that are
called irritable have the active parts more under the direction of
the Mind & less under the command of the will. The state of the
mind greatly affects, the involuntary Actions, that have already
taken place in consequence of disease. Agues have been cured by
affections. of the Mind, local Affections are even altered by the same
means. Tumors have been cured by rubbing them with a dead
mans hand.
189. Diseases are
A. Local
B. Constitutional
or
C. Mixed. –
We judge of the presence & nature of Diseases by their [specific]


 
     
                                    


41.
Symptoms, a symptom is a sensible effect of a peculiar action
Symptoms are either to be referred to the mind or to the senses. The
former only known by the Patient as pain &ca. the latter Perceptible
to the Physician as the state of the Pulse &ca.
When the symptoms are not expressive of the disease we
call them Anomalous symptoms & are either local or universal.
190. In simply local diseases a part may suffer, the General
health of the Body still remaining unaffected, in the Mind both apart
& the constitution are affected. –
191. Diseases may be originally local, or originally constitutional,
& again they may be constitutionally universal or constitutionally
local, or lastly they may be originally local, & at length affecting the
General system become constitutional.
192. The originally local (191) & the Originally Constitutional may
arise in the same person at the same time independant one of the     
other.
193. Dispositions as above said must be formed previous to the
Existence of disease, so that there will be a disposition to produce
originally local effects, an universal disposition to produce local Effects
&ca. –
194. An originally local Disease may take on a part of the Constitutional
one when the former has only been common diseased action
but a local specific disease will not take on a part of a specific constitutional
disease unless the latter has superior powers, in which case
the former local action will be suspended during the presence of a new

10
195. This should seem to refer only to common diseased action
of this we have an instance in fevers curing or increasing an
Ulcer, or a sore increasing.
☿. 201. A – as in diseases of the hip, where it is no uncommon
thing to have the patient complaining of his Knee.
B – as when a stone in the Kidnies produces Sickness & vomiting
as an impression given to the Urethra produces often a
swelling of the Testicles though the Urethra at the time the Testicles become
swelled shall be free from Complaint.

42.
Specific Action.
195. A Constitutional disease may be the cause of increasing or
diminishing local disease & a local disease may be the cause of increasing
or diminishing constitutional disease.
196. It frequently happens that a local diseased appearing some
other will appear.
197. A diseased action once formed will go on increasing, until
either it is destroyed by a new action being induced in a part or
constitution, or until the parts to which it is spreading lose their
susceptibility of the disposition to that action or until it produces
an Abolition of Life.
198. Diseases will be either common or specific.
199. We cannot increase specific diseases, unless we can increase
the susceptibility of the constitution of these diseases. Every
specific Disease will have two modes of Action, the Specific & the Common.
200. If the constitution or a part is susceptible of impression
from a peculiar stimulus & a peculiar disposition is Excited then
a specific disease may be produced & that specific disease may be
either local or Constutional.
201. When A an Impression is given to any part susceptible
of action, & the action is not produced in the part to which the impression
was given but in some other part, or B when an Action
formed in one part produces an Action in another part, or when an
action is formed in one part & the sensation resulting from that action
is felt in another part, sympathy takes place. ☿.



   
     
                                    


43
202. the part (201) receiving the impression is the Sympathent, the
part in which the new consequent action, or the sensation arises,
is the Sympathizer.
203. A...Sympathy is simple or Compound.
B...Similar or dissimilar.
C...Regular or irregular
D...Natural or Unnatural.
E...Real or delusive.
F...Partial or universal.
G...Contiguous, continuous, or Remote.
H...Common or uncommon.
204. The more simple the structure of the being, which is the
subject of the operation of sympathy, the more simple will the
sympathy be found, even some Vegetables are susceptible of it,
as the sensative plant, whose leaves successively dropping on
approach of the hand arises from this simple sympathy between
the different leaves, in successive order sympathizing with one
another. –
205. In the more compound being as the perfect animals the
sympathy may be more complicated, for an impression being given
to one part becomes the cause of action in another part, the action
in the last part becomes a cause of action in the third part. & that
again in a fourth part, hence in many Animals sympathy may
become exceedingly complicate.

206. If one part is affected with pain & another part by
sympathy gives the same sensation then the sympathy is similar
& vice versa – A pain in the Testicles producing by
sympathy sickness in the stomach. the sensation & action in
the latter being different from those of the former the sympathy
is dissimilar.
♄. 207. We observe affections of the brain produce sickness and
Vomiting & this almost invariable here we have an example of
common or ordinary sympathy by attending to this division of
sympathy we learn a knowledge of the symptoms of diseases,
some common sympathies though but few arise in consequence of
disease only & are therefore unnatural, such is the sympathy between
the shoulder & the Liver between which in health there
seems to be no sympathy.
♂. 210. The Father of the great Lord Chancellor Clarendon, had
a stone in his bladder he was affected with it many years & it
was painful, it was always accompanied with a pain in his Arm.

44
206. When a part receiving an impression, an action is formed in
it, & a like action is consequently produced in another part the Sympathy
is similar, but when the action in the one or sympathizer is
different from the action in the other or symphathent, the sympathy
is dissimilar.
207. When an action of a peculiar kind in the Sympathiser has always
been observed to follow an impression & action of a peculiar
kind in the sympathent, such an action in the sympathiser arising
consequent in the impression & action in the sympathent, is called
common sympathy, as also where a particular part being the sympathent,
another particular part, has been observed, to be constantly
the sympathizer. ♄.
208. When an action of an unusual kind arises in a sympathiser,
or when the sympathiser is a part unused to action consequent on
an action in a given sympathent, uncommon sympathy is said
to arise.
209. Sympathy is natural when the sympathent receiving an
impression not productive of disease, & healthy consequent action is
induced in the sympathizer, thus the breasts of Women are affected
previous to coming on of Menstruation.
210. Unnatural or diseased sympathy is when an impression
given to the sympathent produces an affection of the sympathiser,
inconsistent with its healthy or natural action so scratching
an Issue in the Thigh which itched has produced a difficulty of
breathing & a pain in the breast. ♂. –

🜖 211. Delusive sympathy. A Man in a fever & delirium,
when he wanted to go to stool, always signified to the By standers
that some other Person whom he talked of or pointed out wanted to
Ease himself referring his sensations to some other individual. –

45
211. Sympathy is real when the mind refers to the affection or Sensation
produces to the proper sympathiser, & delusive where the mind
refers the Sensation, Action, or Affection, to a sympathiser between wch.
& the sympathent no possible connection can exist. Thus when a
Man under Idiotism or Delirium, has an impression given to any
part of his body, & his mind believes the sensation consequently
produced not to exist in himself but in some other person, he is
under a delusive sympathy. 🜖.
212. Sympathy is partial where one or more parts of the body
are sympathisers, some given part being also the sympathent.
It is universal when an impression, being given, or an action
Excited in any part, the whole constitution sympathizes with it
so a wound being made in the Knee, a fever which is the action of
the constitution sympathizing with a part will often arise. –
213. Sympathy is continued when a part receiving an impression
& a consequent action arising in it, the parts immediately joining
& connected with it are also thrown into action, thus when an Inflammation
arises in a part, as the Skin, & spreads wider & wider
the parts of the to which Inflammation spreads from the first point,
are suffering by continued sympathy.
214. Contiguous sympathy arise where an impression being given
to or an action excited in a part or parts contiguous to, but not
joined & immediately connected with the Sympathent, becomes the
sympathiser, thus an affection of the Integuments of the Abdomen
will produce consequent affection of the bowels.

☽︎. 219. I must remark on the text that the strength of partial & regular
sympathy will be in the Ratio of the powers of life. I think
here we must make a distinction between a readiness or susceptibility
of sympathy, & a strength of sympathizing action, perhaps debilitated
& most irritable persons & those in whom the powers of life are weakest
are the most ready to fall into sympathy of every kind, but the strength
of the sympathizing action in them will be but little, because the
sympathiser can have but little powers of Action.
♃. 220. The Brain Sympathizing with some other part, convulsions,
Epilepsy, or a sudden abolition of the visible Life, may be the
Event, the action in the sympathiser being here more violent than in
the sympathent.

46.
215. The sensitive principle the principle of Life & the Mind
mutually sympathize with each other so that affections of the one,
will produce affections of the other, or of both the others.
216. Remote sympathy is where the part which is the sympathiser,
is distant from the part which is the sympathent, as when a
diseased Testicle shall produce a sickness at the Stomach.
217. some parts are more particularly disposed to become sympathizers
than others, the stomach will sympathize with any part
of the body.
218. Particular habits are more disposed to universal sympathy
than others, the less determined in the disposition to partial sympathy,
the greater will be the disposition to irregularity & universality
of sympathy. Thus Infants are peculiarly subject to universal
sympathy, because when an impression is given to any part of
their body their partial sympathies, not being yet settled, or determined,
no particular part is disposed to become the sympathiser,
but the constitution takes up the sympathizing Action.
219. The strength of regular & partial sympathy will be greater
in proportion to the strength of the powers of Life & vice versa. ☽︎.
220 The affection of the sympathiser will often be more violent than
the affection of the sympathent, but this will depend on the number
& nature of the part & parts taking up the action of the sympathent
& thus becoming the sympathiser. ♃.
221. The vital parts are particularly disposed to partial sympathy
between one another, the further parts which are the sympathents

♀ 221. Thus in Diseases of Extremities, the Constitution is Exceedingly
ready to run into hectic Fever, as in white swellings of
the Knees, Arms or Ancles; but the latter part of the Text in this
Aphorism can only refer to the non vital parts for the constitution
is always most disposed to sympathize when a part necessary to
Vitality is affected. –
☉. 222. Instances of mutual sympathy are but few, the Stomach
will indeed sympathize with the head & the head with the stomach
but the liver is perhaps never the sympathizer when the Shoulder
is affected, though a Morbid change in the Liver produces very commonly
an unusual sensation in the Shoulder. –

47.
are removed from the heart, the greater will be the disposition of the
constitution to sympathize with them ♀.
222. Sympathy being only a secondary Action will cease when the
first part is destroyed, thus if a diseased & Ulcerated joint is attended
with hectic Fever, quick pulse, restless nights &ca. almost immediately
after its removal by amputation the pulse grows slow & calm
& the Patient recovers his sleep. ☉.
223. Sympathy is of many & important uses in the Operations of
life, it connects the principles of different parts, it enables one
part to assist another in the performances of its Operations possibly
when one part is affected with pain by enabling another part to take
on pain also, & thus diffusing the sensation it lessens its violence as
the same quantity of Pain concentrated in one part might be insupportable
to the Animal, but by its being diffused over other parts
the Animal is enabled to endure it with less injury.
224. Sympathy leads us to the knowledge of the causes, nature
& seat of diseases by observing in what manner one part becomes
affected from a prior indisposition of some other part, we learn frequently
from the sympathiser, the state situation & manner in wch.
the sympathent is affected.
225. But sympathy often leads us astray, & causes our judgement
to err, when the sympathiser is only sensibly affected we
refer too frequently the Disease to it entirely, over looking or not suspecting
the affection of the sympathent. (see the notes) We are moreover
often led to imagine from considering the Phenomena of Sympathy,

♂. 225. Thus a Man, having been used to fits of the Gravel if
seized either with a pain in the back or from any
other cause refers his pain to a Nephritic Affection (see symptoms)
228. How can it be proved that water is present in all
animal fluid, so as to act as water in the solution
of substances? for though in the analysis of animal [flu??]
water may be found, yet the process of that analysis
may be separated this water from combination in [wh?]
the nature of water was totally different. Consequently
water in this combination cannot act as it would other
do as a solvent.

48.
Sympathy, parts to be Sympathent, which are free from the action
in question, so also when the mind of the patient has been long
habituated to a particular Idea, it frequently but falsely refers
many sensations to the same cause, that had given rise to that
particular Idea, which sensations arise from the Causes. ♂.
226. When Medicine or Artificial means are employed for the removal
of Diseases, produce either a partial or universal effect,
it is to be considered as a kind of Violence done either to a part
or to the constitution. –
227. Before a Medicine can produce any, except Mechanical effects
upon the constitution, it must be reduced to a state of solution.
228 There is one property only in all the Juices of an Animal
body which is common also to one fluid out of the Body & by the
solubility of substances, in which fluid we can judge of their solubility
in the Animal juices, now all our juices are more or less
of a watery nature. Hence substances soluble in water will also
be soluble in the Animal juices.
229. But not only the substances (219) are soluble in the Animal
juices, almost all substances are so in a greater or lesser degree &
most of them are so in the mouth, as we know by their giving their
impression by the Taste, previous to their doing which they must
be in a state of solution, no substances having any but a Mechanical
action on a part which are insoluble in the juices of that part (228)

232 may not different degrees of galvanic action
be the cause of the separation of the various juices
for what[ever] other cause is so probable.

49
230. many substances are soluble in the Stomach though insensibly
as Earths, which are neither soluble in water, nor in the Saliva
& consequently are insipid. –
231. For a Medicine to produce universal Effects it must be dissolved
in ye Blood.
232. The Blood is a kind of Universal Menstruum for Substances
being found incapable of solution in it. Its properties
of retaining at once so many substances in a state of solution,
may arise from its heterogeneous nature, for it is well known
that a fluid that has dissolved one substance, tho’ it will perhaps
take up no more of that Substance, yet will even by means of that
substance be enabled to dissolve a second Substance for which it had
otherwise been an improper Menstruum; thus Water when pure
will difficulty dissolve Corrosive sublimate, but a saturated aqueous
solution of Sal Ammoniac will enable the water to dissolve abundantly
more of the sublimate, than in its Elementary state it
would have done, so also water impregnated with fixed Air to Saturation
will still dissolve other substances, & even such as unmix’d
it would not have acted upon.
233. Medicines dissolved in the Animal juices have a power
of influencing both the Nervous & Living principle.
234. Medicines perform their operations by their
(a) Stimulating
(b) Irritating or
(c) Sedative powers, & by the Animal body having

are not the stimulation the irritating & the sedate
all chemical.

50.
a susceptibility of that Operation but never produce any change
unless when they act as caustics by any Chemical Operation. –
235. The powers a.b. (234) are to be found in the same Medicine,
the quantity in which it is applied only making the difference.
236. Stimulating Medicines only produce natural action or
increase one already present; Irritating Medicines diminish action
whether natural or unnatural, each of these may produce
both partial & universal effects. –
237. The influence of stimulants, will be as the power of the stimulant,
& the nature, & powers of the part taken together. The same
will also be the influence of an irritation. –
238. The influence or operation of the same Medicine on different
parts will be extremely different, so also the action of Medicine on
a second part will differ from its action on the same part when
in a state of disease.
239. In order to understand aright, the influence of Medicine we
must consider parts as capable of suffering four actions Vizt.
1st. The Action of Health.
2d. The Action of irritation on health.
3d. The Action of Disease.
4th. The Action of irritation on Disease.
240. Irritation acting upon health produces diseased action, Irritation
acting upon disease produces or restores health.
241. As parts are susceptible of a variety of diseased actions the

🜔v 247. Friction can be applied to a larger surface than pressure.

51.
removal of one diseased action by medicine will not always produce
a return of health, a disposition to some other diseased action
may have been formed, & wait only for a removal of the present diseased
action, to go on to its proper Action. One action can only exist
at one time in one part ( ).
242. The irritation of medicine on disease, may although it removes
the present disease, even induce a disposition to some
other diseased action, which as soon as the first action ceases, may
go on to its action.
243. From (241-242) it is evident, we should be careful to discriminate
the consequence of disease, from the consequences of Cure,
we may otherwise persist too long in any mode of Cure.
244. The powers of the living Animal may also be affected by
mechanical means The operation of the application of mechanical
means may be reduced to two Species. Vizt.
A. That of Pressure
B. That of Friction.
245. Both A. & B. (244) produce the same ultimate Effects as
Medicines. –
246. Pressure seems to impede action, it is also of use as a stimulus,
if applied more forcibly it irritates.
247. Friction does not seem to impede but excite action, if
violently applied it irritates, if gently it stimulates. 🜔v.
248. Medicinal applications may produce their Effects either

  
         
     
                                    


52
simply by contact, or by exciting sympathy.
249. It is rarely Medicines act simply by contact, their influence
being carried by Sympathy generally much further than the
parts to which they are immediately applied. –
250. The effects of medicines acting by Sympathy, may be thrown
into the same divisions as the actions of Sympathy particularly
they will act by continued, contiguous, or remote sympathy.
251. In directing the administration of medicines it is necessary
to have respect to the strength & weakness of the part or constitution,
& to the too great or too little action of the part or constitution.
252. As in health the action of a part must be always in due
proportion to its strength ( ) so in your Endeavours to restore
health when impaired, we must always endeavour to proportion the
degree of Action to the strength.
We must never increase action when strength is deficient
without endeavouring to increase strength likewise.
253. A. Strength & Action may both be diminished or Increased
B. Action may be increased, & strength at the same time be
diminished.
In one case A., it must be our care to increase both
strength & Action.
In the other B., we must either reduce the action to the
strength, or increase the strength so as to level it with the action

at the moment of act of solution what change
takes place, does an electric action accompany the chemical
if it does the new solution may acquire new properties of
electric matter, & then modification may effect the animal
the modification too may effect growth of the different
vegetables for how can you account for the same plant
acquiring properties different from in another & the
same situation is then the effect of different organization
or different galvan action.

53.
254. Weakness & want of action are not the same, a part may
have Weakness, & yet too great action, we judge more readily of
too great or too little action than of strength & weakness, because
the former are effects, the latter are often causes.
255. Medicine may act by contact (249) or by Sympathy ( )
256. Medicine may also be absorbed (see absorption (1)) & when
absorbed will again exert their action by sympathy or by Contact,
by contact they may affect either the Lymphatics of the part, or
of as much of the Lymphatic system as they pass through, or again
when mixed with the Blood may by contact affect the constitution
in general.
257. There are also applications which penetrate beyond the surface
to which they are applied, as heat, cold, Electricity
258. Heat [sometimes] increases the Vital & involuntary actions
though it is considered as penetrating it cannot produce that
effect beyond a certain degree because the animal is incapable
either in a part or the whole of receiving or containing a certain portion
of heat.
259. With respect to cold, also the same reasoning will apply the
Animal powers whether in a part or in the whole, will neither
receive nor part with more than a certain quantity of heat, that
is without destruction of its principle of life.
260. Electricity indeed in every capacity of the Animal is Universally
penetrating, as no circumstance or difference in the capacity

more electricity than the natural quantity increases
action.

54.
of the Animal can obstruct its passage.
261. Cold, heat & Electricity are capable of powerfully Exciting Action,
we must therefore be extremely attentive to the circumstances
& degree in which they are applied, least we sometimes excite
an action superior to the strength.
262. Cold applied to the surface of the body may become a Stimulant
& Rouser, or a seadative & weakener.
263. In the first instance (262) it produces heat, in which it
agrees with the warm Bath, with this difference that the latter in
some measure gives heat to the Animal the former obliges the Animal
to produce its own heat, here the powers of generating heat
are increased the Pulse quickens the actions of health are in general
increased. these Effects show the Animal is in full
powers of restoration.
As the cause of these effects is instantaneous, so the Effects
will be but temporary therefore the cold applications must at due
intervals be repeated.
264. In the second instance (262) it proves a sedative & weakener
where the parts to which it is applied either can give no
Alarm to the constitution or the parts, or the constitution have its
power of generating heat diminished here all the consequent
actions will be the actions of weakness.
265. Cold may produce various effects by sympathy even local.
266. Heat is either absolute or sensible, the latter we shall here
notice.

♁. 269. For the general properties & effects of heat & cold, in Animal
Bodies, see the Text & Notes on heat, Cold & Climate. –

55
267. We judge of the sensible heat by our senses, or by
measurement, this sensible heat is either Native or Foreign.
268. Foreign heat in its application will produce different effects,
as it is applied simple, or compounded with  bodies capable
themselves of exciting action.
269. Foreign heat is applied with two intentions. Vizt.
1st. to increase the warmth of the Animal
2d. to act upon the principle of Life.
Heat has the general property of increasing the violence of the
involuntary actions. ♁.
270. According to the degree in which it is applied it will be
either irritating or sedative.
271. Substances compounded with that heat are applied either in a
dry or an humid state.
Heat in dry vapours can be medicated with Essential
Oils, Spirits, &ca. The warm bath is an example of humid bodies
compounded with heat.
272. The Bath ( ) is generally used with a degree of heat
something below that of the Animal, or in a degree above it, the
former is called the tepid Bath, the latter the hot Bath.
273. The former seems in general to soothe the Skin & by Sympathy
to affect other parts with an agreable sensation, hence it
rarely depresses nor does it in general Excite any increased action
further than simply freeing a part from disease.
274. The hot bath produces more powerful effects, by exciting

🜔. 276. Muscles heal or are restored to health more readily
than bones or ligamentous parts, the cellular substance will
take on the healing process more readily if placed about Muscles
than if placed about Tendons or bone &ca. taking on in general
the disposition of the parts it is subservient to.

56
an increased action on the surface it may produce relief to the
internal parts if continued for a length of time it produces weakness
but not commonly a permanent one.
275. It is observed above ( ) that different parts will be more
or less able to resist disease. In the same manner in different
parts when diseased there will be more speedy or slow advances
towards health, & this from the same Cause. Vizt. the difference
in strength or weakness.
276. Parts in which actions are excited with the greatest difficulty,
fall into diseases more slowly, & when diseased are more slowly
restored again to health. 🜔.
277. Touching the slowness or readiness with which parts diseased
recover their health much will depend on their situation in
the body.
278. The power of healing or the facility with which parts diseased
recover their strength or health will also be different during
different ages, other circumstances being similar.
279. This power (278) will be greater [more or less] or more active,
during the growth of the subject than after the growth is
stopped, during the middle age or that which is called stationary
( ) though this is not well ascertained / the power of healing
is less Active, but it will be the least active of all during the state of
decline when [Life] the System seems to take a retrograde motion
& nature begins to unbuild. ( ). –

🜔🜹. 282. A scrophulous Joint, an ill conditioned Ulcer, an
ulcer in the Lungs, or any other similar cause may produce
a constitutional affection & these existing in such a state the Constitutional
affection cannot be removed.
♎︎ 283. Thus the Cranium is at first membranous, it afterwards
in due time becomes bony, or its bones shoot in membranes
if by fracture or other violence a part of it is removed, in the
restoration first membrane is formed & afterwards bone so in
the cylindrical bones as they were at first cartilaginous, when
restoration in consequence of injury becomes necessary, the Union
is first by Cartilage afterwards by Bone.
☿ 284. If a part of a tendon is destroyed as by a Wound &ca.
the injury extending in other parts as Skin, Cellular Membrane
&ca. the Process of restoration being begun, the Union will not be
formed by means of a regeneration of Tendon.

57
280. It frequently happens that one disease will prove the cure
of another. –
281. One local disease being produced may remove a prior
local disease, a constitutional Disease arising may prove the
cure of a local disease ( ) & a local disease arising may
cure a constitutional one. ( )
282. Constitutional Diseases cannot be cured whilst parts are
continually adding to the constitutional affection. 🜔🜹.
283. When loss of substance happens in any part & that loss
is to be restored, the parts which restore the loss or which regenerate
the substance to fill up the loss, in their action for that
purpose [produce] preserve the same disposition with which they
were at first formed. ♎︎.
284. The law (283) does not however universally hold good
as circumstances being present may prevent its operation. ☿.
285. Inflammation, is an increased action in a
part, it is difficult to determine whether it differs from common
Action in a part except in degree.
286. Inflammation is the first principle in Surgery, it is the
cause of many local diseases, it is the means of preventing the
increase of many local diseases, & it is often a powerful instrument
in their Cure, it operation are chiefly performed by the small


  


 
   
    
                                  


58.
Vessels, the larger ones doing more than bringing the
blood to them.
287. It may be divided into
1. the Healthy
2. the Unhealthy.
The first that which is attendant on any healthy
state of a part of the constitution, the other that which attends
on an unhealthy state of the part or Constitution.
288. It may be divided into.
1. Single
2. Compound.
The first the Action of Inflammation alone
the second the Action of Inflammation with the modes of
action
289. It may be divided according to its Effects into
a. The adhesive.
b. The suppurative
c. The Ulcerative
290. The parts Subject to Inflammation are
a. The cellular membrane & circumscribed Cavities.
b. All the Canals & outlets of the body.
291. The three Stages or States of Inflammation may have
a fourth superadded. Vizt. that of a specific disposition to Scrophula

▽. 293. By the effusion of coagulable Lymph & its gluing
up the Cavity, or confining the extent of the inflammation
& in fact a Cyst is formed to contain the purulent matter
when formed, hence we see how matter is confined to one
spot instead of being widely diffused, by it also is formed
a Cyst round Musket Balls, pins, Glass & ca.

59.
Scrophula.
292. In the order (a. 290). The adhesive generally begins first
the suppurative & ulcerative are its sequels. In the order (b. 290) 
The suppurative begins & the ulcerative or adhesive follows.
293. In the adhesive inflammation coagulable Lymph as by
the increased action of the Vessels speedily thrown out between
the surfaces of the Cavities one to another, & thus entirely obliterates
them. ▽.
294. Inflammation is frequently carried no further than
the adhesive (293) & then it may terminate by what is
called Resolution.
295. The adhesive inflammation often prevents an increase
of local disease, it sets bounds to its own progress & it
prevents the diffusion or extent of the suppurative inflammation
when it takes place.
296. The coagulable Lymph thrown out in Inflammation
(293) always partakes of the nature of the solids, which seperate
it.
297. The termination (294) does not always take place when
it does not happen if in the violence of the action the
death of the parts does not ensue the suppurative stage
takes place.


 
 
  
  


 
   
    
                                  


60.
298. The suppurative stage will arise when the death of a
part has actually taken place, but the surrounding parts
have not suffered the same absolution of their vital principle
here indeed the dead part may be considered as a foreign
substance & as a Stimulus to inflammation to those that
surround them.
299. Particular circumstances arising in different parts
of an animal body, the parts may be disposed to absorb
themselves & so to produce a solution of continuity, the Inflammation
attendant on this action is the Ulcerative (289 c)
300. This is commonly the sequel of the suppurative Stage
& therefore may for the most part be rather considered as a
consequence of that stage than as the affection of an original
disposition in a part.
301. This (300) is however not always the Case, it sometimes
arising without a part previously undergoing suppurative
inflammation. –
302. The general order in which inflammation proceeds
in the cellular membrane (290 a) is
1st. Adhesive
2d.. Suppurative
3d.. Ulcerative.
303. But this order is not always observed. The suppurative

☽︎☉ 304. When inflammation attacks the canals, it rarely
goes beyond the suppurative affection as those parts do not
readily fall into Ulceration, adhesion will arise still more rarely
the ulcerative inflammation being in these parts so uncommon,
granulations of course will as seldom be found to take place.
309. This arises from a particular original disposition in the
part brought into action by the fever or by a part taking up an
Universal disposition.

61.
Inflammation will sometimes arise without the adhesive previously
taking place, here the Disease & the extravasated fluid
will be widely diffused this is the Case in all the Erysipelatous
suppuration.
304. In the Canals or outlets of the Body (290 b) the suppurative
generally begins, the ulcerative follows to which the
adhesive succeeds. ☽︎☉.
305. The Erysipelatous affection attacking the parts the order
is here also disturbed, the adhesive or Ulcerative arises
first & the suppuration succeeds.
306. Whatever can increase the violence of the action of parts
may be called a cause of common inflammation.
307. A part will take on the affection of the constitution,
that is an universal affection may become a local one, hence
therefore a cause of local inflammation may be traced.
308. The abscises arising after the termination of specific
febrile constitutional diseases, as Small pox, Measles &ca.        
have nothing specific in their nature, they only arise in consequence
of the common disturbance the constitution has suffered
from the fever if the disease.
309. Simple inflammatory fever may be followed by an Abscess
in a part (308).
310. The remote causes of Inflammation are four Vizt.

  
 
 
  
  


 
   
    
                                  


62
1st: From accidental Violence.
2d: From irritation applied to the part.
3d: From a particular disposition to the part itself.
4th: From a general state of the Constitution affecting
some particular part.
311. Many constitutions have a disposition to specific inflammation,
& will fall into it whenever any exciting cause shall
arise as in Scrophula & in habits subject to Erysipelas.
312. Many parts of the body have a greater tendency to specific
diseased action than others, so any constitutional Affection
arising these will readily take on a diseased specific action.
313. Specific inflammation may be.
a. Specific & healthy, or
b. Specific & unhealthy.
314. Different parts more or less readily take on different Inflammation.
External parts are more inclined to the suppurative,
internal parts take it on less readily suffering [them]
even the presence of foreign stimuli a longtime without going into
this Stage; Vital parts do not readily admit of the suppurative
Inflammation tho’ they willingly take on the first & most simple
inflammation.
315. When a part is inflamed that is not essential to Life the
Constitution does not necessarily sympathize with it, unless from

♀. 316: There are two powers which can produce a change in
the state of the pulse, that of the heart, & that of the Arteries,
the regularity or irregularity will depend upon the heart, the
hardness, fullness, softness & smallness will depend upon the Arteries.
🜔🜹. 317. The effects of Inflammation on different parts.
Stomach. Quick small & hard, sometimes low
pulse, nausea, dull heavy pain, depression of mind.
Small Intestines. nearly similar
Large Intestines: pain more acute, general depression
less nausea:
Liver. This procures besides its own peculiar
symptoms effects somewhat similar to inflammation of the Stomach.
Heart. Its motions are confused & irregular
the pulse quick & lower than common.
Uterus. Great oppression, nausea & obtuse pain.
Lungs the heart frequently sympathizes 

63
the long continuance & violence of the inflammation for here the
operation of inflammation may be carried on without interrupting
the functions of the Vital parts
316. But of the constitution of the patient is very irritable &
readily takes on sympathy nearly the same Phenomena will
arise as in inflammation of the Vital parts; the Pulse will
grow small quick & hard; blood drawn off will be sizy but loose
& its superficies flat, the violence of pain will however be greater
than in the inflammation of the vital parts. ♀.
317. All parts supplied with their Nerves from the intercostals
& par Vagum when attacked with inflammation give symptoms
of lowness, & depression. 🜔🜹.
318. The termination of Inflammation will take place the quicker
the nearer it is to the heart.
319. The pulse growing quick after the commencement of inflammation
is a proof of the constitution becoming affected on
sympathizing.
320. On the commencement of inflammation Rigor is frequently
felt, this is not simply from the debility induced into the constitution,
but also from the Novelty of the action which it performs
but weakly because it is not prepared for, nor accustomed to
it.
321. In Rigors & Syncope the blood is collected about the

preventing a full diastole; when the Muscles are inflamed the
pain is acute, the pulse full & strong. Inflammation of the
bones & Tendons produces a dull heavy pain & the Stomach generally
sympathizes.

64
internal parts, & the External are left in some measure empty.
322. Every new Action in the Constitution must tend to induce
weakness in it, its Effects will however vary in different constitutions,
in the strong it will excite the general powers of action &
an hot fit will soon succeed, in the weak the hot fit will not always
be produced but only a clammy sweat succeeds.
323. Rigors are not attendant on the commencement of Inflammation
alone every new action in the constitution may be accompanied
by them.
324. Life cannot go on always in the same state it must have
its stated seasons of rest & action, hence even in the most continued
diseases, & when the cause is unvaried there will be intervals of Alleviation
& exacerbation, nature observing her general Law rests even
in disease.
325. Exacerbation may be considered as the renewals of the commencement
of diseased action, & so a kin in some measure to
Rigor...
326. Disease may exist & yet the constitution may be insensible
to its action, it may want power of keeping the constitution in
action beyond a certain time in ague the disease exists as much
between as during the Paroxysms.
327. From ( ) it is evident that a change arising in the constitution,
a change in the Blood as partaking of and possessing
the living principle may take place also.


   

        
  
 
 
  
  


 
   
    
                                  


65
328. The appearance of the Blood will not be always the same
under given symptoms of constitutional affections, such as the
state of the pulse &ca.
329. Inflammation begins at a point at first, all the local
symptoms being confined within a small compass, afterwards
it spreads according to the state of the surrounding parts wch.
may be either local or constitutional, as the surrounding parts
are more or less in health they will be more or less disposed to
continued sympathy, at length the inflammation & redness will
be gradually lost in the surrounding parts.
330. Inflammation is attended with a swelling of the part
the more healthy the more the swelling will increase at a
point.
331. The swelling of a part arises from the Vessels of the part
being more distended with fluid than natural from the Extravasation
of coagulable Lymph, & of some serum, which is
known from the Oedema of the surrounding parts, the less extensive
the Oedema is & the firmer the Margin of the Inflammation
is the more healthy inflammation will be present for here
more coagulable Lymph & less serum is thrown out.
332. The colour of the inflamed parts (329) will also be altered
the nearer it approaches to a pale scarlet redness the more healthy
the inflammation will be, the less healthy the inflammation
is, the colour will be less of the scarlet & more of the darker red

♂. 337. Mr. Hunter threw Tartar Emetic qts. iij into the Veins of
a Bitch, it soon vomited her, she became Convulsed & died, she
was astonishingly Cold during Vomiting & upon opening her immediately
after Death the heart & lungs were found remarkably Cold. –

66.
inclining to purple & sometimes to a blueish hue
333. The changes of colour (332) will arise.
a. – from Vessels which naturally contained only Lymph
or Serum, carrying red Blood.
b. from either containing more blood than circulated
through the parts in its natural state according to the Law of
the Animal Oeconemy, the the more a part has to do, the more
blood will be given to it, the colour is that of Arterial blood.
c. from New Vessels being formed in that partly
coagulable Lymph becoming organized. –
334. When inflammation attacks parts near the surface of the
body, heat of the parts will be considerably increased.
335. But the heat of the inflamed part will not be increased
above the standard heat of the Animal, though compared wth.
the heat of other parts of the surface it will be greatly increased.
336. An increase of heat in a part does not always arise from
an increase of its power of action, it may arise from increased
action though attended with weakness. –
337. Coldness in a part is however in general arising from weakness
& want of power of action; but a part may have its degree
of heat lessened by its sympathizing with the affections of other
parts as the stomach, changes in the Mind &ca. ♂.
338. The source of heat is probably in the Stomach from whence

♃. 338. The Stomach sympathizing with any part of the constitution
is the probable cause of Rigors, Rigors are not only produced by
constitutional affections but even by local ones as the Pricking of a
finger, also by affections of the mind as fear, horrid sights &ca. the
absorption of any Contagions or putrid matters into the System is
attended with Rigor, Rigors probably do the same thing in the Constitution
as Vomiting, rousing the constitution to greater action, the
heat of the Blood cannot be altered by the Sympathetic Fever, a
constitutional affection can only produce a change in it. –

67.
by means of circulation it may be conveyed to every part of the
Body. ♃.
339. Inflammation is commonly attended with a painful sensation
communicated from the affected part to the mind, in the
adhesive state it is rather of a dull heavy kind, when proceeding
to suppuration it becomes more acute, when suppuration has taken
place it abates, when Ulceration begins it again increases,
but during the latter state it rather gives the idea of soreness.
340. Every time the Arteries dilate there is an increase of pain hence
the sense of throbbing, the cause of the pain is the distension of Nervous
& sensitive parts.
341. The disposition of inflammation, will sometimes cease before
even adhesions are produced, [& This], after a part has begun to swell,
[this] is called resolution.
342. As the increase of pain was a proof of the progress of Inflammation,
so its diminution is to be attributed to the cessation of the
inflammatory state, when the uneasy state is removed, the disturbing
cause is taken away, & the parts return to their state &
ordinary functions.
343. The Constitution will not only be differently affected by the
different situations & functions of parts inflamed & greater or lesser
extent of the Inflammation, but it will also be differently affected
by the different stages of the inflammation present, thus the suppurative
inflammation will affect it much more than the adhesive
or Ulcerative by where action in general the constitution is but little

♄. 348. Thus if small pox matter is applied, if the constitution
has a peculiar susceptibility of a putrid disposition, the disease will
partake of the constitutional disposition, as in the confluent small
pox. So Venereal matter shall in one person produce a Chancre
surrounded with common inflammation, in a person of a different
constitution it will be accompanied with an Erysipelatous Inflammation
which may spread to a wide Extent.

68.
disturbed.
344. The vital parts subject to inflammation may be divided into
a....Those which readily take in Sympathy. &
b. – Those which do not.
Of the latter, the Lungs, of the former the Stomach are instances.
The Pulse will generally be harder though smaller under
the affection of the former than the latter. –
345. Whatever can obstruct the natural circulation through the
minute Vessels will produce inflammation its causes therefore
may be very different & various. ( ).
346. When a part perceives an alteration in its structure or a
change in or obstruction to its natural functions the Stimulus of imperfection
arises.
347. The stimulus of perfection exists in parts new dispositions
where consequent actions are either processes of restoration or destruction
according to the strength of the parts & their facility in the art
of healing. (252).
348. Irritation of whatever kind being applied may produce inflammation
peculiar to the constitution or condition of parts.
(311-314). ♄.
349. The disposition for restoration of parts injured is the most
simple, (165), that from necessity is more complicated, but the disposition
for disease is the most complicated of any.
350. The stimulus of imperfection may arise in parts from different

🜔. 352. To the first may be referred bruises, strains simple, fractures
&ca. To the second, Wounds of all kinds opening Externally.

69.
different causes, as obstruction to their natural actions, or from an alteration
in their structure by external violence, the latter becomes
chiefly the object of surgery though the former may also fall within
its province.
351. The effects of external Violence will be different according
as that violence is applied to sound parts, or to parts diseased.
352. Mechanical injuries on sound parts may be divided into
two heads
1st. Those which do not communicate externally
2d. Those which do. 🜔.
353. The first division may by circumstance be changed into the
second, & the second may be brought back to the first.
354. The effects of the first division on the constitution will be
different according to the state of the constitution & the nature
of the parts injured & the power of healing in a part is strong,
the part injured not vital, & the constitution not highly disposed
to Sympathy, no material change will take place in the constitution
& the process of restoration will go on with only local effects.
355. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the
parts injured, the kind of violence inflected, & the degree of that
violence.
356. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the

🜔^. 359. When wounds are inflicted it is evident from the Text
that when the first mode of union is to be effected the Surgeon
should bring the lips of it in close contact & retain the blood in the
Wound, then defend the part from the action of the Air, no foreign
matter should be introduced, hence the suture must in general be
objected to.
Union will not only take place between divided parts of the
same body but also between parts of different bodies still retaining
their living principle when brought in contact with each other
Thus Mr. Hunter introduced the testicle of a living cock into the Abdomen
of a Hen, the testicle became united to the liver of the
latter, & sometime after the Hen was killed, Mr. Hunter injected
the Testicle from the body of the Animal.
Again he fixed a Tooth recently extracted on the Comb of
a Cock & on injecting the Animal the Membrane lining the tooth
was also injected.
Upon this Mode of union depends the cure of the hare
Lip from this arises the unnatural cohesion of fingers one to the
other when the Cuticle has been destroyed by burns &ca. from this arises
the union of the Chin to the breast when ulceration has
proceeded &ca.

70.
parts injured, the kind of violence inflicted, & the degree of
that violence.
356. Its effects on the constitution will be determined by the same
laws as those regulating the effects of the first class.
357. When vascular parts violently separated from each other is
accomplished either by
a. The extravasated blood being the Bond of Union
b. The adhesive inflammation, or
c. Granulation.
359. It has been already observed that the blood is a living fluid,
when extravasated it does not immediately lose its living
principle. In  the separation of parts by violence when the
blood is Effused. the first mode of reunion is effected by the red.
particles & Serum being absorbed, & the coagulable Lymph being
left. the Lymph becomes vascular & nervous, & thus readily reunites
the sides of the Wound together, this process is accomplished
with more ease in the first class of injuries than in the second
because the blood by coming in contact with atmospheric Air
the sooner loses its living principle. &ca. 🜔^
360 – But a variety of circumstances may prevent this mode
of union taking place. The second process or that by adhesive inflammation
is next excited – Coagulable Lymph being still the
necessary medium of reunion is supplied from the Vessels of the side

♀ 362. Hence when a Cavity is exposed & the Wound does
not unite by the first or second mode of Union the whole
Cavity still will often escape running into the suppuratory
process, the contact of the Edges, or the part near the Edges
of the wounds with some of the containing parts setting bounds
to the process of the new action.
The parts taking on Sympathy may however produce
an exception to the rule in the Text.
♄. 363. This is illustrated by dissections of Women dying
with the puerperal fever when Inflammation had produced
adhesion between the Peritoneum & some of the contained Viscera,
while the suppuration had generally diffused itself over
the parts of the Abdominal Cavity.

71
of the wound by the first or adhesive inflammation arising,
this becomes organized & again fills up the breach.
361. But many circumstances impede this process also such
as the death of the solid parts receiving the injury, hence their
becoming foreign bodies, the too great violence of the inflammation
(360) producing suppuration; the interposition of foreign bodies &ca.
& here the process of restoration cannot be accomplished without the
third mode of union (348) Granulation.
362. When an internal Cavity is exposed the whole of the cavity
would run into Inflammation unless some part of its surface is
in contact with some other living part, that simple contact will
set Bounds to the spreading of the Inflammation. ♀.
363. The adhesive inflammation is sometimes imperfect not answering
to the final intentions, & this is when the violence giving
rise to it has excited too rapid an Action to admit of the adhesive
process taking its full effect, this however seems rather to belong
to the Erysiplatous Inflammation. ♄.
364. The Cure of Inflammation is by resolution ( ) but before
we attempt the Cure of Inflammation artificially, we must enquire
into the constitution of the patient, as whether he is disposed
to irritability or indolence, his former habit, temper of
mind &ca. & also the situation & other circumstances of the affected
part.
365. The time for attempting the cure of inflammation by

    
      
  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


72
resolution is before the suppurative process has taken place
366. We must consider whether the inflammation is of the true
healthy kind, or has the Erysipelatous disposition, or any other
specific disease mixed with it, We must also consider whether
there is an increase of life or only an increased disposition to
make use of Life; a distinction very necessary to observe.
367. We have noticed (332) that a change of Colour in parts is
produced by inflammation, when inflammation is seated in
parts near the Skin & its action is violent, vesications will arise
the Cuticle being seperated from the Cutis, this arises from the action
producing death of the connecting Medium between the Cuticle
& the Cutis.
368. The Coagulable Lymph (319) fulfills not only the intentions
(290-359-360) but also when the third mode of Union, or as it takes
place becomes the basics of the future Granulations.
369. In the Cure if the Inflammation is of the true healthy kind
we have only to remove whatever cause keeps it up.
370. An increased disposition to make use of life (366) or too
great violence of circulation is to be lessened by weakening with
evacuations & the exciting of nausea, & by soothing or Anodyne remedies.
371. When there is both an increase of Life & powers & an increase
of action weakening the System becomes necessary.
372. The System is weakened by bleeding, if only increased action

🜺 373. Topical Bleedings however [considerable] desirable cannot
always be had recourse to, for instance in increased action of
the Vessels of any of the internal Organs.

73
action is present without increased powers bleeding is only to be had
recourse to from particular indications: Vizt.
a. When it is desired to lessen the present Action in order
to give the disposition time to wear itself out without destroying parts
by its violent action.
b. When the parts affected is a Vital one.
c. When it is near a vital part.
373.. Unless the powers of action are great or the exigency of present
circulations requires that blood should be drawn from
the System. Topical blood letting is to be preferred & that from
or as near to the inflamed part as possible. 🜺.
374. Topical bleeding should be particularly insisted on when
there is a disposition in the habit to form but little blood, & when the
part inflamed is distant from the source of Circulation.
375. When the action only & not the powers are increased it is to
be desired that the constitution should perceive the loss of blood as
little as possible. Topical bleeding give less Alarm to the constitution
than bleeding from the System.
376. In our choice of bleeding we are in a great measure to be regulated
by the Pulse, but as the pulse is differently affected by the inflammation
of different parts we cannot be absolutely determined for or
against bleeding by any one general state of the pulse, for the most
part however, it is to be considered a quick & hard pulse generally
indicates bleeding.
377. An other general indication of Blood letting is the state of the

♃. 381. In weakened habits a single stool frequently produces fainting
may it has even caused an Abolition of the powers of Life.

74.
Blood but this can be only an after proof.
378. If state of the Blood is [only] Sizy & the Coagulum flat & its
texture loose bleeding is contraindicated, or at least to be sparingly
employed.
379. Another general indication of bleeding, is Urine high in Colour
& small in quantity.
380. A comprehensive view of all the Symptoms of health & weakness,
present violence of action, the nature & situation of the parts
affected, can only enable us to decide on the rectitude of using or omitting
bleeding. –
381. Purging weakens universally, it is to be had recourse to
with the same Caution as bleeding & in irritable habits still greater
caution is necessary. ♃
382. Sudorific may be proper when the Constitution Sympathizes
much, because they do not so much diminish strength.
383. Nauseating medicines lessen universally the powers of Life.
Vomiting ones rouse the spirits & powers; for Vomiting seems an
action intended to relieve weakness. (338 note).
384. Soothing remedies. Opium is the principle. Opium will only
lessen actions not alter them, as the disease sometimes consists almost
entirely in increased irritability by lessening the latter it may
diminish the disease.
385. We also endeavour to promote the intention (370) by topical applications;
of these preparations of Lead appear to lessen the power
as well as lessen the action, they are not therefore universally to be

389. Upon this principle we use blister plasters to remove deep
seated pains, upon the same we apply sinapisms to the feet when
the Brain is affected. Vomits when the Testicle is inflamed.

75.
had recourse to (366).
386. Cold powerfully weakens action, from its use therefore great
effects may be expected, the degree & length of applications of Cold
is however to be considered (262). –
387. The effects of topical remedies will be either.
a. Immediate
b. by Repulsion
c. by Revulsion & derivation.
d. by Sympathy.
388. The first order (a) seems to require no Explanation, applications
acting by repulsion only produce their effect upon a part when
the Inflammation has arisen from a parts taking on the disease of the
Constitution, & the disease from a Constitutional has become a local one,
as Gout.
389. Revulsion & derivation are not well defined the distinction between
them is perhaps Ideal, by them we must understand a cessation
of action in one part produced by an increase of Action in another
part this does not depend upon the humours but upon a change in
the place of action, or irritation.
390. Repulsion is the cure of the part, be the consequences of the Cure
what they may.
391. Sympathy. the cure of a part by local Sympathy is when the
same effects arise in the part diseased from an application used to
some other part as if the application was made to the diseased part

☿ 391. Hence it is that Mercurial Ointment applied to the Skin Covering
a Node, will cause the node to disappear in the same manner
as though the Mercury had been applied to the Node itself without
the medium of the Integuments.
🜔vmss 392. Vomits curing inflammation of the Testicle after sedatives
&ca. had been used in Vain, Caustic behind the Ears curing
Ophthalmia which had resisted all applications to the Eyes, elucidate
the truth of the Text.
The Cure of the tooth ach by burning the Ear is to be referred
either to derivation or Sympathy.
Derivation seems to be the reverse of Sympathy We cannot
however always distinguish one effect from the other. The cure
shall often be effected by Sympathy, thus blistering one part will
remove pain existing in another part tho’ the action excited by the
Blister may be of a different kind.
☍ 398. Among the causes of this effect are wounds not uniting by
either of the two first modes of union & the 3d. or Granulation becoming
necessary for their cure, violence having produced the death of parts to
the removal of which suppuration becomes necessary. Violence having
Exposed internal surfaces.

76.
itself. ☿.
392. A cure of local inflammation by derivation or Sympathy
will often take place when sedative applications have proved ineffectual.
🜔vmss.
393. Topical applications may be divided into.
a. Fomentations.
b. Steams.
c. Lotions.
d. Poultices.
394. The order a. & b. are of shorter duration in their actions,
but may afford relief during the application, the order c. are
more lasting in their actions & are only substitutes for the order
d. which of all application produce the most permanent action
395. Poultices will be either.
a. Simply warm & Moist, or
b. Medicated.
396. The effects of a Poultice will be immediate on the parts
to which it is applied, but by sympathy they will be extended
further.
397. Medicated Poultices will be formed according to circumstances;
[of] with Lead, Opium, Mercury &ca.
398. When Inflammation however excited exceeds the adhesive
state, & gets beyond the point of resolution, Suppuration is produced ☍
399. The cause of a parts running into Suppuration is, its

🜍 400. The application of Air to internal surfaces as the Cavities
of the Thorax, Abdomen & Joints, has been considered as the cause of
suppuration but this is evidently not the case, suppuration would
take place even in vacuo. In Emphysema where Air is diffused all
over the body we have no such effect until an Opening is made, but
in case of suppuration from an Opening the stimulus of imperfection
takes place the Cavity being an improper one to prevent this
imperfection as much as possible we observe in a Wound of the Abdomen
of a fowl that adhesion takes place between some of the Intestines
& the edges of the Wound, if this does not happen general
suppuration succeeds, another proof that Air in internal Cavities
is not the Cause of suppuration is that in some Animals the Air
has a free communication from their Lungs into the cells of their
bones & into the Abdominal Cavity without producing suppuration
as in the Case of many Birds.
🜖 404. This we readily account for, knowing that suppuration
is the first ordinary process in inflamed Canals, whereas adhesive
Inflammation is the prior action in the Cavities.

77
perceiving the stimulus of imperfection, & being thence necessitated
to begin a new & unusual process.
400. Communication with the atmospheric Air is not necessary
to suppuration. 🜍.
401. Great violence of action is not necessary to suppuration
it is rather productive of gangrene, suppuration is sometimes
produced in a part without any visible violence of action in the
part which takes it on.
402. Although it sometimes arises without any visible violence of
action in a part, yet in healthy constitutions it is generally found
that the inflammation is considerable.
403. The action producing it is most violent when it arises
spontaneously. –
404. Suppuration takes place more readily in internal Canals
than in internal Cavities. 🜖.
405. It is not necessary to forward Suppuration even in Inflammations
arising from the constitution, the constitutional disposition
seeming to have produced its full action in the Inflammation
or inflammation is to be considered as the disease taken on by the
part from the constitution, & so curing the latter & suppuration is
only the sequel of the disease. –
406. The adhesive inflammation going on to the suppurative,
in the latter stage, the general symptoms increase, the pain becomes
more acute, the sensation arising from it is as much as possible


 
 
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


78
that of simple pain, the redness is more intense, new Vessels being
formed & old ones more dilated, hence a more violent throbbing
from an increased dilatation of the Arteries the swelling of the
parts increases from a still greater effusion of coagulable Lymph
& Serum, the surrounding parts become Oedematous.
407. One, two, or more parts lose the power of resolution & take
on a similar state to Cavities exposed ( ) a Cavity is formed in wch.
pus is secreted, at first mixed with coagulable Lymph.
408. A return of the adhesive inflammation checks the progress
of suppuration.
409. When the progress of suppuration is not stopped, the matter
will be carried onwards to the Skin, the parts between the
cavity & the surface of the body are gradually absorbed the Cavity
becomes daily enlarged, the Skin becomes thinner & thinner, at
length Ulceration from pressure takes place & the abscess bursting
a natural Exit is given to the contained matter.
410. When the suppurative inflammation is going on Rigors
frequently Occur, a common attendant on new actions of the constitution.
411. When suppuration cannot be stopped the progress of the
matter is to be carried as towards the skin, hence the utility of
stimulating plasters &ca. Poultices can do little until the Inflammation
has invaded the Skin, they then keep the surface moist
& soft. –

☍ 415. to 423. Observations on Pus.
Pus cannot be formed from the melting down or waste of
the Solids, otherwise how could the human penis in the virulent
Gonorrhea furnish pus many times exceeding in quantity
the substance of that Organ, some have denied the discharge
from the Urethra & certain other canals to be purulent & affirmed
that it was only Mucus, but it has every characteristic
of Pus, no injury arises from the absorption of pus into the Circulation
otherwise how may those fare who have large sores, as patients
undergoing Amputation whose health is often disturbed
through the whole of their cure, Pus may become offensive by
being mixed with other fluids as putrified Blood & hence its factor
when its discharge attends a diseased Bone. Pus is a bland
unirritating fluid we see it makes its way in psoas & Hip Cases
from the Loins & Hip low down into the thigh without producing
the least sense of pain unless merely from its weight & distention
of the parts amongst which it is seated. Pus cannot
change Animal [matter] Solids into own nature by any fermenting
process. Chemistry cannot irritate the process of nature in
forming pus in the Animal body any more than any of

79.
412. Suppuration sometimes goes on without previous inflammation.
here parts suddenly fall into it without allowing the previous
action of the adhesive inflammation as in the Erysipelatous
suppuration, or it goes on slowly without pain as in some
scrophulous Cases.
413. When an healthy Abscess is opened, [& its cavity become exposed]
the parts readily take on a disposition to heal, but in the
collection of matter (412) when the abscess is opened & its cavity becomes
exposed a general inflammation takes place & a perfect suppuration
is formed; but the constitution is generally much affected by
this process, for here the Inflammation is to arise in a part already
in the habit of disease.
414. The matter contained in the Abscess formed without inflammation
will be different from that in the common Inflammatory
Abscess, in the former it will be a curd like substance mixed
with a thin purulent fluid..
415. The fluid produced by the healthy suppuration is Called
pus, which is quickly & readily formed on the surface of Canals ☍
416. To the formation of pus a particular organization of
parts seems necessary though we do not exactly know in
what the nature of that organization consists, any more
than we do that which is necessary for the different secretions.

the other secretions, nor can Chemistry decide on the nature of
Pus the conclusion drawn from the precipitations of it from
Vitriolic Acid &ca. are irrational & unsatisfactory; the precipitate
from any other Animal Substance so dissolved will give equally
the same appearances.

80.
417. Pus is to be considered as a secretion & the parts secreting it
to be glandular, it does not arise from a destruction or dissolution
of the Solids by fermentation &ca. the solid parts may die, slough
& be found in it, nor is it a mere straining of a matter from the
Blood.
418. Pus is a fluid which in its perfect state has certain peculiar
qualities as Colour & consistence, it is somewhat sweet and
mawkish to the taste. it consists of a number of large whitish
Globules swimming in a fluid resembling serum, of which Globules
it will have a greater or lesser proportion according to the
health of the body that produced it, like serum the fluid is Coagulable
by heat.
419. It is perfectly mild & inoffensive in its natural state incapable
of irritating the most sensible sore.
420. Pus when absorbed into the habit & mixed with the blood is
productive of no ill effects unless it is the vehicle of specific Poison
421. Pus is less disposed to Putrefy than other Animal fluid wn.
in certain situations & in contact with Air, it readily takes on
putrefaction & becomes offensive, but this is probably from other
substances as blood &ca. being mixed with it.
422. When an Abscess is first opened portions of Coagulable Lymph
mixed with pus are commonly found. These are parts of that Lymph
which had been employed in making the Cyst to contain the matter.
becoming loosened from the internal surface of the Abscess & being

🜔vuss. 🜖. 426 Pus may be of use to Sores to keep them Moist &ca.
but this does not explain why it is formed in natural Cavities it
may also be useful as a vehicle in the removal of extraneous substances,
this however can be only a secondary intention with its
final use we are still unacquainted.

81.
blended with Pus. –
423. Chemical experiments cannot explain the nature or manner
of the formation of Pus. (see last note).
424. The formation of Pus is to be considered though a New, yet as
a Process of Health, parts taking on a diseased action, the secretion
of Pus is interrupted, & it is no longer generated pure & possessed of
its peculiar properties.
425. Pus like all other fluids thrown off from Solid Parts will
always partake of the nature & properties of the parts from which
it is secreted & according will have occasionally the specific properties
of the Lues, the Cancer, the Small Pox &ca. –
426. The final use of Pus, or intention of nature in producing it
is not known. 🜔vuss 🜖.
427. Ulcerative Inflammation is that action into which a part
falls from a disposition to absorb itself Even to the solution of continuity.
428. The cause of this Ulcerative absorption will be an inability of
parts to support themselves under present circumstances, these
circumstances will be
a. Irritation.
b. Weakness.
429. These Circumstances give rise to
1st. a consciousness in the parts of the necessity to be
absorbed. 2d. a consciousness in the Absorbents of the necessity of
commencing the absorbing process.

🜔vuss. Φ. 436. When a collection of pus makes its way to the Skin
we find the cellular substance adipose membrane & even Muscles to
a considerable extent ulcerated while the Skin ulcerates only so as to
form a hole for the exit of the matter.

82.
430. Irritation will be given by
a. Pressure (246)
b. Contact with dead or foreign matter.
431. Weakness or a want of power in parts to carry on their natural
functions may be a cause of the ulcerative Absorption.
432. pressure considered as irritating is of two kinds.
a. pressure from the surface inwards.
b. pressure from within outwards.
433. parts strongly resist the action of the pressure (a) but readily
yield to the action of the pressure (b. 432).
434. From the above then we may infer that when the irritation
of the pressure, (a. 432) is applied to produce ulcerative Absorption it
must be very violent in proportion to the strength of the parts, for it
is not sufficient to destroy the power of resistence in the parts pressed
it only produces a thickening of them.
435. Nature resisting the entrance of foreign matters into the
body thickens & thus as it were strengthens the parts to give them
a greater power of resisting the admission of what would prove
injurious to them.
436. In pressure from within outwards (b. 433) the internal parts
as cellular Membrane &ca. fall more readily into the ulcerative absorption
from the Skin. – in irritation from external pressure & from
contact with foreign matter the Skin falls more freely into it than the
other substances. 🜔vuss. Φ

🜔vmss. 🜔. 437. [(When a collection of pus makes its way to the 
Skin we find the cellular substance adipose membrane & even
Muscles to a considerable extent ulcerated while the Skin ulcerates
only so)] If Inflammation attacks the external coat of an intestine
adhesions are produced between it & the peritoneum, & if the
inflammatory action goes on an abscess is formed in the middle of
the adhesion after which the matter contained acts as an Extraneous
body; Ulceration takes place only in the side next the Skin, between
which & the matter (even in the most corpulent person) the
Muscles, fatty Membrane & Cellular substance will be dissected by
the Pressure of the Matter & that fluid eliminated before by so thin an
interior substance as the Intestine will fall into Ulceration (Sidran
gives several cases of this kind but does not explain them).
🜔vuss. 🜖. 439. When living tumors are brought to the Skin, in their
progress the intersticial absorption only goes on until there arises a
necessity for the ulceration in the Skin, many other substances also
are brought to the skin without producing the ulcerative Absorption.
440. Suppuration very commonly & in some parts always attends
on the Ulcerative absorption, of this we have abundant instances
in the Muscles, Cellular substance & skin, we have also instances
of its proceeding without producing pus, in bones when sustaining the
pressure of aneurisms &ca. in the absorption of the alveolar processes after
removing a Tooth & in the removal of Callus after fractures. In Jordansons
Voyage we find that several of his Crew who had been severely

83
437. When the pressure is from within outwards, tho’ all sides are
Equally in contact with & compressed by the body making the
pressure yet that side only will accept of ulceration which is the
nearest to the Surface of the Body. 🜔vmss. 🜔..
438. When bodies making pressure from within outwards are
to be carried to the surface in the natural process the adhesive inflammation
of the neighbouring parts precedes the ulceration of the
Skin, for nature finding exposure must take place by the former
process provides against that inconvenience & renders its extent as
small as possible. (439 🜔vuss. 🜖.
439. When absorption is to take place of the parts between a surface
lodged within & the surface, in order to the removal of that substance
there is always a mixture of the ulcerative & intersticial Absorption.
440. Ulcerative Absorption goes on either with or without Suppuration.
441. Bones as well as soft parts become open to the Ulcerative
Absorption from pressure & irritation but the cuticle is incapable
of irritation & of the ulcerative Absorption.
442. An exception to (437) will arise, when the irritation from
the pressure is violent, & the adhesive inflammation has not duly
taken place in the parts behind, within or on one side of the irritating
substance. 🜔^
443 The difficulty with which the Cuticle (441) is removed for

affected with the Scurvy which occasioned the spontaneous dissolution
of old Cicatrices & even of the Callus formed after Fractures.
442. Hence it is that matter sometimes bursts into the Air
cells of the Lungs when a suppuratory inflammation of the Pleura
& Lungs had happened instead of making its way thro’ the intercostals
Muscles to the Skin; for the same reason pus sometimes in
Abscesses of the Liver makes its way internally, bursting into the
Intestinal Tube or the Abdominal Cavity.
444. A change in the constitution will often occasion a sore
to spread more in one nights time than we can procure in a fortnight.

.84
the expulsion of matter is the cause of the pain in suppurations
where the cuticle is very thick, as in the whitloe, abscess in the sole
of the Foot &ca..
444. The Ulcerative Absorption but little affects the constitution
although the constitution has powerful effects on the ulcerative absorption.
445
As ulceration consists in the division of parts naturally united,
or in a particular made of solution of continuity, so its cure is effected
by a reunion of them either by adhesion (358) or by Granulation,
the third mode of union (358) when the first & second modes of
Union will not take place in parts violently separated the third mode
is preferred or pursued in the process of restoration, this is by means
of Granulation.
446. Granulations are formed by coagulable Lymph, effused from
the surface of the Ulcer becoming vascular, Vessels from the original
parts pass to the basis, & also to the surface of the granulations
& would almost seem to terminate there.
447. Granulations are always of the same nature as the Parts
they arise from.
448. Granulations will be healthy or unhealthy, the more Convex
they are seen, & the smaller their points, & the more florid red
colour they are of the more healthy. The flatter their surface, the
paler or the more they approach to a livid hue the less will they be
found healthy, & the more slowly will they admit of the parts

🜔🜹. 448. By attending to the appearance of a sore, we may judge
whether it is healing or disposed to ulcerate farther, if the latter the
edge will be irregular, inverted, or hanging over the ulcerated surface,
the discharge is in general thin, the surface in the whole or in many
parts concave whereas, when there is a disposition to healing they are
convex, the margin purple covered with a whitish semitransparent
membrane.
☉. 449. In the irritable constitution mostly, the Granulations will
be large & flabby.
☽︎. 450. Mr. Hunter saw two granulations one from the scalp, the
other from the Dura mater arising after trepanning united so firmly
together that they could not be seperated without an hemorrhage.
♂. 451. A Man aged 50, broke his Thigh bone & the attempt of
a reunion both by the first & second intention failed; for the fracture
(which was simple) did not unite after being bound up for a considerable
time, at length the Man died, Upon examination it was
found that Granulation between the ends of the fractured bones though
without suppuration had taken place. Scratches & slight wounds in
the Skin though they unite by the first intention do not always require
suppuration, they heal frequently under a scab.
☿ 456. The contraction of granulations perhaps goes on in some
degree until the cure is compleated, but after a certain time they
contract not sufficiently to oblige the Skin to stretch itself & hence there
must be a necessity for the formation of New Teguments. +

85.
being healed. 🜔🜹.
449. By the appearances of Granulation we may judge in some
measure of the state of the constitution. ☉.
450. When Granulations are healthy they have a strong disposition
to unite one with another. ☽︎.
451. Granulations are in general the consequence of suppuration,
but granulation may sometimes take place without suppuration preceding.
♂.
452. To perfect the Cure of an Ulcer it is necessary that the Granulations
receive a covering, or that the process of Cicatrization takes
place.
453. Cicatrization is performed partly by the elongation of the original
Skin, & partly by the formation of a new Skin.
454. The Original Skin is necessitated to Elongate or stretch itself
by the contraction of the Granulations.
455. Cicatrization is always in view when granulations are formed,
when the Granulations have been carried to a sufficient degree, the
Contraction of the Granulation begins at every point as the contracting
process goes on the Skin on all sides is drawn nearer to the center of
the Sore.
456. When the contraction of the Granulations has been carried
so far as circumstances will admit of; & the consequent elongation
of the Skin has been carried to its greatest point, from the
Margin of the original Skin, the new skin shoots. ☿.
457. The contractions of the granulations or their effect in + elongating

+ When the original is unfit or cannot give the disposition for the
new one to form then there is sometimes a disposition in the Centre
of the Sore to produce it hence it is why we sometimes see sores
begin to cicatrize in the middle.
♃ 457. We see that if the Wound or Ulcer takes place on soft parts
as the Buttocks &ca. & when the Skin is loose, the quantity of new
Skin formed in the healing is very little, but in ulcer in had parts
as on the head; the skin is enabled to stretch but little hence in
Wounds of the scalp, the new formed Skin is nearly of equal extent
to that of the lost Substance.
♀. 458. Hence it is evident that Surgeons cannot be too cautious
in saving Skin, when it becomes necessary for them to remove parts
as in amputation of the Leg &ca. & especially where the wound is to
be inflicted on bone, the natural covering of which is little binds
the Skin, as in the Tibia &ca.
♄. 459. From part of this aphorism it must be evident of how
much utility motion & friction must be to a part stiffened from
having undergone granulation & cicatrization, Mercurial Unction
& Electricity both conduce to this End & seem very properly indicated.
🜍. 461. As in the Negroes who when they are burned or blistered the
Cicatrix formed after healing wants the black tint.
“But even in Negroes the Rete Mucosum is formed as I have
found on examining the Cicatrix of a Negroe adult from which by maceration
I turned off the Cuticle & found the Rete Mucosum perfect”.

86.
elongating the original Skin is impeded by being seated on hard
parts as bone, & where the Sore is circular instead of having considerable
length in proportion to its breadth. ♃.
458. The formation of new Skin is a process nature forms with
difficulty & with more difficulty in the lower Extremities than in the
other parts of the body. ♀.
459. The new skin is a very different substance from the old,
whether it consists of the granulation altered in their structure
or is a new and distinct substance from them is not to be ascertained.
It is less moveable than the original Skin, appears to be
on the stretch, as if a small piece of Skin was stretched & sewed
into a larger hole, so that the sides of the old Skin seem puckered
it gradually however is subjected to Mechanical motion & becomes
[less] more lose & flexible. The young Cutis when first formed is
very full of Vessels, but these are either afterwards taken away
or changed into absorbents until at length the part becomes
quite white. ♄.
460. Whenever a New Cutis is formed a cuticle is found also
the Cutis forming it, more readily than the granulations forms
Cutis, every point of Cutis is forming Cuticle.
461. The Rete Mucosum is always late in forming Cicatrices
between the Cuticle & Cutis, sometimes it is never formed at all. 🜍.
462. The Cicatrization is sometimes materially affected during
the giving on of the processes of restoration above described by certain

🜁. 467 & 468. Thus we see affections of the ligamentous parts
more readily bring on hectic than those of the muscular parts.
Disease of the joints very frequently produces this constitutional
Sympathy, & the larger the joint the Earlier this effect will
take place, An affection of the Knee or Elbow brings on Hectic
speedier than a disease of the Wrist or Ancle, again backwardness
of parts to heal depends much on their situation in the
body (277). In the lower extremities the power of healing
will be less than in the upper, & we see a disease in the Knee or
Hip produce hectic sooner than a disease of the Elbow or Shoulder.
Hectic will arise from Affections of parts whose natural  
powers of healing are not weak, as in large abscess in the
Muscular parts, but it still depends upon the same principle,
a Disease which the Constitution can neither conquer nor get rid
of. (464).
∇. 469. It will arise in affections of the Vital Parts & Joints
even before suppuration has taken place. Did it arise from the
absorption of Pus it should take place in one large Ulcer as well
as another, for it does not appear that there is a greater disposition
for absorption in one ulcerated surface than in another it
should arise from Venereal buboes where the matter is often even
poisonous.
In large Abscesses the Hectic disposition comes on after

87.
Actions.
463. The most ordinary actions are.
a. Hectic
b. The action of dissolution.
c. Spasms.
464. Hectic is a remote constitutional sympathetic affection
taking place in a constitution weakened by a long continued local
disease, which it can neither get rid of nor cure.
465. It will be caused either by an affection of a vital or a
non vital part.
466. It is produced earlier by the affections of a vital than of
a non vital part.
467. In the Non Vital it most frequently arises from affections
of those parts which have a backwardness to, & small powers of
healing. (275-276-277).
468. The more extensive the seat of the diseased Action in
parts of equal powers of healing, the earlier will the Hectic be induced
in the constitution. 🜁.
469. Hectic does not arise from the absorption of Purulent
matter into the System. ∇.
470. Hectic then depends on a part being irritated beyond
its powers of acting for restoration & beyond the power of the Constitution
to overcome the Disease: 🜺.

opening & when the Matter has been discharged.
If the Constitution can heal up these Abscesses, no hectic
arises large suppurations have taken place & the matter been
absorbed again without opening yet without the rise of hectic.
We readily conceive why it should take place sooner in vital
than in non Vital parts because the former gives the alarm
sooner to the constitution (22. Note) Hectic commonly arises from
Lumbar or Psoas abscesses, Scrophulous Joints, white swellings
&ca.
🜺 470. Whatever then will long & Obstinately teize the Constitution
may become the cause of Hectic.
🜔🜹 476. The action of dissolution seems different from Hectic,
it is infinitely more rapid in its progress it is incidental
to opposite Constitutions it is uncurable by the removal of any
part, & therefore seems to be an act of the constitution.

88.
471. It is however sometimes doubtful whether the hectic is
not an original disease of the constitution, we see that it arises
when there is a sore in a part which has no impediment to
healing, & here the Hectic must in general be cured before the
sore will heal.
472. Hectic is a kind of slow diminution of Animal Life, even
to gradual dissolution, its Symptoms are in general slow fever
with great debility, & languor, want of appetite, paleness of the
Skin. Sweats easily provoked, & indeed arising spontaneously
frequent sickness & vomitings, in habitual purging, clear Urine.
473. The administration of internal Medicines can only be useful
in order to the cure of hectic by somewhat strengthening
the constitution & enabling it to support its struggle longer than
it could do unaided.
474. Its cure can only be affected by the removal of the local
Disease either by taking away the part or by inducing in it
a disposition to heal.
475. The constitutions most disposed to Hectic are the weak
& irritable.
476. The action of Dissolution is different from Hectic when the
constitution seems to have every thing in its power having gone
through & supported the processes of inflammation & suppuration
its powers will suddenly sink & the destruction of Animal Life
be readily accomplished. 🜔🜹.

🜖. 481. If a limb has its bone or bones fractured the Muscles
will no longer act in obedience to the Will, the same in the Case
when a joint is rendered useless, if the patella is fractured the
patient cannot voluntary act with the Rectus Muscle.
It is extremly curious to observe that voluntary Muscles,
when the final use of their being no longer exists, become
no longer the Instruments of the will, & they then waste in
bulk, strength & firmness & become soft flabby. -

89.
477. The Symptoms are an universal affection of the Stomach
shivering, Nausea, & frequent vomiting, small quick pulse
Hemorrhage from the surface of the Ulcer, excessive spontaneous
sweatings soon succeeded by Death.
478. The Habits most disposed to it are the Robust & full.
479. For its Cure nothing seems to be effectual.
480. Muscles lose their power of action not only when the
Nerves leading to them or which are their immediate Instruments
of motion, are compressed or destroyed, but also, when
there is no longer a necessity for their propriety in their acting
(53) & here they become though naturally voluntary inobedient
to the Will.
481. They also become open to Intersticial Absorption & waste
in size & firmness. 🜖.
End of the first Part. –






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


90.
Illustration of the Doctrines contained in
Part the First. –
482. In the circumscribed Cavities when taking on inflammation,
the adhesive it is observed ( ) is first to take place
if the progress of the complaint is not checked, or put a stop
to by the adhesion, the suppurative or the ulcerative stages
are the necessary sequels. ( ).
483. In cavities containing Vital parts, the Ulcerative stage
is seldom produced for before the complaint proceeds thus far
it generally kills, to produce adhesions between contained & containing
parts it is not necessary that the surfaces of both
should be inflamed.
484. According to the degree or extent of the adhesions the suppuration
in a circumscribed Cavity will be greater or less, if suppuration
comes on in a Cavity where no adhesions have previously
taken place the whole surface of the Cavity will become the






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


91.
seat of the suppuration.
485. The contents of an inflamed Cavity will not always partake
of the Inflammation of the containing parts, for the
Lungs, or the Intestines may remain uninflamed, though a
Pleuritis or Peritonitis may be present.
486. The preceding doctrines will be illustrated by observations
on the inflammation of the following Cavities.
1st. The Thoracic Cavity or Inflammation of the Pleura.
2d. Inflammation of the Pericardium.
3 --- of the Peritoneum, as contain of the Abdominal
Viscera. 4 --- of the Bladder
5 --- of the Joints & Sacculi Mucosi.
6 --- of the Eye.
7 --- of the Veins.
8 --- of the Encephalon.
9 --- of the Tunica Vaginalis.
also by injuries & diseases of bones, by Wounds in soft parts
& lastly by common & specific diseases of the constitution and
parts.
487. The pleura is more subject to Inflammation than any
other membrane lining [the] a cavity in the body not far from
its particular nature, but from its particular circumstances,
as being much exposed to the action of Cold &ca.
488. The pleura becoming inflamed adhesions are formed,








    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


92
between that Membrane & the Lungs sometimes with but
little pain if any. Sometimes the adhesion is throughout the
whole of their surfaces, sometimes in parts only, these adhesions
frequently terminate the Complaint.
489. But it frequently happens that the Inflammatory Action
goes on to suppuration if the whole Cavity becomes the seat of it
then the true Empyema takes place, if the suppuration is by
means of the adhesions confined to certain parts, then the spurious Empyema
or collection of matter not communicating with the
general Cavity of the Thorax is produced.
490. The Empyema will be preceded by violent pains in the
Thorax, difficult respiration, quick pulse, rigors, &ca. –
491. The Empyema when present will have symptoms peculiar
to itself together with the common Symptoms, & Symptoms from
Sympathy of a Fluid contained in the cavity of the Thorax.
492. The common Symptoms of a Fluid Extravasated in the
chest are difficulty & frequency of Respiration.
Breathing easiest in some particular situations. If the
fluid be in one lateral Cavity only, the Patient lies chiefly & most
easily on the affected side, if in both cavities, then he will only
lie on his back & that not horizontally, the head & chest will be elevated,
otherwise he feels a sense of impending suffocation, there
is a sense of weight in the Diaphragm, there are patients who
perceive the fluctuation within them; frequently Anasarca, & 

🜋 496. Emphysema will often remain a considerable time,
Interior parts do not fall so readily into the adhesive Inflammation
as the more external parts, hence the wound continues
open so long & admits of the egress of ye Air.
I believe the presence of pus, or water extravasated in
the Thoracic Cavity will be alone accompanied with the anasarcous
Symptoms, blood or Air, not producing there appearances.

93.
sometimes Ascites is present.
493. The peculiar Symptoms of the true Empyema are a
great difficulty & uneasiness in expanding the Chest, great
lowness & depression of Spirits, frequent sense of seemingly impending
dissolution, the fluid accumulating Gradually.
494. The Sympathetic Symptoms are great irregularity of the
Pulse, palpitation of the heart &ca..
495. Water may be Extravasated in the Cavity of the Thorax
& the Disease then becomes Dropsy of the Chest, to the common
Symptoms (492) & the Sympathetic (494) may be added the circumstance,
that the fluid is so suddenly collected.
496. Air may be extravasated in the Cavity of the Thorax by
a wound in the Lungs from the end of a fractured Rib, here the
Pleura being also wounded the Air will escape into the Cellular Membrane
& produce a partial or general Emphysema.
497. Blood may be extravasated in the Cavity of the Thorax [by a]
[wound in the Lungs] & will occasion the common & probably several
of the other Symptoms.
498. For the discharge of Extravasated Fluid from the Thoracic
Cavities, the operation for the Empyema or the Paracentesis of the
Chest becomes requisite.
499. This should be performed as rarely as possible because its sequel
(as being an Exposure of & rendering the Thoracic Cavity

🜔. 499. [Emphysema will often remains] When Pus is present
in the Cavity of the Thorax, no objection to the operation
can arise for the part is already in a state of suppuration.
☿. 502. If you make the incision upon or near to the fractured
Rib, with respect to the bone you place it in the state of a compound
fracture & may induce all its consequences, besides rendering
the Chest an Exposed Cavity, the sequels of a compound
fracture will be hereafter shewn.
♁. 503. This must be obvious from considering the text (502) the
scarification need not be more than half an inch long (501) but sufficiently
deep to make exposure of the cavities of the cellular substance,
when much blood is extravasated (497) the Paracentesis of
the Thorax must be generally necessary, from the great danger of
suffocation that must attend its continuance in the Cavity.
Mr. Hunter has sometimes seen patients recover from injuries     
of the thorax, even when suppuration has taken place (as
after Gunshot of Wounds) he finds it difficult to Account for the means
of the Recovery, but thinks it must be by a kind of Resolution for
the Lungs in exposure of the chest are generally collapsed, so that
adhesions between this membrane & the Lungs in those cases cannot
be effected. –
Φ. 506. To such symptoms [for] the name of Angina Pectoris
has been given. –

94
imperfect) is an universal suppuration generally ending in
death. 🜔.
500. When Emphysema (496) in consequence of a wounded
lung arises & extends to a considerable degree the cellular membrane
may be scarified to discharge the offending Air.
501. The scarification should be made at some distance from
the seat of the fracture of the Rib.
502. The Lung on the Opposite side (if only one is wounded) should
not have its action confined nor should the escape of the Air from
the Cavity of the Thorax into the cellular substance be impeded. ☿.
503. In the case before as tight bandage applied on the Thorax
& compressing the parts which received the injury is improper.
♁.
504. It will be difficult to distinguish the Inflammation &
Suppuration of the Pericardium, from that of the Pleura, or Thoracic
lateral cavities, the heart sympathizing with affections
of the latter & the latter with those of the Pericardium.
505 If adhesion takes place between the heart & pericardium,
the Patient generally recovers, if the Inflammation goes on to
suppuration, the patient always is destroyed.
506. The adhesion of the Pericardium to the heart is attended
with palpitations of the heart, irregularity of the Pulse, frequent
& difficult & oppressive breathing, pain in the Sternum, frequent
syncope, debility &ca. Φ.

🜔v 507. By spontaneous inflammation is signified an Inflammation
arising without any visible cause.

95
507. The Peritoneum is the largest inverting membrane in
the body, it is subject both to Spontaneous inflammation & to
inflammation from external injuries. 🜔v
508. The Peritoneum taking on inflammation Runs through
its actions sooner than any membrane or Cavity in the body.
509. The Inflammation may be either Common or Erysipelatous
(303) at the onset it is difficult to determine its nature.
510. Whether it is of the common or erysipelatous kind it will
at first be accompanied with a violence of action of the constitution,
which is powerfully roused, but if of the Erysipelatous kind
the strength of the patient will soon sink.
511. The peculiar symptoms will be a pain in the abdomen not
of the cholicy or spasmodic kind with a sense of soreness of the
abdominal Region, greatly increased by pressure or by stretching
the peritoneum.
512. The Intestines will also from Sympathy take on an unnatural
action, Costiveness in some cases, in others a Diarrhea
will be induced.
513. The inflammation of it does not go off by resolution, or
unless adhesions taking place prove its cure will produce suppuration.
514. The suppuration will be
A. partial of adhesions taking place, limit the extent of it
B. universal if the adhesive inflammation is insufficient 

♂. 520. The Uterus on dissection is generally found sound
& free from inflammation, the disease does not arise then from
an inflammation of the Uterus. But the Uterus conscious of
some change effected in its nature will give the same stimulus
to the Peritoneal Cavity as would arise were the Uterus removed &
thus the abdomen be made an imperfect Cavity, parts may retain
their life & yet give a stimulus productive of death to
other parts.
“This seems to be the action of the Sympathiser becoming
more violent than that of the Sympathent.”
The dissection of Women dying of this disease proves
in general the fatal affection to be a suppuration of the Peritoneal
Cavity.

96.
sufficient either in the time of its duration or degree, to produce
adhesions of the membrane to the contained parts.
515. If the Suppuration is universal it always destroys the patient,
the prevention of this state is therefore to be diligently
prevented.
516. Bleeding seems the only means we have of preventing
suppuration, & therefore should be had recourse to, it should seem
to be improper in the Erysipelatous Species, but even there we
know of no other means of warding off suppuration.
517. When universal suppuration of the Cavity happens,
trial might be made of opening the Cavity with a Trochar
evacuating – the fluid as much as can be, & washing the part
well by injecting warm water.
518. When the suppuration is partial (a. 513. 482. 362) the
matter frequently points outwardly, like any other abscess, either
ulceration takes place, & it bursts, or it is opened & the patient
does well, here is a striking proof of the utility of the
adhesive Inflammation
519. The lying in or puerperal fever is a Sympathy of the
constitution with an inflammation of the Peritoneum.
520. The Cause of the Puerperal [fever] Inflamn. of the Peritoneum arises as
well as every other Inflammation of this part from a stimulus of
imperfection, which in this case is given by the Uterus. ♂.

Δ. 521. [Here] Mr. Hunter supposes the broad & round ligaments
of the womb most affected.
522. This most commonly takes place in Patients with
unsound viscera & Peritoneum, & in whom the disease has been of
long standing, rarely the first time of tapping, but not uncommonly
the 3d. or 4th. time. Mr. Hunter has seen on the second day
after tapping, the inflammation spread over the whole cavity of the
abdomen yet proceed no further, in which case it does not kill,
hence we should be cautious in our Prognosis of the event of tapping.
On dissecting Patients who have died after tapping
the same morbid appearances have occurred to the Examiner, as in
Women dying of puerperal fever & the Symptoms have been the
same during their illness. Mr. Hunter mentioned the Cases of
two men who died after tapping & the appearances on examination
after Death.
🜔🜹. 524. The suppuration of the Peritoneum after the operation
of the Bubonocele & Femoral hernia do not happen because
the sides of the Sac are brought together & closed before the alarm
is given to the Cavity. In the umbilical Hernia, after the operation
the external parts do not adhere, [to the] but the Union must
be formed by suppuration & Granulation.
Here the Omentum should be made the basis of the Granulation
that uniting with the external parts it may prevent

97.
521. Sometimes after lying in the adhesive inflammation will
prevent the suppuration from extending itself far, & an abscess
will form at the lower part of the belly & do well. Δ.
522. The Peritoneal Suppuration will sometimes succeed to
tapping or the common operation of the Paracentesis of the Abdomen.
523. From what has been said it must appear that whatever
can produce in the Peritoneal Cavity the stimulus of imperfection,
whether the death of one of its contained Parts, external violence
or penetrating wounds not healing by the first intention,
or by adhesion formed near the opening between the membrane
& some Viscus, may occasion the Peritoneal suppuration.
524. The Operation for the Bubonocele & Femoral Hernia, the
Cesarean operation, may all be productive of the Peritoneal Suppuration,
because they all occasion an Exposure of the Cavity, to
which suppuration must succeed, if the exposure continues long
enough [after] for the Cavity to take Alarm. 🜔🜹.
525. After the Cesarean Operation & other cases of Wounds into
the Abdomen, care should be taken to bring the Lips of the Wounds
in Contact, but not to pass Ligatures (if suture is used) so deep
as to penetrate the peritoneum. 🜔^

prevent the general inflammation of the abdominal Cavity.
🜔^. 525. A.B. A Crooked Woman was with Child & went her
full time, her pelvis was so narrow & deformed that she could
not have been delivered even by the Crotchets. Mr. Hunter delivered
her of a living healthy Child by the Cesarean Section immediately
on its contents being removed, the Uterus contracted strongly, the
Lips of the Wound was brought together by the uninterrupted
suture, the Woman died soon after, on dissection the small intestines
were found adhering about the Wound, the Uterus was
very much contracted, there was a quantity of extravasated blood
likewise in the abdomen, it should seem from this latter circumstance
that in similar Cases the wound should not be closed until
the bleeding ceases.
☉. 526. Of this we have abundant Evidence in observing what happens
during the cure of Patients, who have undergone Lithotomy
☽︎. 528. Joints as consisting of Ligamentous & membranous
parts have their processes carried on slowly, we see the worst consequences
follow suppuration of the Joints, the loss of limb & even
the Life of the Patient, is no unusual sequel, if a cure is effected
it is by granulation, & the granulation afterwards for the most
part, becomes bony & thus the Joint is rendered motionless.

98.
526. The internal coat of the bladder is liable to Suppuration
on exposure, though not very susceptible of it. ☉.
527. The Doctrines (482-483). are further illustrated by the common
consequences of the Exposure of Cavities of Joints by Penetrating
Wounds, which if they heal not by the first mode of union
( ) a general suppuration takes place, for here there being no
Contained solids, as in the abdominal & Thoracic Cavities, where adhesion
forming might prevent the general action of suppuration
an universal suppuration of the Cavity must be the Event.
528. Joints becoming diseased have a great backwardness in recovering
health (275-277) hence when suppuration has taken
place & the third mode of union ( ) becomes necessary, granulation
goes on with difficulty & slowness, hence also agreeably to what
is observed (427) we are enabled to understand, why Hectic is no unusual
consequence of joints falling into Suppuration. ☽︎.
529. Granulations forming though they effect a Cure, alter the        
structure of the part hence its Utility as a Joint is lost, motion is
destroyed, an anchylosis takes place.
530. Hence it is Evident that Surgeons when they intentionally
cut into a Joint, for the purpose of removing an extraneous body
as a loose bone or

🜖. 530. Therefore Sutures penetrating the Cavity of the
Joint should be avoided.
♀. 531 & 532. The Sacculi Mucosi are found between bone & Tendon,
between Cartilage & Tendon, between Bone & Skin, or between ligament
& Skin. So between the Patella & Skin, the Olecranon
& Skin, the Annular Ligaments of the Fingers & the Skin, &ca. &ca.
(532) Obliterating their Cavity &ca. this is done by opening them
preventing the Lips of the Wound uniting by the first intention, &
so making suppuration & granulation necessary, on the same
principle is the dropsy of these parts to be cured, as that of the
Tunica Vaginalis, or Hydrocele which will hereafter be explaind.

99.
531. The Sacculi Mucosi are similar in their nature & use to
joints & contain a fluid to facilitate motion, the consequences of
injuries done to them will be similar to those inflicted on the Cavities
of Joints.
532. They are subject to dropsy, & when affected with it are to
be cured by obliterating their cavity, this is generally followed by
a weakness & stiffness of the parts to which they belong but this
is soon relieved by giving them motion. ♀.
533. The Chambers of the Eye are subject to the suppurative inflammation,
which may have its seat in one chamber (as the
Anterior) only.
534. The causes of this may be whatever can give the stimulus
of imperfection to the Cavity, whether spontaneous inflammation not
terminating by resolution, or a wound not healing by the first
mode of union, hence it may follow the extraction of the Cataract.
&ca. –
535. By inflammation of the chambers of the Eye the Iris may be
made to adhere to the Chrystalline Lens.
536. The formation of pus in the anterior chamber of the Eye
will obstruct the passage of the Rays of light, similar to an opacity
of the Cornea.        


♀. 541. A Gentleman had an inflammation of the Sclerotica,
but the Cornea, remained clear, he had darting pains in the
back part of his head, with lassitude &ca. A white speck appeared
on the Cornea, which being a collection of pus gradually
increased, at Angth the suppuration filled the whole anterior
chamber & the matter was let out by an incision similar to
that for a Cataract. 5th. day the Eye appeared flat, the Iris &
Pupil could hardly be seen 6th. day the cornea was rendered

100
537. It will produce an appearance of an opake cornea with
which indeed it may be complicated, or it may be single, no
opacity of the Cornea being present.
538. When single it may be distinguished from an opacity of
the cornea by the pus forming in the Anterior chamber, in a section
of a Circle, a straight line forming its superior side, as the accumulation
of pus encreases its figure approached nearer & nearer to a
perfect Circle, till at length it entirely covers the pupil, however when
fully confirmed it is not to be ascertained whether it is complicated
with an opacity of the Cornea or not.
539. In general if the Disease is of long standing, the cornea
is opake.
540. The Removal of the Pus is obtained.
A. by absorption into the System
B. by Ulceration of the Cornea Evacuating it.
C. by an artificial opening.
541. (a. 540) is the most desireable mode of Cure, as if the Cornea
is not opake, Vision is readily restored.
(B) is the worst mode of all being invariably followed
by blindness from the cavity becoming obliterated (as in other
Abscesses) from the injury it may do to the Chrystalline Lens & from
the sprinkling or washing of the Eye – Therefore

full by a thinner & more transparent fluid 8th. day matter
was visible at the bottom of the Cornea in the End his
Eye was lost as to its vision & diminished in Size.
🜍. 543. The internal coat of a Vein may inflame from
the Puncture made in bleeding should it not heal by the first
intention.
Therefore in bleeding the Surgeon should always be careful that
his Launcet is very sharp & that after stopping the Blood he will
closes the orifice. When the Arm bleeds a second time after Venesection
from the same orifice, a sore arm is no unusual Consequence,
this arises from the Orifice not healing a second time without inflammation,
Linnen or Lint is a better application after bleeding
than sticking plaister for obvious reasons, there are more sore arms
after bleeding where sticking plaister is used than where lint.
Sore Arms after bleeding have been commonly attributed to the wound
of a Nerve, but Mr. Hunter thinks they more commonly arise from
an inflammation attacking the internal Coat of the Vein, if when
Horses are bled the Farrier is not careful to produce union between
the edge of the Wound a suppuration not unfrequently
attacks the internal surface of the Vein & if it extends as it sometimes
does to the Heart the Animal dies, adhesion, suppuration
& ulceration may all be going on, in a Vein at the same time

101.
(C) is to be preferred though even from this mode
small hopes of restoring vision can be Entertained. ♀.
542. The Veins are not to be considered as Canals but as Cavities
& like other cavities the internal Coat is liable to
the adhesive as well as the suppurative & ulcerative inflammations.
543. The Causes of the Inflammation of Veins will be the same
as those of inflammations of other Cavities whatever can
produce the Stimulus of imperfection in them will bring on
inflammation. 🜍.
544. If the adhesive Inflammation takes place in any part
of a Vein its Cavity is obliterated & a cure is performed.

as mr Hunter found in Examining the body of a Man in St Georges
Hospital who died after bleeding, we sometimes observe a chain
of Abscesses in the Course of Veins after bleeding in the Saphena
when suppuration takes place a compression on the Vein, above
the seat of the suppuration both to produce contact between the
sides of the Vessel & obliteration of its Cavity & to prevent the blood
from carrying Pus onward to the heart.
♁. 547. This we see by observing the effects of a Ligature put
round an Artery. Mr. Hunter has never seen an Artery suppurate
except once & that was the immediate consequence of mortification. –
🜁. 549. This being the case it is to be observed that when the
cure is attempted by Seton the water being suddenly evacuated,
the Tunic collapses, now though the Seton as a foreign body
may excite inflammation, Yet the Tunic at the time of producing
the Inflammation being in partial contact with the
testicle, it is not certain that the inflammation will extend over
the whole cavity, but it must in general have its progress bounded
by the contact of membranes. (362).

102
545 Suppuration arising, if the means of adhesions taking
Place above the point suppurating a simple abscess will be formed
& no ill consequences arise, but (546)
546. The inflammation & consequent suppuration may Extend
(in default of the adhesive inflammation setting bounds to it)
throughout the whole course even to the right Auricle of the heart,
or pus may be formed & Carried with the blood to the heart; either
of which circumstances taking place, kills the patient.
547. The internal coat of the Arteries is not liable to suppuration
they will however take on the adhesive inflammation.
♁.
548. Brain. We should be extremely cautious how at any
time we open or wound the dura mater, as the exposure of the
pia mater & brain is in general productive of fatal consequences,
the brain will inflame, swell & protrude through the openings
of the dura Mater, as the Cutis throws out a fungus
through the opening of the Cuticle in the whitloe, suppuration
will take place, but the Patient will be destroyed before
a Cure can be effected.
549. Hydrocele.. The Tunica Vaginalis is a circumscribed
Cavity, when exposed the same local circumstances, as
in the exposure of other circumscribed Cavities takes place (362) 🜁
550. It is necessary we should carry this idea (549) in our

🜖. 552. Mr Hunter in his Lectures took notice of the Anasarcous
Hydrocele, but as that is a mere Symptome of Anasarca
& has nothing to do with the doctrines we are now illustrating,
it becomes not an object of our present attention.
A diseased Testicle is frequently the Cause of the first
kind of Hydrocele, we shall have occasion to speak of the diseased
Testis hereafter.
554. Whichever mode of Operation is chosen, Suppuration
is to be expected, since we cannot promise to ourselves
a certain Cure by adhesion only, no one can have any great superiority
in point of utility over the other, different Men will
have different opinions in making their choice.

103.
Minds, when we prepare for the radical Cure of the Hydrocele
or proper dropsy of the Tunica Vaginalis.
551. The Hydrocele is of two kinds.
1. Where the fluid is collected between the Vaginal
Coat & the testicle.
2. Where the fluid is contained in an Hydatid adhering
to the Tunica Vaginalis.
552. We know little of the cause of the first kind if Hydrocele
& of the cause of the second we are totally ignorant. 🜖.
553. The Radical Cure of the Hydrocele is to be obtained by
no other means than the obliteration of the Cavity which is
the seat of it - this obliteration is accomplished by.
A. Inflammation by which the surfaces of the
Tunica Vaginalis & Testicle must be omitted, so that the Cavity
between them shall no longer exist, or
B. A total removal of the membrane of forming
the Cavity, that is the Tunica Vaginalis.
554. The first purpose is fulfilled by one of three operations.
a. Caustic
b. Seton & Tent.
c. Incision.
555. The second (B./554) by the excision or dissecting out of the
whole Tunica Vaginalis except where it adheres at the back

🜔. 555. This must be a certain mode of Cure for it is not
only removing the disease but taking away the very seat of it.
The seventy of the operation however together with its being
follows by more violent Inflammation & greater danger has
brought it generally into disrepute.
Φ. 556. 557. / Mr. Hunter experienced the truth of these aphorisms
in a Patient upon whom he performed the operation for the Radical
cure by Seton, soon as he evacuated the Water, the tunic Collapsed,
the Inflammation excited by the Exposure was not general,
consequently the Cavity was not obliterated, within two
Years the disease returned, stimulating injections have been
practised to bring on the adhesive inflammation & thus obtain a
Cure, but here we shall be too frequently foiled, & on this mode
we can depend but little.
🜔🜹. 559. It has been usual to divide the Cure into the Palliative
& the Radical, of the former unless when it accidentally becomes
the cause of the latter we have little to say since it teaches
nothing respecting the exposure & inflammation of Cavities, it
is needful only to observe that the palliative Cure consists in
Puncturing the Tumor with a launcet, or small trochar & thus
evacuating the fluid but it is rarely that this mode does not
require repetition throughout the Life of the Patient.
The palliative Cure should not be attempted unless the

104.
part of the testicle. 🜔.
556. No certain cure can be performed unless the whole cavity
is obliterated, if any part of the Tunica should not adhere to the
Testicle the disease will return. For
557. In this as in all other circumscribed Cavities the adhesive
inflammation may take place only in a few points & thus the
Perfection of the cavity may still be preserved & consequently the
stimulus of imperfection will not be given to the internal surface
of the Cavity. Φ.
558. The adhesive inflammation will rarely affect the Cure, in
general an universal suppuration must take place before the
purpose of the Surgeon will be accomplished.
559. Tapping for the Hydrocele, the wound not healing by the
first intention may also accomplish the desired effect, the same
circumstances here take place as in the Peritoneal Cavity, after
tapping for the ascites, or accident, as a bruise producing a Rupture
of the Vaginal Coat, & a diffusion of its contents throughout
the cellular substance of the adjacent parts if followed by inflammation
of the Tunic may also effect a Cure. 🜔🜹.
560. It is to be remembered that the operation for the Hydrocele
is not necessary for the preservation of the life of the Patient,
or the support of his health, but only for the removal of
an inconveniency, therefore the danger of the operation is to

Patient can lie by for sometime because sometimes Inflammation
succeeds & the Radical Cure with all its Circumstances
take place when the palliative was only intended.
🜔^ 563. Inflammation arising in Consequence of any Operation
is no unusual circumstance for a considerable quantity
of Coagulable Lymph to be thrown out, surround & give the appearance
of enlargement to the Testicle, this effusion of coagulable
Lymph also forms the sloughs that are thrown off in the processes
when suppuration takes place, & which were by the Author
of a late Publication considered as sloughings of the Vaginal
coat, to which he imputed the Cure by caustic, but the Vaginal
Coat rarely sloughs, the slough discharged being in general
false membranes made from coagulable Lymph now & then
however when the Tunica Vaginalis is in a diseased state a
partial sloughing of it may take place.
The Circumstance which may give an appearance of
an enlarged & diseased testicle deserve particularly to be attended
to as otherwise a surgeon may be induced to remove it
shirrous & incurable, the testicles requiring no such operation.
Case. A Man laboured under an Hydrocele, the tumor inflamed,
suppurated & at last ulcerated, the Surgeon enlarged
the opening & finding the Testis apparently enlarged & supposing
it schirrous was about to remove it Mr. Hunter was desired

105.
be ballanced against the extrication of the Patient from present
trouble.
561. If a Radical Cure for an Hydrocele is resolved upon we are
then to consider in our choice of a mode of performing the Operation
1st. The Comparitive danger of the different methods.
2d. The Comparitive certainty of success of the difft. Methods.
3d. The State of the Testicle.
562. The greatest Comparitive degree of danger attends the Operation
by Excision ( ) which is therefore perhaps never to be advised,
this danger will arise from the Sympathy of other parts
& of the Constitution with the Testicle in this mode of Operating
so rudely handled & so entirely & suddenly exposed.
563. The mode by excision is most certain of success, next to
that the mode by incision, the Caustic & Seton are less sure
in their Effects. 🜔^.
564. All the modes of operating give us an opportunity of
examining into the state of the Testicle, that by Caustic alone excepted,
the mode by excision gives the best opportunity.
565. The mode by incision being the most simple of all, more

to attend the operation, he found the suppuration of the Tunica
Vaginalis too general, for the complaint (in his opinion) to be
Cancerous, the history of the case confirmed this Opinion, the
Patient being extremely timid, there was no difficulty in getting
the Operation put by, it was deferred & he recovered from his ailment
by very simple means.
Further respecting the state of the Testicle it becomes
necessary particularly to attend to it, that if the disease requires
it may be extirpated without the necessity of a second operation,
care should be taken to distinguish a swelled Testicle from a
dropsy of the Tunica Vaginalis, if the tumor consists of the latter
it will be mostly pyriform, if the former it will be flatted,
this attention to the appearance added to the assistance of the
feel, will mostly preserve the Surgeon from an Error.
Again in the Hydrocele the situation of the Testis should
be ascertained, that we may not if we have Occasion to tap the
tumor be in danger of wounding it.
Mr. Hunter by accident wounded a testicle four times & yet
no ill consequence supervened which is somewhat singular
as so much mischief frequently follows the slightest bruise
of this Gland.
A pulpy Testicle will be very apt to be mistaken for an
Hydrocele.

196
certain, yet not more dangerous than either caustic or Seton
& more safe & easy than that by Excision is probably to be with
justice preferred, it is performed by making an incision three
inches in length, or throughout the length of the tumor into
the Cavity containing the water, which being evacuated. Poultice
or Crumb of Bread is to be introduced every where between the
two Tunics & kept in by means of Lint stuffed into the mouth
of the wound. Rags welled in Brandy or Spirits of Wine should
be kept on the Scrotum & often renewed to prevent the too sudden
coming on of Inflammation & the Scrotum should be suspended
in a Bag truss.
566. The advantages of knowing whether a testis is diseased or
not is that if found so in a considerable degree it may be removed
without the patient undergoing a second operation.
567. We cannot perhaps a priori determine whether the disease
be a Hydrocele of the Tunica Vaginalis, or the Water be contained
in an Hydatid, nor is this knowledge of consequence in
the Cure, as in both the same mode of treatment is to be observed,
but the consequences of an opening into the tunica
vaginalis will be different from those of wounding an hydatid.
568. In the former (567) the sympathetic affection usually following
an exposure & inflammation of the Testicle, will come on
such as Rigors, Nausea, vomiting dull pain in the back & Loins

Again respecting the state of the Testicle, we should take care
to distinguish, a Scrophulous Testicle from a cancerous one
Mr. Hunter never saw a Cancer of the Testis follow the Radical
cure of the Hydrocele.
The best means of ascertaining the situation of the
Testicle, & whether this Gland forms the Tumor, is the Sensation
the patients experience in squeezing the Tumor, if it be a diseased
Testis the pain is the same in every part, if only an
Hydrocele, pain is felt on pressing that part alone in which
the Testis is situated. –
∇. 568. In cases where the Hydrocele has been tapped we
should be led to suspect that the Cicatrix left after the Puncture
would be the proper part to perform an operation again, either
for the Palliative or Radical Cure, but this is not always the
Case for the Testis sometimes adheres to the Cicatrix & if this Rule
is observed would be wounded in consequence after the Symptoms
following the radical Cure abate, an enlargement of the parts
always remains, which is not an enlargement of the Testicle
but only a thickening of the Tunica Vaginalis &ca. this gradually
subsides & the parts return almost to their natural size
which diminution may be forwarded by Rubbing in the Mercurial
Ointment.
Hœmatocele is an Extravasation of Blood into the Tunica

107.
great sense of lassitude, swelling of the Testis &ca. these
will generally come in twenty four hours after the operation
but when an hydatid is opened as the body of the Testicle is not
exposed, these will not arise but only the common circumstances
of inflammation as heat, soreness of the Scrotum &ca. ∇.
569. The treatment of both (568) will be the same as in Inflammations
in General, but the Scrotum must necessarily be suspended ☍.
Note Continued.
Tunica Vaginalis, it is not of much consequence to distinguish
it from the Hydrocele as the same treatment is advisable
but it should be carefully distinguished from an enlarged Testis,
sometimes the contents is only Coagulated Blood, & sometimes
coagulated Blood, mixed with Serum, & sometimes the Coagulum
will be found to have become Vascular.
☍. 569. Farther Remarks on the Cure of Hydrocele
by Seton or Tent & by Caustics.
If the Seton is used Care should be taken that the Skain of Silk
or thread be large enough to fill up the Wound made by the
lancet or Seton needle, & thus plugging it up, prevent the Escape
of the water until a general inflammation has taken
place for the water keeping the Tunic every where distended
partial adhesions will be prevented & the influence of the operation
become general (566-567). The Seton should be passed

in the perpendicular Axis of the Tumor, but the Tent about midway
the water should not be suffered to escape before the tent is
introduced for the same reasons as the confinement of that
fluid is recommended where the Seton is used Sponge Tent
is preferable.
Caustic. There is an uncertainty how deep the Caustic will
act, should it not penetrate so as to include the Tunica Vaginalis
in the Eschar, we shall be under the necessity of
making a Puncture through that membrane & so shall gain
no advantage from the use of the Caustic.
When the Eschar is sufficiently deep the inflammation
of the Cavity takes place before the Water is discharged which
here also prevents partial adhesions & an Imperfect Cure, but
the uncertainty of the action of the Caustic is an objection to its
use. It may happen that the Testicle may lie in
the fore part of the Tunic & its situation not be known, or not
attended to by the operation, if in performing the radical cure by
incision he finds that he is cutting into the body of the Testicle
he should carry his Knife more to the lower & outer part of
the Tumor in finishing his incision for fear of wounding the
Spermatic Artery, an accident That has occasioned

108.
570. Fractures. The bones as well as the soft parts
are subject to every stage of Inflammation either arising spontaneous
or being induced by external violence when their continuity
is divided they are reunited by processes somewhat similar to
those which we observe to take place in the soft Parts.
571. Bones are liable to Solution of Continuity from external violence,
solution of continuity in bone is called fracture.
572. Fractures in bones are either
A. Simple
B. Compound. [simple]
C. Compound Simple
D. Simple Compound.
By a simple fracture is meant a solution of continuity
in a bone without a wound communicating Externally.
573. By a compound fracture is meant a solution of continuity
in a bone, with a wound communicating Externally which does
not heal without suppuration & granulation.
574. By a Compound simple fracture is to be understood a fracture
which has a wound communicating Externally but which
Wound heals either by the 1st. or 2d. Mode of union & without Suppuration.
575 The Simple Compound fracture takes place where originally

♄. 578. It has been usual to distinguish all unnatural
states of the Bones, by the name of Caries. Caries was divided
into moist & dry; moist seemed to imply a diseased state of
the Bone, dry the bone becoming dead. By converting the
moist into the dry state a cure was frequently accomplished,
why this happened will appear from (587. 597. 632).
The term caries signifies a Rottenness in the bones it is
evident this was improperly applied to bones becoming [diseased]
dead, because a dead bone is generally thrown off without the
least appearance of Rottenness, indeed it is much more firm &
solid than the margin of suppuration in the living bone which
had thrown it off.

109.
there was no Wound communicating externally, but where in
consequence of some parts losing their living Principle from any    
cause Ulceration of the Integuments is rendered necessary & the circumstances
of a Compound fracture induced.
576. Previous to our entering upon diseases, or mode of restoration
in bones it is necessary to consider the five following aphorisms.
577. Bones consist of an inanimate earthy matter attached to
a living organized substance.
578. Bones may either be in a dead or a diseased state, between
the death & disease of a bone it becomes necessary carefully to
distinguish. ♄.     
579. Bones fall into disease more slowly than soft parts, &
when they become diseased are proportionally slower in the act
of Restoration for all processes go on more slowly & difficultly in
bones, than in soft parts.
580. It will be necessary also to consider the doctrines advanced
in (352. 358. 359. 361. 362. 482.).
581. Also that bones receive their Nutrition & means of support
chiefly from the Periosteum or membrane covering the
bones (382) different Bones varying much in their structure
(577) their diseases will vary, as well as the readiness with wch.
they undergo the process of restoration.
582. When a solution of continuity happens in a bone by External

     

  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


110
External violence, productive of simple fracture (572) the cure may
be effected by the first mode of union ( ) without either Inflammation
or Suppuration. In simple fractures though accident
produces a Rupture of several blood Vessels & an immediate effusion
of Blood into the Cavity made by the division of the bone
if the Œconomy of the Parts is not very much disturbed by this
violence, the bloods retaining the living principle, the red part
& serum, are soon absorbed & the coagulable Lymph alone remaining
becomes Vascular the Cure is accomplished with little
pain & without disturbance of the General System.
583. If so much injury is done to the parts, that a considerable
& unusual action is necessarily Excited in them, the first
& most simple mode of union will not take place, but the Ossific
Inflammation or that which is perfectly similar to the adhesive
Inflammation in soft parts arises. Coagulable Lymph
is poured out into the Cavity (now similar in its nature to any
natural circumscribed cavity) which is to form the callus this
becomes vascular at length Cartilaginous & lastly ossific matter,
as in the first formation is deposited ( ) & thus the cure is accomplished,
here pain, tumefaction of the circumjacent parts
& the common symptoms of the adhesive inflammation takes
place.
584. In the compound fracture ( ) the Cavity made by the division
of the ends of the bone becomes an Exposed one, from the


    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


111
fracture being complicated with a communicating Wound, the
blood effused does not as in (582) retain its living principle, the
stimulus of imperfection obligates the Cavity to set up a new process
suppuration takes place & the only means of reunion left are
those of granulation.
585. As in wounds made into circumscribed Cavities, if the
lips of the wound come in contact & unite either by the first or
second mode of Union, before the Stimulus of imperfection gives
the Alarm to the cavity, a suppuration of the whole Cavity does
not necessarily take place, so in the Compound simple fracture
if the external wound is thus made to unite before the blood effused
into the Cavity has lost its living principle & the stimulus
of imperfection has given rise to a new process, the Cure may be
accomplished, with the same case as in the simple fracture.
586. But it may occur that either a splinter of Bone being
detached & dying, or the extravasated blood losing its living
principle, or from a misplaced end of the bone producing ulceration
of the integuments, or an irrecoverable injury being done
to the parts covering the bone, that Ulceration even to the Exposure
of the Cavity is produced, in this case which we term a
simple Compound Fracture the same circumstances will take
place as in the Compound Fracture (584).
587. When a part of a Bone becomes dead, Exfoliation or the throwing
off the dead part from the living must take place, In what

🜖 588. It can rarely happen that any large portion of Periosteum
shall be destroyed, or become dead without a consequent
death of [the] a portion of the subjacent Bone, if only a small extent
of Periosteum is destroyed, exfoliation of the Bone does not always
follow, because its Life will be still supported by means of its
Vessels anastomosing with those that pass from the Periosteum
nearest to the exposed part.
♀. 592. Of this we have instances in Anchylosis of the Vertebræ of
the Spine especially in Horses, between two or more of the Vertebræ
of these Animals it is Common to have an Anchylosis formed.

112.
the Process of exfoliation consists we will hereafter shew.
588. When a surface of a Bone is exposed, it is very common for
a portion of it to become dead & a necessity for the Process of Exfoliation
to take place. For the Bone receiving its nutrition from the
surrounding periosteum, that being destroyed or becoming
dead a part of the Bone must lose its means of support. 🜖.
589. The Union of broken bones is more slowly accomplished than
that of the soft parts, because in the former two processes are to be accomplished
Viz the formation of soft parts & then the formation of
bone.
590. The Ossific Inflammation arises when there is an increased
disposition in a part to form Bone.
591. It consists in the Vessels of the Bone, or the parts covering
the Bone, taking on the same action as the Vessels of the soft parts do
in the adhesive inflammation.
592. The consequence will be similar, for it will produce tumefaction
& enlargement of the Bone, if extending from one Bone to
another between which & the other there is a natural motion it
will produce Anchyloses, like as the adhesive Inflammation produces
immobility in the soft parts to which it extends, it will
be followed occasionally by suppuration & ulceration. ♀.
593. The Causes also of the Ossific Inflammation will be similar
to those of the adhesive; External Violence, as exposure & pressure,
a necessity for action in the Vessels of the bone or its membrane &ca.

♃. 593. Pressure will not uncommonly occasion ulceration &
absorption of Bone, but it may also Excite the Ossific Inflammation
& a thickening of the Bone.

113.
may give rise to it. ♃.
594. The final intentions for which the ossific Inflammation
may be employed, are first to produce restoration of parts & reunion
in a diseased Bone, & secondly to strengthen weak parts.
595. The seat of disease in bone can only be in its living part.
596. The more spongy & soft the Bone is, or the more living matter
it contains the more liable it is to disease, the harder the Bone
the less ready it is to fall into disease, but a death of some of its
parts is more easily Induced.
597. When a bone becomes diseased it is our business to endeavor
to get the better of the disease, but when a Bone becomes dead nothing
can be done but to produce exfoliation.
598. The treatment of diseased bone is rendered difficult by
the impossibility in general of discerning the extent of the disease
599. The inflammation & suppuration may have its seat either
in the surface of the bone, or within the substance of the
bone, or in the medullary substance.
600. Hard bones becoming diseased are more difficult of cure
than soft One’s, & when cured are more liable to fall again into
a diseased state.
601. Bone is liable both to ulceration & intersticial absorption.
602. When a portion of bone becomes [diseased] dead the process of
exfoliation is performed by the dead Bone giving a stimulus to
the living Bone in contact with it & to which it adheres by the attraction
of Cohesion, the living parts immediately in Contact with
the dead bone are absorbed, & a Cavity between the dead – living

🜔vmss. 🜔. 602. The first appearance of separation in order for exfoliation
is a springiness in the living bone now becoming more vascular,
then a Grove is formed in the direction of the fibres that surround
the dead Bone, the living Bone becomes softened & more porous, part
of the dead Bone seems to be sometimes absorbed for it has the appearance
of having undergone ulceration, it is certain that absorbents have
a power of taking up dead bone. The absorption begins at the circumference
& is continued to the Centre. In the Skull they become first
membranous, nature observing the same order in the repair of bone
as in its first formation, a pulsation in the Granulations often attends
the exfoliation of bone. Granulations will sometimes arise
shoot over the edges of the bone to be exfoliated, & prevent it being
thrown off so soon as it otherwise would be in this case it excites
new Inflammation & Ulceration.
🜔vmss. 🜖. 603. The Granulations forming bone irregularly become
often a considerable obstacle, to the cicatrization of the Ulcer after the process
of Ossification &ca. is finished.

114.
surface is formed, the former now being a mere extraneous body
is according to a law in the Animal Œconemy ( ) carried from within
outwards, & at length thrown off from the body, ulceration of
the integuments having made way for its exit, the cavity is filled
up with Granulations which become New bone. 🜔vmss. 🜔.
603. Granulations will arise from the Surface of bone without Suppuration
having preceded, but this only where that surface has
not been exposed by a penetrating Wound. 🜔vmss. 🜖.
604. A thickening of the Periosteum & integuments has often been
mistaken for an enlargement of a bone.
605. A Bone may be enlarged without any alteration in its original
structure, by bony matter being formed in its natural surface,
this laying on of new Bone will arise from the Ossific inflammation
taking place in the periosteum, or on the surface of the bone, we
call this adventitious Bone.
606. Or a Bone may be increased by the Ossific inflammation taking
place in its substance, which causes an alteration in its
structure & enlargement of its dimensions.
607. A Bone may be increased in size at the same time that
there is an absorption going on in its substance, for the ossific
Inflammation may be laying on New Bone on its surface at
the same time that absorption is removing portions of its more
internal substance thus a bone may at the same time be increasing
in its dimensions & losing in its Quantity.
608. Suppuration may take place either on the surface or in the

  
   
   

        
  
 
 
  
  


 
   
    
                                  


115.
substance of a bone.
609. Matter when formed may be confined, if in the substance of
the Bone, by the natural bone remaining unulcerated through its
substance, & thereby preventing its exit, or if on the surface of the bone
by the ossific Inflammation forming a Case round it of new or adventitious
bone, but in the latter Case the progress of the suppuration
must be rapid, otherwise there will not be time for the bony case to be
constructed & the matter will make its way to the Skin as in a common
deep seated Abscess.
610. Matter may be also confined on the Surface of the bone for a considerable
time, simply by the thickening of the Periosteum just as it
is confined by a fascia in the whitloe.
611. The periosteum & the cellular substance connected with it may
take on the Ossific Inflammation.
612. Suppuration taking place in the substance of a bone, & the Ossific
Inflammation being also taken on by the surface of the bone & the
parts covering it, the matter will produce a disposition to the ulcerative
absorption which will be continually removing large portions of the internal
surface of the bone, the ossific Inflammation at the same time
depositing new bone on the outside, thus the Bone may be enlarged
to any size & there two processes, absorption within & Ossific disposition
without going on together the dimensions of the Bone shall be wonderfully
increased at the same time that perhaps the original
bone shall be entirely removed, & even some of the internal parts of the
New bone shall be taken away & at last instead of a Solid bone only


          
   
   

        
  
 
 
  
  


 
   
    
                                  


116.
a large bony Case shall remain from which at length the matter
shall be evacuated. Ulceration within may however go on even after
the matter has made its escape.
613. Ulceration is the Sequel of suppuration it removes the Effects
of the Ossific Inflammation, when ulceration has gone through the
surface of a bone it affects. 1st. the periosteum next the Muscles and
lastly the cellular substance & Skin.
614. Bones when the first & second modes of Union fail are, as heretofore
observed / cured by the formation of Granulations & those taking
on the [diseased] ossific disposition.
615. But it sometimes happens that the ossific disposition shall
not be taken on by the granulations between the Ends of the bone,
so that there shall be no union by bone, the restorative process going
no further than the production of granulations or the change of them
into Cartilage.
616. It sometimes happens that no union at all is formed between
the separate ends of the Bone even after a simple fracture in
this Case, a New Joint is formed, the ends of the Bones become covered
with a Cartilage, & as in all other Articular Cavities a power of
secretion Synovia is given to it, & it is in every respect similar to any
other Joint Except the want of the proper moving powers, that is
corresponding Muscles, these not being generated the new joint becomes
Extremely inconvenient.
617. Ossific Inflammation may terminate in a Suppuration, or the

☿. 620. Here nature seems to be counteracting her own Ends, but
the final intention of this bony case seems to be an hasty attempt
to obviate the weakness in the limb that might spring from the
extent of death in the bone.

117.
bone may remain swollen, but Indolent.
618. Exfoliation of Bone is of three kinds. Vizt.
A. External.
B. Internal.
C. Mixed Exfoliations.
619. The process of Simple external exfoliation has been already
considered (602) It happens also that an internal part of a bone
shall become dead, becoming dead it gives a stimulus to the surrounding
living parts, as an Extraneous Body, it must ultimately
be thrown off, for all parts, / as has been shewn ( ) admit readily of
the passage of foreign substances from within outwards, hence from
its stimulus & the ulcerative absorption is finally produced in the
surrounding parts & a passage is given at last to the dead bone,
In consequence of the stimulus Granulations also arise & fill up
the loss occasioned by the seperation of a part of the bone & these Granulations
becoming bony the Case is accomplished.
620. The mixed is when the External Exfoliation becomes an internal
one which is accomplished as follows.
At the same time that the process of absorption goes on for
removing the dead bone from its Contact with the living parts, the
parts in the neighbourhood take on  the ossific Inflammation & in
the End forms a bony Case round the dead piece & prevents its Exit. ☿.
621. Bones commonly become painful before a swelling of them
is perceived.

622. This happens 1st. because it is the matter of diseased
parts. 2d. because the Continual irritation of the
bone like other irritation induces a flow of matter.
3d. because there is commonly some Blood
mixed with it, which soon becomes putrid.
♂. 626. The quantity of Mercury to be used may be somewhat
less than that fitted to Cure a Pox.

118.
622. The matter discharged from diseased Bone, or where the process
of exfoliation is going on is seldom laudable pus & is extremely disposed
to putrefy, tinging the probe of various colours.
623. When the Skin is affected, that is when the Inflammation
of the bone is communicated to the Skin, suppuration commonly
takes place.
624. The periosteum becoming inflamed & its internal surface
taking on suppuration, a disease or death of the more external
parts of the bone may be induced.
625. The hard bones having fewest living parts, & of Course fewest
Vessels have their life soonest destroyed by any destructive
cause whatever, it is scarcely possible to lay them bare to any considerable
extent without death & exfoliation being the consequence.
626. Where the ossific Inflammation, or the Inflammation of a bone
requires the assistance of Art it is to be treated by antiphlogistic
remedies & by limiting upon rest being given to the part affected,
& if the lower extremities that the Patient lie in an horizontal
position.
When the swelling of the bone becomes indolent, the parts
are to be rouzed into action, & if possible intersticial Absorption excited
by the administration of Mercury both internally & Externally.
The Mozeron Root has been much recommended as
a specific in the Enlargement of Bones. ♂.
627. If the seat of suppuration is the surface of the bone, or the
internal surface of the Periosteum the matter should be evacuated












 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


119.
as early as possible & this by simple incision through all the integuments
down to the bone, but without removing them & more
especially in case the Cranium is the object of our consideration.
628. sometimes in this Superficial suppuration bones are so
much diseased that they have not a disposition for restoration
& the bone will not exfoliate unless the actual Cautery be used.
629. In case of suppuration in the substance or medullary substance
of the bone, (which is the worst case by far) the matter is
to be evacuated by the actual or potential Cautery, or by the trepan.
630. Bones which have undergone external Ulceration often fall into
an indolent state in which Case stimulating dressings are to be used.
631. When the actual Cautery is applied we must [not] use an Iron
of a thickness sufficient to give a degree of heat in proportion to the
depth of the bone. The time of continuing its application must be
also directed by the same Rule.
632. Cauteries may produce a Cure of diseased bones by inducing
a Death of the diseased parts & so render the process of exfoliation
necessary, but in order to have this effect their action must produce
the Death of the whole diseased Part.
633. The [whole] Actual Cautery induces not only the death of
the diseased parts but an inflammation in the sound parts &
this hastens the seperation of the part to be exfoliated. The potential
Cautery rarely does more than producing the death of
the diseased bone.

☍. 637. Mr. Hunter has seen patients who have fractured their
legs in whom firm union would not take place until they were
set upon their Legs, the fractured bones being well supported & defended
by splints &ca. 

120.
634. However [an] a natural or spontaneous exfoliation is much more
to be desired than an exfoliation produced by Art because of the
uncertainly of our endeavours to extend our operation to the whole
of the diseased bone.
635. Of Specific diseases producing disease in bone & consequent
exfoliation, the exfoliation goes on more readily & kindly from the
venereal disease than from Scrophula or others. In Scrophula the
extent of the disease is more considerable, whereas the venereal is
more partial & confined to a narrower Limit.
636. When after a solution of continuity in a bone the cure proceeds
no further than the soft union, the rest of the Limb should
be discontinued to excite if possible a further disposition to the act
of restoration in the parts.
637. When the fracture with the circumstances (636) is in the lower
extremity care must be taken by means of splints & Iron work,
that the whole weight of the body does not rest on the fractured bone ☍
638. When a new joint is formed (616) the observation & Precautions
are also to be attended to.
639. But it may sometimes be desirrable to attempt the destruction
of the new formed joint & procure firm union between the Ends
of the formerly divided bone, in this Case we are to consider the doctrine
of Inflammation of Cavities & particularly that of the Cavities
of Joints (528) &ca. –
640. The mode of accomplishing this purpose will consist in producing

🜍. 640. It must be evident that the less time has elapsed since
the formation of the New Joint the more readily its destruction
will be accomplished.

121.
producing in the new articular Cavity the stimulus of imperfection
by making an opening into the Joints & introducing some foreign
body to prevent healing of the Wound by the first or second mode
of union & excite universal suppurative Inflammation which
being followed by Granulations & those Granulations becoming
bony, the ends of the bone will be immoveably united. 🜍.
641. Diseases of bone may have powerful influence on the constitution,
we may readily conceive the effects of a constant & long
continued pain, want of Rest &ca. which are their attendants we
also know they will bring on hectic & this is accounted for by considering
what is advanced on hectic (479 & ).
642. When ulceration has removed so large a portion of the bone,
that the remainder on account of its weakness shall be unable to
support its necessary actions, or where disease extends through a
greater part of the substance of the bone, than art can restore to
health, or procure a seperation from the sound parts, or where there
is an inability of the constitution to support the disease, or the
processes necessary to healing.
Amputation becomes indispensable.
643. In simple fracture if the patient be healthy the union
of the Bones will be generally accomplished in about three Weeks
but something sooner in the upper than in the lower extremity.
644. Rest – retention of the bones in their natural position,
freedom from pain, & the prevention of Inflammation are the general

   










 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


122
general indication in all fractures of the Extremities, whatever
position of the limb best fulfills these indications is the position
to be recommended.
645 To prevent the displacement of the Ends of the bone we
use splints & bandages.
646. Of the different species of fractures enumerated (572) the
Compound is the most dangerous, & frequently attended with
troublesome, if not fatal Symptoms, as Fever, Symptoms of
dissolution, Gangrene &ca.
647. We can rarely keep the bones perfectly at rest, in bad
compound fractures, hence constant irritation, pain, &ca.
648. The same indications are to be fulfilled in the compound
as in the simple fracture (582) we should move the Limb as
rarely as possible. Poultices though they should otherwise seem
desirrable applications in Compound fractures, become injurious
by their admitting of motion in the ends of the fractured bones.
649. The simple compound Fracture is attended with less danger
than the compound fracture, although the former also may
produce troublesome & dangerous symptoms.
650. The treatment of the constitution when affected by the
consequences of compound Fracture will be but understood
by recurring to (462 od 479.)
651. From what has been said it must be evident that when
a fracture of a bone is complicated with a communicating

   









 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


123.
wound of parts that cover it, as Muscles, Cellular substance
& Skin, it must be always the duty of the Surgeon to endeavour
to render the Case a simple of a compound Fracture,
to which End he will be careful to remove extraneous bodies wch.
may hereafter produce the Stimulus of imperfection, to place
& retain the bones in their natural site & prevent their irritating
the soft parts, to bring the soft parts into contact
one with the other, in short to observe the rules laid down
in cases of Wounds into Cavities & the doctrine (682).
652. In bones as in soft parts the observation that all new
formed are weaker than original parts holds equally good.
653. In bones as well as in soft parts, the process of restoration
goes on more readily in the upper than in the lower extremities
Compound fractures therefore considered as injuries done both to
the bones & to the soft parts are more dangerous in the leg and
thigh, than in the Arm or fore Arm.
654. Fracture of bones, which communicate with Cavities of
joints, whether simple or Compound require peculiar attention
& peculiar treatment, as
1st. the fractured Patella
2d. --- Olecranon
3 --- either Ancle
655. Also when a fracture happens near a Joint, the bone may











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


124.
be so splintered as to communication with it.
656. In case it be a fracture attended with a wound of the Joint
communicating externally, the Wound must be healed if possible
without suppuration, which arising, will occupy the whole
Cavity of the Joint & too often produce a necessity for amputation.
657. If a simple fracture communicate with a joints cavity
the Bond of Union will escape into the Cavity of the Joint
& form a Case similar to Compound fracture.
658. The fracture of the bone will be here united by the third
mode of union or granulation. (the first & second being lost
by the escape of the Bond of Union into the Cavity of the Joint)
except that here there will be granulation without suppuration
preceding (603) In case of fracture communicating with a
joint, it is apt in the cure to produce a stiffness & loss of action
in the joint from the blood escaping into the Cavity & becoming
organized, in this Case as soon as the fractured bones are united
by the Callus it is necessary to give passive motions to the joint
often repeated them & when the callus is confirmed the patient
should diligently exercise the part affected by constant motion
of the proper Muscles.
659. When the Patella is fractured the union of the fractured
parts will be either by bone or ligament.











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


125.
660. If the fractured parts, remain in contact or very near to
each other, the Union may take place by bone as in the fractures
of other bones; but if the fractured portions are at a distance from
each other, Union by the formation of Ligament will be the mode
adopted.
661. For the Patella being employed in the formation of a Joint
a Union by lengthening the bone two or three inches must have
been extremely inconvenient to the patient & incompatible with
the future motions of the Knee.
662. The Patella being the point to which the principle extensor
Muscle of the Leg is inserted, when fractured transversely the
Muscle being now no longer confined contracts itself & draws the
superior portion of the fractured bone to a considerable distance
from the inferior.
663. When the union is formed by ligament as is always the
case, when the fractured portions remain at a considerable distance,
asunder, the patella is very much lengthened & the two
points of attachment of the Rectus Muscle being therefore brought
much nearer together, the Muscle must be considerably shortened.
664. As the original length of the Muscle is diminished its power
of contraction must be diminished in proportion, for the two
ends of the Muscle have in consequence of the accident approximated

♀. 668. Lady B. broke both her Patellæ, they were reunited by ligament
& she lost entirely the use of her Legs, consequently was [n??]
able to walk, she has been in this state 2 Years when Mr. [H?a?] 
her: conformable to the principle laid down in the Text, he set
upon a Table with her Legs hanging inflected over it, he desired her
think attentively of extending her leg & try by the powers if the will
to raise it forward, at first her mind had not the least [influe??]
on the Leg by repeatedly determining the influence of the will to 
the Muscles & repeating this endeavour several times for two
three days she gained a trifling power of Extending her Legs, by persisting
in the same means she increased that power so as to
be able to extend them compleatly, she was then directed to raise
he Leg with a small weight affixed to the Toe, this weight was
gradually increased, at length she was set upon her feet & obliged
by an attempt to walk to Exert a greater force, by daily exercising
the Muscles in this manner & gradually increasing their labours she
was at last restored to the use of her legs, which were formerly considered
as irrecoverably lost.

126
approximated themselves nearly entirely as much to each other as
they were accustomed to do in voluntary action, hence it is evident
the powers of extending the limb must remain lost unless the
Muscle acquires a new action, thus accommodating itself to the
present Circumstances.     
665. The Muscle will acquire however a new action in time &
moreover will in time be enabled to shorten itself, so that by its
contraction the power of extending the Limb shall return to the
patient.
666. This power will be the sooner restored if the Surgeon & the
patient join their endeavours to induce in the Muscle an habit
of Acting.
667. This is to be done first by giving passive motion to the limb
& then by the Patients exerting attentively the influence of the
will upon the part.
668. For the Muscle being originally under the influence of
the will, if the powers of volition are resolutely [& powerfully] & industriously
exerted, will in time recover its pristine action & voluntary
motion of it will be restored. ♀.
669. If the Union is formed by bone from the irregular formation
of the Callus, a bony ridge may be raised on the internal
surface of the Patella which may impede the future actions of the
Joint.
670. It must be evident that the knee should be kept straight

☍. 673. The Triceps Extensor Cubiti being fixed to the Olecranon
when a fracture of that process happens, the superior portion
of the bone will be drawn upwards by the involuntary contraction
of the Muscle, in the Cure the superior is to be brought
downwards, the Arm for sometime kept extended until Union begins
to take place & the action of the triceps is to be checked by
Bandages, when Union is partly formed, as after a fortnight it
mostly will be, then passive motion is to be given to Prevent stiffness
of the Joint, & lastly when union is compleated a voluntary
motion as in the Case of the Patella.
It is remarkable that in general the luxuriant Callus
of a bone is on the outside if its internal surface is exposed to the
action of Moving parts. Thus a ridge from a callus of a fractured
Rib, is never on the inside of the Rib.
After Muscles have acquired a new action the next step
is to give them strength, which must be done by frequent Exercise
It is to be observed that the greatest possible Contraction of a muscle
is somewhat more than a motion of the Joint which it serves admits
of, hence when the Patella or Oleacranon is fractured – the Extensor
Muscles will be shortened more than they were in voluntary
action.

127.
X that in order to the retention of the bones in their approximate
state we must apply a bandage rolling the thigh from above downwards
to prevent the involuntary Contraction of the Rectus Femoris
also that rest should be insisted on, the Surgeon should repeat his
motion of the Limb once in two or three days, afterwards more frequently,
until at length the proper time comes for the Patient to
Exert self-motion (Sec Lady B's case 667).
671. The union of the Bone will be much sooner accomplished
by bringing the seperated portions of bone near together & retaining
them in that situation, for by this means the Muscle will not lose
its original Length & of course its power of contraction, consequently
less difficulty will hereafter arise to the patient in Extending his
Limb & the Evils of irregularity of Callus & Stiffness of the Joint may
be prevented by the attention of the Surgeon
672. When the Cure has been attempted, as soon as reunion has
begun to take place a slight degree of passive motion should be
given to the Limb, & as soon as Union is perfected, Voluntary or self-motion
should be insisted on.
673. The Olecranon is to be considered as a fixed Patella & the same
principles allowing for that difference will apply to a fracture of it.
674. When the Ancle bones are fractured they are only to be considered
as bones making Joints, & not as liable to be influenced by the action
of Muscles, none of which are inserted into them, they are therefore
to be returned if any displacement has happened to their natural

🌕︎+. 679. Mr. Hunter has once seen a Cartilage die become black
& be thrown off with a portion of bone lying under it, this is also
the Case in White Swellings the Cartilaginous Ends of bones being
observed, the bones are removed together with the Cartilage.
Mr. Bromfield Amputated the Arm of a young Woman
at the shoulder joint, she recovered several years afterwards she came
into St. Georges Hospital where she died on dissecting the shoulder on
which the operation had been performed it appeared that the Granulations
& soft parts were not the least adherent to the subject Cartilage
which they covered loosely like a purse, the same thing happens
when fingers are amputated at Joints. Mr. H has seen the Cartilages
of the Larynx & ribs exfoliate but they have previously ossified & become
a spongy bony substance

128.
natural situation & retained in it by bandage &ca. & when union
has begun to take place between the divided portions of bone passive
motion should be given to the Joint, (675).
675. Cartilage is an animal substance intermediate between the hard
& soft parts, approaching very much in its nature & properties to horn
It has very few Vessels is insensible; has little or no power of absorption,
does not swell from pressure, is not liable to exfoliate even when
exposed & scraped, never goes into the suppurative Inflammation, nor
ever becomes the basis of Granulations.
676. Cartilages may be divided into two kinds.
A. the permanent
B. the changeable.
677. The order A are such as remained unaltered during Life
such are those of the Nose & Ear.
678. The order B. (676) are two fold.
1st. Those which at a certain time become bone for which
before they served as a substitute, such are the Epiphyses of bones wch.
in the Infant are Cartilaginous, in the Adult are bony.
2d. Those whose change into bone to her place at an uncertain
time of Life, & sometimes are never changed into bone, as the
Cartilages of the Ribs, & the ends of the Cylindrical bones.
679. When Cartilages are exposed they do not exfoliate; like bones       
nor do Granulations arise from them, but granulations arising from
the circumjacent soft parts on all sides shoot out & meet over them,
thus losely covering them without adhesion. 🌕︎+.

🜖. 607. The lower Jaw seems an exception to this, the depressors
are always attempting to dislocate the Jaw, but the Elevators keeping
it firm in its socket, opening the Mouth does not give firmness
to the Joint; We see in immoderate Yawning the Jaw will be sometimes
dislocated the Elevators here either for a time losing the power
of action or being over come by the power of the depressors, the latter
are not inserted near the Centre of motion.

129.
680. When the permanent Cartilages are divided the Reunion is
formed by Cartilage, but when the changeable Cartilages undergo
solution of continuity, they are consolidated by bony union.
681. When the changeable Cartilages inflame they take on the ossific
disposition , when they fall into disease they also become bony.
682. Cartilages seldom admit of the ulcerative process, they are
however liable to undergo Contiguous absorption from the Lymphatics
of the surrounding parts.
683. Joints. If we judge of them by the Laws of Mechanics are
in general very ill formed, but this deviation from mechanical
principles, fits them for a vanity of actions, which had the Rules of
Mechanics been strictly adhered to would have required a greater
number of additional Joints.
684. In considering the structure & properties of Joints we are
also to take into account the ligaments & Muscles
685. The Ligaments in general serve as Pivots.
686. The Ligaments of some joints regulate the motion of the
Joint, but there are only such as are moved in one direction only as
the two upper Joints of each finger, others they only serve to sustain
& support.
687. The powers that give force & firmness & direct the Actions of Joints
are the Muscles, the Muscles support the joints in the motions they
have to perform. 🜖.
688. From knowing that the strength & weakness of a joint depends

🜔. 688. 689. These aphorisms require considerable attention
it is observed (48) that the voluntary Muscles may occasionally act
of themselves & independent of the will, & this may be either from disease,
or in spasms, or from a kind of consciousness in themselves of
the necessity of acting when a Man is descending from an eminence
as when he is descending down stairs, the Muscles are all prepared to
support the Joints of the Knee & Ancle, so as to prevent their giving
way, & of course being strained, or any Jarring between the bones
that compose them, & this without any direction from the will, but
seemingly from a kind of attention in the Muscles to the security of
the Joint, but if a Man in walking a longer plane suddenly steps
down a descent which he is not aware of the muscles being unprepared
for the exertion & off their guard do not give firmness to the
Joints, & in this sudden action a jarring & strain of the parts composing
the Joint takes place, hence why strains so often accompany
falls – When a Man falls from an eminence it being uncertain
what part shall immediately receive the shock no particular
set of Muscles can prepare themselves to support a Joint against
Injury.
We gain much information on this Subject from considering
the Cooperation of Muscles. This will enable as to learn why a
Man shall jump from a considerable eminence to the Ground with
out injury, yet from a slight fall shall violently strain the parts
subservient to some of the Joints of his body if we but eagerly clench

130.
depends in a great measure on its muscles we are enabled to account
for several Circumstances otherwise inexplicable.
689. Joints are capable of motion either passive or Active by the
former we mean motion given to a joint by external force, by the
latter that motion derived solely from its proper Muscles. 🜔.
690.
Note continued.
our fist we find not only the Muscles of the hand in motion, but a degree
of rigidity pervades the whole body, the general System of Muscles
cooperating so as to give additional strength to the primary ones
or those immediately concerned in the action of the hand, this is a familiar
instance of the Cooperation of Muscles, so when a Man is about
to jump from an Eminence not only the Muscles of the Legs prepare
themselves to give firmness to the Joint & resist violence but all the Muscles
of the body Exert themselves likewise to give general firmness &
by their general cooperation to assist the Muscles of the legs, in overcoming
the violence of the Jar.. if we suddenly raise an Animal
(as a Cat) upwards the body being elevated its muscles are relaxed, but
the moment we begin to let its body sink towrds the earth the whole
Muscular System becomes in action & a degree of rigidity is sensible
throughout its body, the same holds good with a Child: if in playing
with an Infant (though ever so young) we toss its body tow’rds the
heavens its Muscles whilst it is going upwards remain lax & at
rest, but as it descends towards the Earth they all become Rigid &
firm, prepared as we may say to receive the shock of violence
If

If a Man intentionally Jumps from a considerable Eminence
to the Ground as from an house loss his Knees or Ancle Joints are
injured because the power of the Muscles although prepared to resist
violence & give firmness to the Joints is less than the force with which
his body comes to the Ground & the greater overcomes the lesser.
If a Man jumps out of a Carriage in quick motion he generally
injures his Knee or Ancle Joints from the same cause, for although
he does not in this case jump from any great height, yet the projectile
force of the Carriage (out of which he is thrown as a Stone from a
sling) added to the weight of his body combine to give a greater shock
than the resting power of the Muscles can support, in these cases the
degree of violence, forcing the Joint to passive motion & that perhaps
in an unnatural direction is superior to the power of the muscles to
give firmness & resistence to the Joint.

131
690. Strains always arise from a weakness of the Muscles in
question, or from an intention in them to the task they have to
[ex??ite], being then taken by surprize.
691. If the force of passive motion given to a Joint be greater than
the power in the Muscles to give firmness to that Joint then a Strain
or some other injury to the Joint will ensue (687/689).
692. The Muscles themselves as well as the Joint suffer from strains,
& this from the Causes, being obliged to act unprepared, or being obliged
to resist a force superior to their powers.
693. Dislocations arise from the same Causes as Strains & it is not
impossible but fractures of bones may also be produced by them.
694. Crookedness of the Spine may also originate in a deficiency
of muscular powers, the Muscles of the back not being able to sustain
the trunk in its erect posture.
695. The same Cause likewise, probably gives occasion to Knocked
Knees, we rarely see very muscular People fall into these states.
696. The power of the Muscles in preserving joints being overcome
by the Violence of the external force applied, the joint gives way to
this violence as far as its ligaments will allow, there are stretched to
that side to which the Joint bends & these Ligaments are not unusually 
torn.
697. The joint being thus injured the following circumstances may
arise Vizt. Tumefaction of the Joint & this almost instantaneously.
Ecchymosis.

🜍. 701. When Joints after an injury recover their health it is Probably
the ligaments are injured & not the Cartilages.
702. If dislocations are not easily reduced the parts receiving
the dislocated bone adapt themselves to it.
☿. 703. In speaking of dislocations we say the bone farthest from
the trunk is dislocated, thus when there is a dislocation at the Elbow,
we say the ulna is dislocated not the humerus.

132
Heavy dull pain in the part ( )
Sickness ( ).
698. The tumefaction arises from an increased Secretion of Synovia
added to the other Common Causes of tumefaction from external injuries.
699. The parts which are the seat of pain though in their natural
state insensible now acquire great sensibility, this sensibility
leads to a natural Cure by incapacitating the patient for motion
& so necessitating him to remain in a state of rest.
700. In the treatment of strains & injuries of the ligamentous parts
of Joints, the indications are
Rest.
Topical bleeding, as by leeches.
The application of cold water, Vinegar, Spint; [Oari?]
&ca, or Fomentations.
701. But, the powers of restoration here being weak, the cure will
in general be tedious & too often imperfect, the joint sometimes never
recovering its original health. 🜍.
702 the common causes of Strains (690) will be also the causes of
Dislocations.
703. When a bone is dislocated, its end is thrown beyond the Articular
surface of the bone with which it is naturally conjoined. ☿.
704. The bone being thus displaced the action of the Muscles inserted
into it draws it upwards, so that the limb (if one of the Extremities
is concerned) appears generally shorter than its fellow & if

♁. 705. Here then retrograde motion is to be observed, & the last actions
in the dislocation is the first to be overcome, the last action is that of
the Muscles drawing up the dislocated bone & their force being overcome
by distension, in a proper direction & by it the Head of the bone being
brought to the edge of its receiving articular Surface is then by lateral
pressure to be forced into its place. The humerus is the bone that is
most frequently displaced & its reduction is rendered difficult among
other causes by the Scapula being a moveable bone, it is of the last
consequence sometimes to make the Scapula steadily fixed, a great
variety of motion & a great degree of mobility is incompatible with great
strength, this is a cause why dislocation of the humerus so frequently
occur how far the Ligaments are lacerated in dislocations is not yet
ascertained.
☉. 706. This happens most commonly in irreducible dislocations
of the thigh bone, for its head comes in contact with the Os Illium 
this may also take place in certain dislocations of the Os Humisi
where its head happens to be placed against the Scapula, these necessitous
joints are very similar, to simple fractures not uniting (616).
♂. 708. When a joint inflames it swells & becomes Extremely Painful;
Inflammation of a Joint always requires great attention.
Inflammation arising spontaneously is in general more dangerous
than Inflammation produced by external injuries.

133.
suffered to remain long so the reduction is frequently impossible.
705. In attempting the reduction of a dislocated bone the indications
are.
1st. to make the naturally most immoveable
part a fixed point.
2d. to overcome the action of the Muscles
which draw up the dislocated bone & resist its recovering its natural
situation. –
3d. then by making lateral pressure to force
the head of the dislocated bone in its proper place. ♁.
706. If a dislocated bone remains in its unnatural state a considerable
time & in contact with a bony surface by degrees it forms
to itself a new socket, the bone against which it presses undergoes
absorption, & the adhesive inflammation Arising in the parts around
a new joint is formed, these may be called necessitous joints. ☉.
707. Joints are more subject to fall into diseased habits than
any of the other circumscribed cavities & this from the nature of
the materials of which they are composed, some Joints are more
frequently the subjects of disease than others from being more exposed
to Injury as the Knee.
708. Joints are subject to the adhesive, suppurative & ulcerative
inflammations & to specific diseases as scrophula. ♂.
709. Scrophula may be brought into action in Joints having
a disposition to it by any external violence.



  
       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


134.
710. The adhesive Inflammation is not carried to the same extent
in Cavities of Joints, as in other circumscribed Cavities, because
adhesions being produced, would render a joint useless, but the Inflammation
runs into suppuration, or the Inflammation becomes
of the Scrophulous kind.
711. Inflammation of Joints whether arising spontaneously or
from violence requires.
Rest. Topical Bleeding, sometimes Blistering & general
Antiphlogistic Regimen but as soon as the disease becomes Stationary
it is to be considered as falling into a Scrophulous state &
the treatment of scrophula had recourse to.
712. If a joint takes on Suppuration every point of its Cavity falls
into it, Abscesses in the Joints should always be prevented if possible,
as they are productive of the greatest Evils.   
713. The suppuration here rarely goes on kindly, it is a mixture
of the adhesive & suppurative inflammations, the parts want power
to carry on readily any process, even ulceration goes on very slowly &
a considerable time is taken up, in bringing the matter to the Skin.
714. The ends of the bones forming the joint here become ulcerated,
indeed the bones seem to accept of the ulcerative Absorption more
readily than the other parts employed in forming the joint.
715. From the backwardness or inability of the parts to commence
the process of restoration & the constitution being long teized by an incurable
local Disease Hectic ( ) is produced & the patient is destroyed, unless

719. As between two ribs, this is seldom inconvenient but may
if it is taking place between the Radius & ulna, hinder the pronation
& supination of the hand, it happens when two Bones are within the
reach of ossific Inflammation arising in either of them.
Φ. 719. Here circumstances are similar to a fractured bone being
united by Granulation as in Compound fracture.

135.
saved by a timely Amputation which in general is best performed
early.
716. Diseases of the joints more readily produce Hectic than diseases
of the Bones in which joints are not affected, should circumstances
more kindly arise, & the suppuration & ulceration go on quickly,
it may happen that granulations may arise & a cure be obtained
without the loss of the limb & only with Abolition of motion in the joint.
717. If when motion is lost in a Joint, Anchyloses is said to have
taken place.
718. Anchyloses is produced by two Causes Vizt.
1st. By an immobility of the bones produced by a
change in the soft parts forming or surrounding the Joint.
2d. By an immediate Union between the Bones
themselves.
719. Anchyloses are of five kinds. Vizt.
1 Lateral Anchyloses.
2 Surrounding parts becoming bone.
3. The Capsular Ligaments of Joints taking on the
ossific Inflammation & becoming bony.
4 Granulation arising from the Soft parts in
a joint & afterwards becoming bone.
5. The ends of bones forming a Joint becoming
ulcerated & Granulations taking place, these granulations renting
becoming bony & in fact forming the two bones into one. Φ.


  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


136.
720. When in consequence of proceeding inflammation, or any
other cause, a stiffness & partial loss of motion in a Joint takes place
the Joint [persevering] preserving its original structure or at least
with little alteration, we can often restore its use by giving it a
passive motion frequently repeating it as advised after fracture of
bones communicating with Joints. (658).
721. The powers of Flexion are more easily restored to a limb than
the powers of extension.
722. When joints communicate or are in contact with each other,
as those of the Tarsus & Carpus. Suppuration beginning in one
joint will generally extend itself throughout the whole & all of them
will equally fall into disease.
723. A loose Cartilaginous or bony substance is sometimes found
in the Cavity of the knee Joint this may be formed in the following
manner, some blood being extravasated into the cavity of a
Joint may become organized & at length Cartilaginous or bony, not
being an original formed part, it may in the motions of the Knee
[be] broken off, from the part on which it had been formed, & thus
be found loose in the Cavity of the Joint.
724. Gun shot wounds, are to be considered in general as
wounds accompanied with contusion, they are followed by the same
effects & require the same mode of treatment.
725. These wounds being made by a projectile body driven wth.


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


137.
violence against a part, the extent & degree of the injury will
be in proportion to the magnitude of the projectile body & the Velocity
with which it is driven against a part.
726. The danger of Gun Shot Wounds is to be estimated according
to the nature of the part or parts injured & the degree & Extent
of the part injured.
727. Many circumstances will depend on the degree of velocity
with which the projectile body is driven against a part, as
1st. The greater the Velocity of the projectile body as
a Ball the more the Wound will be made in a straight line.
2d. The greater the Velocity of the ball the more the
Wound will approach to the nature of an incised Wound.
3d. The greater the Velocity of the ball, the greater
will be the danger of Hemorrhage.
4th. The Velocity of the Ball will decrease in invers’d
proportion to the obstruction given to it.
728. Gunshot wounds as all other Contused wounds are attended
in general with less hemorrhage than Wounds from incision
& gun shot wounds are in general slow in taking inflammation.
729. These wounds being attending with a destruction of the life
of several parts, cannot heal by the first or second intention, the dead parts
must slough & be thrown off, so that the process of suppuration
is necessary.


   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


138
730. The slough will be larger where the Ball enters than where
it goes out.
731. We divide Gunshot Wounds into Simple & Compound.
732. By simple we mean where the Ball passes into or through
soft parts only as Muscles & Integuments & which are not attended
with the effects enumerated in the following Aphorism.
733. The Compound [we] subdivide into
1st. Those in which a bone is fractured.
2d. Those attended with the division of some large
Artery. 
3d. Those penetrating some Cavity.
734. The penetrating wounds (733 3d) are either
A. simple penetrating or
B. Those also wounding some contained Viscus.
735. When a Ball passes through a part the most depending
orifice will heal sooner than the superior one.
736. The healing of Gunshot Wounds is always more slowly
performed than the healing of incised Wounds.
737. The degree of mischief done by Gunshot wounds is not
always Early to be ascertained, because parts may suffer violence
without any proof of the kind of injury appearing until sometime
after the accident for.
738. An Artery may be so injured that a portion of it shall become
dead, yet the seperation of the dead portion shall not

🜖. 741. As when a Ball, Bone, or any extravasated fluid presses
on the brain we may remove a portion of scalp to prepare for
the Trephine. As when the intestines come out through the
wound & cannot be returned without dilating it.

139.
take place at the time of the accident, but sometime afterwards,
so that though some hemorrhage happens when the injury is
received, yet a violent one may come on when the dead portion
of the Artery sloughs away – or.
739. A Ball penetrating the abdominal Cavity may bruise
even to death some portion of some Gut, yet the Canal shall
for the present remain entire, nor the exit of faces through its
side take place, until the seperation of the dead from the living
parts is affected.
740. Dilation of Gunshot wounds is not in general necessary
& therefore not to be practised, however the same indications
which require the dilations of other contused Wounds may also
direct us to enlarge these.
741. Dilatation of the Wound, or even the removal of a portion
of soft parts may be necessary when a Ball or other foreign
substance presses in any vital part, a large Artery, or a Nerve,
likewise in case a large Artery is wounded or can be taken up
also when a part is displaced & can be restored by dilating in all
these Cases it is right to enlarge the Wound. 🜖.
742. When a ball is lodged in a part where its continuance may
be the Cause of danger, if we can extract it, it is right to
make dilatation.
743. It is wrong to dilate simply, because a Ball is lodged

🜁. 743. Balls we know, often remain in parts for years
without producing any inconvenience & sometimes they are
never found, with regard then simply to the ball being
lodged in the body, the Surgeon need be under but little concern,
he has only to take into consideration, the other circumstances
present, as the seat of the Ball, the nature of the Part
injured &ca. –
♂. 745. Four Frenchmen were badly wounded by gun shots at
Belisle, two through the Chest, one through the Elbow & one
through the Deltoid Muscles, Scapula &ca. All the Patients did
well without dilatation of their wounds. If the surgeon makes
dilatation, the consequence is that the cure will remain unaccomplished
equally as long as if nothing had been done, The superficial
parts will heal to a very small hole & the deep seated
ones remain open, so that a fistula will remain, incurable untill
all the dead or foreign matter is come away, as exfoliation
of bone &ca. Again in gun shot wounds where the Ball cannot
be followed, as when it has entered the bones of the face, dilatation
must be entirely useless. A Reason given for dilatation
has been the preventing or taking off inflammation & tension,
but has not the incision made in dilating rather a tendency

140
in a fleshy part, or with a view to Extract a Ball, where the
circumstances similar to these (741-742) do not indicate the dilation
of the wound. 🜁.
744. In simple gun shot wounds no advantage is gained by
their dilatation, for the wound made by the knife of the Surgeon
will heal much sooner than the wound made by the Ball
so that dilating will not alter the nature of the Wound or
hasten the Cure.
745. Moreover if an Extraneous body, as a Ball splinter of a
bone &ca. is to be thrown off, the wound though dilated or treated
in any other manner will not heal until the foreign matter
is thrown off, so that, all attempts tow’rds a Cure must be fruitless,
until that Event takes place, the wound will heal so as to
leave a small hole only, open, which will remain unhealed until
all the Extraneous matters, which are to be thrown off
are come away. ♂.
746. In examining Gun shot wounds the probe should never
be used where the finger can be admitted, & forceps &ca is never
to be introduced but when the Ball &ca. is within our reach.
747. If a Ball passes some way under the Skin, & again
passes out at a considerable distance, an opening should be
made midway between the two orifices to prevent the formation
of an Abscess.

to induce these affections.
🜔vmss. 🜔. 751. Balls that do not go through & through are
generally Spent balls, unless it happens that a ball strikes
against a bone; a Ball shall sometimes enter the breast obliquely
& afterwards go almost round the whole body & be directed
by a rib until it pier as the Skin & makes its way outwards.
The Course of some balls is really surprising, Mr. H has seen
a ball enter on one side the Shin bone, go across it & raise up
the Skin from the Periosteum & make its exit on the opposite side
without doing any injury to the bone, now had the Ball struck
the part with great velocity it must have gone directly across the
bone & carried away a Portion of it. A Soldier had a Ball
enter the Biceps Muscle of the Arm & pass out under the Scapula
close to the Spine.
🜔vmss. 🜖. 752. It is difficult to say on what this red line depends,
it seems to be neither the effect of Inflammation nor
of Extravasation.

141.
748. If a Ball passes through & through immediately under
the Skin, the orifices not being far asunder, it might be right
to open the sinuous wound it has made through its whole
length, for the Skin does not so readily unite with the parts
underneath, as muscular parts do with each other.
749. If a Ball is lodged under the Skin & can be felt & the
integuments are bruised & threaten to slough away, it may
be right to incise the Skin & Extract it, for the mischief will
not be increased by taking it out, & it will be giving satisfaction
to the patients mind.
750. If the Skin appears to remain quite sound & free from inflammation
or disposition to slough the immediate extraction
of the ball is by no means necessary.
751. The Course of the ball will be ever extremely irregular it
will vary from the perpendicular or Horizontal direction to Oblique
or tortuous & sometimes its Course will make a considerable
section of a Circle. 🜔vmss. 🜔.
752. A red line appearing on the Skin will in general merk
the Course of the ball. 🜔vmss. 🜖.
753. It is unnecessary to dilate a Wound penetrating a Cavity,
as the Abdomen, or Thorax unless, some other Object requires
the attention of the Surgeon than the simple penetration of the
Cavity.

     

 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


142.
754. Compound Gunshot wounds in which an Artery is divided,
or a bone fractured, as there is nothing specific in their nature
so the general principles of Surgery will apply to their
treatment.
755. Penetrating Wounds (733 3d) are divided into
a. Simply penetrating wounds.
b. Wounds penetrating some contained Viscus.
The containing Cavities will be the abdomen, the thorax & the Cranium.
756. Wounds simply penetrating the Abdomen will in general
do well, provided the first or second mode of union takes place, so
as to exclude the Stimulus of imperfection from giving a general
alarm to the whole Cavity.
757. Compound penetrating wounds of the abdomen will again
divide themselves into two kinds
1st. Those which penetrate some containing Viscus
as the Stomach, small intestines, large intestines, Bladder &ca
2d. Those which penetrate some non containing
Viscus as the liver, spleen &ca.
758. The Compound penetrating Wounds (757 1st.) will have different
Symptoms according to the part receiving the Injury.
759. The Symptoms of wounded Viscera will be either
1. Immediate or
2. Secondary.

🜔vuss. 🜖. 760. A Young Gentleman received two or three Shots
in his abdomen, one of which went through his body, entering
before & coming out near the Spine, his stools were natural, from
which Mr. Hunter pronounced his bowels unhurt, his urine was
bloody, which shewed either his Kidney or his Bladder to be wounded,
he recovered.

143
By the first is meant peculiar Symptoms arising immediately
from the injury done to the Viscus.
By the second, those which arise from the consequences of that injury
& not from the injury itself.
760. The immediate Symptoms of wounded Stomach will be
sickness, Vomiting, great depression of Mind &ca.
Wounded Intestines --- Bloody Stools.
--- Liver --- Pain in the right or left Shoulder,
according as the right or left lobe of the Liver is wounded, discharge
of pure Blood by stool.
Kidneys or Bladder --- Bloody Urine, & here the Ball if it
remains unextracted may prove a nucleus for a future Stone,
a wound of the Spleen will give no particular symptoms, it is
in general followed by a profuse extravasation of blood into the Cavity
of the Abdomen.
In general wounds of the Liver & Spleen will have none but immediate
Symptoms. 🜔vuss. 🜖.
761. It will however be very different in Wounded containing
Viscera or those which naturally contain quantities of foreign secreted
matter, as the Stomach, the Intestinal Canal, the Bladder
the Gall Bladder &ca. the Intestinal Canal being wounded, considerable
time may be elapsed before the seperation of a Slough
gives an opportunity for the fœces to escape, these getting into the
common Cavity of the abdomen, at what distance of time soever from

🜔vuss. Φ. 762. A Gentleman in Duel had a Ball passed through
his Belly, he had no particular Symptoms for 13 days, on the 14th
fœces came through the Wound nothing further indicating mischief
Mr. H pronounced him, out of danger forming his prognosis
on the principles laid down in the text.

144
the injury, will become the cause of general inflammation
of the whole Cavity with all its consequences, as suppuration,
Gangrene & Death. A Wound of the Gall Bladder, ductus Coliducus,
Parceaticus, or Urinary Bladder, if communicating with
the common cavity, may produce the same affects though probably,
more slowly, see ( ).
762. In general Wounds of the containing Viscera will destroy
the Patient, but it sometimes happens that previous to the
appearance of any secondary Symptoms adhesions shall take
place between the Wound in the intestines & the wound in the
peritoneum & common integuments, so that when the slough comes
away the fœces &ca. will escape, not into the Cavity of the Abdomen
but through the artificial Canal formed by the adhesive inflammation,
& which as an artificial Anus or Urethra, will
give an exit to the Substances to be evacuated, when this circumstance
takes place no other ill Symptom forbidding us, we may
offer a favorable prognostic. 🜔vuss. Φ.
763. The time which may elapse before the secondary symptoms
appear may be, 10-12, or 14 days (762 Note).
764. The Artificial Canal (762) will sometimes close & heal up.
765. Wounds simply penetrating the Cavity of the Thorax will
be only so far dangerous, as they may produce exposure of the thoracic
Cavity, if the first or second mode of union takes place before



 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


145.
before the alarm is given to the Cavity no mischief arises.
766. Wounds of the Lungs are not always fatal, those made
by a Shot are less frequently destructive than those made by
a sharp instrument, as a Sword or Bayonet, for
767. One great cause of the Mortality of Wounds in the Lungs
being excessive hemorrhage into the Cavity of the Thorax, the
hemorrhage following a Gun shot wound will be much less than
that produced by a cutting instrument.
768. Symptoms of a wounded Lung will be Bleeding from the
Larynx, Cough, pain, in the side, fainting difficulty of breathing.
Diminution of motion in the muscles of the Thorax because
the Muscles of one side cannot act without those of the other
side acting likewise.
769. The Wound being in a Vital part the pulse will grow quite
hard.
770. The Patient will not lie in an horizontal posture but is
desirous of sitting Erect that his Diaphragm may be as freely
expanded as possible.
771. A profuse Extravasation of blood in the Thoracic Cavity may
be judged of from the sense of weight complain’d of by the patient,
from the lowness & faintness which must attend so sudden & copious
evacuation from the Lungs, & the common Symptoms of a sudden
accumulation of fluid in the Thorax. ( ). –

🜔🜹. 773. Penetrating wounds of the cavity of the head will be
considered among the diseases of the Encephalon (785).

146.
772. A Gun shot wound penetrating the Lungs, the wounded
Lung, commonly collapses & therefore an adhesive of the
wounded part to the pleura cannot take place
773. Gunshot wounds not healing without suppuration soon
will be left for the matter, which may be collected in the Chest
to drain off, but this will be attended with the inconvenience of
making the Thorax an exposed & imperfect Cavity, if the quantity
of Blood Extravasated is small it may be absorbed, but if there
are Symptoms of a large quantity being collected in that Cavity the
operation for the Empyema should be performed as early as possible,
because if the Blood coagulates it will adhere to the sides
of the Cavity & not be got out without the greatest difficulty, or in
some cases it may suffice, or be best to enlarge the original
Wound. 🜔🜹.
774. Gunshot Wounds may so far injure a part, that the process
of restoration cannot take place in it, & therefore the Wound
is rendered incurable, in this case the removal of the part becomes
necessary, & when a part, as are upper or lower limb has been
so much injured that its removal is necessary, we must determine
in what case Amputation should be immediately performed or
in what it may be deferred to some future Period.
775. Should a part, (as an upper or lower extremity) be so far       
nearly seperated from the body, as only to hang by a small Portion


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


147.
Portion of soft parts, it may be immediately removed.
776. Should an hemorrhage from some Vessel, which cannot
be restrained endanger the Life of the Patient, amputation of
the Limb should be immediately performed.
777. But in most other cases, it is adviseable to defer the Amputation
until the Inflammation is gone off.
778. If a Cavity is wounded & any of the contained Viscera protruded
they should be immediately replaced.
779. Bleeding is not indiscriminately to be had recourse to in
Gun shot wounds
780. We are always to be directed in our opinion with respect to
this Evacuation, by the nature & situation of the part injured, & its
powers of action, & the general strength of the patient in proportion
to the general action of the Vessels.
781. Excessive bleedings having been employed, Patients have
sunk suddenly.
782. The use of the bark becomes highly proper after Inflammation
has subsided, & even during the presence of Inflammation if
attended with weakness of the System, it is however necessary sometimes
to accompany its use with small bleedings.
783. After the sloughs occasioned by Gun shot Wounds have been
thrown off, though the Ball or other Extraneous matter remains
in the body, the ulcer will granulate & continue to heal so long

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


148.
as the extraneous matter remains quiet & does not stimulate
784. When an Extraneous body remains unremoved, the ulcer
may become fistulous, or a fistula may even be formed when the
foreign body has been extracted, in which case it is to be treated
as another fistula.
785. Tents are however always improper.
786. Diseases of the Brain are of two kinds, Vizt.
a. Where the imagination is affected, from various
causes as in Mania &ca.
b. from Mechanical Injuries.
787. Mechanichal Injuries (.786.b.) may be either. 1st. concussion
2d. Compression, 3d. Wound or loss of substance 4th want of due compression.
788. The three first may exist seperately, or any two, or all three
together, their Symptoms will be nearly similar, there are as cessation
of sensation, & voluntary actions, the Muscles of the mouth &
throat becoming flaccid, froth being discharged from the mouth
with the appearance of fullness of the Vessels, the Symptoms
of the 4th. will be restlessness & insensibility.
789. Vomiting accompanies all these affections of the brain & arises
from Sympathy.
790. Vomiting however never takes place during the time of perfect
insensibility. –

  
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
791. Injuries done to the Brain diminish sensibility, Injuries
of other parts increase it to a certain degree.
792. Concussion (787) may depend upon a displacement of parts
of the brain, the degree of concussion will be in proportion to the
violence with which the blow is given, whether the head falls
against any Body, or any hard body is driven against it.
793. Compression ( ) may follow accidental Violence immediately
or arise sometime after.
794. Compressions may be owing to any of the following causes
Vizt.
1st. To a depression of the Scull from Fracture
2d. to pressure of some part of the Cranium from the
thickening of a diseased Bone.
3d. To water in the Ventricles
4th. To distention of the Blood Vessels.
5th. To Inflammation.
6th. To the formation of Pus
7th. To the extravasation of Blood.
8th. To a Tumor in the substance of the Brain itself.
The causes of Wounds or loss of substance in the Brain must be
sufficiently obvious.
795. Concussion will be either.
a – Simple – b – Compound immediately or
c – Compound secondarily.
796. Simple Concussion is where there is no fracture, compression

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
or Extravasation, we must endeavour to distinguish between Concussion
& the effects of intoxication. The effects of simple concussion
will soon be carried off by plentiful bleeding &ca. but if it is
Complicated with Compression the effects will not be diminished by
time, but rather increased, Compression may instantaneously follow
Concussion, in which case it is said to be compounded immediately,
or Compression may arise when the effects of Concussion would
be naturally going in which case is said to be compounded
Secondarily.
797. Fractures of the Scull may always be considered as compound
Fractures, they are either made so intentionally by the Surgeon,
or are found by him in that state.
798. Fractures of the Skull are of three kinds. Vizt.
1st. Fracture of the Outer plate
2d. Fissure
3d. Bone broken in several places
These may be complicated with each other.
799. The 1st & 2d. (798) may be the remote Cause of Compression (793)
& the third may in itself become the immediately Cause of Pressure on
the Brain.
800. Bleeding from the Nostrils or Ears, is a common though an equivocal
Symptom of a fracture of the Cranium
801. The concussion will be in general less, where the Bone is much
shattered than when otherwise, for the force being spent upon the Skull
less shock is given to the Brain.

       
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


150.
802. Gun shot Wounds of the Head & those made by other Bodies
moving with great Velocity do not produce for the most part great
concussion.
803. Fissures of the Scull will run in very different directions along
the Cranium, across it, & even across the Sutures. –
804. If the Scull is soft & yielding there will be often depression of the
bone without fracture.
805. When there is fracture & depression of both tables, if the fracture
detaches an entire piece of bone from the undepressed Cranium & that
whole piece is driven downwards, then the fracture of the internal table
will always be larger than that of the External.
806. If the fractured bone is depressed on one Edge only, & through
both Tables, the inner table will still go shelving off beyond the outer.
807. hence (805-806) will appear the difficulty of elevating depressed
portions of bone, so as to make the seperated pieces, fit themselves
to the undepressed Cranium perfectly smooth, hence also the utility
when a portion of bone is to be removed, to make the margin of the depressed
piece a part of it.
808. The indication in all fractures of the Scull, is to prevent or remove
pressure on a Vital part, that is the Encephalon, therefore it is
necessary whenever there is a fraction with depression, when a piece
is detached & driven inward to remove it entirely, or if one edge only
is depressed to take care to elevate it properly, the operation employed
for the purpose of elevating or removing depressed Bone, or for making

🜔vmss 🜖. 814. The situation of the extravasated fluid will be very
different in different Cases & hence the great uncertainty of our Release
the Patient, who labours under compression from some cause independent
of depressed bone, it may be between the dura mater of the Scull,
between the dura & pia mater, between the pia mater & the brain,
or it may be in the Ventricles, & even in the substance of the brain itself.

151.
an opening for any necessary purpose into the Cranium is called
trepanning & the instrument used by Surgeons for that end is called
the Trephine.
809. When a fracture is discovered it should in general be traced as
far as possible throughout its extent, & therefore we are sometimes Obliged
to remove the Scalp freely.
810. Fractures of the Scull are so often complicated with the immediate
or secondary symptoms of Injured brain, that few cases will
offer in which the trephine will not be necessary.
811. It is never necessary to apply the Trephine either in Cases of
fissure or fracture of the outer table only, unless there are also Symptoms
of an injured brain, & those not of Simple concussion alone.
812. In all cases of Compression either immediate or Secondary of Concussion,
complicated with compression, & in all wounds of the brain
it is necessary to apply the Trephine.
813. It may sometimes be impossible to ascertain the exact situation
of the Compressing matter, yet here, as the patient must undoubtedly
die if not relieved, it is justifiable to operate at Random.
814. The situation of extravasated fluid will sometimes be opposite
to the part where the blow was received. 🜔vmss 🜖.
815. The dura mater should never be divided unless from the
greatest & most evident necessity (as when matter or blood is visibly
lodged beneath it) for penetrating Wounds of the dura mater (which
exposes & renders imperfect a Cavity containing the Brain) will in general

♀. 815. Mr. Hunter computes that not more than one in 20 persons in head
would recover from a penetrating wound of the dura mater.
♂. 819. In health we know the Strength is always greater than
the actions.

152.
general be mortal. ♀.
816. The Trephine must be applied (one, twice) or as many times
as the Extent of the Injury shall require.
817. The Trephine may be applied in any part of the arch of the
Cranium where an accident may render it necessary, or eligible, if the
fracture is circular it will be right to repeat the application of the Trephine
until it is surrounded by the perforations.
818. As life consists in the properties of preservation & Action, so
Death is the loss of both.
819. The immediate Cause of death in a part would appear in most
cases to arise from a total loss of Circulation, but this must be the
effect of some remote Cause. ♂.
820. Mortification of a part differs much from common universal
Death, in the latter case the Vessels can be injected & the Structure [cross out]
of the parts examined, but this is not the case with the former its
Vessels cannot be injected, its structure is changed, is destroyed.
821. The immediate cause of mortification, will be whatever can
excite the actions of a part so as to render them superior to its strength,
or reduce the strength of a part so as to be unequal to its actions.
822. Debility Can be only the predisposing Cause of mortification it
cannot immediately produce it, if a part is ever so weak while its
actions, do not exceed its strength it will retain life.
823. From (813) it is evident that a part may fall into mortification
either with or without previous inflammation, in the former Case the

∇. 824. The greater the distance from the heart the more liable are
parts to mortification.

153.
inflammation is the immediate cause of death.
824. Heat should always be in proportion to the living principle otherwise
it produces a necessity of Exertion, which the strength of a
part is not equal to, the exciting of heat then in a part where powers
are very weak may induce mortification.
825. When parts are extremly weakened as to their principle of Life,
by Cold (as when people are frost bitten) the application of heat must be
gradual & Slow, otherwise it will necessarily induce mortification ( ) as
the principle of Life increases the heat may be increased.
826. from (819) we are enabled to discover why scarifications in the
legs of anasarcous patients, or wounds made in their extremities,
either by Art or Accident, why Blisters applied to persons in whose
Systems there is great debility & a disposition to putrefaction should be
followed by [Putrefaction] Mortification.
827. Also why Persons who have suffered severe famine, long exposure
to intense cold, are in extreme old Age, or who have the Circulation
obstructed through a part, or those of tall stature are subject
to Mortification, especially of the feet & Toes.
828. In the Cure of mortification, or restoring parts falling into mortification,
it must be evident that as the cause is a diminution of
powers in proportion to the actions of a part whether common or increased
so the Cure must consist in lessening Actions & in increasing the
powers of the part.
829. Whatever then stimulates a part to action without increasing its

☽︎. 830. The temperature of the atmosphere in which patients to
be cured of Mortification are best placed, should be neither very
hot, nor very Cold, that the natural actions may neither be impeded,
nor hurried on too fast. –

154
strength & powers, must be contraindicated.
830. Hence also it is evident why bark should have so much power
in checking some inflammations, & that opium may prove a very
useful remedy. ☽︎.
831. The Causes will be either (819).
a. Mechanical, as a Blow, or
b. Chemical as a Caustic
832. The less vascular a part is the more readily its Life, is destroyed.
833. Also the weaker the powers of Life in a part are, the more easily
will they be acted on by Caustics.
834. No substance can act chemically but in solution, in order for
the Caustic to act chemically it must be moistened, this is effected
by the serum produced from the vesication which arises from the irritation
caused, by the application of the caustic substance, which Serum mostens
the Substance & thus after the Life of the part is unable to Acts for its
preservation, Operates chemically on the Skin &ca.
835. The action of a caustic when applied to a part produces an
abolition of Life & then the Caustic acts chemically upon its substance
coagulating its Mucilaginous parts & changing its texture.
836. Mortification on the death of a part is often induced with
a view to destroy a diseased or even a sound part (in order to enable
us to make application to some diseased part otherwise out of our
reach) or to give an exit to some foreign substance retained under

 



 
   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


155.
the Skin, as pus &ca.
837. The Effects (834 &ca.) will be produced by a variety of substances
artificially & intentionally applied of these the principal are
Caustic Alkalies
Concentrated Acids & Metallic Salts.
838. Of the Metallic Salts Arsenic is the most powerful, whose action
is different in some measure from that of the other Caustics,
as it produces mortification simply by its exciting violent actions in
parts which they cannot support, & not by any chemical process.
839. The application of these substances to sentient parts is attended
with violent pain, that is to be diminished
1st. By the administration of Opium by the Stomach.
2d. By mixing opium with the substance to be applied
3d. By applying plaisters of Opium to the part for some
hours previous to the application of the Caustic.
840. The natural sequel of mortification is a sloughing of the
mortified part, or the process by which it is thrown off from the living
parts immediately in Contact with the dead & the ulcerative absorption
of them is necessary (449).
842. As in the Exfoliation of Bones, so in the sloughing of soft parts
the absorption begins at the external edges of the dead parts, the dead
part becomes dark Coloured & dry, the ulcerative absorption beginning
at the Edges & going through the whole surface of Contact of the living
with then dead parts, the slough is ultimately thrown off like any

☿. 846. We know with some certainly, how far the parts of the body
the Brain excepted & with what comparitive facility they go through
the process of Sloughing, the nearer the heart Cotises Paribus the
more readily the process of seperation will go on, the common integuments
& Muscles will throw off a dead part sooner than a Tendon
Ligament or Bone, as to the Brain it has not been ascertained
whether it will slough or not, for before the seperation of the dead
part can possibly take place, the Patient in general dies.
🜔^. 847. Thus if a Limb is mortified throughout its substance
we may cut off a portion of the dead parts to lessen the Stench
arising from so large a mass of Putrid matter, & render the patients
situation more comfortable, but we must not proceed to amtating
in the living Parts until a compleat seperation has taken
place.

156.
other extraneous Body.
843. As the weaker the part is the more easily is it Acted upon by Caustic,
so the greater the strength of a part, the more readily the seperation
of the slough will go on.
844. New formed, being weaker than original parts it is evident
they will suffer their Life to be much sooner destroyed by Caustics.
845. From (844) we are enabled to learn, why in new formed parts, Mortification
is so Easily induced, as in larger cicatrices &ca.
846. Also why Caustics so easily destroy the fungous Excrescenous
of Ulcers &ca. ☿.
847. In a mortification no incision or wound is ever to be made,
into living parts, at least until the process of seperation is begun,
a portion of the parts quite dead, may however be removed at pleasure.
🜔^.
End of Volume the First.

INDEX
Aphorism Page
A
Animal actions of---39---10 
Arteries---51---13
Absorbents---53---13
Absorption the final end of---56---14
___ulcerative----61, 440---15, 83
Actions voluntary---75---18
___two different cannot exist &ca.---169---35
Air affecting animals---147---31
Anchyloses---718---135
B
Brain and Nerves &ca---69---17
Blood living principle of---110---24
Bladder inflammation of---526---98
Brain inflammation of---548---102
Bones disease in---595---113
Brain disease of---786---148
C
Cicatrization---452---85
Cesarian Operation---525---97
Cartilage---675---128
D
Disease---154---32
Diseases division of---185---38
___local---190---41
___Constitutional---195---42
Dissolution the action of---476---88
Dislocations---693---131
E
Empyema---493---93
Emphysema---500---94
Eye inflammation of the Chambers of---533---99
Exfoliation---618---117
F
Fermentation in Animals---22---7
Fractures---570---108
___communicating with Joints---654---123

G
Granulation---445---84.
H
Habit---98---21
Heat---122---26
Hectic---464---87
Hydrocele---549---102
I
Ideas---71---17
Inflammation---285---57
___Cure---364---71. 
___Topical applications to---387---75
___ulcerative---427---81
Joints---683---129
___& Sacculi Mucosa exposure of---527---98
Joint Cartilage in---723---136
L
Life principle of---24---7
M
Matter---1---4
Medicines---226---48
___their mode of acting---234---49
Mortification---818---152
P
Part the actions of---239---50
Pus---415---79
Pleura Inflammation of---487---91
Pericardium Inflammation of---504---94
Peritoneum Inflammation of---507---95
Puerperal Fever---519---96
Patella fractures of---659---124
S
Stomach---44---11
Senses---70---17
Sympathy---201---42
Suppuration---398---76
Strains---690---131
Scull Fractures of---797---149
V
Vascular System---49---13
Veins---52---13
___Inflammation of---542---101

Aphorism Page
V
Viscera Wounded---759---142
W
Will---74---18.
Wounds Gunshot---724---136
___Penetrating---755---142.


   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  

























Thomas Windsor
Manchester
?-1745
(1845)
A gift for the library of the Surgeon-General, Washington
T. Windsor
July 18, 1885.
LECTURES
on the
RATIONALE of SURGERY
by
JOHN HUNTER.
VOL.I.






1
Introduction.
In the course of these Lectures I shall differ very much
from what is taught in Books on the subject of Surgery. The Ideas
I have to communicate are mostly my own, & not drawn from Books
I have reason to suppose them true because they are founded upon
facts. –
I shall consider first the Animal Œconemy. I shall mention
chiefly the actions of the body on a diseased state, with their recoveries
& natural functions in health. I have it not in view to
give a full course of Practical Surgery, but to teach the principles
of the Art.
I will be unnecessary to treat of the Operations & of every
particular disease; these are taught by Anatomists & others, the
principles are most necessary & those only shall be the subject of
our enquiry.
Every Art has its principles, from which we are enabled
to establish old facts, and account for new ones, the same holds
good in Surgery.
Effects are what strike the senses more forcibly even
while the cause is unknown, but as these are only consequences we
should endeavour to discover the Causes.
We know the causes of Inflammation, Suppuration
and Mortification, hence we are enabled to check their progress.
We find it necessary sometimes to increase the violence





2
violence of a disease, before we can effect a Cure, as in indolen Inflammations
&ca. –
Sometimes it is necessary to change one disease into
another, - in Venereal Inflammation, by exciting a common Inflammation
we cure the disease.
If the Animal was always equal to the task it has
to perform, surgery would be unnecessary, but the powers of restoration
which arise out of the Animal, being not always sufficient, it
is our business to increase the action where too weak & vice versa.
It becomes often necessary to introduce Chemical means
in the Cure of diseases, these failing we have recourse to Mechanical
ones, as the different Operations.
As the Operations (tho the necessity for them is the
defect of Surgery) become sometimes indispensibly necessary, it is
right to know how to perform them.
A compleat knowledge of the parts of the Animal
Body should be strictly attended to, as this will lead us to their
uses, we should know the different Functions and consider the
dependence one action has upon another.
With regard to operations we should know when
they will relieve, & when nothing but an operation will relieve &  
also know when the Habit will bear an operation (this is sometimes
almost impossible to ascertain)
The facility with which a Man thinks gives him
a superiority over others, few have observed nature with more attention
than myself, yet even now, I think myself scarcely equal to the
task I have undertaken. A man will be ignorant of the knowledge




3
he possesses until he arranges his Ideas.
The principles of Diseases which are the objects of
Surgery, have not been sufficiently attended to, these we intend
chiefly to consider.
We shall begin with Physiology, so far as it is necessary
to understand the principles of diseases.
Disease may be called a perversion of the natural
Actions of the Animal Œconomy.
I will first consider those diseases, that arise from
accident. Secondly those that are similar to them, then
the Union of divided Parts by the first intention, next Inflammations
which will throw a light on various subjects, as adhesions,
The Cure of the Hydrocele, Indurated Tumors &ca. Then the
union of Parts not cured by the first Intention, as Compound Fractures.
&ca.
Lastly we shall treat of some specific Diseases as
Scrophula, Cancer, &ca. –
J. Hunter.

Notes
🜹 3. So also the properties of matter act upon our senses, the sensation
of sweet or sour, are not matter, but the properties of matter
acting upon the Tongue.
Touch arises from resistance in matter. –
+ 5. By attraction of cohesion bodies of similar properties tend to
come in contact with one another & to remain so when this is effected,
this attraction is very slight in fluidity, in this however the stronger
it is the more globular or spherical the particles appear & vice versa.
Elective attraction disposes bodies, to join with various other [cross out] stances,
forming together one homogeneous mass. – of this we
have an instance in the combination of an air with an Alkali; there
are so many different Elective attractions, as there are methods of mixing
matter. – Elective attraction operates only when fluidity & vapour
are present, the compounds may however become solid afterwards
by the attraction of Cohesion. – The increased attraction of
Cohesion found in solid Bodies may be called the attraction of solidity.
 
        
 


4
Rationale of Surgery.
Matter. –
1st. – By matter we mean that substance of which this Globe or
Earth is composed.  
2. By the impressions of matter alone, we are led to the knowledge
of our senses, & by our senses only we judge of the existence
of matter.
3. But our sensations are excited not by the impressions of matter
itself, but by the impressions of the effects of matter; - thus
when we hear a Drum beat, our sensation is not excited by the
Drum, but by the vibrations of the Air produced by the strokes on
the Instruments. 🜹.
4. Matter is found in one of the following states, Solidity, Fluidity
or Vapour.
5. The general kinds & properties of matter are few but different
modifications, & combinations of those kinds & properties of
matter produce great varieties in appearance.
6. The following properties are common to matter, attraction of
cohesion, chemical or elective attractions, & attraction of Gravitation. +
7. Repulsion is also a property of matter but it seems doubtful
whether it is so universal a property as that of attraction, nevertheless
the action of repulsion seems to be in a great measure

🜔 10. Heat seems to destroy all attractions. – Mechanics depend
upon the external figure & magnitude of bodies & upon the properties
of gravitation, attraction, &ca. –
     
        
 


5
the cause of Fluidity & Vapour.
8. Magnetism seems to belong to attraction of gravitation, by the
attraction of gravitation the different parts of matter are kept together,
so as to form one great whole.
9. Each mass of matter though never so minute has in itself
a Centre of Attraction.
10. Heat also seems a generally necessary Agent to Fluidity & Vapor. 🜔 
11. The operations arising from changes in matter are regular &
determined according to certain & fix’d Laws.
12. We have been considering & speaking of the properties & modification
of common matter, but considerations on matter may be
carried much higher, & modifications of, or kinds of matter may
be found entirely different in every respect from common matter.
These are the matter of Animals & Vegetables.
13. The first principles of Animal & Vegetable matter are perhaps
the same, but they have many properties totally distinct
& different from one another.
14. It is observed (13) that the properties of Vegetable & Animal
matter are perfectly distinct, although their first principles may
be similar; & indeed so perfectly & entirely distinct are Vegetables
& Animals in many properties, & in the modification of
matter, as observed in their production & formation that no connection
between them has ever been traced.
15. They differ totally from common matter in that they have
each of them a power of acting, & performing various operations
within themselves & of producing or generating matter of their
own Genus from themselves. –

♂. 17. The circumstances of worms &ca. which feed upon Earth
would seem to afford an exception to this position, it is likely
however that the Earth they take in is only useful so far as it contains
Animal or Vegetable Matter. – In order to determine this
we should combine an Alkaline Salt with Earth, which will destroy
whatever Animal or Vegetable matter it contains, the wash it thoroughly
& try if a Worm will live in it.

6
16. Vegetables & Animals especially differ from each other, both
Indeed have a power of performing operations within themselves
& of generating from themselves new matter, but in other respects
they very essentially differ.
17. The operations of Animals are attended with waste of their
component parts, this waste is recruited by a supply from common
matter, but common matter cannot be immediately converted
into Animal substance, nor can the decay of Animal substance
be supplied from common matter until it has by certain [degrees]
changes been already altered into Animal or Vegetable matter.
Vegetables can immediately convert common matter into their own
substance & be supplied from it, but Animals cannot, which proves
that Animal matter is still farther removed from common Matter,
than the Vegetable. ♂.
18. Animals & Vegetable Matter may be viewed in two states, as
living or dead; - when living it has in itself a power both of
continuance & generating new living Animal matter, but when
dead it loses these powers.
19. Animal & Vegetable Matter after death is capable of being
acted upon by the operations of chemistry., & by those of spontaneous
dissolution, by which latter it is at length reduced to
common matter, out of which probably it is at first formed the
presence of life is an antidote to, and resists both one & the other
20. Animal Matter submitted to Chemical enquiring & the operation
of Fire, yields certain substances peculiar to itself, as
the Volatile Alkali, Empyreumatic Oil, Calcareous Earth [&ca.]
& a kind of Water, other substances as Iron &ca. are also found

 


7
which are superadded & do not constitute its natural component
parts. –
21. Animal Matter may receive a supply of its waste from
Vegetable Matter. –
Fermentation in Animals.
22. Many changes taking place during Life in Animal and
Vegetable matter have been attributed to a certain operation called
Fermentation, for it is known fermentation will alter powerfully
all substances which are subject to its action, & even changes them
into new & totally different substances, to this the secretions of
Animal Bodies have been supposed to be owing, to this the
change of the Water into the Juices of the different Plants nourished
solely by it has been imputed, to this Digestion &ca. –
23. But the Animal & the Vegetable Bodies are the subjects of
fermentation, no change wrought in them during Life can possibly
arise from this cause, for the presence of Life resists fermentation,
it is impossible it can only take place after the destruction
of Life, which is the preserving principle, we here speak of Fermentation
in the same sense the Chemists use it.
Principles of Life.
24. The changes arising in the Animal & Vegetable matter during
the presence of Life, are produced alone, by the peculiar power of
the principle of Life, to its operations we refer all the Secretions

♁ 28. Some experiments to elucidate – 28.
Expt. 1st. Mr. Hunter found that a new laid Egg tho kept by incubation
in an heat of 120° until it was hatched in 2 or 3 weeks,
when the Chicken was excluded, shewed not the least sign of Putrefaction; -
another Egg which was not hatched & of course died,
became in the same circumstances highly Putrid. –
Expt. 2nd. – A new laid Egg was exposed to heat between 17°.
& 15°. Farht. in which situation it was kept half an hour, its Life
being then destroyed by freezing it was thawed by Heat, being
then exposed to 25°. It then froze in half the time it before required,
that is in 15 minutes, while alive it had the power of resisting
Cold & consequently the destruction of its Life, a considerable
time, but when once killed it had no longer the property of resisting
the freezing power of cold. – Mr. Hunter made a number of
other Experiments on Animals & parts of Animals, he attempted to
freeze 2 Carp but without success, he found that for a long time
they generated heat & resisted the destruction of their Life by freezing
at length that power was exhausted & they died; the power
of resisting death almost every thing possessed of Life enjoys.
Mr Hunter found living Vegetables would endure Cold & resist being
frozen much longer than Plants whose vegetable life had been
destroy’d. – Experiments were tried on Dormice &ca. and all
had the same result. –
Experiment 3d. A dead Egg froze in the degree of 32 & a living
one gradually sunk to 29, it then continued stationary for
sometime, after which it rose to 32 & then became frozen, to

8
all the new productions, the digestion of other substances &ca.
25. The Operations of the Principle of Life cannot be referred to
Mechanical powers.
26. Life is totally distinct from any property of Mechanics, we see
indeed the movement & construction of all the Bones are regulated
by Mechanical Laws, but the actions of the Muscles which puts
the Bones into motion are not owing to any Mechanical Power or
Principle, nor by Mechanical principle can they possibly be explained.
27. From an examination & survey of Animal Matter when dead,
we gain an Idea of living Animal Matter, as from Life only we
can gain an Idea of death, so vice versa. –
28. The functions of & changes in an Animal body during Life
are all to be referred to the operation of the principle of Life. – The
properties of the principle of Life consist in preservation of Animal
matter in the living state & in action, Life may exist without
matter being in a state of action, & the property of self preservation
may be alone present, Life at the same time being present in
full force. – Thus a new laid Egg, is truly & really alive, tho
no kind of action is known to be possessed by it. ♁. –
29. Life does not consist in any modification of matter, it either
is something superadded to matter, or it consists in a peculiar
Arrangement of certain fine particles of matter which being
thus disposed acquire the properties of Life. ♂
30. Life has been compared to the spring of a Watch, as that
Spring gives motion to all the Wheels, so Life gives action to the

same Experiment was made on Snails, Snakes, Eels & others of the
colder & imperfect Animals, which proves that the fresh Egg is as
truly alive as the Animals just spoken of, tho’ it has only the property
of resisting death, or self preservation & not any kind of action.
♂. 29. I enquired of Mr. Hunter if this did not make for the
exploded doctrine of Equivocal generation, he told me perhaps it did,
and that as to Equivocal generation, all we could have was negative
proofs of its not taking place, he did not deny that equivocal generation
happened, there were neither positive proofs for or against
its taking place.
🜔🜹 33. The doctrine of colours will tend to the same purpose,
we see by different arrangements the same colours will produce
different Shades. –
☿ 35. Tho’ Organization is not necessary to Life, yet it is to action.

9
several parts of the Body, but this Idea is not just, no one part
of Body is dependent for action on any other part, but the several
parts, each possess life & action in themselves. –
31. Life in a living Animal is as much the property of every
individual part, as Gravity is of every particle of matter, every
one part is as much alive as the whole. –
32. Every action in the Animal body is produced by the living
principle, the secondary actions of Parts are as truly produced
by it as the primary. –
33. Magnetism will truly elucidate what is said of Life being
superadded to Matter, or arising from a particular arrangement
of certain particles of matter, a Bar of Iron placed for a long time
in an upright posture will acquire a magnetic Virtue, so perhaps
the particles of matter arranged & long continued in a
certain Position at length acquire the power of Life. 🜔🜹
34. Two, three, or four, or any number of Particles of Matter thus
animated may form a muscular Fibre, a certain number of
these Fibres collected form a Muscle.
35 Life does not consist in any Organization of matter, for
matter will remain as organized as ever after the destruction of
its life. ☿.
36 As from an observation of matter in its inanimate state we
gain an Idea of living matter, so from an observation of the functions
& actions of parts in a state of disease, we gain a knowledge
of or correct our opinions of the natural actions & functions
of parts in a state of Health.



                      


10
37. Solidity in matter is necessary for its action, it is the fixed
point from which its actions must proceed, & on which they must
depend, therefore we find the parts of Animals destined for action
solid, these Animal Solids are kept together by Cohesion.
38. The Muscular parts of an Animal are active, - of an Animal
scarcely any parts are purely passive, almost all parts
have somewhat of the Muscle in them, and have some kind of
or degree of Action. –
Actions of Animals.
39. The actions of an Animal are two fold, the primary actions
or those which every part hath in itself (as to nutrition
growth & support) without regard to any Operation, for the benefit
of, or for producing some change in the general System,
as the actions of the stomach, Brain &ca. – The first are
the true Animal movements, the second are what are called Operations
of the Animal Œconemy, as most secondary actions
are employed for the ends of the first, having a necessary relation
to the first; - so those secondary actions are in general permanent
and constant. In diseases all these secondary actions
may be suspended for a season, the primary ones are never interrupted
for the least portion of time so long as the parts live.
40. Those are besides the muscular parts (38) which are the
active powers, other parts also which, have a kind of secondary motion,
(that is, a motion communicated to them the Elastic Parts)

    

                      


11
but to the operation of these life is not necessary, their powers
are equal after the death of the Animal to what they were
during life. –
41. There are other parts also in the Animal Body that have
in themselves no kind of action, but whose use is merely
Passive, which are different in strength & density, some for Union,
as the Cellular substance, others for strength, as the
Tendons & Ligaments. –
42. It is said (40) that it is not necessary to parts being
possessed of Elasticity, that life should be present. – Elasticity
is indeed a property of many species of matter besides Animal. –
43. The actions of the living body are simple & compound
The powers of action distinguish living Animals & Vegetables
from dead & common matter.
The Stomach.
44. The operations of an Animal (17) are attended with a
waste of its substance; - supply is therefore necessary to
the continuance, this supply is performed by means of
which tho small in comparison to the bulk of the other parts
of some Animals, is the most important part of all. – This
is the Stomach. – The stomach is the principle distinction
between Animals & Vegetables, all Animals have a stomach, no
Vegetable is possessed of anything like one.; - to many Animl.
the Heart, Brain & Nervous System & many of the Viscera are

the stomach of plants may be said to be, the ground & air in which the
grow, as it furnishes a supply. So living animals which change the
situation of course it is necessary there should be supplied by some
with them, with stomach. HS
          

                      


12
wanting, but no Animal is without a Stomach, it is the Stomach
only which is necessary for the support of a simple Animal,
& organs of generation for the propagation of its species therefore
some Animals consist of little more than a Stomach & Genitals.
45. This Stomach may be called the true & primary Animal;
all other parts may be considered as superadded, according to
the functions of the Animal, to which some or more is given, is
to perform on the Stage of Life, for one Animal that possesses a
Heart, there are millions that want it. –
46. The Stomach by means of its hidden powers, converts
various Substances into one common kind of matter, which is
taken into & forms part of the Animal, this very curious kind
of Operation is called digestion.
47. This Viscus in the most complicated Animal, as in Man,
is intimately connected with the general Æconomy, it is as much
the seat of Irritability as the Brain is of sensibility, it is highly
affected by many external influences, which in themselves have
nothing to do with the Operation of digestion, as Wounds &ca. –
It is more affected by morbid operations produced in Tendons,
Ligaments & other parts of small natural sensibility than by
the same taking place in the Muscles, it is chiefly affected
by changes produced in the internal parts, as the Brain is
by those in the external parts. – It is intimately connected
with affections of the mind, whether produced from injuries
of the Brain or from horrid stories or sights, to which a Vomiting

🜖. 50. Experiments have excluded the Veins from the Theory of
Absorbing, even in the Erection of the Penis the Veins do not absorb,
I consider the Corpora Cavernosa as Veins, through which the Blood
is constantly flowing from the Arteries & that there are a number
of Veins, opening into the Corpora Cavernosa, and that the Blood
is flowing into them, that in the Erection there is a spasm upon
the Veins, which prevents the Blood flowing thro’ them, hence an
accumulation and distention, in the Penis, which ceases with the
spasm. – I found that by tying the Veins of a Dogs Penis an Erection
was produced. – 

13
vomiting or puking has been known to succeed, especially the last.
48. non est inventus.
The Vascular System. –
49. In compound Animals, as Man, the Vascular System
(or that by which fluids are carried to & taken from different parts
of the body, by means of which growth & nutrition are afforded
to parts, & to the whole) becomes an importent subject of enquiry. –
This is divided into, the Arterious, the Venous,
and the Absorbent System. –
50 The animal body is considered as an Hydraulic Machine
by those three sets of Vessels its course of fluids is conducted. 🜖.
51. Arteries. The arteries carry the blood from the Heart
to every other part of the body, consequently they convey the materials,
for the growth, nourishment & support of parts, for the
regeneration of them when lost, and the support or supply of
them when wasted, also for the different secretory Organs to
separate liquors for any further purposes in the Animal Œconomy,
or to diminish anything superfluous or noxious.
52. Veins. The Veins return to the Heart the blood wch
remained of what the Arteries had carried from it, after the
different purposes (51) have been effected, they are also said to
carry blood from certain parts to the Liver for the production of
Bile.
53. Absorbents. The Absorbents take up fluids & also solids
from [many] every part of the Body, which they pour (by means
of a peculiar duct) into the Blood, by this property they become

🜋 53. Also the Gubernaculum, & Membrane Pupillaris &ca.
When a Limb is removed, we know the end of the Bone is sawed
through in a circular figure, with hard edges, if examined
at some length of time after the Operation we find the end of the
stump approaching the section of a sphere.
Aphorism 59 continued. By this property also when their
actions are much excited, they take up the solid parts whether
soft or hard, these producing what has been called Ulceration,
this may be called Ulcerative Absorption.
They also diminish the bulk or density of parts without
ulceration, to this species of absorption no particular name
has yet been given, but it may be called Intersticial Absorption.

14
the means of supplying the system of circulation with nutritive
particles, also of conveying disease into the habit. – Thus being both
the instruments of Health & destruction; by this property of absorbing
solids as well as Fluids, they become the modellers of the
shape, Form & structure of different parts; they prevent parts
from growing into irregular & inconvenient figures; in this light
they may be considered, as the builders of the Animal fabric,
whilst the Arteries are the labours bringing & laying before them
the materials for the work, or as the polishers of the rougher workmanship,
of the arterial vessels; by this property they take up and remove
parts, which though useful in one part of life, becomes useless
in another, as the Thymus Gland &ca. - 🜋
54. The action of this system of Vessels (53) being considered
with regard to the ultimate effects may be divided into two
kinds
1st. Absorption of extraneous bodies.
2d. Absorption of the Animal itself.
55. The absorption of extraneous substances as observed (53) introduces
both the particles of nourishment into the system, & the
particles of Disease.
56. Final use of Absorption. The Absorption of the Animal
itself is employed either for the nutrition of the Animal
when either absorption of extraneous nutrition cannot take place,
or when the mind, is unmindful of directing nutriment to be
taken in, & yet nourishment is still necessary to the life of the
Animal, or when an useless & inconvenient part is to be removed.

                                   


15.
57. The mind is frequently unmindful of taking in food in
fevers, no disease of it being perceived by her, but nourishment being
necessary for the sustenance of the Animal, the fat and other substances
are taken up by the absorbents and carried into circulation for the necessary
purposes of affording nutriment to the different parts of the
system. Thus the Animal is for sometime enabled to feed on itself.
58. every part of the body may be subjected by disease to the second
kind (54-56) of Absorption – Absorption will either take up from
parts portions of their intesticial substance, as Earth from bone &ca. or it
will take whole Parts, as an entire bone. –
59. When a stimulus of any kind is about to excite the process of
Absorption, two circumstances will take place, a consciousness in the
Lymphatics of the propriety or necessity to begin absorption but when
the part to be absorbed is dead the state of consciousness is incompatible
with an inanimate state of matter.
60. to the removal of dead parts by internal process, this System
of Absorbents seems alone to be equal, no chemical process can perform
it.
Ulcerative Absorption. 61. The process of Ulceration, or
Ulcerative Absorption is always the same, different causes may indeed
produce it, & different circumstances may be present with it.
62. The state of consciousness (59) may be induced by different
kinds of stimuli but the mode of impression will always be the same
63. The absorbents have a power of taking up both Solids & Fluids.


 
     
                                    


16
64. The mode of their action is not clearly ascertained, it has
been imagined that they are Capillary Tubes, but capillary Tubes
can only absorb fluids & the absorbents take up solids. (63). –
65. The opinion of their absorbing matter in a fluid state alone
(which would shew, that the solids if to be absorbed, must undergo
solution by means of some fluid which acts upon them as a solvent)
is to be doubted of. –
66. It is equally & more probable that the absorbents have like entire
Animals, mouths & teeth, that the form of their mouths & teeth
in different Absorbents, essentially differ according to the parts they are
to act upon, so that perhaps could we obtain an accurate [class] survey
of them, we might be enabled to class them according to these differences. –
67. It is doubtful whether substances when mixed with the Blood
are essentially altered or not, the indefatigable parts of vegetables, as the
colouring part of Rhubarb pass off by Urine, or by some other secretion
unchanged; the variolus matter is not altered by the Blood the Venereal
matter when taken into the habit is certainly much altered, it is very
different from what it was before it was absorbed, this is the only matter
that we know undergoes a change.
68. The power of living Animal matter to consume itself is equally
probable, with the property of living matter to produce fresh living
matter from itself. –

🜔🜹 69. The existence of the Brain & Nervous System is not necessary
to simple Life, millions of animals want both, but they are necessary
to the performance of certain functions of Life, & without them in
those classes of Animals to which they are given, active Life cannot go
on if the perfect Animal, as Man, there have been instances of Monsters
born without a head; but not being able to support the functions
of Life, necessary to be performed from the time of birth, they die soon
after they come into the World, but they were truly & virtually alive
while in Utero.

17
Brain and Nerves. &ca. –
69. From a peculiar arrangement of the particles of Animal matter,
muscles are produced, a different arrangement of those particles
forms other organs, so from a particular disposition of these particles in
perfect Animals, the Brain & Nerves are fashioned, which being acted
upon by various impressions, various sensations arise, the effects of wch
are the mind & will. 🜔🜹.
Senses. 70. The impressive given by external objects are considered
as of five kinds, of these one is touch or feel, of which every part
of the Body which is sensible is the seat, the other four kinds several
affect the Organs peculiarly adapted to them.
Idea. 71. The sensation raised by an impression is two folds
first its effects on the part to which it is applied, secondly the change
produced in the brain, in consequence of that effect, the first is simply
passive, the second state is active, for then action is produced in the
brain & an Idea is formed.
72. According to the kind of change effected in the Brain the idea
will be agreable or disagreable.
73. As from habit we gain a power of judging & distinguishing
what is advantageous or useful, from what is inconvenient & pernicious,
when an idea respecting an external objects is executed in
the mind, & that idea is followed by an inclination to possess or obtain
that object, we should be irresistibly inclined to gratify that inclination
when arising did not our power of judging of ill consequences that


  
 
 
 
     
                                    


18.
might arise from gratifying the inclination in question (acquired as
before said, from habit, or from reapeted observation) determine us to the
contrary, this weighing an inclination in the mind we call Reason.
Will 74. a determination of the mind whether produced by inclination
or reason (73) is called will. –
Voluntary Action. 75. In consequence of any changes produced
in the brain, as concomitant on the Actions of the will, an action
in any moving part of the body is excited. this is voluntary
motion or action, thus different parts of the body receiving impression,
have a power of acting on, or exciting a change in the brain, & a change
in the brain however produced has a power of producing a change
in other parts of the body. –
76. The vital principle of simple Life & that principle on which
The powers of sansation depend by this connection (75) act mutually
on each other.
77. It seems as if we had no simple sensation, but that every
sensation of which the mind is sensible is compounded of two
states as (71).
78. The Operations of the Brain & Nervous System (64) are not
so extensive as some have imagined, they can neither supply a
part with nourishment, nor preserve a part from dissolution.
79. Every living body has an intelligence of its own feeling after
an impression has been given to it, previous to and exclusive of
any Idea existing in the Brain. Thus every living part has in itself
a consciousness of any impression given to it whether of Pleasure

83. Many fishes have abundance of nerves with a very small
quantity of brain, Fœtuses to whom the Brain has been wanting
Acephilous Monsters have still their Nerves.
85. In Man & the perfect Animals; sensation is intimately connected
with life. if the powers of sensation are constantly kept exercised,
the sensative principle becomes fatigued, & the principle of Life
also suffers with it, Sleep therefore by giving relief to the sensitive
principle, prevents violence being done to the principle. –

19
or of pain & as it were a power of the Mind determining to action,
independent of the powers of the mind.
80. The power of the nerves is purely passive hence previous to any
action being excited in them a impression must necessarily be given 
to them. –
81. The different sensative Organs are appointed to receive the
several kinds of impression given to the body & which impressions
are of five kinds. Yet every Nerve is subject to receive the impression
of touch & pressure.
82. The living principle is coeval in all living Animal Matter wth
the Animal matter itself, & may long exist without sensation. Thus
a Child in Utero has no sensation until it is born. –
83. The Nerves are not indebted to the brain for their existence,
there may be Nerves tho’ there is no brain, but the existence of the
brain is necessary for the formation of Ideas.
84. Parts intended for strong sensations have always a great quantity
of Nerves distributed to them
85. This principle of sensation regulates all our External action
as the principle of Life does our internal ones.
86 When an impression is given it must continue a certain time
in order to produce a sensation. if it lasts but a short space of
time, no sensation will be produced, if an impression continues too
long a distant sensation will be yielded, it will then only produce a
disturbed state of the Nerves. –
87. Sleep is to the sensitive principle, what rest or the state of inaction
is to the living principle as the living principle may exist

89 – here is no notice taken of the eyes being required to be shut
when sleeping, & the absence of the eyelid preventing it. H.I.S.
🝄.
90. A loud noise produces the same effect upon the Ear in lieu   
of distinguishing sounds the idea of pain will be excited, even the Tympanum
of the Ear, has been burst or broken by this Violence. –
91. Ingenuity often gives reasons for things, rather than
not account for them, but their reason unless they have some shads
of probality, or even when they have, may not be the truth. HiS –
does a blow on the ear produce a gretter sensation of sound, than the real ble
occasion.? HiS.

20
tho no action is going on, so the Existence of the sensation is not incompatible
with the abscence of sensations.
88. Thinking is the effect of particular changes in the mind, accompanying
changes in the Brain, tho’ with respect to ourselves, or a consciousness
of action or sensation, we are in a state of non Existence, &
although we have then no sensation, yet the Effect of sensations are not
lost, the mind will be thinking (which is the effect of sensation) while
we are asleep as in dreams, we seem indeed then to have sensations
but our seeming perfections are fallacious. –
89. We often dream when awake, having a seeming perfection
of things & objects which do not exist.
90. Sensation excited in a certain degree is agreable, in a greater
degree painful, & then the natural sensation will not take place, but
the sensation of pain will be produced, Thus are excessively glaring
light applied to the Retina, pain not vision will be produced. 🝄.
91. An impression different from that which is the One, for the perception
of which any Organ is naturally & particularly adapted may
produce in the given organ the same sensation as would have taken
place, had the natural impression been given, thus a smart blow
on the Eye will excite the same sensation as a flash of light, the same
blow on the Ear will produce sensation of sound. –
92 Uneasy sensations may in many respects be similar to a natural
appetite, they rather warn the Animal to the avoiding somewhat
injurious to him, or the removing something unsalutary.

♁ 94. Sensation is not necessary to simple Life, a child in Utero
has no sensations & yet lives. –
♎︎ 95. A Muscle when its action is suspended by the communication
with the brain being interrupted or by any other means it
wastes. It is a law in the Animal Œconemy that the size of a Muscle
will be in proportion to the frequency of its use of this we have a variety
of instances in the legs of chairman, the Arms of Watermen, & the thickness
of the Muscular coat of the bladder when it has been long used to
frequent contractions from Irritations as there from a stone &ca. as will
be hereafter taken notice of when we are considering the diseases of the
Urinary parts &ca. so also Muscles waste if the joint they serve is rendered
useless because their action can be no longer performed.

21
93. During sleep whatever actions are derived from the Brain, whether
consequent on disease or health cease; so St. Vitus’s Dance does
not affect the Patient while he slumbers.
94. The living principle in any part of the body will continue
to exist after the Nerves leading to any part is divided. ♁
95 When a part intended for motion, loses its power of motion, it wastes;
for being now no longer useful to the Animal, as a moving part, it becomes
open to intesticial absorption; (53) the will can no longer influence
it. ♎︎.
96. The more distant any part is from the Centre of its energy, the less
fit will it be, or certain actions, as indeed it will receive less Energy
therefore all the Vital parts are near the heart. All the parts intended
for acute sensation are near the brain. So mortification from debility
more frequently attacks the extreme Vessels, especially if the Patient is
tall, perhaps one reason may be that the blood loses somewhat of its
nutritive powers before it arrives at them.
97. In the Animal Body there are actions which proceed from certain
fixed principles in the Animal Œconemy & are regulated by certain
fixed Laws; these are only actions which arise in consequence of the
other actions which we call sympathy. Sympathy. –
98. There is also another kind of action which we call Habit,
actions frequently repeated in any part induce a custom of acting
in a given manner in any certain part, & from this accustoming
a part to any such action Habit arises. –
99. Habit is a kind of force or violence done, or superadded to the

4
🜔 103. When stimuli are often repeated they lose the power of producing
sensation; hence the mind is at last insensible of the
change hence habit of Disease arise (189) & parts get into & go on
without the mind perceiving it a diseased action, hence also parts
become insensible even to noxious stimuli, to the frequent repetition
of which they have been accustomed hence whilst in strangers
the bites of the Bug & Mushito produce disagreable Effects
those who have been much subject to the application of their poison
have their skin at last insensible to it; as in the Body so it is in
the mind, horrid sights &ca. at first produce in it the greatest
changes but by frequent repetitions of them the mind becomes reconciled
to them & at length scarcely an idea is excited by their impressions
(148). –

22
first principle, parts from habit acquire a power of acting in a more
forcible, or in a different manner from that which primarily took place
in them.
100. This habit may be called a species of Memory, as Memory consists
in a Repetition of Ideas once taking place in the mind. So
habit consists in a frequent repetition of action in any moving part
of the body.
101. Habit is similar to a body, once put in motion which will
not cease from motion unless some new cause for obstructing motion
arises.
102. Habit becomes a cause not only of motion in parts accustomed
to that kind of motion, but also may be a cause of rest at that time
in other parts, like a body once put in motion it does not require
a renewal of the same & equal degree of force which first gave it
motion, but the addition of a small quantity of fresh force is sufficient
to keep up the motion.
103 Habit will even become a cause of action in the will, it will
make these actions of it voluntary which were involuntary & also the
reverse; the strength of habit will be much or little, in proportion
to the violence of the impression which gave rise to it. 🜔
104. As in the Memory it is not necessary that in order to the recollection
or renewal of an idea, the impression which gave rise to it
should be repeated with its full force, so with respect to habit in parts
but it is not necessary in order to excite them to an equal action;
the impression or stimulus should be equally Violent with
wat it was when it first produced the action in the part. Habit


                 

             
 
 
 
 
     
                                    


23.
is always gaining on us and little force is necessary to keep it up.
105. As in the Mind the remembrance of impressions which
were of little force wears off, unless the impression is repeated before
the effect of the first impression ceases, & consequently memory
of the impression will not remain, so neither will the power of
habit remain, if second impressions are not repeated before the
first ceases. –
106. In accustoming parts to habits, or impressions, two circumstances
will arise.
1st. If the impressions are slight & often repeated, or if the
force of the impression be each time gradually augmented, the
parts accustomed to them will become by degrees insensible to
them, so that here the cause may remain though the effect diminishes
or ceases.
2dly. The effect may remain though the cause ceases,
as violent impressions will continue to produce their effects, long
after they themselves have been removed, according to the kinds
of habit complied with, health or sickness will be induced.
107. All stimuli will not produce the same effect when applied
to different parts, hunger will be a stimulus to the stomach alone
light to the Eyes, sound to the Ears &ca..
108. Dispositions of the mind will arise from Ideas produced from
certain impressions given to the brain, a disposition taking place
[from its] may be compared to the state of an elastic body when altered
from its pristine to some other figure, the disposition of the

🜖 110. 111. 112. In inflammation though the Blood coagulates more
slowly, yet there is a greater disposition in the parts to separate one
from the other. The separation will often be so perfect, that if you
dip your finger into the fluid at the top during coagulation, it will
not be couloured at all red. this inflamed blood will sometimes be
half an hour before it is compleatly coagulated. –

24
Elastic body to recover its pristine state is destroyed, by its action in recovering
that state, so when the disposition has produced such a state
of the will as to excite the moving powers to any action, the disposition
no longer remains, with this difference however that the
elastic body loses its disposition instantaneously, the Animal by
degrees.
109. When an action is excited by the powers of the will in consequence
of a particular disposition in the mind taking place, the
brain for the seat of the disposition, which might before be considered,
as in an uneasy or stretched state, now returns with respect to the
consideration of the disposition to a state of rest.
110. The Blood which is the fluid circulating in the Arteries & Veins
is not a passive inanimate matter, but is endowed with a principle of
life in itself equally with the solid parts.
111. A particular a permanent figure of parts in a losing animal is only
necessary to mechanical action. action is not necessary to [illegible] presence of simple Life.
the Blood perhaps has not motion in itself, but motion is not necessary
to Animal life.
112. The blood is not only alive itself, but it also by circulating thro’
every part of the body, becomes the means of & carries life to other parts,
thus being the living support of every part of the Fabric, even the Nerves
themselves are supported by it, they do not convey life to the parts, but
only direct the motion of parts, & without the blood will themselves become
dead. 🜖.
113. Whilst the Blood is circulating in the Vessels, it is always fluid,
but it is not always alive whilst fluidity remains. If by any means

Φ 113. If the life of the Blood is suddenly destroyed &ca.
Cases in support of this.
A Gentleman died suddenly in a violent fit of passion his Blood
did not coagulate. – Two Deers were hunted to death the
Blood of neither would coagulate – The blood of Animals
killed by lightning or Electricity will not coagulate sometimes, but
this will depend upon the manner in which the Electric matter
was applied, if so as to pervade at once the greatest part of both the
fluids & solids, it may produce this Effect.
🜔 116. Though the Blood when in its fluid state has not sensation
yet when formed into solids may acquire sensation. before Blood is
capable of gaining Life & support to parts, it must have circulated
through the Lungs, where it undergoes some Essential change perhaps
it then first is compleatly in its second state or verification. –
🜔vuss 🜖 117. As the Blood acquires an inflammatory disposition when
circulating through inflamed solids so it may lose Quel?

25
the life of the Blood is suddenly & entirely destroyed, after its death
it will still remain in a fluid state. Φ.
114. Whilst alive it is always fluid, if its life is not suddenly & entirely
taken away, it coagulates as it does & the seeming component
parts recede one from another.
115. Long rest out of the Course of Circulation & Exposure to the air
of the atmosphere occasions the Coagulation of the blood, if unexposed
to air, blood will remain long at rest in the living body without
Coagulation.
116. Organization is not necessary to Life, an Egg is not Organized, &
Yet an Egg is alive (28.) so blood is not organized, & yet is possessed of
Life. 🜔.
117. There is a perfect harmony in a state of health between the fluids
& solids of an Animal Body, so also between the Blood, & its containing
Vessels. There is also a consent between them in disease, & when the
solids are affected the blood also puts on a diseased state, thus the Blood
is as capable of disease as the solid parts are so also the blood becoming
diseased the Solid parts also suffer. 🜔vuss 🜖.
118. As the blood conveys to parts the means of nutrition & growth,
so from the blood, new solids are formed, when in consequence of a disease
or violence, there has been a loss of the former ones, or when those
arises a necessity for their production.
119. Where there is a disposition to union in parts naturally distinct
from each other. Inflammation will arise which Inflammation
will be in proportion to the strength of that disposition. The

 
 
 
             
 
 
 
 
     
                                    


26
Blood passing through inflamed parts undergoes a change according
to circumstances, & from the change wrought in this, coagulable Lymph
is fitted to be formed into solids, by the solid parts formed from this
Lymph parts violently separated from each other are again united, &
parts before naturally severed from each other are blended together.
120 The living parts of the Animal, both the blood & the solids
being continually wasting, supply is necessary, this supply is obtained
by means of fluid prepared by the stomach (44) but before the food
taken into the stomach can furnish the desired supply, it must undergo
two process.
1st. Animalization
2d. Verification.
from living matter only, living parts can be made.
121. Sensation is not necessary to life the Blood may therefore be
alive though it wants sensation.
122. Heat. A certain degree of heat is necessary to the preservation
of Animal life whether existing in fluid or solid matter.
123. A certain degree of heat is necessary to Animal Life (122) but a
greater degree of heat is necessary to Animal Action, before the former
the Animal cannot retain simple Life, below the latter, though it
may retain simple life it will not retain the power of action.
124. Almost every order of Animals require a degree of heat peculiar
to itself, some Animals will not endure their heat to vary much
from a common standard without abolition of the actions of Life. A
Bee requires its heat to keep, to go, a Wasp will suffer its heat to vary
with the heat of the Atmosphere.

🜔vmss. 🜔. 126. An explanation of the power Animals have of generating
heat was attempted – 1st. by supposing it to arise from friction
but between the particles [there] of a fluid there can be no friction, nor between
the particles of solids can heat be produced by friction, if a fluid
is interposed. Thus the Wheels of a Coach are prevented from generating
heat by means of greasing them.
2d. By Fermentation (by Dr. Stephenson) but the fermentation of
Animal substances does not produce heat.
3d. From inspiring Atmosphere Air, this seems to be contradicted
by the following Case.
A man had a contusion of his brain, his respiration was exceedingly
Slow, breathing not above 5 times in 2 minutes, yet he had a
General warmth upon his skin, though in the month of February, & the
cloathing was but thin, the power of generating heat & cold depends simply
on the principles of Life, independent of circulation, the influence of the Nerve &c.
This is finely illustrated in the case of a Gentleman who was seized with
an apoplectic fit, whilst he lay insensible in bed, & covered with Blankets
his whole body would in an instant become extremely cold, in ever part, &
continue for sometime, & in as short time become Extremely hot, this was
going on for some hours alternately yet there was no alteration in the state
of his pulse, or in the excitibility of his sensations. X
🜋 128. Animals which are in a state of in action during the Winter,
as sleeping Animals the heat will vary with the seasons. The state
of the Hedge hog in summer is from 91 to 97 in the Winter when the
Atmosphere was 44 the heat of the same Animal was 45, the Experiment

27.
125. In the state (121) digestion & generation with other faculties
will be suspended, & the Animal remain in a torpid in active state.
126. All Animals in themselves have a power of generating heat,
when the actions of the external Cold are so great as to endanger the
preservation of life, this power arises wholly from the principles of life,
this power arises wholly from the principles of life, for dead Animal
matter, posseses no power of resisting cold, this generation of heat
is truly life, operating against its destruction. 🜔vmss 🜔.
x Animal heat is kept up by the circulation of the
blood, which receives oxigen in the lungs from the
atmosphere. The venus blood which has entered, is of a
dark colour, but receiving oxigen the iron in the blood unites
with it, & forms the bright red arterial blood. distributing
this in the required quantity. Perspiration is evaporation
which produces much a degree of cold, to restore the
equilibrium when from violent exercise we induce
too rapid a circulation, or in glass houses when
the beat is too great. HiS
127. The heat of all Animals is diminished during sleep, whilst
in a state of torpor, but more or less in different Animals. –
128. Variations of heat in the Atmosphere, will produce different
changes of the heat of different species of Animals, some animals
as Men, & those which are constantly in action have their heat
little changed by this variation. 🜋. –

Experiment was made on its pelvis.
🜍 132. Animals who suffer their heat to be diminished
with that of the atmosphere, suffer it to be as readily increased to a
certain degree as that of dead matter – A living & a dead Carp
were both placed in a mixture of snow & water, which was gradually
heated, & both received heat one as fast as the other. – different
parts of the same body will have different degrees of heat, and different
powers of generating it, the projecting parts of the body in
Man as the Nose & Penis will be colder than other parts, the urethra
will be colder than the Rectum, than the abdominal Cavity, the Standard
of heat in the Centre of the human body is about 99°. –
🜍 132. Animals have two powers of resisting heat, tho’ only one of
producing it. One by the Evaporation of fluids, but as when fluids
become condensed on the surface, instead of being evaporated they will
not answer the purpose they have which is of actually destroying heat
As the Extremities or projecting parts are more subjected to be influence
by cold, so they [are] more readily allow their heat to be increased than
the central parts. From Dr. Fordyces Experiment in an heated Room
it appears that the human body will for sometime bear heat with
impunity, & such heat as is sufficient to boil Eggs, or roast beef stakes
The Gentlemen present in it found that when they moved from one
place to another in the latter they found the heat also more intense than
that they had been sometime standing in seemed to be when they left it
so also in the hot Bath the Bathers find the water immediately in
Contact with their bodies Cool, & they must either have the water agitated

28.
129. Animals will suffer their heat to sink below the freezing
point before they will be frozen ( ) Expn. on Eggs. –
130. The stonger & more healthy the internal powers of the Animals
the more powerfully will it generate heat.
131. Cold applied to animals in a certain degree proves a sedative
to the powers of Life, but applied beyond that degree it proves a stimulant,
& the faculty of generating heat is excited in an extraordinary
degree.
132. Excess of heat may prove destructive to Animal life as well
as too great a diminution of it, the principle of Life is therefore endowed
with the property of generating Cold, when the external heat
endangers the life of the Animal. 🜍.–
The principle of life serves here as the nectary
in botany, which is Linneus's term for all indescribable
parts HiS
Though the effects of origin in circulation is but
a recent discovery, yet the living princible is
here placed for it, may not this living princible
be as enormous as when it is given to describe
muscular action. page 18, or apts. 34 & 35 p 9.

agitated or move into another part of the Bath to preserve the first
sense of warmth. –
133. The Operation of generating cold seems to weaken an Animal
much more than that of generating heat, before an Animal
perishes in consequence of Cold sleep is induced, an irresistible disposition 
to which always comes on when the powers of action for the generation
of heat are exhausted. The case of Dr. Solander & the people
with him at the Terra del Fuego is a manifest & melancholy illustration
of this, after bearing for a long time an excess of cold several of the
Doctors attendants found this disposition to sleep. In spite of his remonstrance.
who was aware of the event to which it was prelude,
they lay down & slept & presently died. At length Dr. Solander felt &
gave way to the same disposition he had not been asleep above 5
minutes before his Feet became so contracted that his shoes fell off
them & he lost the use of his limbs, he was however found brot away
to the fire & relieved. –
🜍 135. The best Atmosphere for the human subject seems to be
63 to 60. Bear & Fox 50. – Lion & Monkey 70 – The Animals
inhabiting Cold Climates have stronger powers of generating heat
than the human, preserving every part of their bodies free from injury
in Countries where Men are losing their feet, hands &ca. from Cold.
Cold causes the hair of the Bear &ca. to grow much faster & finer,
hence they are better defended.

29
133. Nether excess of heat, nor excess of Cold will destroy the life
of an Animal, until its powers of generating Cold or heat are exhausted,
then the Animal must necessarily Perish. –
134. All the perfect Animals carry on their actions, in an Atmosphere
considerably below the temperature of the body, for it seems
a natural & healthful action, for an Animal to be constantly exerting
itself moderately in the generation of heat. –
135. Different Animals as above mentioned either preserve a standard
heat or have their heat increased or diminished with that of
the atmosphere, yet all animals require a certain degree of heat for the
standard in which their functions are best Performed, many Animals
are obliged to the atmosphere for a Standard heat whilst Man & many
of the perfect Animals, have from their faculty of Generation of heat
& Cold a power of giving a standard heat to themselves. 🜍.
136. The effects of a climate will correspond in a great measure
with the influence of the Sun in that climate, so that as the
Climate is exposed in a different manner to, & is differently acted

♂. 136. Between the Tropics the heat is greatest in Islands the
heat or Cold, is always more moderate than in Continents. Some 
Vegetables have a power of living in both extremes of Climate Some
Animals seem also to have this power, perhaps Animals of Passage
as Birds & Fish change their residence more from want of
proper Food, than from the inconvenience they feel from a given
Climate. Some Animals which have no power of getting their food
in the Winter, Nature has given a power of remaining during that
season in a torpid state, as the power of generating heat is not equal
to the degree of Cold nature has taken another method of preserving
Animals of the very frigid Climates [which] with down, fur, &ca. wch
are bad conductors of heat, so also whatever Animals have their
bodies will covered with hard fat, which is also (as Oils are) a bad
conductor of heat. –
Too much external heat produces diseases of the liver,
spasms, diseases of the Bowels, Tetanic &ca. diseases of Climates
are more slow in their action, & many of them depend on debility
as Chilblains &ca. Cold Climates also increase disease They are
not the causes of, as Venereal disease. &ca.

30.
upon by that body it will be hot or cold; moist or dry; or it will
hot & moist; or hot & dry. ♂. –
137 The effects of heat & cold will be greater according to the
degree of the surface of the Climate. A small surface will be less
hot or less cold than a larger.
138. The effects of Climate will be very great in Animal bodies
the imperfect Animals bear changes of Climate very badly. Man
& many Quadrupeds can accommodate themselves to almost any
Climate, yet great changes of Climate prove the causes of diseases
& destruction both to man & those Quadrupeds especially to the former
139. Besides our being influenced by heat & cold our bodies are surrounded
by & subjected to the influence of the atmosphere, which
will always be of the same temperature as the Climate we live in
140. This atmosphere having a power of dissolving a Variety of bodies,
will be a compound of many heterogeneous particles.
141. The Atmospherical fluids having a constant & powerful influence
on the Animal body, according to the nature of the particles
of which it consists, it will materially affect the health of Animals.
142. All Bodies which the atmospherical fluids take up & dissolve
are to be considered in a state & Volatilization to render
substances Volatile, some degree of heat is required, (perhaps the
lowest degree is sufficient thus to Operate on some bodies) according
to the degree of heat the atmospherical fluid, or the Air will
be enabled to take up a greater variety & a greater or less quantity

☿ 145. Thus the Plague jail fevers &ca are unknown within
the Tropics, another reason why hot climates are not so subject
to Putrid & Contagious diseases as might be expected is, as the Termites
described by Dr. Smeathman, eat up & destroy in a curious
manner amazing quantities of dead Animal & Vegetable substances
thus preventing them becoming putrid Enough to throw
off Volatile noxious Vapours to produce Contagion, it must be
highly Putrefied.
♃ 148. Habit & Custom &ca. -. Prisoners have carried the seeds
of the Jail Fever & communicated it to others by their cloaths,
though they themselves were free from it, of this we have had memorable
instances at the old Bailey & at Oxford Assizes. Again
persons who have never had the small pox themselves have nursed
others labouring under it with impunity, & have on visiting other
people who have never had the disease communicated it to them.

31.
quantity of bodies. –
143. The purity or impurity of the Air will depend upon the
quantity or quality of bodies dissolved in it, & its capacity of dissolving
them be according to its heat.
144. Cold Climate will for the reason given (139-140) be [cotens?]        
paribus, found the purest Air & best adopted to maintain health
nevertheless. –
145 Heat in warm & dry Climates has the property of causing
bodies taken up by & dissolved in the atmospherical fluid to be
decomposed & thus changing their nature renders them less 
noxious.
146. Heat & Moisture especially when dead Animal substances
are acted upon by the Air, produce the most unwholesome Atmosphere.
147. The Air will be injurious to the health of animals by affecting
them in three distinct manners. Viz+.
1st. By its being simply impure it lessens the fitness
of them for their several functions. –
2nd. By its containing specific particles of contagion.
3d. By its containing poisonous Vapour.
148. Habit & Custom are very powerful in enabling Animals to
endure without determent impure & unwholesome Atmospheres, to
some Atmospheres Animals cannot be brought to accustom themselves.
♃.
149. All irritating substances will not act in a state of vapour

♀. 150 Thus previous to a shower of rain we see the beast, running
to the Covert, the Birds flying to the Thicket, People with
corns are capable of presaging this decomposition of the Atmosphere
& also parts labouring under great debility.
“Hence doubtless people who have had Fractures have
the part where the Callus was formed sensibly affected on changes
of weather, is not this because new parts are weaker than Original
parts as will hereafter be shewn.
♄ 152. The Harmatan a Wind that blows from the interior Coast
of Africa, shews how much Winds may affect animal bodies, it
continues from 2 or 3 to 15 days; returning 3 or 4 times a Year, it
blows moderately, its accompanying Fog & Gloom are very considerable
surely this Fog & Gloom cannot be Animalculæ, as we do not find
anything produced by them, not the least moisture can be found in
this Wind, it makes the Lips & Fauces dry & chapped if it continues
3 or 4 days the Cuticle peels off, continuing a few days longer the
perspiration becomes Acrid & is so to the taste, it is yet highly Conducive
to health convalescents recover fast, also those labouring under
intermittents, Dysenteries, &ca. & are Cured, it checks Epidemics [but]
[the small pox did not appear] a number of people were innoculated 
at the accession of the Harmatan, but the small pox did not appear;
some inoculated after the Wind Ceased & recovered perfectly
except one Girl who died of a locked Jaw in consequence of a large
Ulcer from innoculation.

32
or are capable of Volatilization.
150. Water is in a greater or lesser quantity chemically combined
with Air, when a decomposition of this solution of parts in Air takes
place, Rain is produced, previous to this decomposition Animals
are sensibly affected. Brutes & Birds very much so, the human
subject unless unhealthy rarely perceives much difference. ♀.
151. The decomposition of substances in the atmosphere may be succeeded
by new compositions from which various effects may arise
hence to determine a priori the effects of Atmospheric Air is extremely
difficult.
152. Noxious particles taken up by the Air of one Climate may
be conveyed to another, thus Winds by bringing noxious particles
in their currant from distant places or Climates, may materially
affect [the] and alter the salubrity of any given Region. ♄
153. Matter will be found either in a state of perfection or imperfection
if in a state of perfection health is present, if in a state
of imperfection the reverse or diseases take place, this maxim is
universal, it will therefore hold good respecting Animals as well
as inanimate matter.
154. In order to Diseases being present three Circumstances must
take place
1st. Susceptibility of certain impressions
2d. Disposition arising from these impressions
3d. Action in consequence of a disposition
155 In respect to these requisites the body bears a perfect Analogy

☉ 158. Thus a strain gives occasion to Scrophula, a blow to
Cancer &ca. moreover different parts will be more or less liable to
disease, as they are more or less able to resist a diseased action,
this in general will be in proportion to their strength & weakness
the different parts of the body may have their natural actions very
dissimilar. Yet disease may produce similar actions in them, for
instance, the Lungs & the Liver have dissimilar natural actions in them 
yet disease produces a similarity of action when they are affected
with Scrophula a disease of which they are both susceptible, & which
is a specific affection.

33
Analogy to the mind, which must be susceptible of impressions, must
receive impressions, must have a disposition arising in it to which
an action of the proper kind must succeed. –
156. Susceptibility of impression is not sufficient alone to produce
disease but impressions of some kind must be received by
parts endowed with that susceptibility which, a disposition being
produced an Action naturally succeeds.
157. Disease bring a perversion of the regular laws of nature
observe less order, therefore their phenomena are less easily to be 
explained & accounted for than natural actions.
158. With respect to the changes taking place in the body we
know only the causes of them & their effects, we know not the manner
in which those causes, produce those effects. ☉.
159. We can judge only from the consequences of impressions of
the degree of susceptibility of the mind or body. The causes of actions
in the body, bears a strict analogy to the causes of Actions
in the mind.
160. As the human body is compounded of parts very Essentially
different the one from the other, the diseases of different parts will
vary very widely, so also the constitutions of different bodies greatly
vary & of course the susceptibilities of different impressions, in some
the susceptibility for particular diseased action is so strong as only
to require the habitual actions to be obstructed to run into disease
161. Constitutions will be either universally subject to the same
action as the indolent or irritable, or constitutions will be subject


             
 
 
 
 
     
                                    


34.
to some specific kind of Action whether local or general
162. Constitutions are both generally & locally subject to Particular
actions.
163. Constitutions are subject to particular kinds of both local
& general actions.
164. Constitutional Susceptibility may be three fold.
1st. Universal tendency for diseased actions of some kind
or other, where however the whole must be in action.
2d. Universal susceptibility of local action.
3d. Universal susceptibility to fall into an universal
disposition as though something was teizing the constitution as
an inflammatory fever &ca. –
165. Dispositions are natural, unnatural or diseased, of the
natural disposition of sensitive or irritable parts instances are
given in the secretion of Glands.
The unnatural are divided into three kinds Vizt.
1st. Disposition to restoration in parts Injured, as in
Fractures &ca. –
2d. Disposition from necessity as in Ulceration.
3d. Unnatural dispositions of all kinds, of which
great is the variety, the diseased disposition is that which
tends to the destruction of parts.
166. Every disposition to diseased action has a certain time
allowed to it, in which that action will be produced in some

🜔 167. A Girl in the West Indies had a disposition formed for Leprosy,
but it was sometime after she came to England that the
disease appeared; here there was a considerable space between
the disposition & action of the Disease. In some Specific Dispositions.
Years may intervene before the action Commences, as in Cancer.
We should be careful not to confound dispositions with
actions, dispositions are properly the disease, Actions the effect of
the disease, disease may exist for a time though its action is
superadded as in Ague.
🜖 168. Of the first we have instances in the small pox, Measles
Inflammations & Fevers, of the 2d. in Agues, where the disposition
to Action continues though the Action only commences & goes off at
stated Intervals. the disposition in the system for action remaining
undestroyed by the action, & until it has lost its power of conger exciting
the system to action the diseased disposition existing as much
between the fits, as during them: of the 3d. We have instances in
some specific diseases, as the Venereal (Gonorrhea excepted) Cancer
& others where the disposition notwithstanding the Action continues to
exist because it cannot produce its full effects hence it will go on
until it destroys, unless the disposition is removed by an immediate
increase of action. –

35.
sooner than others.
167. A disposition once formed will go on to action, and its ultimate
Action be produced, notwithstanding sometime intervenes
unless the disposition can be destroyed by some change affected in
the part or constitution where it has taken place. 🜔.
168. In Diseases, dispositions & their consequent Actions are of
three kinds.
1st. Where the disposition has its action frequently repeated,
without the disposition itself being destroyed by that action
taking place.
2nd. Where disposition is destroyed by action, & the Action
ceasing, the disease also ceases.
3rd. Where the different action continues to go on without
removing the disposition, until the progress of it is destroyed
by Medicine. 🜖.
169. Two different & opposite actions cannot go on at the same
time neither in a part nor in the whole, if by means of any disposition
a new action is produced, the first action ceases.
170. If two dispositions are excited not two different & neutral
actions will be produced at one time, but a third simple disposition
& consequent action will be generated, which will be entirely

170. Of this we have an instance in Dovers power which consisting
of Opium & Ipecacuanha, a narcotic & an Emetic, Sleep & Vomiting
should be the actions, but as two actions cannot take place at one time
a disposition to a third action arises which produces that third Action
& is called sweating.
☿. 172. Too little actions in any part produces weakness in it which
although not a disease itself becomes the cause of diseases it causes
irritability & thus gives rise to morbid or irregular affections as locked
Jaw &ca. Mr. Hunter says that if the Nerves are weak the Voluntary
parts suffer, if the stomach is weak the general system suffers.
🜍 173. Inflammation arises from too great a degree of Common
action, if a specific action accompanies it, a specific Inflammation
will take place.
☍ 174. By increased Actions in parts, we become sensible of their
actions which before we were insensible of, thus palpitation of the
heart makes us sensible of the hearts action, of this we have no perception
in a natural state of the Organ, the whole body being subject
to similar actions with those arising in parts as observed (7)
the first attack of a disease is probably intimated to the Mind by
the feel of health previous to the attack of some diseases, it is not
unusual for persons to be sensible of an uncommon degree of health
& spirits here the several powers are as it were summoned into
action, to resist & destroy disease.

36.
& altogether distinct from other two.
171. Of Susceptibilities for diseases there will be great variety as above
said ( ) for every disease there must first be a susceptibility, -
172 In diseases either too great or too little a degree of action
will take place & to these two general kinds of action all the Phenomena
of diseased Action may be referred. ☿.
173. Diseased Action will be common or specific, Specific Action
follow certain determined dispositions arising from peculiar kinds
of impressions. 🜍
174. When a part unused to a particular sensation has that
particular sensation, the first alarm or knowledge of Disease is
given to the mind, but the action of Disease is often so slow as not
to be sufficient for a long time to produce any sensation in a part. ☍
175. The whole Animal body will be subject to many actions &
degrees of action, similar to what arise in parts.
176. Whenever a part heretofore subject to the will takes on an
involuntary action the Disease is called Nervous.
177. Whenever the action of a part is [suspended] superior to the
strength a power of a part debility & perhaps the distinction of the
life of the will ensue. –
178. A Diseased action in one part may first produce a particular

♂ 178. Sympathy will hereafter be more fully Explained but an
example in illustration of the Text may be given in the pain in
the Knee being often the first Symptom of the disease in the hip
Joint, or again in Vomiting being excited sometimes by passing a
bougie through the Urethra though there is no pain. –
🜋 179. A variety of diseases have been considered as hereditary,
but it is only the susceptibility of any disease, so that the Child
shall be more susceptible of an impression producing that Disease
than other people, this is all that parents can communicate to their
offspring. Mania has been supposed hereditary, & in some it seems
to arise spontaneously without any apparent Exciting Cause, as impression,
an Explanation of this will be found ( ) where it is said
that in some, the susceptibility for a given disease is so strong
that they will run into it without any other exciting cause, than
simply [the] same obstructions to the natural actions, the small pox is equally,
hereditary with mania or scrophula, the Gout is also considered
hereditary but it is in general otherwise & brought on by irregularity
in living but it sometimes arises in persons under 18,
then it must be considered as hereditary in the same manner that
we have considered Mania to be hereditary, to originate from a strong
susceptibility of the given disease, ready to take it on without any
visible Cause, & only from some unseen one as the least obstruction
to the natural Actions. The Gout is a disease of the Constitution

37.
particular sensation in another part, thus the first knowledge of Disease
will often be conveyed to the mind by sympathy. ♂.
179. Actions [of] are not hereditary, but, susceptibility of impressions
the cause of disposition, the cause of action may be hereditary,
thus diseases are not hereditary but a susceptibility of impression
which is to produce a particular disease may be hereditary. 🜋
180. When the different specific impressions, naturally productive
of two distinct specific dispositions, are given to the system, two

until it falls upon a part & then the full action there being produced,
the local Affection relieves the Constitution. –
🜔🜹. 180. The small pox & measles cannot Exist in Action at
the same time, but one disease will be prevented from action until
the other has gone through its natural course.
Case 1 Mr. Pools was inoculated for the small Pox, in
a few days the redness round the punctures appeared but he was
attacked with measles which suspended for a considerable time
the Eruption of the small pox which however on the decline of the
Measles appeared & went through its usual Course.
Case 2d. A Lady was inoculated for the small pox,
the Measles appeared soon after & the further process of variolous
infection was suspended until the Measles was over.
Case 3d. A Boy was inoculated & the same Events
took place. –

38.
distinct dispositions to specific actions may be formed, but the action
of one will be suspended during action of the other, that being
finished the suspended disposition may produce its action. 🜔🜹.
181. Actions must always correspond with dispositions, if the dispositions
are simple, so will the actions also be.
182. Too great or too small a degree of natural action will cause
a disposition to disease.
183. In health there must be both a due degree of strength as
well as susceptibility of action, moreover the actions must be always
in proportion to the strength.
184. The human body is continually undergoing some changes.
it has been considered to be either in an increasing state, As
between Birth & Manhood when its parts are continually increasing
either in bulk or firmness; to be stationary, or preserving
with little alternation its strength & firmness during a certain
period or lastly to be decreasing, when it loses gradually its, Vigour
& firmness. but these three States or Conditions of the
human Body are not explained by Proofs, but it is difficult
to say, when the Body in all its parts is arrived at its perfect
state, & it is difficult to say that the body, as soon as it is
obtained to its perfect state, does not begin immediately to
suffer, though for sometime, indissensible yet a real & gradual
decay.
185. It is certain however that at different periods of Life

☽︎ 186. The diseases the first stage is particularly subject
to are scrophula consequently diseases of the Lungs, complaints
in bowels from Worms &ca. Hydrocephalus. The Young are
more disposed to local & especially universal sympathy.
The Middle Aged have few specific diseases, if we
Except Nervous & Hypochondriacal disorders they are however
accidentally attacked with the complaints of Youth & Age &
this lays the foundation for disease in a more advanced Age.
In the Aged we have a variety of disorders, here the
necessary actions are not well performed: proper to this Stage are
Cancer Calculi in the Urinary & Gall bladder & Ducts, Ossification    
of Arteries &ca. –
♂ 188. Climates. Climates are hot, Cold & temperate, in hot Climates
the involuntary actions are carried on with more violence
whilst the Voluntary Actions are more sluggishly performed.
So diseased Actions are carried on with more rapidity &
violence hence Diseases run through all their Stage in these Climates
faster than in others, when disease kills absolute, absolute
Death (that is putrefaction) quickly succeeds visible Death. Cold Climates
have not such variety of Diseases as hot ones, neither is the
progress of them so rapid. Cold invigorates the voluntary Actions
at the same time it lessens the violence of the involuntary Ones.
In Cold Climates, [from the irregularity of the] simple
Life is not destroyed until sometime after visible Life is departed, for

39.
the susceptibility of the body for different disposition will be very
different, hence different Ages will have diseases in some measure
peculiar to themselves & these may be divided into.
A. The Diseases of Youth
B. The Diseases of Manhood
C. The Diseases of Old Age.
186. The diseases of the first & last stages (185) are many those
of the second are fewer. ☽︎.
187. The Causes producing disposition to diseases are many
& various when impressions are given which are to produce
diseased dispositions, the dispositions will vary very much
according not only to the constitutional or natural susceptibility
of the body, but according to other circumstances.
188. Whatever can affect or alter the natural susceptibility
of the body, will produce variety of disease, therefore the difference
of Climate, Seasons. The Moon, the atmosphere will produce
differences of disease, & each absolute state of Climates
Atmosphere, Moon [&1/4?] Year will have disease or appearances in
disease peculiar to itself, moreover affections of the mind will
often produce diseased Actions, the weaker the natural powers
of Action in a part are the less able will that part be to resist
disease therefore tendons, bones &ca. have less power to resist disease
than Muscles &ca. ♂.

putrefaction does not so soon follow as in hot Climates.
Temperate Climates from the irregularity of the medium
between heat & Cold furnish us with a greater variety
of diseases than either of the others. Hence Scrophula, Cold, Agues
& such like disease abound.
Seasons. We may consider a change of Seasons as a
change of climate, & as in changes of climate dispositions formed
in one climate by a removal into another are retarded from coming
into action, so upon returning into one similar to the first go
through their action.
The spring at it were ripens Diseases & brings them into
a disposition, for a disposition may be found during a season
which has not sufficient influence to bring it into action, as
the Winter; but in a season more favourable to the forwarding
that disposition, as in the Spring that disease has been brought
into action, so also in hot climates.
The Moon becomes often the immediate cause of diseases,
especially those in which the mind is particularly concerned,
as in Madness; which is always more violent at certain times of
the Moon, the full of the Moon also affects people whose brains
have been contused by any External Violence, this was instanced
in a Lamp lighter who received a fracture of the Cranium with
concussion of the Brain, he was trepanned & recovered, but ever after
found himself much affected by the full of the Moon. The seasons
of the Year affect the influence of the Moon on the human body,

40.
Note Continued.
the lamp lighter was additionally affected in the Spring.
A person of very scrophulous habit was very subject to
deafness at the full of Moon except in Autumn. –
Affections of the mind. Every Action voluntary or involuntary
may be affected by changes in the Mind; by a peculiar
state of it blushing may be produced, other states of it Excite Vomiting,
sickness, irregularity of pulse, diarrhea, discharges of Urine
Spasms &ca.
The Diseases on which the mind has the greatest influence,
are those in which increase or diminution of Action takes
place without any alteration in the structure. Constitutions that are
called irritable have the active parts more under the direction of
the Mind & less under the command of the will. The state of the
mind greatly affects, the involuntary Actions, that have already
taken place in consequence of disease. Agues have been cured by
affections. of the Mind, local Affections are even altered by the same
means. Tumors have been cured by rubbing them with a dead
mans hand.
189. Diseases are
A. Local
B. Constitutional
or
C. Mixed. –
We judge of the presence & nature of Diseases by their [specific]


 
     
                                    


41.
Symptoms, a symptom is a sensible effect of a peculiar action
Symptoms are either to be referred to the mind or to the senses. The
former only known by the Patient as pain &ca. the latter Perceptible
to the Physician as the state of the Pulse &ca.
When the symptoms are not expressive of the disease we
call them Anomalous symptoms & are either local or universal.
190. In simply local diseases a part may suffer, the General
health of the Body still remaining unaffected, in the Mind both apart
& the constitution are affected. –
191. Diseases may be originally local, or originally constitutional,
& again they may be constitutionally universal or constitutionally
local, or lastly they may be originally local, & at length affecting the
General system become constitutional.
192. The originally local (191) & the Originally Constitutional may
arise in the same person at the same time independant one of the     
other.
193. Dispositions as above said must be formed previous to the
Existence of disease, so that there will be a disposition to produce
originally local effects, an universal disposition to produce local Effects
&ca. –
194. An originally local Disease may take on a part of the Constitutional
one when the former has only been common diseased action
but a local specific disease will not take on a part of a specific constitutional
disease unless the latter has superior powers, in which case
the former local action will be suspended during the presence of a new

10
195. This should seem to refer only to common diseased action
of this we have an instance in fevers curing or increasing an
Ulcer, or a sore increasing.
☿. 201. A – as in diseases of the hip, where it is no uncommon
thing to have the patient complaining of his Knee.
B – as when a stone in the Kidnies produces Sickness & vomiting
as an impression given to the Urethra produces often a
swelling of the Testicles though the Urethra at the time the Testicles become
swelled shall be free from Complaint.

42.
Specific Action.
195. A Constitutional disease may be the cause of increasing or
diminishing local disease & a local disease may be the cause of increasing
or diminishing constitutional disease.
196. It frequently happens that a local diseased appearing some
other will appear.
197. A diseased action once formed will go on increasing, until
either it is destroyed by a new action being induced in a part or
constitution, or until the parts to which it is spreading lose their
susceptibility of the disposition to that action or until it produces
an Abolition of Life.
198. Diseases will be either common or specific.
199. We cannot increase specific diseases, unless we can increase
the susceptibility of the constitution of these diseases. Every
specific Disease will have two modes of Action, the Specific & the Common.
200. If the constitution or a part is susceptible of impression
from a peculiar stimulus & a peculiar disposition is Excited then
a specific disease may be produced & that specific disease may be
either local or Constutional.
201. When A an Impression is given to any part susceptible
of action, & the action is not produced in the part to which the impression
was given but in some other part, or B when an Action
formed in one part produces an Action in another part, or when an
action is formed in one part & the sensation resulting from that action
is felt in another part, sympathy takes place. ☿.



   
     
                                    


43
202. the part (201) receiving the impression is the Sympathent, the
part in which the new consequent action, or the sensation arises,
is the Sympathizer.
203. A...Sympathy is simple or Compound.
B...Similar or dissimilar.
C...Regular or irregular
D...Natural or Unnatural.
E...Real or delusive.
F...Partial or universal.
G...Contiguous, continuous, or Remote.
H...Common or uncommon.
204. The more simple the structure of the being, which is the
subject of the operation of sympathy, the more simple will the
sympathy be found, even some Vegetables are susceptible of it,
as the sensative plant, whose leaves successively dropping on
approach of the hand arises from this simple sympathy between
the different leaves, in successive order sympathizing with one
another. –
205. In the more compound being as the perfect animals the
sympathy may be more complicated, for an impression being given
to one part becomes the cause of action in another part, the action
in the last part becomes a cause of action in the third part. & that
again in a fourth part, hence in many Animals sympathy may
become exceedingly complicate.

206. If one part is affected with pain & another part by
sympathy gives the same sensation then the sympathy is similar
& vice versa – A pain in the Testicles producing by
sympathy sickness in the stomach. the sensation & action in
the latter being different from those of the former the sympathy
is dissimilar.
♄. 207. We observe affections of the brain produce sickness and
Vomiting & this almost invariable here we have an example of
common or ordinary sympathy by attending to this division of
sympathy we learn a knowledge of the symptoms of diseases,
some common sympathies though but few arise in consequence of
disease only & are therefore unnatural, such is the sympathy between
the shoulder & the Liver between which in health there
seems to be no sympathy.
♂. 210. The Father of the great Lord Chancellor Clarendon, had
a stone in his bladder he was affected with it many years & it
was painful, it was always accompanied with a pain in his Arm.

44
206. When a part receiving an impression, an action is formed in
it, & a like action is consequently produced in another part the Sympathy
is similar, but when the action in the one or sympathizer is
different from the action in the other or symphathent, the sympathy
is dissimilar.
207. When an action of a peculiar kind in the Sympathiser has always
been observed to follow an impression & action of a peculiar
kind in the sympathent, such an action in the sympathiser arising
consequent in the impression & action in the sympathent, is called
common sympathy, as also where a particular part being the sympathent,
another particular part, has been observed, to be constantly
the sympathizer. ♄.
208. When an action of an unusual kind arises in a sympathiser,
or when the sympathiser is a part unused to action consequent on
an action in a given sympathent, uncommon sympathy is said
to arise.
209. Sympathy is natural when the sympathent receiving an
impression not productive of disease, & healthy consequent action is
induced in the sympathizer, thus the breasts of Women are affected
previous to coming on of Menstruation.
210. Unnatural or diseased sympathy is when an impression
given to the sympathent produces an affection of the sympathiser,
inconsistent with its healthy or natural action so scratching
an Issue in the Thigh which itched has produced a difficulty of
breathing & a pain in the breast. ♂. –

🜖 211. Delusive sympathy. A Man in a fever & delirium,
when he wanted to go to stool, always signified to the By standers
that some other Person whom he talked of or pointed out wanted to
Ease himself referring his sensations to some other individual. –

45
211. Sympathy is real when the mind refers to the affection or Sensation
produces to the proper sympathiser, & delusive where the mind
refers the Sensation, Action, or Affection, to a sympathiser between wch.
& the sympathent no possible connection can exist. Thus when a
Man under Idiotism or Delirium, has an impression given to any
part of his body, & his mind believes the sensation consequently
produced not to exist in himself but in some other person, he is
under a delusive sympathy. 🜖.
212. Sympathy is partial where one or more parts of the body
are sympathisers, some given part being also the sympathent.
It is universal when an impression, being given, or an action
Excited in any part, the whole constitution sympathizes with it
so a wound being made in the Knee, a fever which is the action of
the constitution sympathizing with a part will often arise. –
213. Sympathy is continued when a part receiving an impression
& a consequent action arising in it, the parts immediately joining
& connected with it are also thrown into action, thus when an Inflammation
arises in a part, as the Skin, & spreads wider & wider
the parts of the to which Inflammation spreads from the first point,
are suffering by continued sympathy.
214. Contiguous sympathy arise where an impression being given
to or an action excited in a part or parts contiguous to, but not
joined & immediately connected with the Sympathent, becomes the
sympathiser, thus an affection of the Integuments of the Abdomen
will produce consequent affection of the bowels.

☽︎. 219. I must remark on the text that the strength of partial & regular
sympathy will be in the Ratio of the powers of life. I think
here we must make a distinction between a readiness or susceptibility
of sympathy, & a strength of sympathizing action, perhaps debilitated
& most irritable persons & those in whom the powers of life are weakest
are the most ready to fall into sympathy of every kind, but the strength
of the sympathizing action in them will be but little, because the
sympathiser can have but little powers of Action.
♃. 220. The Brain Sympathizing with some other part, convulsions,
Epilepsy, or a sudden abolition of the visible Life, may be the
Event, the action in the sympathiser being here more violent than in
the sympathent.

46.
215. The sensitive principle the principle of Life & the Mind
mutually sympathize with each other so that affections of the one,
will produce affections of the other, or of both the others.
216. Remote sympathy is where the part which is the sympathiser,
is distant from the part which is the sympathent, as when a
diseased Testicle shall produce a sickness at the Stomach.
217. some parts are more particularly disposed to become sympathizers
than others, the stomach will sympathize with any part
of the body.
218. Particular habits are more disposed to universal sympathy
than others, the less determined in the disposition to partial sympathy,
the greater will be the disposition to irregularity & universality
of sympathy. Thus Infants are peculiarly subject to universal
sympathy, because when an impression is given to any part of
their body their partial sympathies, not being yet settled, or determined,
no particular part is disposed to become the sympathiser,
but the constitution takes up the sympathizing Action.
219. The strength of regular & partial sympathy will be greater
in proportion to the strength of the powers of Life & vice versa. ☽︎.
220 The affection of the sympathiser will often be more violent than
the affection of the sympathent, but this will depend on the number
& nature of the part & parts taking up the action of the sympathent
& thus becoming the sympathiser. ♃.
221. The vital parts are particularly disposed to partial sympathy
between one another, the further parts which are the sympathents

♀ 221. Thus in Diseases of Extremities, the Constitution is Exceedingly
ready to run into hectic Fever, as in white swellings of
the Knees, Arms or Ancles; but the latter part of the Text in this
Aphorism can only refer to the non vital parts for the constitution
is always most disposed to sympathize when a part necessary to
Vitality is affected. –
☉. 222. Instances of mutual sympathy are but few, the Stomach
will indeed sympathize with the head & the head with the stomach
but the liver is perhaps never the sympathizer when the Shoulder
is affected, though a Morbid change in the Liver produces very commonly
an unusual sensation in the Shoulder. –

47.
are removed from the heart, the greater will be the disposition of the
constitution to sympathize with them ♀.
222. Sympathy being only a secondary Action will cease when the
first part is destroyed, thus if a diseased & Ulcerated joint is attended
with hectic Fever, quick pulse, restless nights &ca. almost immediately
after its removal by amputation the pulse grows slow & calm
& the Patient recovers his sleep. ☉.
223. Sympathy is of many & important uses in the Operations of
life, it connects the principles of different parts, it enables one
part to assist another in the performances of its Operations possibly
when one part is affected with pain by enabling another part to take
on pain also, & thus diffusing the sensation it lessens its violence as
the same quantity of Pain concentrated in one part might be insupportable
to the Animal, but by its being diffused over other parts
the Animal is enabled to endure it with less injury.
224. Sympathy leads us to the knowledge of the causes, nature
& seat of diseases by observing in what manner one part becomes
affected from a prior indisposition of some other part, we learn frequently
from the sympathiser, the state situation & manner in wch.
the sympathent is affected.
225. But sympathy often leads us astray, & causes our judgement
to err, when the sympathiser is only sensibly affected we
refer too frequently the Disease to it entirely, over looking or not suspecting
the affection of the sympathent. (see the notes) We are moreover
often led to imagine from considering the Phenomena of Sympathy,

♂. 225. Thus a Man, having been used to fits of the Gravel if
seized either with a pain in the back or from any
other cause refers his pain to a Nephritic Affection (see symptoms)
228. How can it be proved that water is present in all
animal fluid, so as to act as water in the solution
of substances? for though in the analysis of animal [flu??]
water may be found, yet the process of that analysis
may be separated this water from combination in [wh?]
the nature of water was totally different. Consequently
water in this combination cannot act as it would other
do as a solvent.

48.
Sympathy, parts to be Sympathent, which are free from the action
in question, so also when the mind of the patient has been long
habituated to a particular Idea, it frequently but falsely refers
many sensations to the same cause, that had given rise to that
particular Idea, which sensations arise from the Causes. ♂.
226. When Medicine or Artificial means are employed for the removal
of Diseases, produce either a partial or universal effect,
it is to be considered as a kind of Violence done either to a part
or to the constitution. –
227. Before a Medicine can produce any, except Mechanical effects
upon the constitution, it must be reduced to a state of solution.
228 There is one property only in all the Juices of an Animal
body which is common also to one fluid out of the Body & by the
solubility of substances, in which fluid we can judge of their solubility
in the Animal juices, now all our juices are more or less
of a watery nature. Hence substances soluble in water will also
be soluble in the Animal juices.
229. But not only the substances (219) are soluble in the Animal
juices, almost all substances are so in a greater or lesser degree &
most of them are so in the mouth, as we know by their giving their
impression by the Taste, previous to their doing which they must
be in a state of solution, no substances having any but a Mechanical
action on a part which are insoluble in the juices of that part (228)

232 may not different degrees of galvanic action
be the cause of the separation of the various juices
for what[ever] other cause is so probable.

49
230. many substances are soluble in the Stomach though insensibly
as Earths, which are neither soluble in water, nor in the Saliva
& consequently are insipid. –
231. For a Medicine to produce universal Effects it must be dissolved
in ye Blood.
232. The Blood is a kind of Universal Menstruum for Substances
being found incapable of solution in it. Its properties
of retaining at once so many substances in a state of solution,
may arise from its heterogeneous nature, for it is well known
that a fluid that has dissolved one substance, tho’ it will perhaps
take up no more of that Substance, yet will even by means of that
substance be enabled to dissolve a second Substance for which it had
otherwise been an improper Menstruum; thus Water when pure
will difficulty dissolve Corrosive sublimate, but a saturated aqueous
solution of Sal Ammoniac will enable the water to dissolve abundantly
more of the sublimate, than in its Elementary state it
would have done, so also water impregnated with fixed Air to Saturation
will still dissolve other substances, & even such as unmix’d
it would not have acted upon.
233. Medicines dissolved in the Animal juices have a power
of influencing both the Nervous & Living principle.
234. Medicines perform their operations by their
(a) Stimulating
(b) Irritating or
(c) Sedative powers, & by the Animal body having

are not the stimulation the irritating & the sedate
all chemical.

50.
a susceptibility of that Operation but never produce any change
unless when they act as caustics by any Chemical Operation. –
235. The powers a.b. (234) are to be found in the same Medicine,
the quantity in which it is applied only making the difference.
236. Stimulating Medicines only produce natural action or
increase one already present; Irritating Medicines diminish action
whether natural or unnatural, each of these may produce
both partial & universal effects. –
237. The influence of stimulants, will be as the power of the stimulant,
& the nature, & powers of the part taken together. The same
will also be the influence of an irritation. –
238. The influence or operation of the same Medicine on different
parts will be extremely different, so also the action of Medicine on
a second part will differ from its action on the same part when
in a state of disease.
239. In order to understand aright, the influence of Medicine we
must consider parts as capable of suffering four actions Vizt.
1st. The Action of Health.
2d. The Action of irritation on health.
3d. The Action of Disease.
4th. The Action of irritation on Disease.
240. Irritation acting upon health produces diseased action, Irritation
acting upon disease produces or restores health.
241. As parts are susceptible of a variety of diseased actions the

🜔v 247. Friction can be applied to a larger surface than pressure.

51.
removal of one diseased action by medicine will not always produce
a return of health, a disposition to some other diseased action
may have been formed, & wait only for a removal of the present diseased
action, to go on to its proper Action. One action can only exist
at one time in one part ( ).
242. The irritation of medicine on disease, may although it removes
the present disease, even induce a disposition to some
other diseased action, which as soon as the first action ceases, may
go on to its action.
243. From (241-242) it is evident, we should be careful to discriminate
the consequence of disease, from the consequences of Cure,
we may otherwise persist too long in any mode of Cure.
244. The powers of the living Animal may also be affected by
mechanical means The operation of the application of mechanical
means may be reduced to two Species. Vizt.
A. That of Pressure
B. That of Friction.
245. Both A. & B. (244) produce the same ultimate Effects as
Medicines. –
246. Pressure seems to impede action, it is also of use as a stimulus,
if applied more forcibly it irritates.
247. Friction does not seem to impede but excite action, if
violently applied it irritates, if gently it stimulates. 🜔v.
248. Medicinal applications may produce their Effects either

  
         
     
                                    


52
simply by contact, or by exciting sympathy.
249. It is rarely Medicines act simply by contact, their influence
being carried by Sympathy generally much further than the
parts to which they are immediately applied. –
250. The effects of medicines acting by Sympathy, may be thrown
into the same divisions as the actions of Sympathy particularly
they will act by continued, contiguous, or remote sympathy.
251. In directing the administration of medicines it is necessary
to have respect to the strength & weakness of the part or constitution,
& to the too great or too little action of the part or constitution.
252. As in health the action of a part must be always in due
proportion to its strength ( ) so in your Endeavours to restore
health when impaired, we must always endeavour to proportion the
degree of Action to the strength.
We must never increase action when strength is deficient
without endeavouring to increase strength likewise.
253. A. Strength & Action may both be diminished or Increased
B. Action may be increased, & strength at the same time be
diminished.
In one case A., it must be our care to increase both
strength & Action.
In the other B., we must either reduce the action to the
strength, or increase the strength so as to level it with the action

at the moment of act of solution what change
takes place, does an electric action accompany the chemical
if it does the new solution may acquire new properties of
electric matter, & then modification may effect the animal
the modification too may effect growth of the different
vegetables for how can you account for the same plant
acquiring properties different from in another & the
same situation is then the effect of different organization
or different galvan action.

53.
254. Weakness & want of action are not the same, a part may
have Weakness, & yet too great action, we judge more readily of
too great or too little action than of strength & weakness, because
the former are effects, the latter are often causes.
255. Medicine may act by contact (249) or by Sympathy ( )
256. Medicine may also be absorbed (see absorption (1)) & when
absorbed will again exert their action by sympathy or by Contact,
by contact they may affect either the Lymphatics of the part, or
of as much of the Lymphatic system as they pass through, or again
when mixed with the Blood may by contact affect the constitution
in general.
257. There are also applications which penetrate beyond the surface
to which they are applied, as heat, cold, Electricity
258. Heat [sometimes] increases the Vital & involuntary actions
though it is considered as penetrating it cannot produce that
effect beyond a certain degree because the animal is incapable
either in a part or the whole of receiving or containing a certain portion
of heat.
259. With respect to cold, also the same reasoning will apply the
Animal powers whether in a part or in the whole, will neither
receive nor part with more than a certain quantity of heat, that
is without destruction of its principle of life.
260. Electricity indeed in every capacity of the Animal is Universally
penetrating, as no circumstance or difference in the capacity

more electricity than the natural quantity increases
action.

54.
of the Animal can obstruct its passage.
261. Cold, heat & Electricity are capable of powerfully Exciting Action,
we must therefore be extremely attentive to the circumstances
& degree in which they are applied, least we sometimes excite
an action superior to the strength.
262. Cold applied to the surface of the body may become a Stimulant
& Rouser, or a seadative & weakener.
263. In the first instance (262) it produces heat, in which it
agrees with the warm Bath, with this difference that the latter in
some measure gives heat to the Animal the former obliges the Animal
to produce its own heat, here the powers of generating heat
are increased the Pulse quickens the actions of health are in general
increased. these Effects show the Animal is in full
powers of restoration.
As the cause of these effects is instantaneous, so the Effects
will be but temporary therefore the cold applications must at due
intervals be repeated.
264. In the second instance (262) it proves a sedative & weakener
where the parts to which it is applied either can give no
Alarm to the constitution or the parts, or the constitution have its
power of generating heat diminished here all the consequent
actions will be the actions of weakness.
265. Cold may produce various effects by sympathy even local.
266. Heat is either absolute or sensible, the latter we shall here
notice.

♁. 269. For the general properties & effects of heat & cold, in Animal
Bodies, see the Text & Notes on heat, Cold & Climate. –

55
267. We judge of the sensible heat by our senses, or by
measurement, this sensible heat is either Native or Foreign.
268. Foreign heat in its application will produce different effects,
as it is applied simple, or compounded with  bodies capable
themselves of exciting action.
269. Foreign heat is applied with two intentions. Vizt.
1st. to increase the warmth of the Animal
2d. to act upon the principle of Life.
Heat has the general property of increasing the violence of the
involuntary actions. ♁.
270. According to the degree in which it is applied it will be
either irritating or sedative.
271. Substances compounded with that heat are applied either in a
dry or an humid state.
Heat in dry vapours can be medicated with Essential
Oils, Spirits, &ca. The warm bath is an example of humid bodies
compounded with heat.
272. The Bath ( ) is generally used with a degree of heat
something below that of the Animal, or in a degree above it, the
former is called the tepid Bath, the latter the hot Bath.
273. The former seems in general to soothe the Skin & by Sympathy
to affect other parts with an agreable sensation, hence it
rarely depresses nor does it in general Excite any increased action
further than simply freeing a part from disease.
274. The hot bath produces more powerful effects, by exciting

🜔. 276. Muscles heal or are restored to health more readily
than bones or ligamentous parts, the cellular substance will
take on the healing process more readily if placed about Muscles
than if placed about Tendons or bone &ca. taking on in general
the disposition of the parts it is subservient to.

56
an increased action on the surface it may produce relief to the
internal parts if continued for a length of time it produces weakness
but not commonly a permanent one.
275. It is observed above ( ) that different parts will be more
or less able to resist disease. In the same manner in different
parts when diseased there will be more speedy or slow advances
towards health, & this from the same Cause. Vizt. the difference
in strength or weakness.
276. Parts in which actions are excited with the greatest difficulty,
fall into diseases more slowly, & when diseased are more slowly
restored again to health. 🜔.
277. Touching the slowness or readiness with which parts diseased
recover their health much will depend on their situation in
the body.
278. The power of healing or the facility with which parts diseased
recover their strength or health will also be different during
different ages, other circumstances being similar.
279. This power (278) will be greater [more or less] or more active,
during the growth of the subject than after the growth is
stopped, during the middle age or that which is called stationary
( ) though this is not well ascertained / the power of healing
is less Active, but it will be the least active of all during the state of
decline when [Life] the System seems to take a retrograde motion
& nature begins to unbuild. ( ). –

🜔🜹. 282. A scrophulous Joint, an ill conditioned Ulcer, an
ulcer in the Lungs, or any other similar cause may produce
a constitutional affection & these existing in such a state the Constitutional
affection cannot be removed.
♎︎ 283. Thus the Cranium is at first membranous, it afterwards
in due time becomes bony, or its bones shoot in membranes
if by fracture or other violence a part of it is removed, in the
restoration first membrane is formed & afterwards bone so in
the cylindrical bones as they were at first cartilaginous, when
restoration in consequence of injury becomes necessary, the Union
is first by Cartilage afterwards by Bone.
☿ 284. If a part of a tendon is destroyed as by a Wound &ca.
the injury extending in other parts as Skin, Cellular Membrane
&ca. the Process of restoration being begun, the Union will not be
formed by means of a regeneration of Tendon.

57
280. It frequently happens that one disease will prove the cure
of another. –
281. One local disease being produced may remove a prior
local disease, a constitutional Disease arising may prove the
cure of a local disease ( ) & a local disease arising may
cure a constitutional one. ( )
282. Constitutional Diseases cannot be cured whilst parts are
continually adding to the constitutional affection. 🜔🜹.
283. When loss of substance happens in any part & that loss
is to be restored, the parts which restore the loss or which regenerate
the substance to fill up the loss, in their action for that
purpose [produce] preserve the same disposition with which they
were at first formed. ♎︎.
284. The law (283) does not however universally hold good
as circumstances being present may prevent its operation. ☿.
285. Inflammation, is an increased action in a
part, it is difficult to determine whether it differs from common
Action in a part except in degree.
286. Inflammation is the first principle in Surgery, it is the
cause of many local diseases, it is the means of preventing the
increase of many local diseases, & it is often a powerful instrument
in their Cure, it operation are chiefly performed by the small


  


 
   
    
                                  


58.
Vessels, the larger ones doing more than bringing the
blood to them.
287. It may be divided into
1. the Healthy
2. the Unhealthy.
The first that which is attendant on any healthy
state of a part of the constitution, the other that which attends
on an unhealthy state of the part or Constitution.
288. It may be divided into.
1. Single
2. Compound.
The first the Action of Inflammation alone
the second the Action of Inflammation with the modes of
action
289. It may be divided according to its Effects into
a. The adhesive.
b. The suppurative
c. The Ulcerative
290. The parts Subject to Inflammation are
a. The cellular membrane & circumscribed Cavities.
b. All the Canals & outlets of the body.
291. The three Stages or States of Inflammation may have
a fourth superadded. Vizt. that of a specific disposition to Scrophula

▽. 293. By the effusion of coagulable Lymph & its gluing
up the Cavity, or confining the extent of the inflammation
& in fact a Cyst is formed to contain the purulent matter
when formed, hence we see how matter is confined to one
spot instead of being widely diffused, by it also is formed
a Cyst round Musket Balls, pins, Glass & ca.

59.
Scrophula.
292. In the order (a. 290). The adhesive generally begins first
the suppurative & ulcerative are its sequels. In the order (b. 290) 
The suppurative begins & the ulcerative or adhesive follows.
293. In the adhesive inflammation coagulable Lymph as by
the increased action of the Vessels speedily thrown out between
the surfaces of the Cavities one to another, & thus entirely obliterates
them. ▽.
294. Inflammation is frequently carried no further than
the adhesive (293) & then it may terminate by what is
called Resolution.
295. The adhesive inflammation often prevents an increase
of local disease, it sets bounds to its own progress & it
prevents the diffusion or extent of the suppurative inflammation
when it takes place.
296. The coagulable Lymph thrown out in Inflammation
(293) always partakes of the nature of the solids, which seperate
it.
297. The termination (294) does not always take place when
it does not happen if in the violence of the action the
death of the parts does not ensue the suppurative stage
takes place.


 
 
  
  


 
   
    
                                  


60.
298. The suppurative stage will arise when the death of a
part has actually taken place, but the surrounding parts
have not suffered the same absolution of their vital principle
here indeed the dead part may be considered as a foreign
substance & as a Stimulus to inflammation to those that
surround them.
299. Particular circumstances arising in different parts
of an animal body, the parts may be disposed to absorb
themselves & so to produce a solution of continuity, the Inflammation
attendant on this action is the Ulcerative (289 c)
300. This is commonly the sequel of the suppurative Stage
& therefore may for the most part be rather considered as a
consequence of that stage than as the affection of an original
disposition in a part.
301. This (300) is however not always the Case, it sometimes
arising without a part previously undergoing suppurative
inflammation. –
302. The general order in which inflammation proceeds
in the cellular membrane (290 a) is
1st. Adhesive
2d.. Suppurative
3d.. Ulcerative.
303. But this order is not always observed. The suppurative

☽︎☉ 304. When inflammation attacks the canals, it rarely
goes beyond the suppurative affection as those parts do not
readily fall into Ulceration, adhesion will arise still more rarely
the ulcerative inflammation being in these parts so uncommon,
granulations of course will as seldom be found to take place.
309. This arises from a particular original disposition in the
part brought into action by the fever or by a part taking up an
Universal disposition.

61.
Inflammation will sometimes arise without the adhesive previously
taking place, here the Disease & the extravasated fluid
will be widely diffused this is the Case in all the Erysipelatous
suppuration.
304. In the Canals or outlets of the Body (290 b) the suppurative
generally begins, the ulcerative follows to which the
adhesive succeeds. ☽︎☉.
305. The Erysipelatous affection attacking the parts the order
is here also disturbed, the adhesive or Ulcerative arises
first & the suppuration succeeds.
306. Whatever can increase the violence of the action of parts
may be called a cause of common inflammation.
307. A part will take on the affection of the constitution,
that is an universal affection may become a local one, hence
therefore a cause of local inflammation may be traced.
308. The abscises arising after the termination of specific
febrile constitutional diseases, as Small pox, Measles &ca.        
have nothing specific in their nature, they only arise in consequence
of the common disturbance the constitution has suffered
from the fever if the disease.
309. Simple inflammatory fever may be followed by an Abscess
in a part (308).
310. The remote causes of Inflammation are four Vizt.

  
 
 
  
  


 
   
    
                                  


62
1st: From accidental Violence.
2d: From irritation applied to the part.
3d: From a particular disposition to the part itself.
4th: From a general state of the Constitution affecting
some particular part.
311. Many constitutions have a disposition to specific inflammation,
& will fall into it whenever any exciting cause shall
arise as in Scrophula & in habits subject to Erysipelas.
312. Many parts of the body have a greater tendency to specific
diseased action than others, so any constitutional Affection
arising these will readily take on a diseased specific action.
313. Specific inflammation may be.
a. Specific & healthy, or
b. Specific & unhealthy.
314. Different parts more or less readily take on different Inflammation.
External parts are more inclined to the suppurative,
internal parts take it on less readily suffering [them]
even the presence of foreign stimuli a longtime without going into
this Stage; Vital parts do not readily admit of the suppurative
Inflammation tho’ they willingly take on the first & most simple
inflammation.
315. When a part is inflamed that is not essential to Life the
Constitution does not necessarily sympathize with it, unless from

♀. 316: There are two powers which can produce a change in
the state of the pulse, that of the heart, & that of the Arteries,
the regularity or irregularity will depend upon the heart, the
hardness, fullness, softness & smallness will depend upon the Arteries.
🜔🜹. 317. The effects of Inflammation on different parts.
Stomach. Quick small & hard, sometimes low
pulse, nausea, dull heavy pain, depression of mind.
Small Intestines. nearly similar
Large Intestines: pain more acute, general depression
less nausea:
Liver. This procures besides its own peculiar
symptoms effects somewhat similar to inflammation of the Stomach.
Heart. Its motions are confused & irregular
the pulse quick & lower than common.
Uterus. Great oppression, nausea & obtuse pain.
Lungs the heart frequently sympathizes 

63
the long continuance & violence of the inflammation for here the
operation of inflammation may be carried on without interrupting
the functions of the Vital parts
316. But of the constitution of the patient is very irritable &
readily takes on sympathy nearly the same Phenomena will
arise as in inflammation of the Vital parts; the Pulse will
grow small quick & hard; blood drawn off will be sizy but loose
& its superficies flat, the violence of pain will however be greater
than in the inflammation of the vital parts. ♀.
317. All parts supplied with their Nerves from the intercostals
& par Vagum when attacked with inflammation give symptoms
of lowness, & depression. 🜔🜹.
318. The termination of Inflammation will take place the quicker
the nearer it is to the heart.
319. The pulse growing quick after the commencement of inflammation
is a proof of the constitution becoming affected on
sympathizing.
320. On the commencement of inflammation Rigor is frequently
felt, this is not simply from the debility induced into the constitution,
but also from the Novelty of the action which it performs
but weakly because it is not prepared for, nor accustomed to
it.
321. In Rigors & Syncope the blood is collected about the

preventing a full diastole; when the Muscles are inflamed the
pain is acute, the pulse full & strong. Inflammation of the
bones & Tendons produces a dull heavy pain & the Stomach generally
sympathizes.

64
internal parts, & the External are left in some measure empty.
322. Every new Action in the Constitution must tend to induce
weakness in it, its Effects will however vary in different constitutions,
in the strong it will excite the general powers of action &
an hot fit will soon succeed, in the weak the hot fit will not always
be produced but only a clammy sweat succeeds.
323. Rigors are not attendant on the commencement of Inflammation
alone every new action in the constitution may be accompanied
by them.
324. Life cannot go on always in the same state it must have
its stated seasons of rest & action, hence even in the most continued
diseases, & when the cause is unvaried there will be intervals of Alleviation
& exacerbation, nature observing her general Law rests even
in disease.
325. Exacerbation may be considered as the renewals of the commencement
of diseased action, & so a kin in some measure to
Rigor...
326. Disease may exist & yet the constitution may be insensible
to its action, it may want power of keeping the constitution in
action beyond a certain time in ague the disease exists as much
between as during the Paroxysms.
327. From ( ) it is evident that a change arising in the constitution,
a change in the Blood as partaking of and possessing
the living principle may take place also.


   

        
  
 
 
  
  


 
   
    
                                  


65
328. The appearance of the Blood will not be always the same
under given symptoms of constitutional affections, such as the
state of the pulse &ca.
329. Inflammation begins at a point at first, all the local
symptoms being confined within a small compass, afterwards
it spreads according to the state of the surrounding parts wch.
may be either local or constitutional, as the surrounding parts
are more or less in health they will be more or less disposed to
continued sympathy, at length the inflammation & redness will
be gradually lost in the surrounding parts.
330. Inflammation is attended with a swelling of the part
the more healthy the more the swelling will increase at a
point.
331. The swelling of a part arises from the Vessels of the part
being more distended with fluid than natural from the Extravasation
of coagulable Lymph, & of some serum, which is
known from the Oedema of the surrounding parts, the less extensive
the Oedema is & the firmer the Margin of the Inflammation
is the more healthy inflammation will be present for here
more coagulable Lymph & less serum is thrown out.
332. The colour of the inflamed parts (329) will also be altered
the nearer it approaches to a pale scarlet redness the more healthy
the inflammation will be, the less healthy the inflammation
is, the colour will be less of the scarlet & more of the darker red

♂. 337. Mr. Hunter threw Tartar Emetic qts. iij into the Veins of
a Bitch, it soon vomited her, she became Convulsed & died, she
was astonishingly Cold during Vomiting & upon opening her immediately
after Death the heart & lungs were found remarkably Cold. –

66.
inclining to purple & sometimes to a blueish hue
333. The changes of colour (332) will arise.
a. – from Vessels which naturally contained only Lymph
or Serum, carrying red Blood.
b. from either containing more blood than circulated
through the parts in its natural state according to the Law of
the Animal Oeconemy, the the more a part has to do, the more
blood will be given to it, the colour is that of Arterial blood.
c. from New Vessels being formed in that partly
coagulable Lymph becoming organized. –
334. When inflammation attacks parts near the surface of the
body, heat of the parts will be considerably increased.
335. But the heat of the inflamed part will not be increased
above the standard heat of the Animal, though compared wth.
the heat of other parts of the surface it will be greatly increased.
336. An increase of heat in a part does not always arise from
an increase of its power of action, it may arise from increased
action though attended with weakness. –
337. Coldness in a part is however in general arising from weakness
& want of power of action; but a part may have its degree
of heat lessened by its sympathizing with the affections of other
parts as the stomach, changes in the Mind &ca. ♂.
338. The source of heat is probably in the Stomach from whence

♃. 338. The Stomach sympathizing with any part of the constitution
is the probable cause of Rigors, Rigors are not only produced by
constitutional affections but even by local ones as the Pricking of a
finger, also by affections of the mind as fear, horrid sights &ca. the
absorption of any Contagions or putrid matters into the System is
attended with Rigor, Rigors probably do the same thing in the Constitution
as Vomiting, rousing the constitution to greater action, the
heat of the Blood cannot be altered by the Sympathetic Fever, a
constitutional affection can only produce a change in it. –

67.
by means of circulation it may be conveyed to every part of the
Body. ♃.
339. Inflammation is commonly attended with a painful sensation
communicated from the affected part to the mind, in the
adhesive state it is rather of a dull heavy kind, when proceeding
to suppuration it becomes more acute, when suppuration has taken
place it abates, when Ulceration begins it again increases,
but during the latter state it rather gives the idea of soreness.
340. Every time the Arteries dilate there is an increase of pain hence
the sense of throbbing, the cause of the pain is the distension of Nervous
& sensitive parts.
341. The disposition of inflammation, will sometimes cease before
even adhesions are produced, [& This], after a part has begun to swell,
[this] is called resolution.
342. As the increase of pain was a proof of the progress of Inflammation,
so its diminution is to be attributed to the cessation of the
inflammatory state, when the uneasy state is removed, the disturbing
cause is taken away, & the parts return to their state &
ordinary functions.
343. The Constitution will not only be differently affected by the
different situations & functions of parts inflamed & greater or lesser
extent of the Inflammation, but it will also be differently affected
by the different stages of the inflammation present, thus the suppurative
inflammation will affect it much more than the adhesive
or Ulcerative by where action in general the constitution is but little

♄. 348. Thus if small pox matter is applied, if the constitution
has a peculiar susceptibility of a putrid disposition, the disease will
partake of the constitutional disposition, as in the confluent small
pox. So Venereal matter shall in one person produce a Chancre
surrounded with common inflammation, in a person of a different
constitution it will be accompanied with an Erysipelatous Inflammation
which may spread to a wide Extent.

68.
disturbed.
344. The vital parts subject to inflammation may be divided into
a....Those which readily take in Sympathy. &
b. – Those which do not.
Of the latter, the Lungs, of the former the Stomach are instances.
The Pulse will generally be harder though smaller under
the affection of the former than the latter. –
345. Whatever can obstruct the natural circulation through the
minute Vessels will produce inflammation its causes therefore
may be very different & various. ( ).
346. When a part perceives an alteration in its structure or a
change in or obstruction to its natural functions the Stimulus of imperfection
arises.
347. The stimulus of perfection exists in parts new dispositions
where consequent actions are either processes of restoration or destruction
according to the strength of the parts & their facility in the art
of healing. (252).
348. Irritation of whatever kind being applied may produce inflammation
peculiar to the constitution or condition of parts.
(311-314). ♄.
349. The disposition for restoration of parts injured is the most
simple, (165), that from necessity is more complicated, but the disposition
for disease is the most complicated of any.
350. The stimulus of imperfection may arise in parts from different

🜔. 352. To the first may be referred bruises, strains simple, fractures
&ca. To the second, Wounds of all kinds opening Externally.

69.
different causes, as obstruction to their natural actions, or from an alteration
in their structure by external violence, the latter becomes
chiefly the object of surgery though the former may also fall within
its province.
351. The effects of external Violence will be different according
as that violence is applied to sound parts, or to parts diseased.
352. Mechanical injuries on sound parts may be divided into
two heads
1st. Those which do not communicate externally
2d. Those which do. 🜔.
353. The first division may by circumstance be changed into the
second, & the second may be brought back to the first.
354. The effects of the first division on the constitution will be
different according to the state of the constitution & the nature
of the parts injured & the power of healing in a part is strong,
the part injured not vital, & the constitution not highly disposed
to Sympathy, no material change will take place in the constitution
& the process of restoration will go on with only local effects.
355. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the
parts injured, the kind of violence inflected, & the degree of that
violence.
356. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the

🜔^. 359. When wounds are inflicted it is evident from the Text
that when the first mode of union is to be effected the Surgeon
should bring the lips of it in close contact & retain the blood in the
Wound, then defend the part from the action of the Air, no foreign
matter should be introduced, hence the suture must in general be
objected to.
Union will not only take place between divided parts of the
same body but also between parts of different bodies still retaining
their living principle when brought in contact with each other
Thus Mr. Hunter introduced the testicle of a living cock into the Abdomen
of a Hen, the testicle became united to the liver of the
latter, & sometime after the Hen was killed, Mr. Hunter injected
the Testicle from the body of the Animal.
Again he fixed a Tooth recently extracted on the Comb of
a Cock & on injecting the Animal the Membrane lining the tooth
was also injected.
Upon this Mode of union depends the cure of the hare
Lip from this arises the unnatural cohesion of fingers one to the
other when the Cuticle has been destroyed by burns &ca. from this arises
the union of the Chin to the breast when ulceration has
proceeded &ca.

70.
parts injured, the kind of violence inflicted, & the degree of
that violence.
356. Its effects on the constitution will be determined by the same
laws as those regulating the effects of the first class.
357. When vascular parts violently separated from each other is
accomplished either by
a. The extravasated blood being the Bond of Union
b. The adhesive inflammation, or
c. Granulation.
359. It has been already observed that the blood is a living fluid,
when extravasated it does not immediately lose its living
principle. In  the separation of parts by violence when the
blood is Effused. the first mode of reunion is effected by the red.
particles & Serum being absorbed, & the coagulable Lymph being
left. the Lymph becomes vascular & nervous, & thus readily reunites
the sides of the Wound together, this process is accomplished
with more ease in the first class of injuries than in the second
because the blood by coming in contact with atmospheric Air
the sooner loses its living principle. &ca. 🜔^
360 – But a variety of circumstances may prevent this mode
of union taking place. The second process or that by adhesive inflammation
is next excited – Coagulable Lymph being still the
necessary medium of reunion is supplied from the Vessels of the side

♀ 362. Hence when a Cavity is exposed & the Wound does
not unite by the first or second mode of Union the whole
Cavity still will often escape running into the suppuratory
process, the contact of the Edges, or the part near the Edges
of the wounds with some of the containing parts setting bounds
to the process of the new action.
The parts taking on Sympathy may however produce
an exception to the rule in the Text.
♄. 363. This is illustrated by dissections of Women dying
with the puerperal fever when Inflammation had produced
adhesion between the Peritoneum & some of the contained Viscera,
while the suppuration had generally diffused itself over
the parts of the Abdominal Cavity.

71
of the wound by the first or adhesive inflammation arising,
this becomes organized & again fills up the breach.
361. But many circumstances impede this process also such
as the death of the solid parts receiving the injury, hence their
becoming foreign bodies, the too great violence of the inflammation
(360) producing suppuration; the interposition of foreign bodies &ca.
& here the process of restoration cannot be accomplished without the
third mode of union (348) Granulation.
362. When an internal Cavity is exposed the whole of the cavity
would run into Inflammation unless some part of its surface is
in contact with some other living part, that simple contact will
set Bounds to the spreading of the Inflammation. ♀.
363. The adhesive inflammation is sometimes imperfect not answering
to the final intentions, & this is when the violence giving
rise to it has excited too rapid an Action to admit of the adhesive
process taking its full effect, this however seems rather to belong
to the Erysiplatous Inflammation. ♄.
364. The Cure of Inflammation is by resolution ( ) but before
we attempt the Cure of Inflammation artificially, we must enquire
into the constitution of the patient, as whether he is disposed
to irritability or indolence, his former habit, temper of
mind &ca. & also the situation & other circumstances of the affected
part.
365. The time for attempting the cure of inflammation by

    
      
  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


72
resolution is before the suppurative process has taken place
366. We must consider whether the inflammation is of the true
healthy kind, or has the Erysipelatous disposition, or any other
specific disease mixed with it, We must also consider whether
there is an increase of life or only an increased disposition to
make use of Life; a distinction very necessary to observe.
367. We have noticed (332) that a change of Colour in parts is
produced by inflammation, when inflammation is seated in
parts near the Skin & its action is violent, vesications will arise
the Cuticle being seperated from the Cutis, this arises from the action
producing death of the connecting Medium between the Cuticle
& the Cutis.
368. The Coagulable Lymph (319) fulfills not only the intentions
(290-359-360) but also when the third mode of Union, or as it takes
place becomes the basics of the future Granulations.
369. In the Cure if the Inflammation is of the true healthy kind
we have only to remove whatever cause keeps it up.
370. An increased disposition to make use of life (366) or too
great violence of circulation is to be lessened by weakening with
evacuations & the exciting of nausea, & by soothing or Anodyne remedies.
371. When there is both an increase of Life & powers & an increase
of action weakening the System becomes necessary.
372. The System is weakened by bleeding, if only increased action

🜺 373. Topical Bleedings however [considerable] desirable cannot
always be had recourse to, for instance in increased action of
the Vessels of any of the internal Organs.

73
action is present without increased powers bleeding is only to be had
recourse to from particular indications: Vizt.
a. When it is desired to lessen the present Action in order
to give the disposition time to wear itself out without destroying parts
by its violent action.
b. When the parts affected is a Vital one.
c. When it is near a vital part.
373.. Unless the powers of action are great or the exigency of present
circulations requires that blood should be drawn from
the System. Topical blood letting is to be preferred & that from
or as near to the inflamed part as possible. 🜺.
374. Topical bleeding should be particularly insisted on when
there is a disposition in the habit to form but little blood, & when the
part inflamed is distant from the source of Circulation.
375. When the action only & not the powers are increased it is to
be desired that the constitution should perceive the loss of blood as
little as possible. Topical bleeding give less Alarm to the constitution
than bleeding from the System.
376. In our choice of bleeding we are in a great measure to be regulated
by the Pulse, but as the pulse is differently affected by the inflammation
of different parts we cannot be absolutely determined for or
against bleeding by any one general state of the pulse, for the most
part however, it is to be considered a quick & hard pulse generally
indicates bleeding.
377. An other general indication of Blood letting is the state of the

♃. 381. In weakened habits a single stool frequently produces fainting
may it has even caused an Abolition of the powers of Life.

74.
Blood but this can be only an after proof.
378. If state of the Blood is [only] Sizy & the Coagulum flat & its
texture loose bleeding is contraindicated, or at least to be sparingly
employed.
379. Another general indication of bleeding, is Urine high in Colour
& small in quantity.
380. A comprehensive view of all the Symptoms of health & weakness,
present violence of action, the nature & situation of the parts
affected, can only enable us to decide on the rectitude of using or omitting
bleeding. –
381. Purging weakens universally, it is to be had recourse to
with the same Caution as bleeding & in irritable habits still greater
caution is necessary. ♃
382. Sudorific may be proper when the Constitution Sympathizes
much, because they do not so much diminish strength.
383. Nauseating medicines lessen universally the powers of Life.
Vomiting ones rouse the spirits & powers; for Vomiting seems an
action intended to relieve weakness. (338 note).
384. Soothing remedies. Opium is the principle. Opium will only
lessen actions not alter them, as the disease sometimes consists almost
entirely in increased irritability by lessening the latter it may
diminish the disease.
385. We also endeavour to promote the intention (370) by topical applications;
of these preparations of Lead appear to lessen the power
as well as lessen the action, they are not therefore universally to be

389. Upon this principle we use blister plasters to remove deep
seated pains, upon the same we apply sinapisms to the feet when
the Brain is affected. Vomits when the Testicle is inflamed.

75.
had recourse to (366).
386. Cold powerfully weakens action, from its use therefore great
effects may be expected, the degree & length of applications of Cold
is however to be considered (262). –
387. The effects of topical remedies will be either.
a. Immediate
b. by Repulsion
c. by Revulsion & derivation.
d. by Sympathy.
388. The first order (a) seems to require no Explanation, applications
acting by repulsion only produce their effect upon a part when
the Inflammation has arisen from a parts taking on the disease of the
Constitution, & the disease from a Constitutional has become a local one,
as Gout.
389. Revulsion & derivation are not well defined the distinction between
them is perhaps Ideal, by them we must understand a cessation
of action in one part produced by an increase of Action in another
part this does not depend upon the humours but upon a change in
the place of action, or irritation.
390. Repulsion is the cure of the part, be the consequences of the Cure
what they may.
391. Sympathy. the cure of a part by local Sympathy is when the
same effects arise in the part diseased from an application used to
some other part as if the application was made to the diseased part

☿ 391. Hence it is that Mercurial Ointment applied to the Skin Covering
a Node, will cause the node to disappear in the same manner
as though the Mercury had been applied to the Node itself without
the medium of the Integuments.
🜔vmss 392. Vomits curing inflammation of the Testicle after sedatives
&ca. had been used in Vain, Caustic behind the Ears curing
Ophthalmia which had resisted all applications to the Eyes, elucidate
the truth of the Text.
The Cure of the tooth ach by burning the Ear is to be referred
either to derivation or Sympathy.
Derivation seems to be the reverse of Sympathy We cannot
however always distinguish one effect from the other. The cure
shall often be effected by Sympathy, thus blistering one part will
remove pain existing in another part tho’ the action excited by the
Blister may be of a different kind.
☍ 398. Among the causes of this effect are wounds not uniting by
either of the two first modes of union & the 3d. or Granulation becoming
necessary for their cure, violence having produced the death of parts to
the removal of which suppuration becomes necessary. Violence having
Exposed internal surfaces.

76.
itself. ☿.
392. A cure of local inflammation by derivation or Sympathy
will often take place when sedative applications have proved ineffectual.
🜔vmss.
393. Topical applications may be divided into.
a. Fomentations.
b. Steams.
c. Lotions.
d. Poultices.
394. The order a. & b. are of shorter duration in their actions,
but may afford relief during the application, the order c. are
more lasting in their actions & are only substitutes for the order
d. which of all application produce the most permanent action
395. Poultices will be either.
a. Simply warm & Moist, or
b. Medicated.
396. The effects of a Poultice will be immediate on the parts
to which it is applied, but by sympathy they will be extended
further.
397. Medicated Poultices will be formed according to circumstances;
[of] with Lead, Opium, Mercury &ca.
398. When Inflammation however excited exceeds the adhesive
state, & gets beyond the point of resolution, Suppuration is produced ☍
399. The cause of a parts running into Suppuration is, its

🜍 400. The application of Air to internal surfaces as the Cavities
of the Thorax, Abdomen & Joints, has been considered as the cause of
suppuration but this is evidently not the case, suppuration would
take place even in vacuo. In Emphysema where Air is diffused all
over the body we have no such effect until an Opening is made, but
in case of suppuration from an Opening the stimulus of imperfection
takes place the Cavity being an improper one to prevent this
imperfection as much as possible we observe in a Wound of the Abdomen
of a fowl that adhesion takes place between some of the Intestines
& the edges of the Wound, if this does not happen general
suppuration succeeds, another proof that Air in internal Cavities
is not the Cause of suppuration is that in some Animals the Air
has a free communication from their Lungs into the cells of their
bones & into the Abdominal Cavity without producing suppuration
as in the Case of many Birds.
🜖 404. This we readily account for, knowing that suppuration
is the first ordinary process in inflamed Canals, whereas adhesive
Inflammation is the prior action in the Cavities.

77
perceiving the stimulus of imperfection, & being thence necessitated
to begin a new & unusual process.
400. Communication with the atmospheric Air is not necessary
to suppuration. 🜍.
401. Great violence of action is not necessary to suppuration
it is rather productive of gangrene, suppuration is sometimes
produced in a part without any visible violence of action in the
part which takes it on.
402. Although it sometimes arises without any visible violence of
action in a part, yet in healthy constitutions it is generally found
that the inflammation is considerable.
403. The action producing it is most violent when it arises
spontaneously. –
404. Suppuration takes place more readily in internal Canals
than in internal Cavities. 🜖.
405. It is not necessary to forward Suppuration even in Inflammations
arising from the constitution, the constitutional disposition
seeming to have produced its full action in the Inflammation
or inflammation is to be considered as the disease taken on by the
part from the constitution, & so curing the latter & suppuration is
only the sequel of the disease. –
406. The adhesive inflammation going on to the suppurative,
in the latter stage, the general symptoms increase, the pain becomes
more acute, the sensation arising from it is as much as possible


 
 
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


78
that of simple pain, the redness is more intense, new Vessels being
formed & old ones more dilated, hence a more violent throbbing
from an increased dilatation of the Arteries the swelling of the
parts increases from a still greater effusion of coagulable Lymph
& Serum, the surrounding parts become Oedematous.
407. One, two, or more parts lose the power of resolution & take
on a similar state to Cavities exposed ( ) a Cavity is formed in wch.
pus is secreted, at first mixed with coagulable Lymph.
408. A return of the adhesive inflammation checks the progress
of suppuration.
409. When the progress of suppuration is not stopped, the matter
will be carried onwards to the Skin, the parts between the
cavity & the surface of the body are gradually absorbed the Cavity
becomes daily enlarged, the Skin becomes thinner & thinner, at
length Ulceration from pressure takes place & the abscess bursting
a natural Exit is given to the contained matter.
410. When the suppurative inflammation is going on Rigors
frequently Occur, a common attendant on new actions of the constitution.
411. When suppuration cannot be stopped the progress of the
matter is to be carried as towards the skin, hence the utility of
stimulating plasters &ca. Poultices can do little until the Inflammation
has invaded the Skin, they then keep the surface moist
& soft. –

☍ 415. to 423. Observations on Pus.
Pus cannot be formed from the melting down or waste of
the Solids, otherwise how could the human penis in the virulent
Gonorrhea furnish pus many times exceeding in quantity
the substance of that Organ, some have denied the discharge
from the Urethra & certain other canals to be purulent & affirmed
that it was only Mucus, but it has every characteristic
of Pus, no injury arises from the absorption of pus into the Circulation
otherwise how may those fare who have large sores, as patients
undergoing Amputation whose health is often disturbed
through the whole of their cure, Pus may become offensive by
being mixed with other fluids as putrified Blood & hence its factor
when its discharge attends a diseased Bone. Pus is a bland
unirritating fluid we see it makes its way in psoas & Hip Cases
from the Loins & Hip low down into the thigh without producing
the least sense of pain unless merely from its weight & distention
of the parts amongst which it is seated. Pus cannot
change Animal [matter] Solids into own nature by any fermenting
process. Chemistry cannot irritate the process of nature in
forming pus in the Animal body any more than any of

79.
412. Suppuration sometimes goes on without previous inflammation.
here parts suddenly fall into it without allowing the previous
action of the adhesive inflammation as in the Erysipelatous
suppuration, or it goes on slowly without pain as in some
scrophulous Cases.
413. When an healthy Abscess is opened, [& its cavity become exposed]
the parts readily take on a disposition to heal, but in the
collection of matter (412) when the abscess is opened & its cavity becomes
exposed a general inflammation takes place & a perfect suppuration
is formed; but the constitution is generally much affected by
this process, for here the Inflammation is to arise in a part already
in the habit of disease.
414. The matter contained in the Abscess formed without inflammation
will be different from that in the common Inflammatory
Abscess, in the former it will be a curd like substance mixed
with a thin purulent fluid..
415. The fluid produced by the healthy suppuration is Called
pus, which is quickly & readily formed on the surface of Canals ☍
416. To the formation of pus a particular organization of
parts seems necessary though we do not exactly know in
what the nature of that organization consists, any more
than we do that which is necessary for the different secretions.

the other secretions, nor can Chemistry decide on the nature of
Pus the conclusion drawn from the precipitations of it from
Vitriolic Acid &ca. are irrational & unsatisfactory; the precipitate
from any other Animal Substance so dissolved will give equally
the same appearances.

80.
417. Pus is to be considered as a secretion & the parts secreting it
to be glandular, it does not arise from a destruction or dissolution
of the Solids by fermentation &ca. the solid parts may die, slough
& be found in it, nor is it a mere straining of a matter from the
Blood.
418. Pus is a fluid which in its perfect state has certain peculiar
qualities as Colour & consistence, it is somewhat sweet and
mawkish to the taste. it consists of a number of large whitish
Globules swimming in a fluid resembling serum, of which Globules
it will have a greater or lesser proportion according to the
health of the body that produced it, like serum the fluid is Coagulable
by heat.
419. It is perfectly mild & inoffensive in its natural state incapable
of irritating the most sensible sore.
420. Pus when absorbed into the habit & mixed with the blood is
productive of no ill effects unless it is the vehicle of specific Poison
421. Pus is less disposed to Putrefy than other Animal fluid wn.
in certain situations & in contact with Air, it readily takes on
putrefaction & becomes offensive, but this is probably from other
substances as blood &ca. being mixed with it.
422. When an Abscess is first opened portions of Coagulable Lymph
mixed with pus are commonly found. These are parts of that Lymph
which had been employed in making the Cyst to contain the matter.
becoming loosened from the internal surface of the Abscess & being

🜔vuss. 🜖. 426 Pus may be of use to Sores to keep them Moist &ca.
but this does not explain why it is formed in natural Cavities it
may also be useful as a vehicle in the removal of extraneous substances,
this however can be only a secondary intention with its
final use we are still unacquainted.

81.
blended with Pus. –
423. Chemical experiments cannot explain the nature or manner
of the formation of Pus. (see last note).
424. The formation of Pus is to be considered though a New, yet as
a Process of Health, parts taking on a diseased action, the secretion
of Pus is interrupted, & it is no longer generated pure & possessed of
its peculiar properties.
425. Pus like all other fluids thrown off from Solid Parts will
always partake of the nature & properties of the parts from which
it is secreted & according will have occasionally the specific properties
of the Lues, the Cancer, the Small Pox &ca. –
426. The final use of Pus, or intention of nature in producing it
is not known. 🜔vuss 🜖.
427. Ulcerative Inflammation is that action into which a part
falls from a disposition to absorb itself Even to the solution of continuity.
428. The cause of this Ulcerative absorption will be an inability of
parts to support themselves under present circumstances, these
circumstances will be
a. Irritation.
b. Weakness.
429. These Circumstances give rise to
1st. a consciousness in the parts of the necessity to be
absorbed. 2d. a consciousness in the Absorbents of the necessity of
commencing the absorbing process.

🜔vuss. Φ. 436. When a collection of pus makes its way to the Skin
we find the cellular substance adipose membrane & even Muscles to
a considerable extent ulcerated while the Skin ulcerates only so as to
form a hole for the exit of the matter.

82.
430. Irritation will be given by
a. Pressure (246)
b. Contact with dead or foreign matter.
431. Weakness or a want of power in parts to carry on their natural
functions may be a cause of the ulcerative Absorption.
432. pressure considered as irritating is of two kinds.
a. pressure from the surface inwards.
b. pressure from within outwards.
433. parts strongly resist the action of the pressure (a) but readily
yield to the action of the pressure (b. 432).
434. From the above then we may infer that when the irritation
of the pressure, (a. 432) is applied to produce ulcerative Absorption it
must be very violent in proportion to the strength of the parts, for it
is not sufficient to destroy the power of resistence in the parts pressed
it only produces a thickening of them.
435. Nature resisting the entrance of foreign matters into the
body thickens & thus as it were strengthens the parts to give them
a greater power of resisting the admission of what would prove
injurious to them.
436. In pressure from within outwards (b. 433) the internal parts
as cellular Membrane &ca. fall more readily into the ulcerative absorption
from the Skin. – in irritation from external pressure & from
contact with foreign matter the Skin falls more freely into it than the
other substances. 🜔vuss. Φ

🜔vmss. 🜔. 437. [(When a collection of pus makes its way to the 
Skin we find the cellular substance adipose membrane & even
Muscles to a considerable extent ulcerated while the Skin ulcerates
only so)] If Inflammation attacks the external coat of an intestine
adhesions are produced between it & the peritoneum, & if the
inflammatory action goes on an abscess is formed in the middle of
the adhesion after which the matter contained acts as an Extraneous
body; Ulceration takes place only in the side next the Skin, between
which & the matter (even in the most corpulent person) the
Muscles, fatty Membrane & Cellular substance will be dissected by
the Pressure of the Matter & that fluid eliminated before by so thin an
interior substance as the Intestine will fall into Ulceration (Sidran
gives several cases of this kind but does not explain them).
🜔vuss. 🜖. 439. When living tumors are brought to the Skin, in their
progress the intersticial absorption only goes on until there arises a
necessity for the ulceration in the Skin, many other substances also
are brought to the skin without producing the ulcerative Absorption.
440. Suppuration very commonly & in some parts always attends
on the Ulcerative absorption, of this we have abundant instances
in the Muscles, Cellular substance & skin, we have also instances
of its proceeding without producing pus, in bones when sustaining the
pressure of aneurisms &ca. in the absorption of the alveolar processes after
removing a Tooth & in the removal of Callus after fractures. In Jordansons
Voyage we find that several of his Crew who had been severely

83
437. When the pressure is from within outwards, tho’ all sides are
Equally in contact with & compressed by the body making the
pressure yet that side only will accept of ulceration which is the
nearest to the Surface of the Body. 🜔vmss. 🜔..
438. When bodies making pressure from within outwards are
to be carried to the surface in the natural process the adhesive inflammation
of the neighbouring parts precedes the ulceration of the
Skin, for nature finding exposure must take place by the former
process provides against that inconvenience & renders its extent as
small as possible. (439 🜔vuss. 🜖.
439. When absorption is to take place of the parts between a surface
lodged within & the surface, in order to the removal of that substance
there is always a mixture of the ulcerative & intersticial Absorption.
440. Ulcerative Absorption goes on either with or without Suppuration.
441. Bones as well as soft parts become open to the Ulcerative
Absorption from pressure & irritation but the cuticle is incapable
of irritation & of the ulcerative Absorption.
442. An exception to (437) will arise, when the irritation from
the pressure is violent, & the adhesive inflammation has not duly
taken place in the parts behind, within or on one side of the irritating
substance. 🜔^
443 The difficulty with which the Cuticle (441) is removed for

affected with the Scurvy which occasioned the spontaneous dissolution
of old Cicatrices & even of the Callus formed after Fractures.
442. Hence it is that matter sometimes bursts into the Air
cells of the Lungs when a suppuratory inflammation of the Pleura
& Lungs had happened instead of making its way thro’ the intercostals
Muscles to the Skin; for the same reason pus sometimes in
Abscesses of the Liver makes its way internally, bursting into the
Intestinal Tube or the Abdominal Cavity.
444. A change in the constitution will often occasion a sore
to spread more in one nights time than we can procure in a fortnight.

.84
the expulsion of matter is the cause of the pain in suppurations
where the cuticle is very thick, as in the whitloe, abscess in the sole
of the Foot &ca..
444. The Ulcerative Absorption but little affects the constitution
although the constitution has powerful effects on the ulcerative absorption.
445
As ulceration consists in the division of parts naturally united,
or in a particular made of solution of continuity, so its cure is effected
by a reunion of them either by adhesion (358) or by Granulation,
the third mode of union (358) when the first & second modes of
Union will not take place in parts violently separated the third mode
is preferred or pursued in the process of restoration, this is by means
of Granulation.
446. Granulations are formed by coagulable Lymph, effused from
the surface of the Ulcer becoming vascular, Vessels from the original
parts pass to the basis, & also to the surface of the granulations
& would almost seem to terminate there.
447. Granulations are always of the same nature as the Parts
they arise from.
448. Granulations will be healthy or unhealthy, the more Convex
they are seen, & the smaller their points, & the more florid red
colour they are of the more healthy. The flatter their surface, the
paler or the more they approach to a livid hue the less will they be
found healthy, & the more slowly will they admit of the parts

🜔🜹. 448. By attending to the appearance of a sore, we may judge
whether it is healing or disposed to ulcerate farther, if the latter the
edge will be irregular, inverted, or hanging over the ulcerated surface,
the discharge is in general thin, the surface in the whole or in many
parts concave whereas, when there is a disposition to healing they are
convex, the margin purple covered with a whitish semitransparent
membrane.
☉. 449. In the irritable constitution mostly, the Granulations will
be large & flabby.
☽︎. 450. Mr. Hunter saw two granulations one from the scalp, the
other from the Dura mater arising after trepanning united so firmly
together that they could not be seperated without an hemorrhage.
♂. 451. A Man aged 50, broke his Thigh bone & the attempt of
a reunion both by the first & second intention failed; for the fracture
(which was simple) did not unite after being bound up for a considerable
time, at length the Man died, Upon examination it was
found that Granulation between the ends of the fractured bones though
without suppuration had taken place. Scratches & slight wounds in
the Skin though they unite by the first intention do not always require
suppuration, they heal frequently under a scab.
☿ 456. The contraction of granulations perhaps goes on in some
degree until the cure is compleated, but after a certain time they
contract not sufficiently to oblige the Skin to stretch itself & hence there
must be a necessity for the formation of New Teguments. +

85.
being healed. 🜔🜹.
449. By the appearances of Granulation we may judge in some
measure of the state of the constitution. ☉.
450. When Granulations are healthy they have a strong disposition
to unite one with another. ☽︎.
451. Granulations are in general the consequence of suppuration,
but granulation may sometimes take place without suppuration preceding.
♂.
452. To perfect the Cure of an Ulcer it is necessary that the Granulations
receive a covering, or that the process of Cicatrization takes
place.
453. Cicatrization is performed partly by the elongation of the original
Skin, & partly by the formation of a new Skin.
454. The Original Skin is necessitated to Elongate or stretch itself
by the contraction of the Granulations.
455. Cicatrization is always in view when granulations are formed,
when the Granulations have been carried to a sufficient degree, the
Contraction of the Granulation begins at every point as the contracting
process goes on the Skin on all sides is drawn nearer to the center of
the Sore.
456. When the contraction of the Granulations has been carried
so far as circumstances will admit of; & the consequent elongation
of the Skin has been carried to its greatest point, from the
Margin of the original Skin, the new skin shoots. ☿.
457. The contractions of the granulations or their effect in + elongating

+ When the original is unfit or cannot give the disposition for the
new one to form then there is sometimes a disposition in the Centre
of the Sore to produce it hence it is why we sometimes see sores
begin to cicatrize in the middle.
♃ 457. We see that if the Wound or Ulcer takes place on soft parts
as the Buttocks &ca. & when the Skin is loose, the quantity of new
Skin formed in the healing is very little, but in ulcer in had parts
as on the head; the skin is enabled to stretch but little hence in
Wounds of the scalp, the new formed Skin is nearly of equal extent
to that of the lost Substance.
♀. 458. Hence it is evident that Surgeons cannot be too cautious
in saving Skin, when it becomes necessary for them to remove parts
as in amputation of the Leg &ca. & especially where the wound is to
be inflicted on bone, the natural covering of which is little binds
the Skin, as in the Tibia &ca.
♄. 459. From part of this aphorism it must be evident of how
much utility motion & friction must be to a part stiffened from
having undergone granulation & cicatrization, Mercurial Unction
& Electricity both conduce to this End & seem very properly indicated.
🜍. 461. As in the Negroes who when they are burned or blistered the
Cicatrix formed after healing wants the black tint.
“But even in Negroes the Rete Mucosum is formed as I have
found on examining the Cicatrix of a Negroe adult from which by maceration
I turned off the Cuticle & found the Rete Mucosum perfect”.

86.
elongating the original Skin is impeded by being seated on hard
parts as bone, & where the Sore is circular instead of having considerable
length in proportion to its breadth. ♃.
458. The formation of new Skin is a process nature forms with
difficulty & with more difficulty in the lower Extremities than in the
other parts of the body. ♀.
459. The new skin is a very different substance from the old,
whether it consists of the granulation altered in their structure
or is a new and distinct substance from them is not to be ascertained.
It is less moveable than the original Skin, appears to be
on the stretch, as if a small piece of Skin was stretched & sewed
into a larger hole, so that the sides of the old Skin seem puckered
it gradually however is subjected to Mechanical motion & becomes
[less] more lose & flexible. The young Cutis when first formed is
very full of Vessels, but these are either afterwards taken away
or changed into absorbents until at length the part becomes
quite white. ♄.
460. Whenever a New Cutis is formed a cuticle is found also
the Cutis forming it, more readily than the granulations forms
Cutis, every point of Cutis is forming Cuticle.
461. The Rete Mucosum is always late in forming Cicatrices
between the Cuticle & Cutis, sometimes it is never formed at all. 🜍.
462. The Cicatrization is sometimes materially affected during
the giving on of the processes of restoration above described by certain

🜁. 467 & 468. Thus we see affections of the ligamentous parts
more readily bring on hectic than those of the muscular parts.
Disease of the joints very frequently produces this constitutional
Sympathy, & the larger the joint the Earlier this effect will
take place, An affection of the Knee or Elbow brings on Hectic
speedier than a disease of the Wrist or Ancle, again backwardness
of parts to heal depends much on their situation in the
body (277). In the lower extremities the power of healing
will be less than in the upper, & we see a disease in the Knee or
Hip produce hectic sooner than a disease of the Elbow or Shoulder.
Hectic will arise from Affections of parts whose natural  
powers of healing are not weak, as in large abscess in the
Muscular parts, but it still depends upon the same principle,
a Disease which the Constitution can neither conquer nor get rid
of. (464).
∇. 469. It will arise in affections of the Vital Parts & Joints
even before suppuration has taken place. Did it arise from the
absorption of Pus it should take place in one large Ulcer as well
as another, for it does not appear that there is a greater disposition
for absorption in one ulcerated surface than in another it
should arise from Venereal buboes where the matter is often even
poisonous.
In large Abscesses the Hectic disposition comes on after

87.
Actions.
463. The most ordinary actions are.
a. Hectic
b. The action of dissolution.
c. Spasms.
464. Hectic is a remote constitutional sympathetic affection
taking place in a constitution weakened by a long continued local
disease, which it can neither get rid of nor cure.
465. It will be caused either by an affection of a vital or a
non vital part.
466. It is produced earlier by the affections of a vital than of
a non vital part.
467. In the Non Vital it most frequently arises from affections
of those parts which have a backwardness to, & small powers of
healing. (275-276-277).
468. The more extensive the seat of the diseased Action in
parts of equal powers of healing, the earlier will the Hectic be induced
in the constitution. 🜁.
469. Hectic does not arise from the absorption of Purulent
matter into the System. ∇.
470. Hectic then depends on a part being irritated beyond
its powers of acting for restoration & beyond the power of the Constitution
to overcome the Disease: 🜺.

opening & when the Matter has been discharged.
If the Constitution can heal up these Abscesses, no hectic
arises large suppurations have taken place & the matter been
absorbed again without opening yet without the rise of hectic.
We readily conceive why it should take place sooner in vital
than in non Vital parts because the former gives the alarm
sooner to the constitution (22. Note) Hectic commonly arises from
Lumbar or Psoas abscesses, Scrophulous Joints, white swellings
&ca.
🜺 470. Whatever then will long & Obstinately teize the Constitution
may become the cause of Hectic.
🜔🜹 476. The action of dissolution seems different from Hectic,
it is infinitely more rapid in its progress it is incidental
to opposite Constitutions it is uncurable by the removal of any
part, & therefore seems to be an act of the constitution.

88.
471. It is however sometimes doubtful whether the hectic is
not an original disease of the constitution, we see that it arises
when there is a sore in a part which has no impediment to
healing, & here the Hectic must in general be cured before the
sore will heal.
472. Hectic is a kind of slow diminution of Animal Life, even
to gradual dissolution, its Symptoms are in general slow fever
with great debility, & languor, want of appetite, paleness of the
Skin. Sweats easily provoked, & indeed arising spontaneously
frequent sickness & vomitings, in habitual purging, clear Urine.
473. The administration of internal Medicines can only be useful
in order to the cure of hectic by somewhat strengthening
the constitution & enabling it to support its struggle longer than
it could do unaided.
474. Its cure can only be affected by the removal of the local
Disease either by taking away the part or by inducing in it
a disposition to heal.
475. The constitutions most disposed to Hectic are the weak
& irritable.
476. The action of Dissolution is different from Hectic when the
constitution seems to have every thing in its power having gone
through & supported the processes of inflammation & suppuration
its powers will suddenly sink & the destruction of Animal Life
be readily accomplished. 🜔🜹.

🜖. 481. If a limb has its bone or bones fractured the Muscles
will no longer act in obedience to the Will, the same in the Case
when a joint is rendered useless, if the patella is fractured the
patient cannot voluntary act with the Rectus Muscle.
It is extremly curious to observe that voluntary Muscles,
when the final use of their being no longer exists, become
no longer the Instruments of the will, & they then waste in
bulk, strength & firmness & become soft flabby. -

89.
477. The Symptoms are an universal affection of the Stomach
shivering, Nausea, & frequent vomiting, small quick pulse
Hemorrhage from the surface of the Ulcer, excessive spontaneous
sweatings soon succeeded by Death.
478. The Habits most disposed to it are the Robust & full.
479. For its Cure nothing seems to be effectual.
480. Muscles lose their power of action not only when the
Nerves leading to them or which are their immediate Instruments
of motion, are compressed or destroyed, but also, when
there is no longer a necessity for their propriety in their acting
(53) & here they become though naturally voluntary inobedient
to the Will.
481. They also become open to Intersticial Absorption & waste
in size & firmness. 🜖.
End of the first Part. –






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


90.
Illustration of the Doctrines contained in
Part the First. –
482. In the circumscribed Cavities when taking on inflammation,
the adhesive it is observed ( ) is first to take place
if the progress of the complaint is not checked, or put a stop
to by the adhesion, the suppurative or the ulcerative stages
are the necessary sequels. ( ).
483. In cavities containing Vital parts, the Ulcerative stage
is seldom produced for before the complaint proceeds thus far
it generally kills, to produce adhesions between contained & containing
parts it is not necessary that the surfaces of both
should be inflamed.
484. According to the degree or extent of the adhesions the suppuration
in a circumscribed Cavity will be greater or less, if suppuration
comes on in a Cavity where no adhesions have previously
taken place the whole surface of the Cavity will become the






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


91.
seat of the suppuration.
485. The contents of an inflamed Cavity will not always partake
of the Inflammation of the containing parts, for the
Lungs, or the Intestines may remain uninflamed, though a
Pleuritis or Peritonitis may be present.
486. The preceding doctrines will be illustrated by observations
on the inflammation of the following Cavities.
1st. The Thoracic Cavity or Inflammation of the Pleura.
2d. Inflammation of the Pericardium.
3 --- of the Peritoneum, as contain of the Abdominal
Viscera. 4 --- of the Bladder
5 --- of the Joints & Sacculi Mucosi.
6 --- of the Eye.
7 --- of the Veins.
8 --- of the Encephalon.
9 --- of the Tunica Vaginalis.
also by injuries & diseases of bones, by Wounds in soft parts
& lastly by common & specific diseases of the constitution and
parts.
487. The pleura is more subject to Inflammation than any
other membrane lining [the] a cavity in the body not far from
its particular nature, but from its particular circumstances,
as being much exposed to the action of Cold &ca.
488. The pleura becoming inflamed adhesions are formed,








    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


92
between that Membrane & the Lungs sometimes with but
little pain if any. Sometimes the adhesion is throughout the
whole of their surfaces, sometimes in parts only, these adhesions
frequently terminate the Complaint.
489. But it frequently happens that the Inflammatory Action
goes on to suppuration if the whole Cavity becomes the seat of it
then the true Empyema takes place, if the suppuration is by
means of the adhesions confined to certain parts, then the spurious Empyema
or collection of matter not communicating with the
general Cavity of the Thorax is produced.
490. The Empyema will be preceded by violent pains in the
Thorax, difficult respiration, quick pulse, rigors, &ca. –
491. The Empyema when present will have symptoms peculiar
to itself together with the common Symptoms, & Symptoms from
Sympathy of a Fluid contained in the cavity of the Thorax.
492. The common Symptoms of a Fluid Extravasated in the
chest are difficulty & frequency of Respiration.
Breathing easiest in some particular situations. If the
fluid be in one lateral Cavity only, the Patient lies chiefly & most
easily on the affected side, if in both cavities, then he will only
lie on his back & that not horizontally, the head & chest will be elevated,
otherwise he feels a sense of impending suffocation, there
is a sense of weight in the Diaphragm, there are patients who
perceive the fluctuation within them; frequently Anasarca, & 

🜋 496. Emphysema will often remain a considerable time,
Interior parts do not fall so readily into the adhesive Inflammation
as the more external parts, hence the wound continues
open so long & admits of the egress of ye Air.
I believe the presence of pus, or water extravasated in
the Thoracic Cavity will be alone accompanied with the anasarcous
Symptoms, blood or Air, not producing there appearances.

93.
sometimes Ascites is present.
493. The peculiar Symptoms of the true Empyema are a
great difficulty & uneasiness in expanding the Chest, great
lowness & depression of Spirits, frequent sense of seemingly impending
dissolution, the fluid accumulating Gradually.
494. The Sympathetic Symptoms are great irregularity of the
Pulse, palpitation of the heart &ca..
495. Water may be Extravasated in the Cavity of the Thorax
& the Disease then becomes Dropsy of the Chest, to the common
Symptoms (492) & the Sympathetic (494) may be added the circumstance,
that the fluid is so suddenly collected.
496. Air may be extravasated in the Cavity of the Thorax by
a wound in the Lungs from the end of a fractured Rib, here the
Pleura being also wounded the Air will escape into the Cellular Membrane
& produce a partial or general Emphysema.
497. Blood may be extravasated in the Cavity of the Thorax [by a]
[wound in the Lungs] & will occasion the common & probably several
of the other Symptoms.
498. For the discharge of Extravasated Fluid from the Thoracic
Cavities, the operation for the Empyema or the Paracentesis of the
Chest becomes requisite.
499. This should be performed as rarely as possible because its sequel
(as being an Exposure of & rendering the Thoracic Cavity

🜔. 499. [Emphysema will often remains] When Pus is present
in the Cavity of the Thorax, no objection to the operation
can arise for the part is already in a state of suppuration.
☿. 502. If you make the incision upon or near to the fractured
Rib, with respect to the bone you place it in the state of a compound
fracture & may induce all its consequences, besides rendering
the Chest an Exposed Cavity, the sequels of a compound
fracture will be hereafter shewn.
♁. 503. This must be obvious from considering the text (502) the
scarification need not be more than half an inch long (501) but sufficiently
deep to make exposure of the cavities of the cellular substance,
when much blood is extravasated (497) the Paracentesis of
the Thorax must be generally necessary, from the great danger of
suffocation that must attend its continuance in the Cavity.
Mr. Hunter has sometimes seen patients recover from injuries     
of the thorax, even when suppuration has taken place (as
after Gunshot of Wounds) he finds it difficult to Account for the means
of the Recovery, but thinks it must be by a kind of Resolution for
the Lungs in exposure of the chest are generally collapsed, so that
adhesions between this membrane & the Lungs in those cases cannot
be effected. –
Φ. 506. To such symptoms [for] the name of Angina Pectoris
has been given. –

94
imperfect) is an universal suppuration generally ending in
death. 🜔.
500. When Emphysema (496) in consequence of a wounded
lung arises & extends to a considerable degree the cellular membrane
may be scarified to discharge the offending Air.
501. The scarification should be made at some distance from
the seat of the fracture of the Rib.
502. The Lung on the Opposite side (if only one is wounded) should
not have its action confined nor should the escape of the Air from
the Cavity of the Thorax into the cellular substance be impeded. ☿.
503. In the case before as tight bandage applied on the Thorax
& compressing the parts which received the injury is improper.
♁.
504. It will be difficult to distinguish the Inflammation &
Suppuration of the Pericardium, from that of the Pleura, or Thoracic
lateral cavities, the heart sympathizing with affections
of the latter & the latter with those of the Pericardium.
505 If adhesion takes place between the heart & pericardium,
the Patient generally recovers, if the Inflammation goes on to
suppuration, the patient always is destroyed.
506. The adhesion of the Pericardium to the heart is attended
with palpitations of the heart, irregularity of the Pulse, frequent
& difficult & oppressive breathing, pain in the Sternum, frequent
syncope, debility &ca. Φ.

🜔v 507. By spontaneous inflammation is signified an Inflammation
arising without any visible cause.

95
507. The Peritoneum is the largest inverting membrane in
the body, it is subject both to Spontaneous inflammation & to
inflammation from external injuries. 🜔v
508. The Peritoneum taking on inflammation Runs through
its actions sooner than any membrane or Cavity in the body.
509. The Inflammation may be either Common or Erysipelatous
(303) at the onset it is difficult to determine its nature.
510. Whether it is of the common or erysipelatous kind it will
at first be accompanied with a violence of action of the constitution,
which is powerfully roused, but if of the Erysipelatous kind
the strength of the patient will soon sink.
511. The peculiar symptoms will be a pain in the abdomen not
of the cholicy or spasmodic kind with a sense of soreness of the
abdominal Region, greatly increased by pressure or by stretching
the peritoneum.
512. The Intestines will also from Sympathy take on an unnatural
action, Costiveness in some cases, in others a Diarrhea
will be induced.
513. The inflammation of it does not go off by resolution, or
unless adhesions taking place prove its cure will produce suppuration.
514. The suppuration will be
A. partial of adhesions taking place, limit the extent of it
B. universal if the adhesive inflammation is insufficient 

♂. 520. The Uterus on dissection is generally found sound
& free from inflammation, the disease does not arise then from
an inflammation of the Uterus. But the Uterus conscious of
some change effected in its nature will give the same stimulus
to the Peritoneal Cavity as would arise were the Uterus removed &
thus the abdomen be made an imperfect Cavity, parts may retain
their life & yet give a stimulus productive of death to
other parts.
“This seems to be the action of the Sympathiser becoming
more violent than that of the Sympathent.”
The dissection of Women dying of this disease proves
in general the fatal affection to be a suppuration of the Peritoneal
Cavity.

96.
sufficient either in the time of its duration or degree, to produce
adhesions of the membrane to the contained parts.
515. If the Suppuration is universal it always destroys the patient,
the prevention of this state is therefore to be diligently
prevented.
516. Bleeding seems the only means we have of preventing
suppuration, & therefore should be had recourse to, it should seem
to be improper in the Erysipelatous Species, but even there we
know of no other means of warding off suppuration.
517. When universal suppuration of the Cavity happens,
trial might be made of opening the Cavity with a Trochar
evacuating – the fluid as much as can be, & washing the part
well by injecting warm water.
518. When the suppuration is partial (a. 513. 482. 362) the
matter frequently points outwardly, like any other abscess, either
ulceration takes place, & it bursts, or it is opened & the patient
does well, here is a striking proof of the utility of the
adhesive Inflammation
519. The lying in or puerperal fever is a Sympathy of the
constitution with an inflammation of the Peritoneum.
520. The Cause of the Puerperal [fever] Inflamn. of the Peritoneum arises as
well as every other Inflammation of this part from a stimulus of
imperfection, which in this case is given by the Uterus. ♂.

Δ. 521. [Here] Mr. Hunter supposes the broad & round ligaments
of the womb most affected.
522. This most commonly takes place in Patients with
unsound viscera & Peritoneum, & in whom the disease has been of
long standing, rarely the first time of tapping, but not uncommonly
the 3d. or 4th. time. Mr. Hunter has seen on the second day
after tapping, the inflammation spread over the whole cavity of the
abdomen yet proceed no further, in which case it does not kill,
hence we should be cautious in our Prognosis of the event of tapping.
On dissecting Patients who have died after tapping
the same morbid appearances have occurred to the Examiner, as in
Women dying of puerperal fever & the Symptoms have been the
same during their illness. Mr. Hunter mentioned the Cases of
two men who died after tapping & the appearances on examination
after Death.
🜔🜹. 524. The suppuration of the Peritoneum after the operation
of the Bubonocele & Femoral hernia do not happen because
the sides of the Sac are brought together & closed before the alarm
is given to the Cavity. In the umbilical Hernia, after the operation
the external parts do not adhere, [to the] but the Union must
be formed by suppuration & Granulation.
Here the Omentum should be made the basis of the Granulation
that uniting with the external parts it may prevent

97.
521. Sometimes after lying in the adhesive inflammation will
prevent the suppuration from extending itself far, & an abscess
will form at the lower part of the belly & do well. Δ.
522. The Peritoneal Suppuration will sometimes succeed to
tapping or the common operation of the Paracentesis of the Abdomen.
523. From what has been said it must appear that whatever
can produce in the Peritoneal Cavity the stimulus of imperfection,
whether the death of one of its contained Parts, external violence
or penetrating wounds not healing by the first intention,
or by adhesion formed near the opening between the membrane
& some Viscus, may occasion the Peritoneal suppuration.
524. The Operation for the Bubonocele & Femoral Hernia, the
Cesarean operation, may all be productive of the Peritoneal Suppuration,
because they all occasion an Exposure of the Cavity, to
which suppuration must succeed, if the exposure continues long
enough [after] for the Cavity to take Alarm. 🜔🜹.
525. After the Cesarean Operation & other cases of Wounds into
the Abdomen, care should be taken to bring the Lips of the Wounds
in Contact, but not to pass Ligatures (if suture is used) so deep
as to penetrate the peritoneum. 🜔^

prevent the general inflammation of the abdominal Cavity.
🜔^. 525. A.B. A Crooked Woman was with Child & went her
full time, her pelvis was so narrow & deformed that she could
not have been delivered even by the Crotchets. Mr. Hunter delivered
her of a living healthy Child by the Cesarean Section immediately
on its contents being removed, the Uterus contracted strongly, the
Lips of the Wound was brought together by the uninterrupted
suture, the Woman died soon after, on dissection the small intestines
were found adhering about the Wound, the Uterus was
very much contracted, there was a quantity of extravasated blood
likewise in the abdomen, it should seem from this latter circumstance
that in similar Cases the wound should not be closed until
the bleeding ceases.
☉. 526. Of this we have abundant Evidence in observing what happens
during the cure of Patients, who have undergone Lithotomy
☽︎. 528. Joints as consisting of Ligamentous & membranous
parts have their processes carried on slowly, we see the worst consequences
follow suppuration of the Joints, the loss of limb & even
the Life of the Patient, is no unusual sequel, if a cure is effected
it is by granulation, & the granulation afterwards for the most
part, becomes bony & thus the Joint is rendered motionless.

98.
526. The internal coat of the bladder is liable to Suppuration
on exposure, though not very susceptible of it. ☉.
527. The Doctrines (482-483). are further illustrated by the common
consequences of the Exposure of Cavities of Joints by Penetrating
Wounds, which if they heal not by the first mode of union
( ) a general suppuration takes place, for here there being no
Contained solids, as in the abdominal & Thoracic Cavities, where adhesion
forming might prevent the general action of suppuration
an universal suppuration of the Cavity must be the Event.
528. Joints becoming diseased have a great backwardness in recovering
health (275-277) hence when suppuration has taken
place & the third mode of union ( ) becomes necessary, granulation
goes on with difficulty & slowness, hence also agreeably to what
is observed (427) we are enabled to understand, why Hectic is no unusual
consequence of joints falling into Suppuration. ☽︎.
529. Granulations forming though they effect a Cure, alter the        
structure of the part hence its Utility as a Joint is lost, motion is
destroyed, an anchylosis takes place.
530. Hence it is Evident that Surgeons when they intentionally
cut into a Joint, for the purpose of removing an extraneous body
as a loose bone or

🜖. 530. Therefore Sutures penetrating the Cavity of the
Joint should be avoided.
♀. 531 & 532. The Sacculi Mucosi are found between bone & Tendon,
between Cartilage & Tendon, between Bone & Skin, or between ligament
& Skin. So between the Patella & Skin, the Olecranon
& Skin, the Annular Ligaments of the Fingers & the Skin, &ca. &ca.
(532) Obliterating their Cavity &ca. this is done by opening them
preventing the Lips of the Wound uniting by the first intention, &
so making suppuration & granulation necessary, on the same
principle is the dropsy of these parts to be cured, as that of the
Tunica Vaginalis, or Hydrocele which will hereafter be explaind.

99.
531. The Sacculi Mucosi are similar in their nature & use to
joints & contain a fluid to facilitate motion, the consequences of
injuries done to them will be similar to those inflicted on the Cavities
of Joints.
532. They are subject to dropsy, & when affected with it are to
be cured by obliterating their cavity, this is generally followed by
a weakness & stiffness of the parts to which they belong but this
is soon relieved by giving them motion. ♀.
533. The Chambers of the Eye are subject to the suppurative inflammation,
which may have its seat in one chamber (as the
Anterior) only.
534. The causes of this may be whatever can give the stimulus
of imperfection to the Cavity, whether spontaneous inflammation not
terminating by resolution, or a wound not healing by the first
mode of union, hence it may follow the extraction of the Cataract.
&ca. –
535. By inflammation of the chambers of the Eye the Iris may be
made to adhere to the Chrystalline Lens.
536. The formation of pus in the anterior chamber of the Eye
will obstruct the passage of the Rays of light, similar to an opacity
of the Cornea.        


♀. 541. A Gentleman had an inflammation of the Sclerotica,
but the Cornea, remained clear, he had darting pains in the
back part of his head, with lassitude &ca. A white speck appeared
on the Cornea, which being a collection of pus gradually
increased, at Angth the suppuration filled the whole anterior
chamber & the matter was let out by an incision similar to
that for a Cataract. 5th. day the Eye appeared flat, the Iris &
Pupil could hardly be seen 6th. day the cornea was rendered

100
537. It will produce an appearance of an opake cornea with
which indeed it may be complicated, or it may be single, no
opacity of the Cornea being present.
538. When single it may be distinguished from an opacity of
the cornea by the pus forming in the Anterior chamber, in a section
of a Circle, a straight line forming its superior side, as the accumulation
of pus encreases its figure approached nearer & nearer to a
perfect Circle, till at length it entirely covers the pupil, however when
fully confirmed it is not to be ascertained whether it is complicated
with an opacity of the Cornea or not.
539. In general if the Disease is of long standing, the cornea
is opake.
540. The Removal of the Pus is obtained.
A. by absorption into the System
B. by Ulceration of the Cornea Evacuating it.
C. by an artificial opening.
541. (a. 540) is the most desireable mode of Cure, as if the Cornea
is not opake, Vision is readily restored.
(B) is the worst mode of all being invariably followed
by blindness from the cavity becoming obliterated (as in other
Abscesses) from the injury it may do to the Chrystalline Lens & from
the sprinkling or washing of the Eye – Therefore

full by a thinner & more transparent fluid 8th. day matter
was visible at the bottom of the Cornea in the End his
Eye was lost as to its vision & diminished in Size.
🜍. 543. The internal coat of a Vein may inflame from
the Puncture made in bleeding should it not heal by the first
intention.
Therefore in bleeding the Surgeon should always be careful that
his Launcet is very sharp & that after stopping the Blood he will
closes the orifice. When the Arm bleeds a second time after Venesection
from the same orifice, a sore arm is no unusual Consequence,
this arises from the Orifice not healing a second time without inflammation,
Linnen or Lint is a better application after bleeding
than sticking plaister for obvious reasons, there are more sore arms
after bleeding where sticking plaister is used than where lint.
Sore Arms after bleeding have been commonly attributed to the wound
of a Nerve, but Mr. Hunter thinks they more commonly arise from
an inflammation attacking the internal Coat of the Vein, if when
Horses are bled the Farrier is not careful to produce union between
the edge of the Wound a suppuration not unfrequently
attacks the internal surface of the Vein & if it extends as it sometimes
does to the Heart the Animal dies, adhesion, suppuration
& ulceration may all be going on, in a Vein at the same time

101.
(C) is to be preferred though even from this mode
small hopes of restoring vision can be Entertained. ♀.
542. The Veins are not to be considered as Canals but as Cavities
& like other cavities the internal Coat is liable to
the adhesive as well as the suppurative & ulcerative inflammations.
543. The Causes of the Inflammation of Veins will be the same
as those of inflammations of other Cavities whatever can
produce the Stimulus of imperfection in them will bring on
inflammation. 🜍.
544. If the adhesive Inflammation takes place in any part
of a Vein its Cavity is obliterated & a cure is performed.

as mr Hunter found in Examining the body of a Man in St Georges
Hospital who died after bleeding, we sometimes observe a chain
of Abscesses in the Course of Veins after bleeding in the Saphena
when suppuration takes place a compression on the Vein, above
the seat of the suppuration both to produce contact between the
sides of the Vessel & obliteration of its Cavity & to prevent the blood
from carrying Pus onward to the heart.
♁. 547. This we see by observing the effects of a Ligature put
round an Artery. Mr. Hunter has never seen an Artery suppurate
except once & that was the immediate consequence of mortification. –
🜁. 549. This being the case it is to be observed that when the
cure is attempted by Seton the water being suddenly evacuated,
the Tunic collapses, now though the Seton as a foreign body
may excite inflammation, Yet the Tunic at the time of producing
the Inflammation being in partial contact with the
testicle, it is not certain that the inflammation will extend over
the whole cavity, but it must in general have its progress bounded
by the contact of membranes. (362).

102
545 Suppuration arising, if the means of adhesions taking
Place above the point suppurating a simple abscess will be formed
& no ill consequences arise, but (546)
546. The inflammation & consequent suppuration may Extend
(in default of the adhesive inflammation setting bounds to it)
throughout the whole course even to the right Auricle of the heart,
or pus may be formed & Carried with the blood to the heart; either
of which circumstances taking place, kills the patient.
547. The internal coat of the Arteries is not liable to suppuration
they will however take on the adhesive inflammation.
♁.
548. Brain. We should be extremely cautious how at any
time we open or wound the dura mater, as the exposure of the
pia mater & brain is in general productive of fatal consequences,
the brain will inflame, swell & protrude through the openings
of the dura Mater, as the Cutis throws out a fungus
through the opening of the Cuticle in the whitloe, suppuration
will take place, but the Patient will be destroyed before
a Cure can be effected.
549. Hydrocele.. The Tunica Vaginalis is a circumscribed
Cavity, when exposed the same local circumstances, as
in the exposure of other circumscribed Cavities takes place (362) 🜁
550. It is necessary we should carry this idea (549) in our

🜖. 552. Mr Hunter in his Lectures took notice of the Anasarcous
Hydrocele, but as that is a mere Symptome of Anasarca
& has nothing to do with the doctrines we are now illustrating,
it becomes not an object of our present attention.
A diseased Testicle is frequently the Cause of the first
kind of Hydrocele, we shall have occasion to speak of the diseased
Testis hereafter.
554. Whichever mode of Operation is chosen, Suppuration
is to be expected, since we cannot promise to ourselves
a certain Cure by adhesion only, no one can have any great superiority
in point of utility over the other, different Men will
have different opinions in making their choice.

103.
Minds, when we prepare for the radical Cure of the Hydrocele
or proper dropsy of the Tunica Vaginalis.
551. The Hydrocele is of two kinds.
1. Where the fluid is collected between the Vaginal
Coat & the testicle.
2. Where the fluid is contained in an Hydatid adhering
to the Tunica Vaginalis.
552. We know little of the cause of the first kind if Hydrocele
& of the cause of the second we are totally ignorant. 🜖.
553. The Radical Cure of the Hydrocele is to be obtained by
no other means than the obliteration of the Cavity which is
the seat of it - this obliteration is accomplished by.
A. Inflammation by which the surfaces of the
Tunica Vaginalis & Testicle must be omitted, so that the Cavity
between them shall no longer exist, or
B. A total removal of the membrane of forming
the Cavity, that is the Tunica Vaginalis.
554. The first purpose is fulfilled by one of three operations.
a. Caustic
b. Seton & Tent.
c. Incision.
555. The second (B./554) by the excision or dissecting out of the
whole Tunica Vaginalis except where it adheres at the back

🜔. 555. This must be a certain mode of Cure for it is not
only removing the disease but taking away the very seat of it.
The seventy of the operation however together with its being
follows by more violent Inflammation & greater danger has
brought it generally into disrepute.
Φ. 556. 557. / Mr. Hunter experienced the truth of these aphorisms
in a Patient upon whom he performed the operation for the Radical
cure by Seton, soon as he evacuated the Water, the tunic Collapsed,
the Inflammation excited by the Exposure was not general,
consequently the Cavity was not obliterated, within two
Years the disease returned, stimulating injections have been
practised to bring on the adhesive inflammation & thus obtain a
Cure, but here we shall be too frequently foiled, & on this mode
we can depend but little.
🜔🜹. 559. It has been usual to divide the Cure into the Palliative
& the Radical, of the former unless when it accidentally becomes
the cause of the latter we have little to say since it teaches
nothing respecting the exposure & inflammation of Cavities, it
is needful only to observe that the palliative Cure consists in
Puncturing the Tumor with a launcet, or small trochar & thus
evacuating the fluid but it is rarely that this mode does not
require repetition throughout the Life of the Patient.
The palliative Cure should not be attempted unless the

104.
part of the testicle. 🜔.
556. No certain cure can be performed unless the whole cavity
is obliterated, if any part of the Tunica should not adhere to the
Testicle the disease will return. For
557. In this as in all other circumscribed Cavities the adhesive
inflammation may take place only in a few points & thus the
Perfection of the cavity may still be preserved & consequently the
stimulus of imperfection will not be given to the internal surface
of the Cavity. Φ.
558. The adhesive inflammation will rarely affect the Cure, in
general an universal suppuration must take place before the
purpose of the Surgeon will be accomplished.
559. Tapping for the Hydrocele, the wound not healing by the
first intention may also accomplish the desired effect, the same
circumstances here take place as in the Peritoneal Cavity, after
tapping for the ascites, or accident, as a bruise producing a Rupture
of the Vaginal Coat, & a diffusion of its contents throughout
the cellular substance of the adjacent parts if followed by inflammation
of the Tunic may also effect a Cure. 🜔🜹.
560. It is to be remembered that the operation for the Hydrocele
is not necessary for the preservation of the life of the Patient,
or the support of his health, but only for the removal of
an inconveniency, therefore the danger of the operation is to

Patient can lie by for sometime because sometimes Inflammation
succeeds & the Radical Cure with all its Circumstances
take place when the palliative was only intended.
🜔^ 563. Inflammation arising in Consequence of any Operation
is no unusual circumstance for a considerable quantity
of Coagulable Lymph to be thrown out, surround & give the appearance
of enlargement to the Testicle, this effusion of coagulable
Lymph also forms the sloughs that are thrown off in the processes
when suppuration takes place, & which were by the Author
of a late Publication considered as sloughings of the Vaginal
coat, to which he imputed the Cure by caustic, but the Vaginal
Coat rarely sloughs, the slough discharged being in general
false membranes made from coagulable Lymph now & then
however when the Tunica Vaginalis is in a diseased state a
partial sloughing of it may take place.
The Circumstance which may give an appearance of
an enlarged & diseased testicle deserve particularly to be attended
to as otherwise a surgeon may be induced to remove it
shirrous & incurable, the testicles requiring no such operation.
Case. A Man laboured under an Hydrocele, the tumor inflamed,
suppurated & at last ulcerated, the Surgeon enlarged
the opening & finding the Testis apparently enlarged & supposing
it schirrous was about to remove it Mr. Hunter was desired

105.
be ballanced against the extrication of the Patient from present
trouble.
561. If a Radical Cure for an Hydrocele is resolved upon we are
then to consider in our choice of a mode of performing the Operation
1st. The Comparitive danger of the different methods.
2d. The Comparitive certainty of success of the difft. Methods.
3d. The State of the Testicle.
562. The greatest Comparitive degree of danger attends the Operation
by Excision ( ) which is therefore perhaps never to be advised,
this danger will arise from the Sympathy of other parts
& of the Constitution with the Testicle in this mode of Operating
so rudely handled & so entirely & suddenly exposed.
563. The mode by excision is most certain of success, next to
that the mode by incision, the Caustic & Seton are less sure
in their Effects. 🜔^.
564. All the modes of operating give us an opportunity of
examining into the state of the Testicle, that by Caustic alone excepted,
the mode by excision gives the best opportunity.
565. The mode by incision being the most simple of all, more

to attend the operation, he found the suppuration of the Tunica
Vaginalis too general, for the complaint (in his opinion) to be
Cancerous, the history of the case confirmed this Opinion, the
Patient being extremely timid, there was no difficulty in getting
the Operation put by, it was deferred & he recovered from his ailment
by very simple means.
Further respecting the state of the Testicle it becomes
necessary particularly to attend to it, that if the disease requires
it may be extirpated without the necessity of a second operation,
care should be taken to distinguish a swelled Testicle from a
dropsy of the Tunica Vaginalis, if the tumor consists of the latter
it will be mostly pyriform, if the former it will be flatted,
this attention to the appearance added to the assistance of the
feel, will mostly preserve the Surgeon from an Error.
Again in the Hydrocele the situation of the Testis should
be ascertained, that we may not if we have Occasion to tap the
tumor be in danger of wounding it.
Mr. Hunter by accident wounded a testicle four times & yet
no ill consequence supervened which is somewhat singular
as so much mischief frequently follows the slightest bruise
of this Gland.
A pulpy Testicle will be very apt to be mistaken for an
Hydrocele.

196
certain, yet not more dangerous than either caustic or Seton
& more safe & easy than that by Excision is probably to be with
justice preferred, it is performed by making an incision three
inches in length, or throughout the length of the tumor into
the Cavity containing the water, which being evacuated. Poultice
or Crumb of Bread is to be introduced every where between the
two Tunics & kept in by means of Lint stuffed into the mouth
of the wound. Rags welled in Brandy or Spirits of Wine should
be kept on the Scrotum & often renewed to prevent the too sudden
coming on of Inflammation & the Scrotum should be suspended
in a Bag truss.
566. The advantages of knowing whether a testis is diseased or
not is that if found so in a considerable degree it may be removed
without the patient undergoing a second operation.
567. We cannot perhaps a priori determine whether the disease
be a Hydrocele of the Tunica Vaginalis, or the Water be contained
in an Hydatid, nor is this knowledge of consequence in
the Cure, as in both the same mode of treatment is to be observed,
but the consequences of an opening into the tunica
vaginalis will be different from those of wounding an hydatid.
568. In the former (567) the sympathetic affection usually following
an exposure & inflammation of the Testicle, will come on
such as Rigors, Nausea, vomiting dull pain in the back & Loins

Again respecting the state of the Testicle, we should take care
to distinguish, a Scrophulous Testicle from a cancerous one
Mr. Hunter never saw a Cancer of the Testis follow the Radical
cure of the Hydrocele.
The best means of ascertaining the situation of the
Testicle, & whether this Gland forms the Tumor, is the Sensation
the patients experience in squeezing the Tumor, if it be a diseased
Testis the pain is the same in every part, if only an
Hydrocele, pain is felt on pressing that part alone in which
the Testis is situated. –
∇. 568. In cases where the Hydrocele has been tapped we
should be led to suspect that the Cicatrix left after the Puncture
would be the proper part to perform an operation again, either
for the Palliative or Radical Cure, but this is not always the
Case for the Testis sometimes adheres to the Cicatrix & if this Rule
is observed would be wounded in consequence after the Symptoms
following the radical Cure abate, an enlargement of the parts
always remains, which is not an enlargement of the Testicle
but only a thickening of the Tunica Vaginalis &ca. this gradually
subsides & the parts return almost to their natural size
which diminution may be forwarded by Rubbing in the Mercurial
Ointment.
Hœmatocele is an Extravasation of Blood into the Tunica

107.
great sense of lassitude, swelling of the Testis &ca. these
will generally come in twenty four hours after the operation
but when an hydatid is opened as the body of the Testicle is not
exposed, these will not arise but only the common circumstances
of inflammation as heat, soreness of the Scrotum &ca. ∇.
569. The treatment of both (568) will be the same as in Inflammations
in General, but the Scrotum must necessarily be suspended ☍.
Note Continued.
Tunica Vaginalis, it is not of much consequence to distinguish
it from the Hydrocele as the same treatment is advisable
but it should be carefully distinguished from an enlarged Testis,
sometimes the contents is only Coagulated Blood, & sometimes
coagulated Blood, mixed with Serum, & sometimes the Coagulum
will be found to have become Vascular.
☍. 569. Farther Remarks on the Cure of Hydrocele
by Seton or Tent & by Caustics.
If the Seton is used Care should be taken that the Skain of Silk
or thread be large enough to fill up the Wound made by the
lancet or Seton needle, & thus plugging it up, prevent the Escape
of the water until a general inflammation has taken
place for the water keeping the Tunic every where distended
partial adhesions will be prevented & the influence of the operation
become general (566-567). The Seton should be passed

in the perpendicular Axis of the Tumor, but the Tent about midway
the water should not be suffered to escape before the tent is
introduced for the same reasons as the confinement of that
fluid is recommended where the Seton is used Sponge Tent
is preferable.
Caustic. There is an uncertainty how deep the Caustic will
act, should it not penetrate so as to include the Tunica Vaginalis
in the Eschar, we shall be under the necessity of
making a Puncture through that membrane & so shall gain
no advantage from the use of the Caustic.
When the Eschar is sufficiently deep the inflammation
of the Cavity takes place before the Water is discharged which
here also prevents partial adhesions & an Imperfect Cure, but
the uncertainty of the action of the Caustic is an objection to its
use. It may happen that the Testicle may lie in
the fore part of the Tunic & its situation not be known, or not
attended to by the operation, if in performing the radical cure by
incision he finds that he is cutting into the body of the Testicle
he should carry his Knife more to the lower & outer part of
the Tumor in finishing his incision for fear of wounding the
Spermatic Artery, an accident That has occasioned

108.
570. Fractures. The bones as well as the soft parts
are subject to every stage of Inflammation either arising spontaneous
or being induced by external violence when their continuity
is divided they are reunited by processes somewhat similar to
those which we observe to take place in the soft Parts.
571. Bones are liable to Solution of Continuity from external violence,
solution of continuity in bone is called fracture.
572. Fractures in bones are either
A. Simple
B. Compound. [simple]
C. Compound Simple
D. Simple Compound.
By a simple fracture is meant a solution of continuity
in a bone without a wound communicating Externally.
573. By a compound fracture is meant a solution of continuity
in a bone, with a wound communicating Externally which does
not heal without suppuration & granulation.
574. By a Compound simple fracture is to be understood a fracture
which has a wound communicating Externally but which
Wound heals either by the 1st. or 2d. Mode of union & without Suppuration.
575 The Simple Compound fracture takes place where originally

♄. 578. It has been usual to distinguish all unnatural
states of the Bones, by the name of Caries. Caries was divided
into moist & dry; moist seemed to imply a diseased state of
the Bone, dry the bone becoming dead. By converting the
moist into the dry state a cure was frequently accomplished,
why this happened will appear from (587. 597. 632).
The term caries signifies a Rottenness in the bones it is
evident this was improperly applied to bones becoming [diseased]
dead, because a dead bone is generally thrown off without the
least appearance of Rottenness, indeed it is much more firm &
solid than the margin of suppuration in the living bone which
had thrown it off.

109.
there was no Wound communicating externally, but where in
consequence of some parts losing their living Principle from any    
cause Ulceration of the Integuments is rendered necessary & the circumstances
of a Compound fracture induced.
576. Previous to our entering upon diseases, or mode of restoration
in bones it is necessary to consider the five following aphorisms.
577. Bones consist of an inanimate earthy matter attached to
a living organized substance.
578. Bones may either be in a dead or a diseased state, between
the death & disease of a bone it becomes necessary carefully to
distinguish. ♄.     
579. Bones fall into disease more slowly than soft parts, &
when they become diseased are proportionally slower in the act
of Restoration for all processes go on more slowly & difficultly in
bones, than in soft parts.
580. It will be necessary also to consider the doctrines advanced
in (352. 358. 359. 361. 362. 482.).
581. Also that bones receive their Nutrition & means of support
chiefly from the Periosteum or membrane covering the
bones (382) different Bones varying much in their structure
(577) their diseases will vary, as well as the readiness with wch.
they undergo the process of restoration.
582. When a solution of continuity happens in a bone by External

     

  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


110
External violence, productive of simple fracture (572) the cure may
be effected by the first mode of union ( ) without either Inflammation
or Suppuration. In simple fractures though accident
produces a Rupture of several blood Vessels & an immediate effusion
of Blood into the Cavity made by the division of the bone
if the Œconomy of the Parts is not very much disturbed by this
violence, the bloods retaining the living principle, the red part
& serum, are soon absorbed & the coagulable Lymph alone remaining
becomes Vascular the Cure is accomplished with little
pain & without disturbance of the General System.
583. If so much injury is done to the parts, that a considerable
& unusual action is necessarily Excited in them, the first
& most simple mode of union will not take place, but the Ossific
Inflammation or that which is perfectly similar to the adhesive
Inflammation in soft parts arises. Coagulable Lymph
is poured out into the Cavity (now similar in its nature to any
natural circumscribed cavity) which is to form the callus this
becomes vascular at length Cartilaginous & lastly ossific matter,
as in the first formation is deposited ( ) & thus the cure is accomplished,
here pain, tumefaction of the circumjacent parts
& the common symptoms of the adhesive inflammation takes
place.
584. In the compound fracture ( ) the Cavity made by the division
of the ends of the bone becomes an Exposed one, from the


    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


111
fracture being complicated with a communicating Wound, the
blood effused does not as in (582) retain its living principle, the
stimulus of imperfection obligates the Cavity to set up a new process
suppuration takes place & the only means of reunion left are
those of granulation.
585. As in wounds made into circumscribed Cavities, if the
lips of the wound come in contact & unite either by the first or
second mode of Union, before the Stimulus of imperfection gives
the Alarm to the cavity, a suppuration of the whole Cavity does
not necessarily take place, so in the Compound simple fracture
if the external wound is thus made to unite before the blood effused
into the Cavity has lost its living principle & the stimulus
of imperfection has given rise to a new process, the Cure may be
accomplished, with the same case as in the simple fracture.
586. But it may occur that either a splinter of Bone being
detached & dying, or the extravasated blood losing its living
principle, or from a misplaced end of the bone producing ulceration
of the integuments, or an irrecoverable injury being done
to the parts covering the bone, that Ulceration even to the Exposure
of the Cavity is produced, in this case which we term a
simple Compound Fracture the same circumstances will take
place as in the Compound Fracture (584).
587. When a part of a Bone becomes dead, Exfoliation or the throwing
off the dead part from the living must take place, In what

🜖 588. It can rarely happen that any large portion of Periosteum
shall be destroyed, or become dead without a consequent
death of [the] a portion of the subjacent Bone, if only a small extent
of Periosteum is destroyed, exfoliation of the Bone does not always
follow, because its Life will be still supported by means of its
Vessels anastomosing with those that pass from the Periosteum
nearest to the exposed part.
♀. 592. Of this we have instances in Anchylosis of the Vertebræ of
the Spine especially in Horses, between two or more of the Vertebræ
of these Animals it is Common to have an Anchylosis formed.

112.
the Process of exfoliation consists we will hereafter shew.
588. When a surface of a Bone is exposed, it is very common for
a portion of it to become dead & a necessity for the Process of Exfoliation
to take place. For the Bone receiving its nutrition from the
surrounding periosteum, that being destroyed or becoming
dead a part of the Bone must lose its means of support. 🜖.
589. The Union of broken bones is more slowly accomplished than
that of the soft parts, because in the former two processes are to be accomplished
Viz the formation of soft parts & then the formation of
bone.
590. The Ossific Inflammation arises when there is an increased
disposition in a part to form Bone.
591. It consists in the Vessels of the Bone, or the parts covering
the Bone, taking on the same action as the Vessels of the soft parts do
in the adhesive inflammation.
592. The consequence will be similar, for it will produce tumefaction
& enlargement of the Bone, if extending from one Bone to
another between which & the other there is a natural motion it
will produce Anchyloses, like as the adhesive Inflammation produces
immobility in the soft parts to which it extends, it will
be followed occasionally by suppuration & ulceration. ♀.
593. The Causes also of the Ossific Inflammation will be similar
to those of the adhesive; External Violence, as exposure & pressure,
a necessity for action in the Vessels of the bone or its membrane &ca.

♃. 593. Pressure will not uncommonly occasion ulceration &
absorption of Bone, but it may also Excite the Ossific Inflammation
& a thickening of the Bone.

113.
may give rise to it. ♃.
594. The final intentions for which the ossific Inflammation
may be employed, are first to produce restoration of parts & reunion
in a diseased Bone, & secondly to strengthen weak parts.
595. The seat of disease in bone can only be in its living part.
596. The more spongy & soft the Bone is, or the more living matter
it contains the more liable it is to disease, the harder the Bone
the less ready it is to fall into disease, but a death of some of its
parts is more easily Induced.
597. When a bone becomes diseased it is our business to endeavor
to get the better of the disease, but when a Bone becomes dead nothing
can be done but to produce exfoliation.
598. The treatment of diseased bone is rendered difficult by
the impossibility in general of discerning the extent of the disease
599. The inflammation & suppuration may have its seat either
in the surface of the bone, or within the substance of the
bone, or in the medullary substance.
600. Hard bones becoming diseased are more difficult of cure
than soft One’s, & when cured are more liable to fall again into
a diseased state.
601. Bone is liable both to ulceration & intersticial absorption.
602. When a portion of bone becomes [diseased] dead the process of
exfoliation is performed by the dead Bone giving a stimulus to
the living Bone in contact with it & to which it adheres by the attraction
of Cohesion, the living parts immediately in Contact with
the dead bone are absorbed, & a Cavity between the dead – living

🜔vmss. 🜔. 602. The first appearance of separation in order for exfoliation
is a springiness in the living bone now becoming more vascular,
then a Grove is formed in the direction of the fibres that surround
the dead Bone, the living Bone becomes softened & more porous, part
of the dead Bone seems to be sometimes absorbed for it has the appearance
of having undergone ulceration, it is certain that absorbents have
a power of taking up dead bone. The absorption begins at the circumference
& is continued to the Centre. In the Skull they become first
membranous, nature observing the same order in the repair of bone
as in its first formation, a pulsation in the Granulations often attends
the exfoliation of bone. Granulations will sometimes arise
shoot over the edges of the bone to be exfoliated, & prevent it being
thrown off so soon as it otherwise would be in this case it excites
new Inflammation & Ulceration.
🜔vmss. 🜖. 603. The Granulations forming bone irregularly become
often a considerable obstacle, to the cicatrization of the Ulcer after the process
of Ossification &ca. is finished.

114.
surface is formed, the former now being a mere extraneous body
is according to a law in the Animal Œconemy ( ) carried from within
outwards, & at length thrown off from the body, ulceration of
the integuments having made way for its exit, the cavity is filled
up with Granulations which become New bone. 🜔vmss. 🜔.
603. Granulations will arise from the Surface of bone without Suppuration
having preceded, but this only where that surface has
not been exposed by a penetrating Wound. 🜔vmss. 🜖.
604. A thickening of the Periosteum & integuments has often been
mistaken for an enlargement of a bone.
605. A Bone may be enlarged without any alteration in its original
structure, by bony matter being formed in its natural surface,
this laying on of new Bone will arise from the Ossific inflammation
taking place in the periosteum, or on the surface of the bone, we
call this adventitious Bone.
606. Or a Bone may be increased by the Ossific inflammation taking
place in its substance, which causes an alteration in its
structure & enlargement of its dimensions.
607. A Bone may be increased in size at the same time that
there is an absorption going on in its substance, for the ossific
Inflammation may be laying on New Bone on its surface at
the same time that absorption is removing portions of its more
internal substance thus a bone may at the same time be increasing
in its dimensions & losing in its Quantity.
608. Suppuration may take place either on the surface or in the

  
   
   

        
  
 
 
  
  


 
   
    
                                  


115.
substance of a bone.
609. Matter when formed may be confined, if in the substance of
the Bone, by the natural bone remaining unulcerated through its
substance, & thereby preventing its exit, or if on the surface of the bone
by the ossific Inflammation forming a Case round it of new or adventitious
bone, but in the latter Case the progress of the suppuration
must be rapid, otherwise there will not be time for the bony case to be
constructed & the matter will make its way to the Skin as in a common
deep seated Abscess.
610. Matter may be also confined on the Surface of the bone for a considerable
time, simply by the thickening of the Periosteum just as it
is confined by a fascia in the whitloe.
611. The periosteum & the cellular substance connected with it may
take on the Ossific Inflammation.
612. Suppuration taking place in the substance of a bone, & the Ossific
Inflammation being also taken on by the surface of the bone & the
parts covering it, the matter will produce a disposition to the ulcerative
absorption which will be continually removing large portions of the internal
surface of the bone, the ossific Inflammation at the same time
depositing new bone on the outside, thus the Bone may be enlarged
to any size & there two processes, absorption within & Ossific disposition
without going on together the dimensions of the Bone shall be wonderfully
increased at the same time that perhaps the original
bone shall be entirely removed, & even some of the internal parts of the
New bone shall be taken away & at last instead of a Solid bone only


          
   
   

        
  
 
 
  
  


 
   
    
                                  


116.
a large bony Case shall remain from which at length the matter
shall be evacuated. Ulceration within may however go on even after
the matter has made its escape.
613. Ulceration is the Sequel of suppuration it removes the Effects
of the Ossific Inflammation, when ulceration has gone through the
surface of a bone it affects. 1st. the periosteum next the Muscles and
lastly the cellular substance & Skin.
614. Bones when the first & second modes of Union fail are, as heretofore
observed / cured by the formation of Granulations & those taking
on the [diseased] ossific disposition.
615. But it sometimes happens that the ossific disposition shall
not be taken on by the granulations between the Ends of the bone,
so that there shall be no union by bone, the restorative process going
no further than the production of granulations or the change of them
into Cartilage.
616. It sometimes happens that no union at all is formed between
the separate ends of the Bone even after a simple fracture in
this Case, a New Joint is formed, the ends of the Bones become covered
with a Cartilage, & as in all other Articular Cavities a power of
secretion Synovia is given to it, & it is in every respect similar to any
other Joint Except the want of the proper moving powers, that is
corresponding Muscles, these not being generated the new joint becomes
Extremely inconvenient.
617. Ossific Inflammation may terminate in a Suppuration, or the

☿. 620. Here nature seems to be counteracting her own Ends, but
the final intention of this bony case seems to be an hasty attempt
to obviate the weakness in the limb that might spring from the
extent of death in the bone.

117.
bone may remain swollen, but Indolent.
618. Exfoliation of Bone is of three kinds. Vizt.
A. External.
B. Internal.
C. Mixed Exfoliations.
619. The process of Simple external exfoliation has been already
considered (602) It happens also that an internal part of a bone
shall become dead, becoming dead it gives a stimulus to the surrounding
living parts, as an Extraneous Body, it must ultimately
be thrown off, for all parts, / as has been shewn ( ) admit readily of
the passage of foreign substances from within outwards, hence from
its stimulus & the ulcerative absorption is finally produced in the
surrounding parts & a passage is given at last to the dead bone,
In consequence of the stimulus Granulations also arise & fill up
the loss occasioned by the seperation of a part of the bone & these Granulations
becoming bony the Case is accomplished.
620. The mixed is when the External Exfoliation becomes an internal
one which is accomplished as follows.
At the same time that the process of absorption goes on for
removing the dead bone from its Contact with the living parts, the
parts in the neighbourhood take on  the ossific Inflammation & in
the End forms a bony Case round the dead piece & prevents its Exit. ☿.
621. Bones commonly become painful before a swelling of them
is perceived.

622. This happens 1st. because it is the matter of diseased
parts. 2d. because the Continual irritation of the
bone like other irritation induces a flow of matter.
3d. because there is commonly some Blood
mixed with it, which soon becomes putrid.
♂. 626. The quantity of Mercury to be used may be somewhat
less than that fitted to Cure a Pox.

118.
622. The matter discharged from diseased Bone, or where the process
of exfoliation is going on is seldom laudable pus & is extremely disposed
to putrefy, tinging the probe of various colours.
623. When the Skin is affected, that is when the Inflammation
of the bone is communicated to the Skin, suppuration commonly
takes place.
624. The periosteum becoming inflamed & its internal surface
taking on suppuration, a disease or death of the more external
parts of the bone may be induced.
625. The hard bones having fewest living parts, & of Course fewest
Vessels have their life soonest destroyed by any destructive
cause whatever, it is scarcely possible to lay them bare to any considerable
extent without death & exfoliation being the consequence.
626. Where the ossific Inflammation, or the Inflammation of a bone
requires the assistance of Art it is to be treated by antiphlogistic
remedies & by limiting upon rest being given to the part affected,
& if the lower extremities that the Patient lie in an horizontal
position.
When the swelling of the bone becomes indolent, the parts
are to be rouzed into action, & if possible intersticial Absorption excited
by the administration of Mercury both internally & Externally.
The Mozeron Root has been much recommended as
a specific in the Enlargement of Bones. ♂.
627. If the seat of suppuration is the surface of the bone, or the
internal surface of the Periosteum the matter should be evacuated












 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


119.
as early as possible & this by simple incision through all the integuments
down to the bone, but without removing them & more
especially in case the Cranium is the object of our consideration.
628. sometimes in this Superficial suppuration bones are so
much diseased that they have not a disposition for restoration
& the bone will not exfoliate unless the actual Cautery be used.
629. In case of suppuration in the substance or medullary substance
of the bone, (which is the worst case by far) the matter is
to be evacuated by the actual or potential Cautery, or by the trepan.
630. Bones which have undergone external Ulceration often fall into
an indolent state in which Case stimulating dressings are to be used.
631. When the actual Cautery is applied we must [not] use an Iron
of a thickness sufficient to give a degree of heat in proportion to the
depth of the bone. The time of continuing its application must be
also directed by the same Rule.
632. Cauteries may produce a Cure of diseased bones by inducing
a Death of the diseased parts & so render the process of exfoliation
necessary, but in order to have this effect their action must produce
the Death of the whole diseased Part.
633. The [whole] Actual Cautery induces not only the death of
the diseased parts but an inflammation in the sound parts &
this hastens the seperation of the part to be exfoliated. The potential
Cautery rarely does more than producing the death of
the diseased bone.

☍. 637. Mr. Hunter has seen patients who have fractured their
legs in whom firm union would not take place until they were
set upon their Legs, the fractured bones being well supported & defended
by splints &ca. 

120.
634. However [an] a natural or spontaneous exfoliation is much more
to be desired than an exfoliation produced by Art because of the
uncertainly of our endeavours to extend our operation to the whole
of the diseased bone.
635. Of Specific diseases producing disease in bone & consequent
exfoliation, the exfoliation goes on more readily & kindly from the
venereal disease than from Scrophula or others. In Scrophula the
extent of the disease is more considerable, whereas the venereal is
more partial & confined to a narrower Limit.
636. When after a solution of continuity in a bone the cure proceeds
no further than the soft union, the rest of the Limb should
be discontinued to excite if possible a further disposition to the act
of restoration in the parts.
637. When the fracture with the circumstances (636) is in the lower
extremity care must be taken by means of splints & Iron work,
that the whole weight of the body does not rest on the fractured bone ☍
638. When a new joint is formed (616) the observation & Precautions
are also to be attended to.
639. But it may sometimes be desirrable to attempt the destruction
of the new formed joint & procure firm union between the Ends
of the formerly divided bone, in this Case we are to consider the doctrine
of Inflammation of Cavities & particularly that of the Cavities
of Joints (528) &ca. –
640. The mode of accomplishing this purpose will consist in producing

🜍. 640. It must be evident that the less time has elapsed since
the formation of the New Joint the more readily its destruction
will be accomplished.

121.
producing in the new articular Cavity the stimulus of imperfection
by making an opening into the Joints & introducing some foreign
body to prevent healing of the Wound by the first or second mode
of union & excite universal suppurative Inflammation which
being followed by Granulations & those Granulations becoming
bony, the ends of the bone will be immoveably united. 🜍.
641. Diseases of bone may have powerful influence on the constitution,
we may readily conceive the effects of a constant & long
continued pain, want of Rest &ca. which are their attendants we
also know they will bring on hectic & this is accounted for by considering
what is advanced on hectic (479 & ).
642. When ulceration has removed so large a portion of the bone,
that the remainder on account of its weakness shall be unable to
support its necessary actions, or where disease extends through a
greater part of the substance of the bone, than art can restore to
health, or procure a seperation from the sound parts, or where there
is an inability of the constitution to support the disease, or the
processes necessary to healing.
Amputation becomes indispensable.
643. In simple fracture if the patient be healthy the union
of the Bones will be generally accomplished in about three Weeks
but something sooner in the upper than in the lower extremity.
644. Rest – retention of the bones in their natural position,
freedom from pain, & the prevention of Inflammation are the general

   










 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


122
general indication in all fractures of the Extremities, whatever
position of the limb best fulfills these indications is the position
to be recommended.
645 To prevent the displacement of the Ends of the bone we
use splints & bandages.
646. Of the different species of fractures enumerated (572) the
Compound is the most dangerous, & frequently attended with
troublesome, if not fatal Symptoms, as Fever, Symptoms of
dissolution, Gangrene &ca.
647. We can rarely keep the bones perfectly at rest, in bad
compound fractures, hence constant irritation, pain, &ca.
648. The same indications are to be fulfilled in the compound
as in the simple fracture (582) we should move the Limb as
rarely as possible. Poultices though they should otherwise seem
desirrable applications in Compound fractures, become injurious
by their admitting of motion in the ends of the fractured bones.
649. The simple compound Fracture is attended with less danger
than the compound fracture, although the former also may
produce troublesome & dangerous symptoms.
650. The treatment of the constitution when affected by the
consequences of compound Fracture will be but understood
by recurring to (462 od 479.)
651. From what has been said it must be evident that when
a fracture of a bone is complicated with a communicating

   









 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


123.
wound of parts that cover it, as Muscles, Cellular substance
& Skin, it must be always the duty of the Surgeon to endeavour
to render the Case a simple of a compound Fracture,
to which End he will be careful to remove extraneous bodies wch.
may hereafter produce the Stimulus of imperfection, to place
& retain the bones in their natural site & prevent their irritating
the soft parts, to bring the soft parts into contact
one with the other, in short to observe the rules laid down
in cases of Wounds into Cavities & the doctrine (682).
652. In bones as in soft parts the observation that all new
formed are weaker than original parts holds equally good.
653. In bones as well as in soft parts, the process of restoration
goes on more readily in the upper than in the lower extremities
Compound fractures therefore considered as injuries done both to
the bones & to the soft parts are more dangerous in the leg and
thigh, than in the Arm or fore Arm.
654. Fracture of bones, which communicate with Cavities of
joints, whether simple or Compound require peculiar attention
& peculiar treatment, as
1st. the fractured Patella
2d. --- Olecranon
3 --- either Ancle
655. Also when a fracture happens near a Joint, the bone may











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


124.
be so splintered as to communication with it.
656. In case it be a fracture attended with a wound of the Joint
communicating externally, the Wound must be healed if possible
without suppuration, which arising, will occupy the whole
Cavity of the Joint & too often produce a necessity for amputation.
657. If a simple fracture communicate with a joints cavity
the Bond of Union will escape into the Cavity of the Joint
& form a Case similar to Compound fracture.
658. The fracture of the bone will be here united by the third
mode of union or granulation. (the first & second being lost
by the escape of the Bond of Union into the Cavity of the Joint)
except that here there will be granulation without suppuration
preceding (603) In case of fracture communicating with a
joint, it is apt in the cure to produce a stiffness & loss of action
in the joint from the blood escaping into the Cavity & becoming
organized, in this Case as soon as the fractured bones are united
by the Callus it is necessary to give passive motions to the joint
often repeated them & when the callus is confirmed the patient
should diligently exercise the part affected by constant motion
of the proper Muscles.
659. When the Patella is fractured the union of the fractured
parts will be either by bone or ligament.











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


125.
660. If the fractured parts, remain in contact or very near to
each other, the Union may take place by bone as in the fractures
of other bones; but if the fractured portions are at a distance from
each other, Union by the formation of Ligament will be the mode
adopted.
661. For the Patella being employed in the formation of a Joint
a Union by lengthening the bone two or three inches must have
been extremely inconvenient to the patient & incompatible with
the future motions of the Knee.
662. The Patella being the point to which the principle extensor
Muscle of the Leg is inserted, when fractured transversely the
Muscle being now no longer confined contracts itself & draws the
superior portion of the fractured bone to a considerable distance
from the inferior.
663. When the union is formed by ligament as is always the
case, when the fractured portions remain at a considerable distance,
asunder, the patella is very much lengthened & the two
points of attachment of the Rectus Muscle being therefore brought
much nearer together, the Muscle must be considerably shortened.
664. As the original length of the Muscle is diminished its power
of contraction must be diminished in proportion, for the two
ends of the Muscle have in consequence of the accident approximated

♀. 668. Lady B. broke both her Patellæ, they were reunited by ligament
& she lost entirely the use of her Legs, consequently was [n??]
able to walk, she has been in this state 2 Years when Mr. [H?a?] 
her: conformable to the principle laid down in the Text, he set
upon a Table with her Legs hanging inflected over it, he desired her
think attentively of extending her leg & try by the powers if the will
to raise it forward, at first her mind had not the least [influe??]
on the Leg by repeatedly determining the influence of the will to 
the Muscles & repeating this endeavour several times for two
three days she gained a trifling power of Extending her Legs, by persisting
in the same means she increased that power so as to
be able to extend them compleatly, she was then directed to raise
he Leg with a small weight affixed to the Toe, this weight was
gradually increased, at length she was set upon her feet & obliged
by an attempt to walk to Exert a greater force, by daily exercising
the Muscles in this manner & gradually increasing their labours she
was at last restored to the use of her legs, which were formerly considered
as irrecoverably lost.

126
approximated themselves nearly entirely as much to each other as
they were accustomed to do in voluntary action, hence it is evident
the powers of extending the limb must remain lost unless the
Muscle acquires a new action, thus accommodating itself to the
present Circumstances.     
665. The Muscle will acquire however a new action in time &
moreover will in time be enabled to shorten itself, so that by its
contraction the power of extending the Limb shall return to the
patient.
666. This power will be the sooner restored if the Surgeon & the
patient join their endeavours to induce in the Muscle an habit
of Acting.
667. This is to be done first by giving passive motion to the limb
& then by the Patients exerting attentively the influence of the
will upon the part.
668. For the Muscle being originally under the influence of
the will, if the powers of volition are resolutely [& powerfully] & industriously
exerted, will in time recover its pristine action & voluntary
motion of it will be restored. ♀.
669. If the Union is formed by bone from the irregular formation
of the Callus, a bony ridge may be raised on the internal
surface of the Patella which may impede the future actions of the
Joint.
670. It must be evident that the knee should be kept straight

☍. 673. The Triceps Extensor Cubiti being fixed to the Olecranon
when a fracture of that process happens, the superior portion
of the bone will be drawn upwards by the involuntary contraction
of the Muscle, in the Cure the superior is to be brought
downwards, the Arm for sometime kept extended until Union begins
to take place & the action of the triceps is to be checked by
Bandages, when Union is partly formed, as after a fortnight it
mostly will be, then passive motion is to be given to Prevent stiffness
of the Joint, & lastly when union is compleated a voluntary
motion as in the Case of the Patella.
It is remarkable that in general the luxuriant Callus
of a bone is on the outside if its internal surface is exposed to the
action of Moving parts. Thus a ridge from a callus of a fractured
Rib, is never on the inside of the Rib.
After Muscles have acquired a new action the next step
is to give them strength, which must be done by frequent Exercise
It is to be observed that the greatest possible Contraction of a muscle
is somewhat more than a motion of the Joint which it serves admits
of, hence when the Patella or Oleacranon is fractured – the Extensor
Muscles will be shortened more than they were in voluntary
action.

127.
X that in order to the retention of the bones in their approximate
state we must apply a bandage rolling the thigh from above downwards
to prevent the involuntary Contraction of the Rectus Femoris
also that rest should be insisted on, the Surgeon should repeat his
motion of the Limb once in two or three days, afterwards more frequently,
until at length the proper time comes for the Patient to
Exert self-motion (Sec Lady B's case 667).
671. The union of the Bone will be much sooner accomplished
by bringing the seperated portions of bone near together & retaining
them in that situation, for by this means the Muscle will not lose
its original Length & of course its power of contraction, consequently
less difficulty will hereafter arise to the patient in Extending his
Limb & the Evils of irregularity of Callus & Stiffness of the Joint may
be prevented by the attention of the Surgeon
672. When the Cure has been attempted, as soon as reunion has
begun to take place a slight degree of passive motion should be
given to the Limb, & as soon as Union is perfected, Voluntary or self-motion
should be insisted on.
673. The Olecranon is to be considered as a fixed Patella & the same
principles allowing for that difference will apply to a fracture of it.
674. When the Ancle bones are fractured they are only to be considered
as bones making Joints, & not as liable to be influenced by the action
of Muscles, none of which are inserted into them, they are therefore
to be returned if any displacement has happened to their natural

🌕︎+. 679. Mr. Hunter has once seen a Cartilage die become black
& be thrown off with a portion of bone lying under it, this is also
the Case in White Swellings the Cartilaginous Ends of bones being
observed, the bones are removed together with the Cartilage.
Mr. Bromfield Amputated the Arm of a young Woman
at the shoulder joint, she recovered several years afterwards she came
into St. Georges Hospital where she died on dissecting the shoulder on
which the operation had been performed it appeared that the Granulations
& soft parts were not the least adherent to the subject Cartilage
which they covered loosely like a purse, the same thing happens
when fingers are amputated at Joints. Mr. H has seen the Cartilages
of the Larynx & ribs exfoliate but they have previously ossified & become
a spongy bony substance

128.
natural situation & retained in it by bandage &ca. & when union
has begun to take place between the divided portions of bone passive
motion should be given to the Joint, (675).
675. Cartilage is an animal substance intermediate between the hard
& soft parts, approaching very much in its nature & properties to horn
It has very few Vessels is insensible; has little or no power of absorption,
does not swell from pressure, is not liable to exfoliate even when
exposed & scraped, never goes into the suppurative Inflammation, nor
ever becomes the basis of Granulations.
676. Cartilages may be divided into two kinds.
A. the permanent
B. the changeable.
677. The order A are such as remained unaltered during Life
such are those of the Nose & Ear.
678. The order B. (676) are two fold.
1st. Those which at a certain time become bone for which
before they served as a substitute, such are the Epiphyses of bones wch.
in the Infant are Cartilaginous, in the Adult are bony.
2d. Those whose change into bone to her place at an uncertain
time of Life, & sometimes are never changed into bone, as the
Cartilages of the Ribs, & the ends of the Cylindrical bones.
679. When Cartilages are exposed they do not exfoliate; like bones       
nor do Granulations arise from them, but granulations arising from
the circumjacent soft parts on all sides shoot out & meet over them,
thus losely covering them without adhesion. 🌕︎+.

🜖. 607. The lower Jaw seems an exception to this, the depressors
are always attempting to dislocate the Jaw, but the Elevators keeping
it firm in its socket, opening the Mouth does not give firmness
to the Joint; We see in immoderate Yawning the Jaw will be sometimes
dislocated the Elevators here either for a time losing the power
of action or being over come by the power of the depressors, the latter
are not inserted near the Centre of motion.

129.
680. When the permanent Cartilages are divided the Reunion is
formed by Cartilage, but when the changeable Cartilages undergo
solution of continuity, they are consolidated by bony union.
681. When the changeable Cartilages inflame they take on the ossific
disposition , when they fall into disease they also become bony.
682. Cartilages seldom admit of the ulcerative process, they are
however liable to undergo Contiguous absorption from the Lymphatics
of the surrounding parts.
683. Joints. If we judge of them by the Laws of Mechanics are
in general very ill formed, but this deviation from mechanical
principles, fits them for a vanity of actions, which had the Rules of
Mechanics been strictly adhered to would have required a greater
number of additional Joints.
684. In considering the structure & properties of Joints we are
also to take into account the ligaments & Muscles
685. The Ligaments in general serve as Pivots.
686. The Ligaments of some joints regulate the motion of the
Joint, but there are only such as are moved in one direction only as
the two upper Joints of each finger, others they only serve to sustain
& support.
687. The powers that give force & firmness & direct the Actions of Joints
are the Muscles, the Muscles support the joints in the motions they
have to perform. 🜖.
688. From knowing that the strength & weakness of a joint depends

🜔. 688. 689. These aphorisms require considerable attention
it is observed (48) that the voluntary Muscles may occasionally act
of themselves & independent of the will, & this may be either from disease,
or in spasms, or from a kind of consciousness in themselves of
the necessity of acting when a Man is descending from an eminence
as when he is descending down stairs, the Muscles are all prepared to
support the Joints of the Knee & Ancle, so as to prevent their giving
way, & of course being strained, or any Jarring between the bones
that compose them, & this without any direction from the will, but
seemingly from a kind of attention in the Muscles to the security of
the Joint, but if a Man in walking a longer plane suddenly steps
down a descent which he is not aware of the muscles being unprepared
for the exertion & off their guard do not give firmness to the
Joints, & in this sudden action a jarring & strain of the parts composing
the Joint takes place, hence why strains so often accompany
falls – When a Man falls from an eminence it being uncertain
what part shall immediately receive the shock no particular
set of Muscles can prepare themselves to support a Joint against
Injury.
We gain much information on this Subject from considering
the Cooperation of Muscles. This will enable as to learn why a
Man shall jump from a considerable eminence to the Ground with
out injury, yet from a slight fall shall violently strain the parts
subservient to some of the Joints of his body if we but eagerly clench

130.
depends in a great measure on its muscles we are enabled to account
for several Circumstances otherwise inexplicable.
689. Joints are capable of motion either passive or Active by the
former we mean motion given to a joint by external force, by the
latter that motion derived solely from its proper Muscles. 🜔.
690.
Note continued.
our fist we find not only the Muscles of the hand in motion, but a degree
of rigidity pervades the whole body, the general System of Muscles
cooperating so as to give additional strength to the primary ones
or those immediately concerned in the action of the hand, this is a familiar
instance of the Cooperation of Muscles, so when a Man is about
to jump from an Eminence not only the Muscles of the Legs prepare
themselves to give firmness to the Joint & resist violence but all the Muscles
of the body Exert themselves likewise to give general firmness &
by their general cooperation to assist the Muscles of the legs, in overcoming
the violence of the Jar.. if we suddenly raise an Animal
(as a Cat) upwards the body being elevated its muscles are relaxed, but
the moment we begin to let its body sink towrds the earth the whole
Muscular System becomes in action & a degree of rigidity is sensible
throughout its body, the same holds good with a Child: if in playing
with an Infant (though ever so young) we toss its body tow’rds the
heavens its Muscles whilst it is going upwards remain lax & at
rest, but as it descends towards the Earth they all become Rigid &
firm, prepared as we may say to receive the shock of violence
If

If a Man intentionally Jumps from a considerable Eminence
to the Ground as from an house loss his Knees or Ancle Joints are
injured because the power of the Muscles although prepared to resist
violence & give firmness to the Joints is less than the force with which
his body comes to the Ground & the greater overcomes the lesser.
If a Man jumps out of a Carriage in quick motion he generally
injures his Knee or Ancle Joints from the same cause, for although
he does not in this case jump from any great height, yet the projectile
force of the Carriage (out of which he is thrown as a Stone from a
sling) added to the weight of his body combine to give a greater shock
than the resting power of the Muscles can support, in these cases the
degree of violence, forcing the Joint to passive motion & that perhaps
in an unnatural direction is superior to the power of the muscles to
give firmness & resistence to the Joint.

131
690. Strains always arise from a weakness of the Muscles in
question, or from an intention in them to the task they have to
[ex??ite], being then taken by surprize.
691. If the force of passive motion given to a Joint be greater than
the power in the Muscles to give firmness to that Joint then a Strain
or some other injury to the Joint will ensue (687/689).
692. The Muscles themselves as well as the Joint suffer from strains,
& this from the Causes, being obliged to act unprepared, or being obliged
to resist a force superior to their powers.
693. Dislocations arise from the same Causes as Strains & it is not
impossible but fractures of bones may also be produced by them.
694. Crookedness of the Spine may also originate in a deficiency
of muscular powers, the Muscles of the back not being able to sustain
the trunk in its erect posture.
695. The same Cause likewise, probably gives occasion to Knocked
Knees, we rarely see very muscular People fall into these states.
696. The power of the Muscles in preserving joints being overcome
by the Violence of the external force applied, the joint gives way to
this violence as far as its ligaments will allow, there are stretched to
that side to which the Joint bends & these Ligaments are not unusually 
torn.
697. The joint being thus injured the following circumstances may
arise Vizt. Tumefaction of the Joint & this almost instantaneously.
Ecchymosis.

🜍. 701. When Joints after an injury recover their health it is Probably
the ligaments are injured & not the Cartilages.
702. If dislocations are not easily reduced the parts receiving
the dislocated bone adapt themselves to it.
☿. 703. In speaking of dislocations we say the bone farthest from
the trunk is dislocated, thus when there is a dislocation at the Elbow,
we say the ulna is dislocated not the humerus.

132
Heavy dull pain in the part ( )
Sickness ( ).
698. The tumefaction arises from an increased Secretion of Synovia
added to the other Common Causes of tumefaction from external injuries.
699. The parts which are the seat of pain though in their natural
state insensible now acquire great sensibility, this sensibility
leads to a natural Cure by incapacitating the patient for motion
& so necessitating him to remain in a state of rest.
700. In the treatment of strains & injuries of the ligamentous parts
of Joints, the indications are
Rest.
Topical bleeding, as by leeches.
The application of cold water, Vinegar, Spint; [Oari?]
&ca, or Fomentations.
701. But, the powers of restoration here being weak, the cure will
in general be tedious & too often imperfect, the joint sometimes never
recovering its original health. 🜍.
702 the common causes of Strains (690) will be also the causes of
Dislocations.
703. When a bone is dislocated, its end is thrown beyond the Articular
surface of the bone with which it is naturally conjoined. ☿.
704. The bone being thus displaced the action of the Muscles inserted
into it draws it upwards, so that the limb (if one of the Extremities
is concerned) appears generally shorter than its fellow & if

♁. 705. Here then retrograde motion is to be observed, & the last actions
in the dislocation is the first to be overcome, the last action is that of
the Muscles drawing up the dislocated bone & their force being overcome
by distension, in a proper direction & by it the Head of the bone being
brought to the edge of its receiving articular Surface is then by lateral
pressure to be forced into its place. The humerus is the bone that is
most frequently displaced & its reduction is rendered difficult among
other causes by the Scapula being a moveable bone, it is of the last
consequence sometimes to make the Scapula steadily fixed, a great
variety of motion & a great degree of mobility is incompatible with great
strength, this is a cause why dislocation of the humerus so frequently
occur how far the Ligaments are lacerated in dislocations is not yet
ascertained.
☉. 706. This happens most commonly in irreducible dislocations
of the thigh bone, for its head comes in contact with the Os Illium 
this may also take place in certain dislocations of the Os Humisi
where its head happens to be placed against the Scapula, these necessitous
joints are very similar, to simple fractures not uniting (616).
♂. 708. When a joint inflames it swells & becomes Extremely Painful;
Inflammation of a Joint always requires great attention.
Inflammation arising spontaneously is in general more dangerous
than Inflammation produced by external injuries.

133.
suffered to remain long so the reduction is frequently impossible.
705. In attempting the reduction of a dislocated bone the indications
are.
1st. to make the naturally most immoveable
part a fixed point.
2d. to overcome the action of the Muscles
which draw up the dislocated bone & resist its recovering its natural
situation. –
3d. then by making lateral pressure to force
the head of the dislocated bone in its proper place. ♁.
706. If a dislocated bone remains in its unnatural state a considerable
time & in contact with a bony surface by degrees it forms
to itself a new socket, the bone against which it presses undergoes
absorption, & the adhesive inflammation Arising in the parts around
a new joint is formed, these may be called necessitous joints. ☉.
707. Joints are more subject to fall into diseased habits than
any of the other circumscribed cavities & this from the nature of
the materials of which they are composed, some Joints are more
frequently the subjects of disease than others from being more exposed
to Injury as the Knee.
708. Joints are subject to the adhesive, suppurative & ulcerative
inflammations & to specific diseases as scrophula. ♂.
709. Scrophula may be brought into action in Joints having
a disposition to it by any external violence.



  
       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


134.
710. The adhesive Inflammation is not carried to the same extent
in Cavities of Joints, as in other circumscribed Cavities, because
adhesions being produced, would render a joint useless, but the Inflammation
runs into suppuration, or the Inflammation becomes
of the Scrophulous kind.
711. Inflammation of Joints whether arising spontaneously or
from violence requires.
Rest. Topical Bleeding, sometimes Blistering & general
Antiphlogistic Regimen but as soon as the disease becomes Stationary
it is to be considered as falling into a Scrophulous state &
the treatment of scrophula had recourse to.
712. If a joint takes on Suppuration every point of its Cavity falls
into it, Abscesses in the Joints should always be prevented if possible,
as they are productive of the greatest Evils.   
713. The suppuration here rarely goes on kindly, it is a mixture
of the adhesive & suppurative inflammations, the parts want power
to carry on readily any process, even ulceration goes on very slowly &
a considerable time is taken up, in bringing the matter to the Skin.
714. The ends of the bones forming the joint here become ulcerated,
indeed the bones seem to accept of the ulcerative Absorption more
readily than the other parts employed in forming the joint.
715. From the backwardness or inability of the parts to commence
the process of restoration & the constitution being long teized by an incurable
local Disease Hectic ( ) is produced & the patient is destroyed, unless

719. As between two ribs, this is seldom inconvenient but may
if it is taking place between the Radius & ulna, hinder the pronation
& supination of the hand, it happens when two Bones are within the
reach of ossific Inflammation arising in either of them.
Φ. 719. Here circumstances are similar to a fractured bone being
united by Granulation as in Compound fracture.

135.
saved by a timely Amputation which in general is best performed
early.
716. Diseases of the joints more readily produce Hectic than diseases
of the Bones in which joints are not affected, should circumstances
more kindly arise, & the suppuration & ulceration go on quickly,
it may happen that granulations may arise & a cure be obtained
without the loss of the limb & only with Abolition of motion in the joint.
717. If when motion is lost in a Joint, Anchyloses is said to have
taken place.
718. Anchyloses is produced by two Causes Vizt.
1st. By an immobility of the bones produced by a
change in the soft parts forming or surrounding the Joint.
2d. By an immediate Union between the Bones
themselves.
719. Anchyloses are of five kinds. Vizt.
1 Lateral Anchyloses.
2 Surrounding parts becoming bone.
3. The Capsular Ligaments of Joints taking on the
ossific Inflammation & becoming bony.
4 Granulation arising from the Soft parts in
a joint & afterwards becoming bone.
5. The ends of bones forming a Joint becoming
ulcerated & Granulations taking place, these granulations renting
becoming bony & in fact forming the two bones into one. Φ.


  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


136.
720. When in consequence of proceeding inflammation, or any
other cause, a stiffness & partial loss of motion in a Joint takes place
the Joint [persevering] preserving its original structure or at least
with little alteration, we can often restore its use by giving it a
passive motion frequently repeating it as advised after fracture of
bones communicating with Joints. (658).
721. The powers of Flexion are more easily restored to a limb than
the powers of extension.
722. When joints communicate or are in contact with each other,
as those of the Tarsus & Carpus. Suppuration beginning in one
joint will generally extend itself throughout the whole & all of them
will equally fall into disease.
723. A loose Cartilaginous or bony substance is sometimes found
in the Cavity of the knee Joint this may be formed in the following
manner, some blood being extravasated into the cavity of a
Joint may become organized & at length Cartilaginous or bony, not
being an original formed part, it may in the motions of the Knee
[be] broken off, from the part on which it had been formed, & thus
be found loose in the Cavity of the Joint.
724. Gun shot wounds, are to be considered in general as
wounds accompanied with contusion, they are followed by the same
effects & require the same mode of treatment.
725. These wounds being made by a projectile body driven wth.


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


137.
violence against a part, the extent & degree of the injury will
be in proportion to the magnitude of the projectile body & the Velocity
with which it is driven against a part.
726. The danger of Gun Shot Wounds is to be estimated according
to the nature of the part or parts injured & the degree & Extent
of the part injured.
727. Many circumstances will depend on the degree of velocity
with which the projectile body is driven against a part, as
1st. The greater the Velocity of the projectile body as
a Ball the more the Wound will be made in a straight line.
2d. The greater the Velocity of the ball the more the
Wound will approach to the nature of an incised Wound.
3d. The greater the Velocity of the ball, the greater
will be the danger of Hemorrhage.
4th. The Velocity of the Ball will decrease in invers’d
proportion to the obstruction given to it.
728. Gunshot wounds as all other Contused wounds are attended
in general with less hemorrhage than Wounds from incision
& gun shot wounds are in general slow in taking inflammation.
729. These wounds being attending with a destruction of the life
of several parts, cannot heal by the first or second intention, the dead parts
must slough & be thrown off, so that the process of suppuration
is necessary.


   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


138
730. The slough will be larger where the Ball enters than where
it goes out.
731. We divide Gunshot Wounds into Simple & Compound.
732. By simple we mean where the Ball passes into or through
soft parts only as Muscles & Integuments & which are not attended
with the effects enumerated in the following Aphorism.
733. The Compound [we] subdivide into
1st. Those in which a bone is fractured.
2d. Those attended with the division of some large
Artery. 
3d. Those penetrating some Cavity.
734. The penetrating wounds (733 3d) are either
A. simple penetrating or
B. Those also wounding some contained Viscus.
735. When a Ball passes through a part the most depending
orifice will heal sooner than the superior one.
736. The healing of Gunshot Wounds is always more slowly
performed than the healing of incised Wounds.
737. The degree of mischief done by Gunshot wounds is not
always Early to be ascertained, because parts may suffer violence
without any proof of the kind of injury appearing until sometime
after the accident for.
738. An Artery may be so injured that a portion of it shall become
dead, yet the seperation of the dead portion shall not

🜖. 741. As when a Ball, Bone, or any extravasated fluid presses
on the brain we may remove a portion of scalp to prepare for
the Trephine. As when the intestines come out through the
wound & cannot be returned without dilating it.

139.
take place at the time of the accident, but sometime afterwards,
so that though some hemorrhage happens when the injury is
received, yet a violent one may come on when the dead portion
of the Artery sloughs away – or.
739. A Ball penetrating the abdominal Cavity may bruise
even to death some portion of some Gut, yet the Canal shall
for the present remain entire, nor the exit of faces through its
side take place, until the seperation of the dead from the living
parts is affected.
740. Dilation of Gunshot wounds is not in general necessary
& therefore not to be practised, however the same indications
which require the dilations of other contused Wounds may also
direct us to enlarge these.
741. Dilatation of the Wound, or even the removal of a portion
of soft parts may be necessary when a Ball or other foreign
substance presses in any vital part, a large Artery, or a Nerve,
likewise in case a large Artery is wounded or can be taken up
also when a part is displaced & can be restored by dilating in all
these Cases it is right to enlarge the Wound. 🜖.
742. When a ball is lodged in a part where its continuance may
be the Cause of danger, if we can extract it, it is right to
make dilatation.
743. It is wrong to dilate simply, because a Ball is lodged

🜁. 743. Balls we know, often remain in parts for years
without producing any inconvenience & sometimes they are
never found, with regard then simply to the ball being
lodged in the body, the Surgeon need be under but little concern,
he has only to take into consideration, the other circumstances
present, as the seat of the Ball, the nature of the Part
injured &ca. –
♂. 745. Four Frenchmen were badly wounded by gun shots at
Belisle, two through the Chest, one through the Elbow & one
through the Deltoid Muscles, Scapula &ca. All the Patients did
well without dilatation of their wounds. If the surgeon makes
dilatation, the consequence is that the cure will remain unaccomplished
equally as long as if nothing had been done, The superficial
parts will heal to a very small hole & the deep seated
ones remain open, so that a fistula will remain, incurable untill
all the dead or foreign matter is come away, as exfoliation
of bone &ca. Again in gun shot wounds where the Ball cannot
be followed, as when it has entered the bones of the face, dilatation
must be entirely useless. A Reason given for dilatation
has been the preventing or taking off inflammation & tension,
but has not the incision made in dilating rather a tendency

140
in a fleshy part, or with a view to Extract a Ball, where the
circumstances similar to these (741-742) do not indicate the dilation
of the wound. 🜁.
744. In simple gun shot wounds no advantage is gained by
their dilatation, for the wound made by the knife of the Surgeon
will heal much sooner than the wound made by the Ball
so that dilating will not alter the nature of the Wound or
hasten the Cure.
745. Moreover if an Extraneous body, as a Ball splinter of a
bone &ca. is to be thrown off, the wound though dilated or treated
in any other manner will not heal until the foreign matter
is thrown off, so that, all attempts tow’rds a Cure must be fruitless,
until that Event takes place, the wound will heal so as to
leave a small hole only, open, which will remain unhealed until
all the Extraneous matters, which are to be thrown off
are come away. ♂.
746. In examining Gun shot wounds the probe should never
be used where the finger can be admitted, & forceps &ca is never
to be introduced but when the Ball &ca. is within our reach.
747. If a Ball passes some way under the Skin, & again
passes out at a considerable distance, an opening should be
made midway between the two orifices to prevent the formation
of an Abscess.

to induce these affections.
🜔vmss. 🜔. 751. Balls that do not go through & through are
generally Spent balls, unless it happens that a ball strikes
against a bone; a Ball shall sometimes enter the breast obliquely
& afterwards go almost round the whole body & be directed
by a rib until it pier as the Skin & makes its way outwards.
The Course of some balls is really surprising, Mr. H has seen
a ball enter on one side the Shin bone, go across it & raise up
the Skin from the Periosteum & make its exit on the opposite side
without doing any injury to the bone, now had the Ball struck
the part with great velocity it must have gone directly across the
bone & carried away a Portion of it. A Soldier had a Ball
enter the Biceps Muscle of the Arm & pass out under the Scapula
close to the Spine.
🜔vmss. 🜖. 752. It is difficult to say on what this red line depends,
it seems to be neither the effect of Inflammation nor
of Extravasation.

141.
748. If a Ball passes through & through immediately under
the Skin, the orifices not being far asunder, it might be right
to open the sinuous wound it has made through its whole
length, for the Skin does not so readily unite with the parts
underneath, as muscular parts do with each other.
749. If a Ball is lodged under the Skin & can be felt & the
integuments are bruised & threaten to slough away, it may
be right to incise the Skin & Extract it, for the mischief will
not be increased by taking it out, & it will be giving satisfaction
to the patients mind.
750. If the Skin appears to remain quite sound & free from inflammation
or disposition to slough the immediate extraction
of the ball is by no means necessary.
751. The Course of the ball will be ever extremely irregular it
will vary from the perpendicular or Horizontal direction to Oblique
or tortuous & sometimes its Course will make a considerable
section of a Circle. 🜔vmss. 🜔.
752. A red line appearing on the Skin will in general merk
the Course of the ball. 🜔vmss. 🜖.
753. It is unnecessary to dilate a Wound penetrating a Cavity,
as the Abdomen, or Thorax unless, some other Object requires
the attention of the Surgeon than the simple penetration of the
Cavity.

     

 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


142.
754. Compound Gunshot wounds in which an Artery is divided,
or a bone fractured, as there is nothing specific in their nature
so the general principles of Surgery will apply to their
treatment.
755. Penetrating Wounds (733 3d) are divided into
a. Simply penetrating wounds.
b. Wounds penetrating some contained Viscus.
The containing Cavities will be the abdomen, the thorax & the Cranium.
756. Wounds simply penetrating the Abdomen will in general
do well, provided the first or second mode of union takes place, so
as to exclude the Stimulus of imperfection from giving a general
alarm to the whole Cavity.
757. Compound penetrating wounds of the abdomen will again
divide themselves into two kinds
1st. Those which penetrate some containing Viscus
as the Stomach, small intestines, large intestines, Bladder &ca
2d. Those which penetrate some non containing
Viscus as the liver, spleen &ca.
758. The Compound penetrating Wounds (757 1st.) will have different
Symptoms according to the part receiving the Injury.
759. The Symptoms of wounded Viscera will be either
1. Immediate or
2. Secondary.

🜔vuss. 🜖. 760. A Young Gentleman received two or three Shots
in his abdomen, one of which went through his body, entering
before & coming out near the Spine, his stools were natural, from
which Mr. Hunter pronounced his bowels unhurt, his urine was
bloody, which shewed either his Kidney or his Bladder to be wounded,
he recovered.

143
By the first is meant peculiar Symptoms arising immediately
from the injury done to the Viscus.
By the second, those which arise from the consequences of that injury
& not from the injury itself.
760. The immediate Symptoms of wounded Stomach will be
sickness, Vomiting, great depression of Mind &ca.
Wounded Intestines --- Bloody Stools.
--- Liver --- Pain in the right or left Shoulder,
according as the right or left lobe of the Liver is wounded, discharge
of pure Blood by stool.
Kidneys or Bladder --- Bloody Urine, & here the Ball if it
remains unextracted may prove a nucleus for a future Stone,
a wound of the Spleen will give no particular symptoms, it is
in general followed by a profuse extravasation of blood into the Cavity
of the Abdomen.
In general wounds of the Liver & Spleen will have none but immediate
Symptoms. 🜔vuss. 🜖.
761. It will however be very different in Wounded containing
Viscera or those which naturally contain quantities of foreign secreted
matter, as the Stomach, the Intestinal Canal, the Bladder
the Gall Bladder &ca. the Intestinal Canal being wounded, considerable
time may be elapsed before the seperation of a Slough
gives an opportunity for the fœces to escape, these getting into the
common Cavity of the abdomen, at what distance of time soever from

🜔vuss. Φ. 762. A Gentleman in Duel had a Ball passed through
his Belly, he had no particular Symptoms for 13 days, on the 14th
fœces came through the Wound nothing further indicating mischief
Mr. H pronounced him, out of danger forming his prognosis
on the principles laid down in the text.

144
the injury, will become the cause of general inflammation
of the whole Cavity with all its consequences, as suppuration,
Gangrene & Death. A Wound of the Gall Bladder, ductus Coliducus,
Parceaticus, or Urinary Bladder, if communicating with
the common cavity, may produce the same affects though probably,
more slowly, see ( ).
762. In general Wounds of the containing Viscera will destroy
the Patient, but it sometimes happens that previous to the
appearance of any secondary Symptoms adhesions shall take
place between the Wound in the intestines & the wound in the
peritoneum & common integuments, so that when the slough comes
away the fœces &ca. will escape, not into the Cavity of the Abdomen
but through the artificial Canal formed by the adhesive inflammation,
& which as an artificial Anus or Urethra, will
give an exit to the Substances to be evacuated, when this circumstance
takes place no other ill Symptom forbidding us, we may
offer a favorable prognostic. 🜔vuss. Φ.
763. The time which may elapse before the secondary symptoms
appear may be, 10-12, or 14 days (762 Note).
764. The Artificial Canal (762) will sometimes close & heal up.
765. Wounds simply penetrating the Cavity of the Thorax will
be only so far dangerous, as they may produce exposure of the thoracic
Cavity, if the first or second mode of union takes place before



 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


145.
before the alarm is given to the Cavity no mischief arises.
766. Wounds of the Lungs are not always fatal, those made
by a Shot are less frequently destructive than those made by
a sharp instrument, as a Sword or Bayonet, for
767. One great cause of the Mortality of Wounds in the Lungs
being excessive hemorrhage into the Cavity of the Thorax, the
hemorrhage following a Gun shot wound will be much less than
that produced by a cutting instrument.
768. Symptoms of a wounded Lung will be Bleeding from the
Larynx, Cough, pain, in the side, fainting difficulty of breathing.
Diminution of motion in the muscles of the Thorax because
the Muscles of one side cannot act without those of the other
side acting likewise.
769. The Wound being in a Vital part the pulse will grow quite
hard.
770. The Patient will not lie in an horizontal posture but is
desirous of sitting Erect that his Diaphragm may be as freely
expanded as possible.
771. A profuse Extravasation of blood in the Thoracic Cavity may
be judged of from the sense of weight complain’d of by the patient,
from the lowness & faintness which must attend so sudden & copious
evacuation from the Lungs, & the common Symptoms of a sudden
accumulation of fluid in the Thorax. ( ). –

🜔🜹. 773. Penetrating wounds of the cavity of the head will be
considered among the diseases of the Encephalon (785).

146.
772. A Gun shot wound penetrating the Lungs, the wounded
Lung, commonly collapses & therefore an adhesive of the
wounded part to the pleura cannot take place
773. Gunshot wounds not healing without suppuration soon
will be left for the matter, which may be collected in the Chest
to drain off, but this will be attended with the inconvenience of
making the Thorax an exposed & imperfect Cavity, if the quantity
of Blood Extravasated is small it may be absorbed, but if there
are Symptoms of a large quantity being collected in that Cavity the
operation for the Empyema should be performed as early as possible,
because if the Blood coagulates it will adhere to the sides
of the Cavity & not be got out without the greatest difficulty, or in
some cases it may suffice, or be best to enlarge the original
Wound. 🜔🜹.
774. Gunshot Wounds may so far injure a part, that the process
of restoration cannot take place in it, & therefore the Wound
is rendered incurable, in this case the removal of the part becomes
necessary, & when a part, as are upper or lower limb has been
so much injured that its removal is necessary, we must determine
in what case Amputation should be immediately performed or
in what it may be deferred to some future Period.
775. Should a part, (as an upper or lower extremity) be so far       
nearly seperated from the body, as only to hang by a small Portion


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


147.
Portion of soft parts, it may be immediately removed.
776. Should an hemorrhage from some Vessel, which cannot
be restrained endanger the Life of the Patient, amputation of
the Limb should be immediately performed.
777. But in most other cases, it is adviseable to defer the Amputation
until the Inflammation is gone off.
778. If a Cavity is wounded & any of the contained Viscera protruded
they should be immediately replaced.
779. Bleeding is not indiscriminately to be had recourse to in
Gun shot wounds
780. We are always to be directed in our opinion with respect to
this Evacuation, by the nature & situation of the part injured, & its
powers of action, & the general strength of the patient in proportion
to the general action of the Vessels.
781. Excessive bleedings having been employed, Patients have
sunk suddenly.
782. The use of the bark becomes highly proper after Inflammation
has subsided, & even during the presence of Inflammation if
attended with weakness of the System, it is however necessary sometimes
to accompany its use with small bleedings.
783. After the sloughs occasioned by Gun shot Wounds have been
thrown off, though the Ball or other Extraneous matter remains
in the body, the ulcer will granulate & continue to heal so long

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


148.
as the extraneous matter remains quiet & does not stimulate
784. When an Extraneous body remains unremoved, the ulcer
may become fistulous, or a fistula may even be formed when the
foreign body has been extracted, in which case it is to be treated
as another fistula.
785. Tents are however always improper.
786. Diseases of the Brain are of two kinds, Vizt.
a. Where the imagination is affected, from various
causes as in Mania &ca.
b. from Mechanical Injuries.
787. Mechanichal Injuries (.786.b.) may be either. 1st. concussion
2d. Compression, 3d. Wound or loss of substance 4th want of due compression.
788. The three first may exist seperately, or any two, or all three
together, their Symptoms will be nearly similar, there are as cessation
of sensation, & voluntary actions, the Muscles of the mouth &
throat becoming flaccid, froth being discharged from the mouth
with the appearance of fullness of the Vessels, the Symptoms
of the 4th. will be restlessness & insensibility.
789. Vomiting accompanies all these affections of the brain & arises
from Sympathy.
790. Vomiting however never takes place during the time of perfect
insensibility. –

  
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
791. Injuries done to the Brain diminish sensibility, Injuries
of other parts increase it to a certain degree.
792. Concussion (787) may depend upon a displacement of parts
of the brain, the degree of concussion will be in proportion to the
violence with which the blow is given, whether the head falls
against any Body, or any hard body is driven against it.
793. Compression ( ) may follow accidental Violence immediately
or arise sometime after.
794. Compressions may be owing to any of the following causes
Vizt.
1st. To a depression of the Scull from Fracture
2d. to pressure of some part of the Cranium from the
thickening of a diseased Bone.
3d. To water in the Ventricles
4th. To distention of the Blood Vessels.
5th. To Inflammation.
6th. To the formation of Pus
7th. To the extravasation of Blood.
8th. To a Tumor in the substance of the Brain itself.
The causes of Wounds or loss of substance in the Brain must be
sufficiently obvious.
795. Concussion will be either.
a – Simple – b – Compound immediately or
c – Compound secondarily.
796. Simple Concussion is where there is no fracture, compression

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
or Extravasation, we must endeavour to distinguish between Concussion
& the effects of intoxication. The effects of simple concussion
will soon be carried off by plentiful bleeding &ca. but if it is
Complicated with Compression the effects will not be diminished by
time, but rather increased, Compression may instantaneously follow
Concussion, in which case it is said to be compounded immediately,
or Compression may arise when the effects of Concussion would
be naturally going in which case is said to be compounded
Secondarily.
797. Fractures of the Scull may always be considered as compound
Fractures, they are either made so intentionally by the Surgeon,
or are found by him in that state.
798. Fractures of the Skull are of three kinds. Vizt.
1st. Fracture of the Outer plate
2d. Fissure
3d. Bone broken in several places
These may be complicated with each other.
799. The 1st & 2d. (798) may be the remote Cause of Compression (793)
& the third may in itself become the immediately Cause of Pressure on
the Brain.
800. Bleeding from the Nostrils or Ears, is a common though an equivocal
Symptom of a fracture of the Cranium
801. The concussion will be in general less, where the Bone is much
shattered than when otherwise, for the force being spent upon the Skull
less shock is given to the Brain.

       
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


150.
802. Gun shot Wounds of the Head & those made by other Bodies
moving with great Velocity do not produce for the most part great
concussion.
803. Fissures of the Scull will run in very different directions along
the Cranium, across it, & even across the Sutures. –
804. If the Scull is soft & yielding there will be often depression of the
bone without fracture.
805. When there is fracture & depression of both tables, if the fracture
detaches an entire piece of bone from the undepressed Cranium & that
whole piece is driven downwards, then the fracture of the internal table
will always be larger than that of the External.
806. If the fractured bone is depressed on one Edge only, & through
both Tables, the inner table will still go shelving off beyond the outer.
807. hence (805-806) will appear the difficulty of elevating depressed
portions of bone, so as to make the seperated pieces, fit themselves
to the undepressed Cranium perfectly smooth, hence also the utility
when a portion of bone is to be removed, to make the margin of the depressed
piece a part of it.
808. The indication in all fractures of the Scull, is to prevent or remove
pressure on a Vital part, that is the Encephalon, therefore it is
necessary whenever there is a fraction with depression, when a piece
is detached & driven inward to remove it entirely, or if one edge only
is depressed to take care to elevate it properly, the operation employed
for the purpose of elevating or removing depressed Bone, or for making

🜔vmss 🜖. 814. The situation of the extravasated fluid will be very
different in different Cases & hence the great uncertainty of our Release
the Patient, who labours under compression from some cause independent
of depressed bone, it may be between the dura mater of the Scull,
between the dura & pia mater, between the pia mater & the brain,
or it may be in the Ventricles, & even in the substance of the brain itself.

151.
an opening for any necessary purpose into the Cranium is called
trepanning & the instrument used by Surgeons for that end is called
the Trephine.
809. When a fracture is discovered it should in general be traced as
far as possible throughout its extent, & therefore we are sometimes Obliged
to remove the Scalp freely.
810. Fractures of the Scull are so often complicated with the immediate
or secondary symptoms of Injured brain, that few cases will
offer in which the trephine will not be necessary.
811. It is never necessary to apply the Trephine either in Cases of
fissure or fracture of the outer table only, unless there are also Symptoms
of an injured brain, & those not of Simple concussion alone.
812. In all cases of Compression either immediate or Secondary of Concussion,
complicated with compression, & in all wounds of the brain
it is necessary to apply the Trephine.
813. It may sometimes be impossible to ascertain the exact situation
of the Compressing matter, yet here, as the patient must undoubtedly
die if not relieved, it is justifiable to operate at Random.
814. The situation of extravasated fluid will sometimes be opposite
to the part where the blow was received. 🜔vmss 🜖.
815. The dura mater should never be divided unless from the
greatest & most evident necessity (as when matter or blood is visibly
lodged beneath it) for penetrating Wounds of the dura mater (which
exposes & renders imperfect a Cavity containing the Brain) will in general

♀. 815. Mr. Hunter computes that not more than one in 20 persons in head
would recover from a penetrating wound of the dura mater.
♂. 819. In health we know the Strength is always greater than
the actions.

152.
general be mortal. ♀.
816. The Trephine must be applied (one, twice) or as many times
as the Extent of the Injury shall require.
817. The Trephine may be applied in any part of the arch of the
Cranium where an accident may render it necessary, or eligible, if the
fracture is circular it will be right to repeat the application of the Trephine
until it is surrounded by the perforations.
818. As life consists in the properties of preservation & Action, so
Death is the loss of both.
819. The immediate Cause of death in a part would appear in most
cases to arise from a total loss of Circulation, but this must be the
effect of some remote Cause. ♂.
820. Mortification of a part differs much from common universal
Death, in the latter case the Vessels can be injected & the Structure [cross out]
of the parts examined, but this is not the case with the former its
Vessels cannot be injected, its structure is changed, is destroyed.
821. The immediate cause of mortification, will be whatever can
excite the actions of a part so as to render them superior to its strength,
or reduce the strength of a part so as to be unequal to its actions.
822. Debility Can be only the predisposing Cause of mortification it
cannot immediately produce it, if a part is ever so weak while its
actions, do not exceed its strength it will retain life.
823. From (813) it is evident that a part may fall into mortification
either with or without previous inflammation, in the former Case the

∇. 824. The greater the distance from the heart the more liable are
parts to mortification.

153.
inflammation is the immediate cause of death.
824. Heat should always be in proportion to the living principle otherwise
it produces a necessity of Exertion, which the strength of a
part is not equal to, the exciting of heat then in a part where powers
are very weak may induce mortification.
825. When parts are extremly weakened as to their principle of Life,
by Cold (as when people are frost bitten) the application of heat must be
gradual & Slow, otherwise it will necessarily induce mortification ( ) as
the principle of Life increases the heat may be increased.
826. from (819) we are enabled to discover why scarifications in the
legs of anasarcous patients, or wounds made in their extremities,
either by Art or Accident, why Blisters applied to persons in whose
Systems there is great debility & a disposition to putrefaction should be
followed by [Putrefaction] Mortification.
827. Also why Persons who have suffered severe famine, long exposure
to intense cold, are in extreme old Age, or who have the Circulation
obstructed through a part, or those of tall stature are subject
to Mortification, especially of the feet & Toes.
828. In the Cure of mortification, or restoring parts falling into mortification,
it must be evident that as the cause is a diminution of
powers in proportion to the actions of a part whether common or increased
so the Cure must consist in lessening Actions & in increasing the
powers of the part.
829. Whatever then stimulates a part to action without increasing its

☽︎. 830. The temperature of the atmosphere in which patients to
be cured of Mortification are best placed, should be neither very
hot, nor very Cold, that the natural actions may neither be impeded,
nor hurried on too fast. –

154
strength & powers, must be contraindicated.
830. Hence also it is evident why bark should have so much power
in checking some inflammations, & that opium may prove a very
useful remedy. ☽︎.
831. The Causes will be either (819).
a. Mechanical, as a Blow, or
b. Chemical as a Caustic
832. The less vascular a part is the more readily its Life, is destroyed.
833. Also the weaker the powers of Life in a part are, the more easily
will they be acted on by Caustics.
834. No substance can act chemically but in solution, in order for
the Caustic to act chemically it must be moistened, this is effected
by the serum produced from the vesication which arises from the irritation
caused, by the application of the caustic substance, which Serum mostens
the Substance & thus after the Life of the part is unable to Acts for its
preservation, Operates chemically on the Skin &ca.
835. The action of a caustic when applied to a part produces an
abolition of Life & then the Caustic acts chemically upon its substance
coagulating its Mucilaginous parts & changing its texture.
836. Mortification on the death of a part is often induced with
a view to destroy a diseased or even a sound part (in order to enable
us to make application to some diseased part otherwise out of our
reach) or to give an exit to some foreign substance retained under

 



 
   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


155.
the Skin, as pus &ca.
837. The Effects (834 &ca.) will be produced by a variety of substances
artificially & intentionally applied of these the principal are
Caustic Alkalies
Concentrated Acids & Metallic Salts.
838. Of the Metallic Salts Arsenic is the most powerful, whose action
is different in some measure from that of the other Caustics,
as it produces mortification simply by its exciting violent actions in
parts which they cannot support, & not by any chemical process.
839. The application of these substances to sentient parts is attended
with violent pain, that is to be diminished
1st. By the administration of Opium by the Stomach.
2d. By mixing opium with the substance to be applied
3d. By applying plaisters of Opium to the part for some
hours previous to the application of the Caustic.
840. The natural sequel of mortification is a sloughing of the
mortified part, or the process by which it is thrown off from the living
parts immediately in Contact with the dead & the ulcerative absorption
of them is necessary (449).
842. As in the Exfoliation of Bones, so in the sloughing of soft parts
the absorption begins at the external edges of the dead parts, the dead
part becomes dark Coloured & dry, the ulcerative absorption beginning
at the Edges & going through the whole surface of Contact of the living
with then dead parts, the slough is ultimately thrown off like any

☿. 846. We know with some certainly, how far the parts of the body
the Brain excepted & with what comparitive facility they go through
the process of Sloughing, the nearer the heart Cotises Paribus the
more readily the process of seperation will go on, the common integuments
& Muscles will throw off a dead part sooner than a Tendon
Ligament or Bone, as to the Brain it has not been ascertained
whether it will slough or not, for before the seperation of the dead
part can possibly take place, the Patient in general dies.
🜔^. 847. Thus if a Limb is mortified throughout its substance
we may cut off a portion of the dead parts to lessen the Stench
arising from so large a mass of Putrid matter, & render the patients
situation more comfortable, but we must not proceed to amtating
in the living Parts until a compleat seperation has taken
place.

156.
other extraneous Body.
843. As the weaker the part is the more easily is it Acted upon by Caustic,
so the greater the strength of a part, the more readily the seperation
of the slough will go on.
844. New formed, being weaker than original parts it is evident
they will suffer their Life to be much sooner destroyed by Caustics.
845. From (844) we are enabled to learn, why in new formed parts, Mortification
is so Easily induced, as in larger cicatrices &ca.
846. Also why Caustics so easily destroy the fungous Excrescenous
of Ulcers &ca. ☿.
847. In a mortification no incision or wound is ever to be made,
into living parts, at least until the process of seperation is begun,
a portion of the parts quite dead, may however be removed at pleasure.
🜔^.
End of Volume the First.

INDEX
Aphorism Page
A
Animal actions of---39---10 
Arteries---51---13
Absorbents---53---13
Absorption the final end of---56---14
___ulcerative----61, 440---15, 83
Actions voluntary---75---18
___two different cannot exist &ca.---169---35
Air affecting animals---147---31
Anchyloses---718---135
B
Brain and Nerves &ca---69---17
Blood living principle of---110---24
Bladder inflammation of---526---98
Brain inflammation of---548---102
Bones disease in---595---113
Brain disease of---786---148
C
Cicatrization---452---85
Cesarian Operation---525---97
Cartilage---675---128
D
Disease---154---32
Diseases division of---185---38
___local---190---41
___Constitutional---195---42
Dissolution the action of---476---88
Dislocations---693---131
E
Empyema---493---93
Emphysema---500---94
Eye inflammation of the Chambers of---533---99
Exfoliation---618---117
F
Fermentation in Animals---22---7
Fractures---570---108
___communicating with Joints---654---123

G
Granulation---445---84.
H
Habit---98---21
Heat---122---26
Hectic---464---87
Hydrocele---549---102
I
Ideas---71---17
Inflammation---285---57
___Cure---364---71. 
___Topical applications to---387---75
___ulcerative---427---81
Joints---683---129
___& Sacculi Mucosa exposure of---527---98
Joint Cartilage in---723---136
L
Life principle of---24---7
M
Matter---1---4
Medicines---226---48
___their mode of acting---234---49
Mortification---818---152
P
Part the actions of---239---50
Pus---415---79
Pleura Inflammation of---487---91
Pericardium Inflammation of---504---94
Peritoneum Inflammation of---507---95
Puerperal Fever---519---96
Patella fractures of---659---124
S
Stomach---44---11
Senses---70---17
Sympathy---201---42
Suppuration---398---76
Strains---690---131
Scull Fractures of---797---149
V
Vascular System---49---13
Veins---52---13
___Inflammation of---542---101

Aphorism Page
V
Viscera Wounded---759---142
W
Will---74---18.
Wounds Gunshot---724---136
___Penetrating---755---142.


   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  



   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  

























Thomas Windsor
Manchester
?-1745
(1845)
A gift for the library of the Surgeon-General, Washington
T. Windsor
July 18, 1885.
LECTURES
on the
RATIONALE of SURGERY
by
JOHN HUNTER.
VOL.I.






1
Introduction.
In the course of these Lectures I shall differ very much
from what is taught in Books on the subject of Surgery. The Ideas
I have to communicate are mostly my own, & not drawn from Books
I have reason to suppose them true because they are founded upon
facts. –
I shall consider first the Animal Œconemy. I shall mention
chiefly the actions of the body on a diseased state, with their recoveries
& natural functions in health. I have it not in view to
give a full course of Practical Surgery, but to teach the principles
of the Art.
I will be unnecessary to treat of the Operations & of every
particular disease; these are taught by Anatomists & others, the
principles are most necessary & those only shall be the subject of
our enquiry.
Every Art has its principles, from which we are enabled
to establish old facts, and account for new ones, the same holds
good in Surgery.
Effects are what strike the senses more forcibly even
while the cause is unknown, but as these are only consequences we
should endeavour to discover the Causes.
We know the causes of Inflammation, Suppuration
and Mortification, hence we are enabled to check their progress.
We find it necessary sometimes to increase the violence





2
violence of a disease, before we can effect a Cure, as in indolen Inflammations
&ca. –
Sometimes it is necessary to change one disease into
another, - in Venereal Inflammation, by exciting a common Inflammation
we cure the disease.
If the Animal was always equal to the task it has
to perform, surgery would be unnecessary, but the powers of restoration
which arise out of the Animal, being not always sufficient, it
is our business to increase the action where too weak & vice versa.
It becomes often necessary to introduce Chemical means
in the Cure of diseases, these failing we have recourse to Mechanical
ones, as the different Operations.
As the Operations (tho the necessity for them is the
defect of Surgery) become sometimes indispensibly necessary, it is
right to know how to perform them.
A compleat knowledge of the parts of the Animal
Body should be strictly attended to, as this will lead us to their
uses, we should know the different Functions and consider the
dependence one action has upon another.
With regard to operations we should know when
they will relieve, & when nothing but an operation will relieve &  
also know when the Habit will bear an operation (this is sometimes
almost impossible to ascertain)
The facility with which a Man thinks gives him
a superiority over others, few have observed nature with more attention
than myself, yet even now, I think myself scarcely equal to the
task I have undertaken. A man will be ignorant of the knowledge




3
he possesses until he arranges his Ideas.
The principles of Diseases which are the objects of
Surgery, have not been sufficiently attended to, these we intend
chiefly to consider.
We shall begin with Physiology, so far as it is necessary
to understand the principles of diseases.
Disease may be called a perversion of the natural
Actions of the Animal Œconomy.
I will first consider those diseases, that arise from
accident. Secondly those that are similar to them, then
the Union of divided Parts by the first intention, next Inflammations
which will throw a light on various subjects, as adhesions,
The Cure of the Hydrocele, Indurated Tumors &ca. Then the
union of Parts not cured by the first Intention, as Compound Fractures.
&ca.
Lastly we shall treat of some specific Diseases as
Scrophula, Cancer, &ca. –
J. Hunter.

Notes
🜹 3. So also the properties of matter act upon our senses, the sensation
of sweet or sour, are not matter, but the properties of matter
acting upon the Tongue.
Touch arises from resistance in matter. –
+ 5. By attraction of cohesion bodies of similar properties tend to
come in contact with one another & to remain so when this is effected,
this attraction is very slight in fluidity, in this however the stronger
it is the more globular or spherical the particles appear & vice versa.
Elective attraction disposes bodies, to join with various other [cross out] stances,
forming together one homogeneous mass. – of this we
have an instance in the combination of an air with an Alkali; there
are so many different Elective attractions, as there are methods of mixing
matter. – Elective attraction operates only when fluidity & vapour
are present, the compounds may however become solid afterwards
by the attraction of Cohesion. – The increased attraction of
Cohesion found in solid Bodies may be called the attraction of solidity.
 
        
 


4
Rationale of Surgery.
Matter. –
1st. – By matter we mean that substance of which this Globe or
Earth is composed.  
2. By the impressions of matter alone, we are led to the knowledge
of our senses, & by our senses only we judge of the existence
of matter.
3. But our sensations are excited not by the impressions of matter
itself, but by the impressions of the effects of matter; - thus
when we hear a Drum beat, our sensation is not excited by the
Drum, but by the vibrations of the Air produced by the strokes on
the Instruments. 🜹.
4. Matter is found in one of the following states, Solidity, Fluidity
or Vapour.
5. The general kinds & properties of matter are few but different
modifications, & combinations of those kinds & properties of
matter produce great varieties in appearance.
6. The following properties are common to matter, attraction of
cohesion, chemical or elective attractions, & attraction of Gravitation. +
7. Repulsion is also a property of matter but it seems doubtful
whether it is so universal a property as that of attraction, nevertheless
the action of repulsion seems to be in a great measure

🜔 10. Heat seems to destroy all attractions. – Mechanics depend
upon the external figure & magnitude of bodies & upon the properties
of gravitation, attraction, &ca. –
     
        
 


5
the cause of Fluidity & Vapour.
8. Magnetism seems to belong to attraction of gravitation, by the
attraction of gravitation the different parts of matter are kept together,
so as to form one great whole.
9. Each mass of matter though never so minute has in itself
a Centre of Attraction.
10. Heat also seems a generally necessary Agent to Fluidity & Vapor. 🜔 
11. The operations arising from changes in matter are regular &
determined according to certain & fix’d Laws.
12. We have been considering & speaking of the properties & modification
of common matter, but considerations on matter may be
carried much higher, & modifications of, or kinds of matter may
be found entirely different in every respect from common matter.
These are the matter of Animals & Vegetables.
13. The first principles of Animal & Vegetable matter are perhaps
the same, but they have many properties totally distinct
& different from one another.
14. It is observed (13) that the properties of Vegetable & Animal
matter are perfectly distinct, although their first principles may
be similar; & indeed so perfectly & entirely distinct are Vegetables
& Animals in many properties, & in the modification of
matter, as observed in their production & formation that no connection
between them has ever been traced.
15. They differ totally from common matter in that they have
each of them a power of acting, & performing various operations
within themselves & of producing or generating matter of their
own Genus from themselves. –

♂. 17. The circumstances of worms &ca. which feed upon Earth
would seem to afford an exception to this position, it is likely
however that the Earth they take in is only useful so far as it contains
Animal or Vegetable Matter. – In order to determine this
we should combine an Alkaline Salt with Earth, which will destroy
whatever Animal or Vegetable matter it contains, the wash it thoroughly
& try if a Worm will live in it.

6
16. Vegetables & Animals especially differ from each other, both
Indeed have a power of performing operations within themselves
& of generating from themselves new matter, but in other respects
they very essentially differ.
17. The operations of Animals are attended with waste of their
component parts, this waste is recruited by a supply from common
matter, but common matter cannot be immediately converted
into Animal substance, nor can the decay of Animal substance
be supplied from common matter until it has by certain [degrees]
changes been already altered into Animal or Vegetable matter.
Vegetables can immediately convert common matter into their own
substance & be supplied from it, but Animals cannot, which proves
that Animal matter is still farther removed from common Matter,
than the Vegetable. ♂.
18. Animals & Vegetable Matter may be viewed in two states, as
living or dead; - when living it has in itself a power both of
continuance & generating new living Animal matter, but when
dead it loses these powers.
19. Animal & Vegetable Matter after death is capable of being
acted upon by the operations of chemistry., & by those of spontaneous
dissolution, by which latter it is at length reduced to
common matter, out of which probably it is at first formed the
presence of life is an antidote to, and resists both one & the other
20. Animal Matter submitted to Chemical enquiring & the operation
of Fire, yields certain substances peculiar to itself, as
the Volatile Alkali, Empyreumatic Oil, Calcareous Earth [&ca.]
& a kind of Water, other substances as Iron &ca. are also found

 


7
which are superadded & do not constitute its natural component
parts. –
21. Animal Matter may receive a supply of its waste from
Vegetable Matter. –
Fermentation in Animals.
22. Many changes taking place during Life in Animal and
Vegetable matter have been attributed to a certain operation called
Fermentation, for it is known fermentation will alter powerfully
all substances which are subject to its action, & even changes them
into new & totally different substances, to this the secretions of
Animal Bodies have been supposed to be owing, to this the
change of the Water into the Juices of the different Plants nourished
solely by it has been imputed, to this Digestion &ca. –
23. But the Animal & the Vegetable Bodies are the subjects of
fermentation, no change wrought in them during Life can possibly
arise from this cause, for the presence of Life resists fermentation,
it is impossible it can only take place after the destruction
of Life, which is the preserving principle, we here speak of Fermentation
in the same sense the Chemists use it.
Principles of Life.
24. The changes arising in the Animal & Vegetable matter during
the presence of Life, are produced alone, by the peculiar power of
the principle of Life, to its operations we refer all the Secretions

♁ 28. Some experiments to elucidate – 28.
Expt. 1st. Mr. Hunter found that a new laid Egg tho kept by incubation
in an heat of 120° until it was hatched in 2 or 3 weeks,
when the Chicken was excluded, shewed not the least sign of Putrefaction; -
another Egg which was not hatched & of course died,
became in the same circumstances highly Putrid. –
Expt. 2nd. – A new laid Egg was exposed to heat between 17°.
& 15°. Farht. in which situation it was kept half an hour, its Life
being then destroyed by freezing it was thawed by Heat, being
then exposed to 25°. It then froze in half the time it before required,
that is in 15 minutes, while alive it had the power of resisting
Cold & consequently the destruction of its Life, a considerable
time, but when once killed it had no longer the property of resisting
the freezing power of cold. – Mr. Hunter made a number of
other Experiments on Animals & parts of Animals, he attempted to
freeze 2 Carp but without success, he found that for a long time
they generated heat & resisted the destruction of their Life by freezing
at length that power was exhausted & they died; the power
of resisting death almost every thing possessed of Life enjoys.
Mr Hunter found living Vegetables would endure Cold & resist being
frozen much longer than Plants whose vegetable life had been
destroy’d. – Experiments were tried on Dormice &ca. and all
had the same result. –
Experiment 3d. A dead Egg froze in the degree of 32 & a living
one gradually sunk to 29, it then continued stationary for
sometime, after which it rose to 32 & then became frozen, to

8
all the new productions, the digestion of other substances &ca.
25. The Operations of the Principle of Life cannot be referred to
Mechanical powers.
26. Life is totally distinct from any property of Mechanics, we see
indeed the movement & construction of all the Bones are regulated
by Mechanical Laws, but the actions of the Muscles which puts
the Bones into motion are not owing to any Mechanical Power or
Principle, nor by Mechanical principle can they possibly be explained.
27. From an examination & survey of Animal Matter when dead,
we gain an Idea of living Animal Matter, as from Life only we
can gain an Idea of death, so vice versa. –
28. The functions of & changes in an Animal body during Life
are all to be referred to the operation of the principle of Life. – The
properties of the principle of Life consist in preservation of Animal
matter in the living state & in action, Life may exist without
matter being in a state of action, & the property of self preservation
may be alone present, Life at the same time being present in
full force. – Thus a new laid Egg, is truly & really alive, tho
no kind of action is known to be possessed by it. ♁. –
29. Life does not consist in any modification of matter, it either
is something superadded to matter, or it consists in a peculiar
Arrangement of certain fine particles of matter which being
thus disposed acquire the properties of Life. ♂
30. Life has been compared to the spring of a Watch, as that
Spring gives motion to all the Wheels, so Life gives action to the

same Experiment was made on Snails, Snakes, Eels & others of the
colder & imperfect Animals, which proves that the fresh Egg is as
truly alive as the Animals just spoken of, tho’ it has only the property
of resisting death, or self preservation & not any kind of action.
♂. 29. I enquired of Mr. Hunter if this did not make for the
exploded doctrine of Equivocal generation, he told me perhaps it did,
and that as to Equivocal generation, all we could have was negative
proofs of its not taking place, he did not deny that equivocal generation
happened, there were neither positive proofs for or against
its taking place.
🜔🜹 33. The doctrine of colours will tend to the same purpose,
we see by different arrangements the same colours will produce
different Shades. –
☿ 35. Tho’ Organization is not necessary to Life, yet it is to action.

9
several parts of the Body, but this Idea is not just, no one part
of Body is dependent for action on any other part, but the several
parts, each possess life & action in themselves. –
31. Life in a living Animal is as much the property of every
individual part, as Gravity is of every particle of matter, every
one part is as much alive as the whole. –
32. Every action in the Animal body is produced by the living
principle, the secondary actions of Parts are as truly produced
by it as the primary. –
33. Magnetism will truly elucidate what is said of Life being
superadded to Matter, or arising from a particular arrangement
of certain particles of matter, a Bar of Iron placed for a long time
in an upright posture will acquire a magnetic Virtue, so perhaps
the particles of matter arranged & long continued in a
certain Position at length acquire the power of Life. 🜔🜹
34. Two, three, or four, or any number of Particles of Matter thus
animated may form a muscular Fibre, a certain number of
these Fibres collected form a Muscle.
35 Life does not consist in any Organization of matter, for
matter will remain as organized as ever after the destruction of
its life. ☿.
36 As from an observation of matter in its inanimate state we
gain an Idea of living matter, so from an observation of the functions
& actions of parts in a state of disease, we gain a knowledge
of or correct our opinions of the natural actions & functions
of parts in a state of Health.



                      


10
37. Solidity in matter is necessary for its action, it is the fixed
point from which its actions must proceed, & on which they must
depend, therefore we find the parts of Animals destined for action
solid, these Animal Solids are kept together by Cohesion.
38. The Muscular parts of an Animal are active, - of an Animal
scarcely any parts are purely passive, almost all parts
have somewhat of the Muscle in them, and have some kind of
or degree of Action. –
Actions of Animals.
39. The actions of an Animal are two fold, the primary actions
or those which every part hath in itself (as to nutrition
growth & support) without regard to any Operation, for the benefit
of, or for producing some change in the general System,
as the actions of the stomach, Brain &ca. – The first are
the true Animal movements, the second are what are called Operations
of the Animal Œconemy, as most secondary actions
are employed for the ends of the first, having a necessary relation
to the first; - so those secondary actions are in general permanent
and constant. In diseases all these secondary actions
may be suspended for a season, the primary ones are never interrupted
for the least portion of time so long as the parts live.
40. Those are besides the muscular parts (38) which are the
active powers, other parts also which, have a kind of secondary motion,
(that is, a motion communicated to them the Elastic Parts)

    

                      


11
but to the operation of these life is not necessary, their powers
are equal after the death of the Animal to what they were
during life. –
41. There are other parts also in the Animal Body that have
in themselves no kind of action, but whose use is merely
Passive, which are different in strength & density, some for Union,
as the Cellular substance, others for strength, as the
Tendons & Ligaments. –
42. It is said (40) that it is not necessary to parts being
possessed of Elasticity, that life should be present. – Elasticity
is indeed a property of many species of matter besides Animal. –
43. The actions of the living body are simple & compound
The powers of action distinguish living Animals & Vegetables
from dead & common matter.
The Stomach.
44. The operations of an Animal (17) are attended with a
waste of its substance; - supply is therefore necessary to
the continuance, this supply is performed by means of
which tho small in comparison to the bulk of the other parts
of some Animals, is the most important part of all. – This
is the Stomach. – The stomach is the principle distinction
between Animals & Vegetables, all Animals have a stomach, no
Vegetable is possessed of anything like one.; - to many Animl.
the Heart, Brain & Nervous System & many of the Viscera are

the stomach of plants may be said to be, the ground & air in which the
grow, as it furnishes a supply. So living animals which change the
situation of course it is necessary there should be supplied by some
with them, with stomach. HS
          

                      


12
wanting, but no Animal is without a Stomach, it is the Stomach
only which is necessary for the support of a simple Animal,
& organs of generation for the propagation of its species therefore
some Animals consist of little more than a Stomach & Genitals.
45. This Stomach may be called the true & primary Animal;
all other parts may be considered as superadded, according to
the functions of the Animal, to which some or more is given, is
to perform on the Stage of Life, for one Animal that possesses a
Heart, there are millions that want it. –
46. The Stomach by means of its hidden powers, converts
various Substances into one common kind of matter, which is
taken into & forms part of the Animal, this very curious kind
of Operation is called digestion.
47. This Viscus in the most complicated Animal, as in Man,
is intimately connected with the general Æconomy, it is as much
the seat of Irritability as the Brain is of sensibility, it is highly
affected by many external influences, which in themselves have
nothing to do with the Operation of digestion, as Wounds &ca. –
It is more affected by morbid operations produced in Tendons,
Ligaments & other parts of small natural sensibility than by
the same taking place in the Muscles, it is chiefly affected
by changes produced in the internal parts, as the Brain is
by those in the external parts. – It is intimately connected
with affections of the mind, whether produced from injuries
of the Brain or from horrid stories or sights, to which a Vomiting

🜖. 50. Experiments have excluded the Veins from the Theory of
Absorbing, even in the Erection of the Penis the Veins do not absorb,
I consider the Corpora Cavernosa as Veins, through which the Blood
is constantly flowing from the Arteries & that there are a number
of Veins, opening into the Corpora Cavernosa, and that the Blood
is flowing into them, that in the Erection there is a spasm upon
the Veins, which prevents the Blood flowing thro’ them, hence an
accumulation and distention, in the Penis, which ceases with the
spasm. – I found that by tying the Veins of a Dogs Penis an Erection
was produced. – 

13
vomiting or puking has been known to succeed, especially the last.
48. non est inventus.
The Vascular System. –
49. In compound Animals, as Man, the Vascular System
(or that by which fluids are carried to & taken from different parts
of the body, by means of which growth & nutrition are afforded
to parts, & to the whole) becomes an importent subject of enquiry. –
This is divided into, the Arterious, the Venous,
and the Absorbent System. –
50 The animal body is considered as an Hydraulic Machine
by those three sets of Vessels its course of fluids is conducted. 🜖.
51. Arteries. The arteries carry the blood from the Heart
to every other part of the body, consequently they convey the materials,
for the growth, nourishment & support of parts, for the
regeneration of them when lost, and the support or supply of
them when wasted, also for the different secretory Organs to
separate liquors for any further purposes in the Animal Œconomy,
or to diminish anything superfluous or noxious.
52. Veins. The Veins return to the Heart the blood wch
remained of what the Arteries had carried from it, after the
different purposes (51) have been effected, they are also said to
carry blood from certain parts to the Liver for the production of
Bile.
53. Absorbents. The Absorbents take up fluids & also solids
from [many] every part of the Body, which they pour (by means
of a peculiar duct) into the Blood, by this property they become

🜋 53. Also the Gubernaculum, & Membrane Pupillaris &ca.
When a Limb is removed, we know the end of the Bone is sawed
through in a circular figure, with hard edges, if examined
at some length of time after the Operation we find the end of the
stump approaching the section of a sphere.
Aphorism 59 continued. By this property also when their
actions are much excited, they take up the solid parts whether
soft or hard, these producing what has been called Ulceration,
this may be called Ulcerative Absorption.
They also diminish the bulk or density of parts without
ulceration, to this species of absorption no particular name
has yet been given, but it may be called Intersticial Absorption.

14
the means of supplying the system of circulation with nutritive
particles, also of conveying disease into the habit. – Thus being both
the instruments of Health & destruction; by this property of absorbing
solids as well as Fluids, they become the modellers of the
shape, Form & structure of different parts; they prevent parts
from growing into irregular & inconvenient figures; in this light
they may be considered, as the builders of the Animal fabric,
whilst the Arteries are the labours bringing & laying before them
the materials for the work, or as the polishers of the rougher workmanship,
of the arterial vessels; by this property they take up and remove
parts, which though useful in one part of life, becomes useless
in another, as the Thymus Gland &ca. - 🜋
54. The action of this system of Vessels (53) being considered
with regard to the ultimate effects may be divided into two
kinds
1st. Absorption of extraneous bodies.
2d. Absorption of the Animal itself.
55. The absorption of extraneous substances as observed (53) introduces
both the particles of nourishment into the system, & the
particles of Disease.
56. Final use of Absorption. The Absorption of the Animal
itself is employed either for the nutrition of the Animal
when either absorption of extraneous nutrition cannot take place,
or when the mind, is unmindful of directing nutriment to be
taken in, & yet nourishment is still necessary to the life of the
Animal, or when an useless & inconvenient part is to be removed.

                                   


15.
57. The mind is frequently unmindful of taking in food in
fevers, no disease of it being perceived by her, but nourishment being
necessary for the sustenance of the Animal, the fat and other substances
are taken up by the absorbents and carried into circulation for the necessary
purposes of affording nutriment to the different parts of the
system. Thus the Animal is for sometime enabled to feed on itself.
58. every part of the body may be subjected by disease to the second
kind (54-56) of Absorption – Absorption will either take up from
parts portions of their intesticial substance, as Earth from bone &ca. or it
will take whole Parts, as an entire bone. –
59. When a stimulus of any kind is about to excite the process of
Absorption, two circumstances will take place, a consciousness in the
Lymphatics of the propriety or necessity to begin absorption but when
the part to be absorbed is dead the state of consciousness is incompatible
with an inanimate state of matter.
60. to the removal of dead parts by internal process, this System
of Absorbents seems alone to be equal, no chemical process can perform
it.
Ulcerative Absorption. 61. The process of Ulceration, or
Ulcerative Absorption is always the same, different causes may indeed
produce it, & different circumstances may be present with it.
62. The state of consciousness (59) may be induced by different
kinds of stimuli but the mode of impression will always be the same
63. The absorbents have a power of taking up both Solids & Fluids.


 
     
                                    


16
64. The mode of their action is not clearly ascertained, it has
been imagined that they are Capillary Tubes, but capillary Tubes
can only absorb fluids & the absorbents take up solids. (63). –
65. The opinion of their absorbing matter in a fluid state alone
(which would shew, that the solids if to be absorbed, must undergo
solution by means of some fluid which acts upon them as a solvent)
is to be doubted of. –
66. It is equally & more probable that the absorbents have like entire
Animals, mouths & teeth, that the form of their mouths & teeth
in different Absorbents, essentially differ according to the parts they are
to act upon, so that perhaps could we obtain an accurate [class] survey
of them, we might be enabled to class them according to these differences. –
67. It is doubtful whether substances when mixed with the Blood
are essentially altered or not, the indefatigable parts of vegetables, as the
colouring part of Rhubarb pass off by Urine, or by some other secretion
unchanged; the variolus matter is not altered by the Blood the Venereal
matter when taken into the habit is certainly much altered, it is very
different from what it was before it was absorbed, this is the only matter
that we know undergoes a change.
68. The power of living Animal matter to consume itself is equally
probable, with the property of living matter to produce fresh living
matter from itself. –

🜔🜹 69. The existence of the Brain & Nervous System is not necessary
to simple Life, millions of animals want both, but they are necessary
to the performance of certain functions of Life, & without them in
those classes of Animals to which they are given, active Life cannot go
on if the perfect Animal, as Man, there have been instances of Monsters
born without a head; but not being able to support the functions
of Life, necessary to be performed from the time of birth, they die soon
after they come into the World, but they were truly & virtually alive
while in Utero.

17
Brain and Nerves. &ca. –
69. From a peculiar arrangement of the particles of Animal matter,
muscles are produced, a different arrangement of those particles
forms other organs, so from a particular disposition of these particles in
perfect Animals, the Brain & Nerves are fashioned, which being acted
upon by various impressions, various sensations arise, the effects of wch
are the mind & will. 🜔🜹.
Senses. 70. The impressive given by external objects are considered
as of five kinds, of these one is touch or feel, of which every part
of the Body which is sensible is the seat, the other four kinds several
affect the Organs peculiarly adapted to them.
Idea. 71. The sensation raised by an impression is two folds
first its effects on the part to which it is applied, secondly the change
produced in the brain, in consequence of that effect, the first is simply
passive, the second state is active, for then action is produced in the
brain & an Idea is formed.
72. According to the kind of change effected in the Brain the idea
will be agreable or disagreable.
73. As from habit we gain a power of judging & distinguishing
what is advantageous or useful, from what is inconvenient & pernicious,
when an idea respecting an external objects is executed in
the mind, & that idea is followed by an inclination to possess or obtain
that object, we should be irresistibly inclined to gratify that inclination
when arising did not our power of judging of ill consequences that


  
 
 
 
     
                                    


18.
might arise from gratifying the inclination in question (acquired as
before said, from habit, or from reapeted observation) determine us to the
contrary, this weighing an inclination in the mind we call Reason.
Will 74. a determination of the mind whether produced by inclination
or reason (73) is called will. –
Voluntary Action. 75. In consequence of any changes produced
in the brain, as concomitant on the Actions of the will, an action
in any moving part of the body is excited. this is voluntary
motion or action, thus different parts of the body receiving impression,
have a power of acting on, or exciting a change in the brain, & a change
in the brain however produced has a power of producing a change
in other parts of the body. –
76. The vital principle of simple Life & that principle on which
The powers of sansation depend by this connection (75) act mutually
on each other.
77. It seems as if we had no simple sensation, but that every
sensation of which the mind is sensible is compounded of two
states as (71).
78. The Operations of the Brain & Nervous System (64) are not
so extensive as some have imagined, they can neither supply a
part with nourishment, nor preserve a part from dissolution.
79. Every living body has an intelligence of its own feeling after
an impression has been given to it, previous to and exclusive of
any Idea existing in the Brain. Thus every living part has in itself
a consciousness of any impression given to it whether of Pleasure

83. Many fishes have abundance of nerves with a very small
quantity of brain, Fœtuses to whom the Brain has been wanting
Acephilous Monsters have still their Nerves.
85. In Man & the perfect Animals; sensation is intimately connected
with life. if the powers of sensation are constantly kept exercised,
the sensative principle becomes fatigued, & the principle of Life
also suffers with it, Sleep therefore by giving relief to the sensitive
principle, prevents violence being done to the principle. –

19
or of pain & as it were a power of the Mind determining to action,
independent of the powers of the mind.
80. The power of the nerves is purely passive hence previous to any
action being excited in them a impression must necessarily be given 
to them. –
81. The different sensative Organs are appointed to receive the
several kinds of impression given to the body & which impressions
are of five kinds. Yet every Nerve is subject to receive the impression
of touch & pressure.
82. The living principle is coeval in all living Animal Matter wth
the Animal matter itself, & may long exist without sensation. Thus
a Child in Utero has no sensation until it is born. –
83. The Nerves are not indebted to the brain for their existence,
there may be Nerves tho’ there is no brain, but the existence of the
brain is necessary for the formation of Ideas.
84. Parts intended for strong sensations have always a great quantity
of Nerves distributed to them
85. This principle of sensation regulates all our External action
as the principle of Life does our internal ones.
86 When an impression is given it must continue a certain time
in order to produce a sensation. if it lasts but a short space of
time, no sensation will be produced, if an impression continues too
long a distant sensation will be yielded, it will then only produce a
disturbed state of the Nerves. –
87. Sleep is to the sensitive principle, what rest or the state of inaction
is to the living principle as the living principle may exist

89 – here is no notice taken of the eyes being required to be shut
when sleeping, & the absence of the eyelid preventing it. H.I.S.
🝄.
90. A loud noise produces the same effect upon the Ear in lieu   
of distinguishing sounds the idea of pain will be excited, even the Tympanum
of the Ear, has been burst or broken by this Violence. –
91. Ingenuity often gives reasons for things, rather than
not account for them, but their reason unless they have some shads
of probality, or even when they have, may not be the truth. HiS –
does a blow on the ear produce a gretter sensation of sound, than the real ble
occasion.? HiS.

20
tho no action is going on, so the Existence of the sensation is not incompatible
with the abscence of sensations.
88. Thinking is the effect of particular changes in the mind, accompanying
changes in the Brain, tho’ with respect to ourselves, or a consciousness
of action or sensation, we are in a state of non Existence, &
although we have then no sensation, yet the Effect of sensations are not
lost, the mind will be thinking (which is the effect of sensation) while
we are asleep as in dreams, we seem indeed then to have sensations
but our seeming perfections are fallacious. –
89. We often dream when awake, having a seeming perfection
of things & objects which do not exist.
90. Sensation excited in a certain degree is agreable, in a greater
degree painful, & then the natural sensation will not take place, but
the sensation of pain will be produced, Thus are excessively glaring
light applied to the Retina, pain not vision will be produced. 🝄.
91. An impression different from that which is the One, for the perception
of which any Organ is naturally & particularly adapted may
produce in the given organ the same sensation as would have taken
place, had the natural impression been given, thus a smart blow
on the Eye will excite the same sensation as a flash of light, the same
blow on the Ear will produce sensation of sound. –
92 Uneasy sensations may in many respects be similar to a natural
appetite, they rather warn the Animal to the avoiding somewhat
injurious to him, or the removing something unsalutary.

♁ 94. Sensation is not necessary to simple Life, a child in Utero
has no sensations & yet lives. –
♎︎ 95. A Muscle when its action is suspended by the communication
with the brain being interrupted or by any other means it
wastes. It is a law in the Animal Œconemy that the size of a Muscle
will be in proportion to the frequency of its use of this we have a variety
of instances in the legs of chairman, the Arms of Watermen, & the thickness
of the Muscular coat of the bladder when it has been long used to
frequent contractions from Irritations as there from a stone &ca. as will
be hereafter taken notice of when we are considering the diseases of the
Urinary parts &ca. so also Muscles waste if the joint they serve is rendered
useless because their action can be no longer performed.

21
93. During sleep whatever actions are derived from the Brain, whether
consequent on disease or health cease; so St. Vitus’s Dance does
not affect the Patient while he slumbers.
94. The living principle in any part of the body will continue
to exist after the Nerves leading to any part is divided. ♁
95 When a part intended for motion, loses its power of motion, it wastes;
for being now no longer useful to the Animal, as a moving part, it becomes
open to intesticial absorption; (53) the will can no longer influence
it. ♎︎.
96. The more distant any part is from the Centre of its energy, the less
fit will it be, or certain actions, as indeed it will receive less Energy
therefore all the Vital parts are near the heart. All the parts intended
for acute sensation are near the brain. So mortification from debility
more frequently attacks the extreme Vessels, especially if the Patient is
tall, perhaps one reason may be that the blood loses somewhat of its
nutritive powers before it arrives at them.
97. In the Animal Body there are actions which proceed from certain
fixed principles in the Animal Œconemy & are regulated by certain
fixed Laws; these are only actions which arise in consequence of the
other actions which we call sympathy. Sympathy. –
98. There is also another kind of action which we call Habit,
actions frequently repeated in any part induce a custom of acting
in a given manner in any certain part, & from this accustoming
a part to any such action Habit arises. –
99. Habit is a kind of force or violence done, or superadded to the

4
🜔 103. When stimuli are often repeated they lose the power of producing
sensation; hence the mind is at last insensible of the
change hence habit of Disease arise (189) & parts get into & go on
without the mind perceiving it a diseased action, hence also parts
become insensible even to noxious stimuli, to the frequent repetition
of which they have been accustomed hence whilst in strangers
the bites of the Bug & Mushito produce disagreable Effects
those who have been much subject to the application of their poison
have their skin at last insensible to it; as in the Body so it is in
the mind, horrid sights &ca. at first produce in it the greatest
changes but by frequent repetitions of them the mind becomes reconciled
to them & at length scarcely an idea is excited by their impressions
(148). –

22
first principle, parts from habit acquire a power of acting in a more
forcible, or in a different manner from that which primarily took place
in them.
100. This habit may be called a species of Memory, as Memory consists
in a Repetition of Ideas once taking place in the mind. So
habit consists in a frequent repetition of action in any moving part
of the body.
101. Habit is similar to a body, once put in motion which will
not cease from motion unless some new cause for obstructing motion
arises.
102. Habit becomes a cause not only of motion in parts accustomed
to that kind of motion, but also may be a cause of rest at that time
in other parts, like a body once put in motion it does not require
a renewal of the same & equal degree of force which first gave it
motion, but the addition of a small quantity of fresh force is sufficient
to keep up the motion.
103 Habit will even become a cause of action in the will, it will
make these actions of it voluntary which were involuntary & also the
reverse; the strength of habit will be much or little, in proportion
to the violence of the impression which gave rise to it. 🜔
104. As in the Memory it is not necessary that in order to the recollection
or renewal of an idea, the impression which gave rise to it
should be repeated with its full force, so with respect to habit in parts
but it is not necessary in order to excite them to an equal action;
the impression or stimulus should be equally Violent with
wat it was when it first produced the action in the part. Habit


                 

             
 
 
 
 
     
                                    


23.
is always gaining on us and little force is necessary to keep it up.
105. As in the Mind the remembrance of impressions which
were of little force wears off, unless the impression is repeated before
the effect of the first impression ceases, & consequently memory
of the impression will not remain, so neither will the power of
habit remain, if second impressions are not repeated before the
first ceases. –
106. In accustoming parts to habits, or impressions, two circumstances
will arise.
1st. If the impressions are slight & often repeated, or if the
force of the impression be each time gradually augmented, the
parts accustomed to them will become by degrees insensible to
them, so that here the cause may remain though the effect diminishes
or ceases.
2dly. The effect may remain though the cause ceases,
as violent impressions will continue to produce their effects, long
after they themselves have been removed, according to the kinds
of habit complied with, health or sickness will be induced.
107. All stimuli will not produce the same effect when applied
to different parts, hunger will be a stimulus to the stomach alone
light to the Eyes, sound to the Ears &ca..
108. Dispositions of the mind will arise from Ideas produced from
certain impressions given to the brain, a disposition taking place
[from its] may be compared to the state of an elastic body when altered
from its pristine to some other figure, the disposition of the

🜖 110. 111. 112. In inflammation though the Blood coagulates more
slowly, yet there is a greater disposition in the parts to separate one
from the other. The separation will often be so perfect, that if you
dip your finger into the fluid at the top during coagulation, it will
not be couloured at all red. this inflamed blood will sometimes be
half an hour before it is compleatly coagulated. –

24
Elastic body to recover its pristine state is destroyed, by its action in recovering
that state, so when the disposition has produced such a state
of the will as to excite the moving powers to any action, the disposition
no longer remains, with this difference however that the
elastic body loses its disposition instantaneously, the Animal by
degrees.
109. When an action is excited by the powers of the will in consequence
of a particular disposition in the mind taking place, the
brain for the seat of the disposition, which might before be considered,
as in an uneasy or stretched state, now returns with respect to the
consideration of the disposition to a state of rest.
110. The Blood which is the fluid circulating in the Arteries & Veins
is not a passive inanimate matter, but is endowed with a principle of
life in itself equally with the solid parts.
111. A particular a permanent figure of parts in a losing animal is only
necessary to mechanical action. action is not necessary to [illegible] presence of simple Life.
the Blood perhaps has not motion in itself, but motion is not necessary
to Animal life.
112. The blood is not only alive itself, but it also by circulating thro’
every part of the body, becomes the means of & carries life to other parts,
thus being the living support of every part of the Fabric, even the Nerves
themselves are supported by it, they do not convey life to the parts, but
only direct the motion of parts, & without the blood will themselves become
dead. 🜖.
113. Whilst the Blood is circulating in the Vessels, it is always fluid,
but it is not always alive whilst fluidity remains. If by any means

Φ 113. If the life of the Blood is suddenly destroyed &ca.
Cases in support of this.
A Gentleman died suddenly in a violent fit of passion his Blood
did not coagulate. – Two Deers were hunted to death the
Blood of neither would coagulate – The blood of Animals
killed by lightning or Electricity will not coagulate sometimes, but
this will depend upon the manner in which the Electric matter
was applied, if so as to pervade at once the greatest part of both the
fluids & solids, it may produce this Effect.
🜔 116. Though the Blood when in its fluid state has not sensation
yet when formed into solids may acquire sensation. before Blood is
capable of gaining Life & support to parts, it must have circulated
through the Lungs, where it undergoes some Essential change perhaps
it then first is compleatly in its second state or verification. –
🜔vuss 🜖 117. As the Blood acquires an inflammatory disposition when
circulating through inflamed solids so it may lose Quel?

25
the life of the Blood is suddenly & entirely destroyed, after its death
it will still remain in a fluid state. Φ.
114. Whilst alive it is always fluid, if its life is not suddenly & entirely
taken away, it coagulates as it does & the seeming component
parts recede one from another.
115. Long rest out of the Course of Circulation & Exposure to the air
of the atmosphere occasions the Coagulation of the blood, if unexposed
to air, blood will remain long at rest in the living body without
Coagulation.
116. Organization is not necessary to Life, an Egg is not Organized, &
Yet an Egg is alive (28.) so blood is not organized, & yet is possessed of
Life. 🜔.
117. There is a perfect harmony in a state of health between the fluids
& solids of an Animal Body, so also between the Blood, & its containing
Vessels. There is also a consent between them in disease, & when the
solids are affected the blood also puts on a diseased state, thus the Blood
is as capable of disease as the solid parts are so also the blood becoming
diseased the Solid parts also suffer. 🜔vuss 🜖.
118. As the blood conveys to parts the means of nutrition & growth,
so from the blood, new solids are formed, when in consequence of a disease
or violence, there has been a loss of the former ones, or when those
arises a necessity for their production.
119. Where there is a disposition to union in parts naturally distinct
from each other. Inflammation will arise which Inflammation
will be in proportion to the strength of that disposition. The

 
 
 
             
 
 
 
 
     
                                    


26
Blood passing through inflamed parts undergoes a change according
to circumstances, & from the change wrought in this, coagulable Lymph
is fitted to be formed into solids, by the solid parts formed from this
Lymph parts violently separated from each other are again united, &
parts before naturally severed from each other are blended together.
120 The living parts of the Animal, both the blood & the solids
being continually wasting, supply is necessary, this supply is obtained
by means of fluid prepared by the stomach (44) but before the food
taken into the stomach can furnish the desired supply, it must undergo
two process.
1st. Animalization
2d. Verification.
from living matter only, living parts can be made.
121. Sensation is not necessary to life the Blood may therefore be
alive though it wants sensation.
122. Heat. A certain degree of heat is necessary to the preservation
of Animal life whether existing in fluid or solid matter.
123. A certain degree of heat is necessary to Animal Life (122) but a
greater degree of heat is necessary to Animal Action, before the former
the Animal cannot retain simple Life, below the latter, though it
may retain simple life it will not retain the power of action.
124. Almost every order of Animals require a degree of heat peculiar
to itself, some Animals will not endure their heat to vary much
from a common standard without abolition of the actions of Life. A
Bee requires its heat to keep, to go, a Wasp will suffer its heat to vary
with the heat of the Atmosphere.

🜔vmss. 🜔. 126. An explanation of the power Animals have of generating
heat was attempted – 1st. by supposing it to arise from friction
but between the particles [there] of a fluid there can be no friction, nor between
the particles of solids can heat be produced by friction, if a fluid
is interposed. Thus the Wheels of a Coach are prevented from generating
heat by means of greasing them.
2d. By Fermentation (by Dr. Stephenson) but the fermentation of
Animal substances does not produce heat.
3d. From inspiring Atmosphere Air, this seems to be contradicted
by the following Case.
A man had a contusion of his brain, his respiration was exceedingly
Slow, breathing not above 5 times in 2 minutes, yet he had a
General warmth upon his skin, though in the month of February, & the
cloathing was but thin, the power of generating heat & cold depends simply
on the principles of Life, independent of circulation, the influence of the Nerve &c.
This is finely illustrated in the case of a Gentleman who was seized with
an apoplectic fit, whilst he lay insensible in bed, & covered with Blankets
his whole body would in an instant become extremely cold, in ever part, &
continue for sometime, & in as short time become Extremely hot, this was
going on for some hours alternately yet there was no alteration in the state
of his pulse, or in the excitibility of his sensations. X
🜋 128. Animals which are in a state of in action during the Winter,
as sleeping Animals the heat will vary with the seasons. The state
of the Hedge hog in summer is from 91 to 97 in the Winter when the
Atmosphere was 44 the heat of the same Animal was 45, the Experiment

27.
125. In the state (121) digestion & generation with other faculties
will be suspended, & the Animal remain in a torpid in active state.
126. All Animals in themselves have a power of generating heat,
when the actions of the external Cold are so great as to endanger the
preservation of life, this power arises wholly from the principles of life,
this power arises wholly from the principles of life, for dead Animal
matter, posseses no power of resisting cold, this generation of heat
is truly life, operating against its destruction. 🜔vmss 🜔.
x Animal heat is kept up by the circulation of the
blood, which receives oxigen in the lungs from the
atmosphere. The venus blood which has entered, is of a
dark colour, but receiving oxigen the iron in the blood unites
with it, & forms the bright red arterial blood. distributing
this in the required quantity. Perspiration is evaporation
which produces much a degree of cold, to restore the
equilibrium when from violent exercise we induce
too rapid a circulation, or in glass houses when
the beat is too great. HiS
127. The heat of all Animals is diminished during sleep, whilst
in a state of torpor, but more or less in different Animals. –
128. Variations of heat in the Atmosphere, will produce different
changes of the heat of different species of Animals, some animals
as Men, & those which are constantly in action have their heat
little changed by this variation. 🜋. –

Experiment was made on its pelvis.
🜍 132. Animals who suffer their heat to be diminished
with that of the atmosphere, suffer it to be as readily increased to a
certain degree as that of dead matter – A living & a dead Carp
were both placed in a mixture of snow & water, which was gradually
heated, & both received heat one as fast as the other. – different
parts of the same body will have different degrees of heat, and different
powers of generating it, the projecting parts of the body in
Man as the Nose & Penis will be colder than other parts, the urethra
will be colder than the Rectum, than the abdominal Cavity, the Standard
of heat in the Centre of the human body is about 99°. –
🜍 132. Animals have two powers of resisting heat, tho’ only one of
producing it. One by the Evaporation of fluids, but as when fluids
become condensed on the surface, instead of being evaporated they will
not answer the purpose they have which is of actually destroying heat
As the Extremities or projecting parts are more subjected to be influence
by cold, so they [are] more readily allow their heat to be increased than
the central parts. From Dr. Fordyces Experiment in an heated Room
it appears that the human body will for sometime bear heat with
impunity, & such heat as is sufficient to boil Eggs, or roast beef stakes
The Gentlemen present in it found that when they moved from one
place to another in the latter they found the heat also more intense than
that they had been sometime standing in seemed to be when they left it
so also in the hot Bath the Bathers find the water immediately in
Contact with their bodies Cool, & they must either have the water agitated

28.
129. Animals will suffer their heat to sink below the freezing
point before they will be frozen ( ) Expn. on Eggs. –
130. The stonger & more healthy the internal powers of the Animals
the more powerfully will it generate heat.
131. Cold applied to animals in a certain degree proves a sedative
to the powers of Life, but applied beyond that degree it proves a stimulant,
& the faculty of generating heat is excited in an extraordinary
degree.
132. Excess of heat may prove destructive to Animal life as well
as too great a diminution of it, the principle of Life is therefore endowed
with the property of generating Cold, when the external heat
endangers the life of the Animal. 🜍.–
The principle of life serves here as the nectary
in botany, which is Linneus's term for all indescribable
parts HiS
Though the effects of origin in circulation is but
a recent discovery, yet the living princible is
here placed for it, may not this living princible
be as enormous as when it is given to describe
muscular action. page 18, or apts. 34 & 35 p 9.

agitated or move into another part of the Bath to preserve the first
sense of warmth. –
133. The Operation of generating cold seems to weaken an Animal
much more than that of generating heat, before an Animal
perishes in consequence of Cold sleep is induced, an irresistible disposition 
to which always comes on when the powers of action for the generation
of heat are exhausted. The case of Dr. Solander & the people
with him at the Terra del Fuego is a manifest & melancholy illustration
of this, after bearing for a long time an excess of cold several of the
Doctors attendants found this disposition to sleep. In spite of his remonstrance.
who was aware of the event to which it was prelude,
they lay down & slept & presently died. At length Dr. Solander felt &
gave way to the same disposition he had not been asleep above 5
minutes before his Feet became so contracted that his shoes fell off
them & he lost the use of his limbs, he was however found brot away
to the fire & relieved. –
🜍 135. The best Atmosphere for the human subject seems to be
63 to 60. Bear & Fox 50. – Lion & Monkey 70 – The Animals
inhabiting Cold Climates have stronger powers of generating heat
than the human, preserving every part of their bodies free from injury
in Countries where Men are losing their feet, hands &ca. from Cold.
Cold causes the hair of the Bear &ca. to grow much faster & finer,
hence they are better defended.

29
133. Nether excess of heat, nor excess of Cold will destroy the life
of an Animal, until its powers of generating Cold or heat are exhausted,
then the Animal must necessarily Perish. –
134. All the perfect Animals carry on their actions, in an Atmosphere
considerably below the temperature of the body, for it seems
a natural & healthful action, for an Animal to be constantly exerting
itself moderately in the generation of heat. –
135. Different Animals as above mentioned either preserve a standard
heat or have their heat increased or diminished with that of
the atmosphere, yet all animals require a certain degree of heat for the
standard in which their functions are best Performed, many Animals
are obliged to the atmosphere for a Standard heat whilst Man & many
of the perfect Animals, have from their faculty of Generation of heat
& Cold a power of giving a standard heat to themselves. 🜍.
136. The effects of a climate will correspond in a great measure
with the influence of the Sun in that climate, so that as the
Climate is exposed in a different manner to, & is differently acted

♂. 136. Between the Tropics the heat is greatest in Islands the
heat or Cold, is always more moderate than in Continents. Some 
Vegetables have a power of living in both extremes of Climate Some
Animals seem also to have this power, perhaps Animals of Passage
as Birds & Fish change their residence more from want of
proper Food, than from the inconvenience they feel from a given
Climate. Some Animals which have no power of getting their food
in the Winter, Nature has given a power of remaining during that
season in a torpid state, as the power of generating heat is not equal
to the degree of Cold nature has taken another method of preserving
Animals of the very frigid Climates [which] with down, fur, &ca. wch
are bad conductors of heat, so also whatever Animals have their
bodies will covered with hard fat, which is also (as Oils are) a bad
conductor of heat. –
Too much external heat produces diseases of the liver,
spasms, diseases of the Bowels, Tetanic &ca. diseases of Climates
are more slow in their action, & many of them depend on debility
as Chilblains &ca. Cold Climates also increase disease They are
not the causes of, as Venereal disease. &ca.

30.
upon by that body it will be hot or cold; moist or dry; or it will
hot & moist; or hot & dry. ♂. –
137 The effects of heat & cold will be greater according to the
degree of the surface of the Climate. A small surface will be less
hot or less cold than a larger.
138. The effects of Climate will be very great in Animal bodies
the imperfect Animals bear changes of Climate very badly. Man
& many Quadrupeds can accommodate themselves to almost any
Climate, yet great changes of Climate prove the causes of diseases
& destruction both to man & those Quadrupeds especially to the former
139. Besides our being influenced by heat & cold our bodies are surrounded
by & subjected to the influence of the atmosphere, which
will always be of the same temperature as the Climate we live in
140. This atmosphere having a power of dissolving a Variety of bodies,
will be a compound of many heterogeneous particles.
141. The Atmospherical fluids having a constant & powerful influence
on the Animal body, according to the nature of the particles
of which it consists, it will materially affect the health of Animals.
142. All Bodies which the atmospherical fluids take up & dissolve
are to be considered in a state & Volatilization to render
substances Volatile, some degree of heat is required, (perhaps the
lowest degree is sufficient thus to Operate on some bodies) according
to the degree of heat the atmospherical fluid, or the Air will
be enabled to take up a greater variety & a greater or less quantity

☿ 145. Thus the Plague jail fevers &ca are unknown within
the Tropics, another reason why hot climates are not so subject
to Putrid & Contagious diseases as might be expected is, as the Termites
described by Dr. Smeathman, eat up & destroy in a curious
manner amazing quantities of dead Animal & Vegetable substances
thus preventing them becoming putrid Enough to throw
off Volatile noxious Vapours to produce Contagion, it must be
highly Putrefied.
♃ 148. Habit & Custom &ca. -. Prisoners have carried the seeds
of the Jail Fever & communicated it to others by their cloaths,
though they themselves were free from it, of this we have had memorable
instances at the old Bailey & at Oxford Assizes. Again
persons who have never had the small pox themselves have nursed
others labouring under it with impunity, & have on visiting other
people who have never had the disease communicated it to them.

31.
quantity of bodies. –
143. The purity or impurity of the Air will depend upon the
quantity or quality of bodies dissolved in it, & its capacity of dissolving
them be according to its heat.
144. Cold Climate will for the reason given (139-140) be [cotens?]        
paribus, found the purest Air & best adopted to maintain health
nevertheless. –
145 Heat in warm & dry Climates has the property of causing
bodies taken up by & dissolved in the atmospherical fluid to be
decomposed & thus changing their nature renders them less 
noxious.
146. Heat & Moisture especially when dead Animal substances
are acted upon by the Air, produce the most unwholesome Atmosphere.
147. The Air will be injurious to the health of animals by affecting
them in three distinct manners. Viz+.
1st. By its being simply impure it lessens the fitness
of them for their several functions. –
2nd. By its containing specific particles of contagion.
3d. By its containing poisonous Vapour.
148. Habit & Custom are very powerful in enabling Animals to
endure without determent impure & unwholesome Atmospheres, to
some Atmospheres Animals cannot be brought to accustom themselves.
♃.
149. All irritating substances will not act in a state of vapour

♀. 150 Thus previous to a shower of rain we see the beast, running
to the Covert, the Birds flying to the Thicket, People with
corns are capable of presaging this decomposition of the Atmosphere
& also parts labouring under great debility.
“Hence doubtless people who have had Fractures have
the part where the Callus was formed sensibly affected on changes
of weather, is not this because new parts are weaker than Original
parts as will hereafter be shewn.
♄ 152. The Harmatan a Wind that blows from the interior Coast
of Africa, shews how much Winds may affect animal bodies, it
continues from 2 or 3 to 15 days; returning 3 or 4 times a Year, it
blows moderately, its accompanying Fog & Gloom are very considerable
surely this Fog & Gloom cannot be Animalculæ, as we do not find
anything produced by them, not the least moisture can be found in
this Wind, it makes the Lips & Fauces dry & chapped if it continues
3 or 4 days the Cuticle peels off, continuing a few days longer the
perspiration becomes Acrid & is so to the taste, it is yet highly Conducive
to health convalescents recover fast, also those labouring under
intermittents, Dysenteries, &ca. & are Cured, it checks Epidemics [but]
[the small pox did not appear] a number of people were innoculated 
at the accession of the Harmatan, but the small pox did not appear;
some inoculated after the Wind Ceased & recovered perfectly
except one Girl who died of a locked Jaw in consequence of a large
Ulcer from innoculation.

32
or are capable of Volatilization.
150. Water is in a greater or lesser quantity chemically combined
with Air, when a decomposition of this solution of parts in Air takes
place, Rain is produced, previous to this decomposition Animals
are sensibly affected. Brutes & Birds very much so, the human
subject unless unhealthy rarely perceives much difference. ♀.
151. The decomposition of substances in the atmosphere may be succeeded
by new compositions from which various effects may arise
hence to determine a priori the effects of Atmospheric Air is extremely
difficult.
152. Noxious particles taken up by the Air of one Climate may
be conveyed to another, thus Winds by bringing noxious particles
in their currant from distant places or Climates, may materially
affect [the] and alter the salubrity of any given Region. ♄
153. Matter will be found either in a state of perfection or imperfection
if in a state of perfection health is present, if in a state
of imperfection the reverse or diseases take place, this maxim is
universal, it will therefore hold good respecting Animals as well
as inanimate matter.
154. In order to Diseases being present three Circumstances must
take place
1st. Susceptibility of certain impressions
2d. Disposition arising from these impressions
3d. Action in consequence of a disposition
155 In respect to these requisites the body bears a perfect Analogy

☉ 158. Thus a strain gives occasion to Scrophula, a blow to
Cancer &ca. moreover different parts will be more or less liable to
disease, as they are more or less able to resist a diseased action,
this in general will be in proportion to their strength & weakness
the different parts of the body may have their natural actions very
dissimilar. Yet disease may produce similar actions in them, for
instance, the Lungs & the Liver have dissimilar natural actions in them 
yet disease produces a similarity of action when they are affected
with Scrophula a disease of which they are both susceptible, & which
is a specific affection.

33
Analogy to the mind, which must be susceptible of impressions, must
receive impressions, must have a disposition arising in it to which
an action of the proper kind must succeed. –
156. Susceptibility of impression is not sufficient alone to produce
disease but impressions of some kind must be received by
parts endowed with that susceptibility which, a disposition being
produced an Action naturally succeeds.
157. Disease bring a perversion of the regular laws of nature
observe less order, therefore their phenomena are less easily to be 
explained & accounted for than natural actions.
158. With respect to the changes taking place in the body we
know only the causes of them & their effects, we know not the manner
in which those causes, produce those effects. ☉.
159. We can judge only from the consequences of impressions of
the degree of susceptibility of the mind or body. The causes of actions
in the body, bears a strict analogy to the causes of Actions
in the mind.
160. As the human body is compounded of parts very Essentially
different the one from the other, the diseases of different parts will
vary very widely, so also the constitutions of different bodies greatly
vary & of course the susceptibilities of different impressions, in some
the susceptibility for particular diseased action is so strong as only
to require the habitual actions to be obstructed to run into disease
161. Constitutions will be either universally subject to the same
action as the indolent or irritable, or constitutions will be subject


             
 
 
 
 
     
                                    


34.
to some specific kind of Action whether local or general
162. Constitutions are both generally & locally subject to Particular
actions.
163. Constitutions are subject to particular kinds of both local
& general actions.
164. Constitutional Susceptibility may be three fold.
1st. Universal tendency for diseased actions of some kind
or other, where however the whole must be in action.
2d. Universal susceptibility of local action.
3d. Universal susceptibility to fall into an universal
disposition as though something was teizing the constitution as
an inflammatory fever &ca. –
165. Dispositions are natural, unnatural or diseased, of the
natural disposition of sensitive or irritable parts instances are
given in the secretion of Glands.
The unnatural are divided into three kinds Vizt.
1st. Disposition to restoration in parts Injured, as in
Fractures &ca. –
2d. Disposition from necessity as in Ulceration.
3d. Unnatural dispositions of all kinds, of which
great is the variety, the diseased disposition is that which
tends to the destruction of parts.
166. Every disposition to diseased action has a certain time
allowed to it, in which that action will be produced in some

🜔 167. A Girl in the West Indies had a disposition formed for Leprosy,
but it was sometime after she came to England that the
disease appeared; here there was a considerable space between
the disposition & action of the Disease. In some Specific Dispositions.
Years may intervene before the action Commences, as in Cancer.
We should be careful not to confound dispositions with
actions, dispositions are properly the disease, Actions the effect of
the disease, disease may exist for a time though its action is
superadded as in Ague.
🜖 168. Of the first we have instances in the small pox, Measles
Inflammations & Fevers, of the 2d. in Agues, where the disposition
to Action continues though the Action only commences & goes off at
stated Intervals. the disposition in the system for action remaining
undestroyed by the action, & until it has lost its power of conger exciting
the system to action the diseased disposition existing as much
between the fits, as during them: of the 3d. We have instances in
some specific diseases, as the Venereal (Gonorrhea excepted) Cancer
& others where the disposition notwithstanding the Action continues to
exist because it cannot produce its full effects hence it will go on
until it destroys, unless the disposition is removed by an immediate
increase of action. –

35.
sooner than others.
167. A disposition once formed will go on to action, and its ultimate
Action be produced, notwithstanding sometime intervenes
unless the disposition can be destroyed by some change affected in
the part or constitution where it has taken place. 🜔.
168. In Diseases, dispositions & their consequent Actions are of
three kinds.
1st. Where the disposition has its action frequently repeated,
without the disposition itself being destroyed by that action
taking place.
2nd. Where disposition is destroyed by action, & the Action
ceasing, the disease also ceases.
3rd. Where the different action continues to go on without
removing the disposition, until the progress of it is destroyed
by Medicine. 🜖.
169. Two different & opposite actions cannot go on at the same
time neither in a part nor in the whole, if by means of any disposition
a new action is produced, the first action ceases.
170. If two dispositions are excited not two different & neutral
actions will be produced at one time, but a third simple disposition
& consequent action will be generated, which will be entirely

170. Of this we have an instance in Dovers power which consisting
of Opium & Ipecacuanha, a narcotic & an Emetic, Sleep & Vomiting
should be the actions, but as two actions cannot take place at one time
a disposition to a third action arises which produces that third Action
& is called sweating.
☿. 172. Too little actions in any part produces weakness in it which
although not a disease itself becomes the cause of diseases it causes
irritability & thus gives rise to morbid or irregular affections as locked
Jaw &ca. Mr. Hunter says that if the Nerves are weak the Voluntary
parts suffer, if the stomach is weak the general system suffers.
🜍 173. Inflammation arises from too great a degree of Common
action, if a specific action accompanies it, a specific Inflammation
will take place.
☍ 174. By increased Actions in parts, we become sensible of their
actions which before we were insensible of, thus palpitation of the
heart makes us sensible of the hearts action, of this we have no perception
in a natural state of the Organ, the whole body being subject
to similar actions with those arising in parts as observed (7)
the first attack of a disease is probably intimated to the Mind by
the feel of health previous to the attack of some diseases, it is not
unusual for persons to be sensible of an uncommon degree of health
& spirits here the several powers are as it were summoned into
action, to resist & destroy disease.

36.
& altogether distinct from other two.
171. Of Susceptibilities for diseases there will be great variety as above
said ( ) for every disease there must first be a susceptibility, -
172 In diseases either too great or too little a degree of action
will take place & to these two general kinds of action all the Phenomena
of diseased Action may be referred. ☿.
173. Diseased Action will be common or specific, Specific Action
follow certain determined dispositions arising from peculiar kinds
of impressions. 🜍
174. When a part unused to a particular sensation has that
particular sensation, the first alarm or knowledge of Disease is
given to the mind, but the action of Disease is often so slow as not
to be sufficient for a long time to produce any sensation in a part. ☍
175. The whole Animal body will be subject to many actions &
degrees of action, similar to what arise in parts.
176. Whenever a part heretofore subject to the will takes on an
involuntary action the Disease is called Nervous.
177. Whenever the action of a part is [suspended] superior to the
strength a power of a part debility & perhaps the distinction of the
life of the will ensue. –
178. A Diseased action in one part may first produce a particular

♂ 178. Sympathy will hereafter be more fully Explained but an
example in illustration of the Text may be given in the pain in
the Knee being often the first Symptom of the disease in the hip
Joint, or again in Vomiting being excited sometimes by passing a
bougie through the Urethra though there is no pain. –
🜋 179. A variety of diseases have been considered as hereditary,
but it is only the susceptibility of any disease, so that the Child
shall be more susceptible of an impression producing that Disease
than other people, this is all that parents can communicate to their
offspring. Mania has been supposed hereditary, & in some it seems
to arise spontaneously without any apparent Exciting Cause, as impression,
an Explanation of this will be found ( ) where it is said
that in some, the susceptibility for a given disease is so strong
that they will run into it without any other exciting cause, than
simply [the] same obstructions to the natural actions, the small pox is equally,
hereditary with mania or scrophula, the Gout is also considered
hereditary but it is in general otherwise & brought on by irregularity
in living but it sometimes arises in persons under 18,
then it must be considered as hereditary in the same manner that
we have considered Mania to be hereditary, to originate from a strong
susceptibility of the given disease, ready to take it on without any
visible Cause, & only from some unseen one as the least obstruction
to the natural Actions. The Gout is a disease of the Constitution

37.
particular sensation in another part, thus the first knowledge of Disease
will often be conveyed to the mind by sympathy. ♂.
179. Actions [of] are not hereditary, but, susceptibility of impressions
the cause of disposition, the cause of action may be hereditary,
thus diseases are not hereditary but a susceptibility of impression
which is to produce a particular disease may be hereditary. 🜋
180. When the different specific impressions, naturally productive
of two distinct specific dispositions, are given to the system, two

until it falls upon a part & then the full action there being produced,
the local Affection relieves the Constitution. –
🜔🜹. 180. The small pox & measles cannot Exist in Action at
the same time, but one disease will be prevented from action until
the other has gone through its natural course.
Case 1 Mr. Pools was inoculated for the small Pox, in
a few days the redness round the punctures appeared but he was
attacked with measles which suspended for a considerable time
the Eruption of the small pox which however on the decline of the
Measles appeared & went through its usual Course.
Case 2d. A Lady was inoculated for the small pox,
the Measles appeared soon after & the further process of variolous
infection was suspended until the Measles was over.
Case 3d. A Boy was inoculated & the same Events
took place. –

38.
distinct dispositions to specific actions may be formed, but the action
of one will be suspended during action of the other, that being
finished the suspended disposition may produce its action. 🜔🜹.
181. Actions must always correspond with dispositions, if the dispositions
are simple, so will the actions also be.
182. Too great or too small a degree of natural action will cause
a disposition to disease.
183. In health there must be both a due degree of strength as
well as susceptibility of action, moreover the actions must be always
in proportion to the strength.
184. The human body is continually undergoing some changes.
it has been considered to be either in an increasing state, As
between Birth & Manhood when its parts are continually increasing
either in bulk or firmness; to be stationary, or preserving
with little alternation its strength & firmness during a certain
period or lastly to be decreasing, when it loses gradually its, Vigour
& firmness. but these three States or Conditions of the
human Body are not explained by Proofs, but it is difficult
to say, when the Body in all its parts is arrived at its perfect
state, & it is difficult to say that the body, as soon as it is
obtained to its perfect state, does not begin immediately to
suffer, though for sometime, indissensible yet a real & gradual
decay.
185. It is certain however that at different periods of Life

☽︎ 186. The diseases the first stage is particularly subject
to are scrophula consequently diseases of the Lungs, complaints
in bowels from Worms &ca. Hydrocephalus. The Young are
more disposed to local & especially universal sympathy.
The Middle Aged have few specific diseases, if we
Except Nervous & Hypochondriacal disorders they are however
accidentally attacked with the complaints of Youth & Age &
this lays the foundation for disease in a more advanced Age.
In the Aged we have a variety of disorders, here the
necessary actions are not well performed: proper to this Stage are
Cancer Calculi in the Urinary & Gall bladder & Ducts, Ossification    
of Arteries &ca. –
♂ 188. Climates. Climates are hot, Cold & temperate, in hot Climates
the involuntary actions are carried on with more violence
whilst the Voluntary Actions are more sluggishly performed.
So diseased Actions are carried on with more rapidity &
violence hence Diseases run through all their Stage in these Climates
faster than in others, when disease kills absolute, absolute
Death (that is putrefaction) quickly succeeds visible Death. Cold Climates
have not such variety of Diseases as hot ones, neither is the
progress of them so rapid. Cold invigorates the voluntary Actions
at the same time it lessens the violence of the involuntary Ones.
In Cold Climates, [from the irregularity of the] simple
Life is not destroyed until sometime after visible Life is departed, for

39.
the susceptibility of the body for different disposition will be very
different, hence different Ages will have diseases in some measure
peculiar to themselves & these may be divided into.
A. The Diseases of Youth
B. The Diseases of Manhood
C. The Diseases of Old Age.
186. The diseases of the first & last stages (185) are many those
of the second are fewer. ☽︎.
187. The Causes producing disposition to diseases are many
& various when impressions are given which are to produce
diseased dispositions, the dispositions will vary very much
according not only to the constitutional or natural susceptibility
of the body, but according to other circumstances.
188. Whatever can affect or alter the natural susceptibility
of the body, will produce variety of disease, therefore the difference
of Climate, Seasons. The Moon, the atmosphere will produce
differences of disease, & each absolute state of Climates
Atmosphere, Moon [&1/4?] Year will have disease or appearances in
disease peculiar to itself, moreover affections of the mind will
often produce diseased Actions, the weaker the natural powers
of Action in a part are the less able will that part be to resist
disease therefore tendons, bones &ca. have less power to resist disease
than Muscles &ca. ♂.

putrefaction does not so soon follow as in hot Climates.
Temperate Climates from the irregularity of the medium
between heat & Cold furnish us with a greater variety
of diseases than either of the others. Hence Scrophula, Cold, Agues
& such like disease abound.
Seasons. We may consider a change of Seasons as a
change of climate, & as in changes of climate dispositions formed
in one climate by a removal into another are retarded from coming
into action, so upon returning into one similar to the first go
through their action.
The spring at it were ripens Diseases & brings them into
a disposition, for a disposition may be found during a season
which has not sufficient influence to bring it into action, as
the Winter; but in a season more favourable to the forwarding
that disposition, as in the Spring that disease has been brought
into action, so also in hot climates.
The Moon becomes often the immediate cause of diseases,
especially those in which the mind is particularly concerned,
as in Madness; which is always more violent at certain times of
the Moon, the full of the Moon also affects people whose brains
have been contused by any External Violence, this was instanced
in a Lamp lighter who received a fracture of the Cranium with
concussion of the Brain, he was trepanned & recovered, but ever after
found himself much affected by the full of the Moon. The seasons
of the Year affect the influence of the Moon on the human body,

40.
Note Continued.
the lamp lighter was additionally affected in the Spring.
A person of very scrophulous habit was very subject to
deafness at the full of Moon except in Autumn. –
Affections of the mind. Every Action voluntary or involuntary
may be affected by changes in the Mind; by a peculiar
state of it blushing may be produced, other states of it Excite Vomiting,
sickness, irregularity of pulse, diarrhea, discharges of Urine
Spasms &ca.
The Diseases on which the mind has the greatest influence,
are those in which increase or diminution of Action takes
place without any alteration in the structure. Constitutions that are
called irritable have the active parts more under the direction of
the Mind & less under the command of the will. The state of the
mind greatly affects, the involuntary Actions, that have already
taken place in consequence of disease. Agues have been cured by
affections. of the Mind, local Affections are even altered by the same
means. Tumors have been cured by rubbing them with a dead
mans hand.
189. Diseases are
A. Local
B. Constitutional
or
C. Mixed. –
We judge of the presence & nature of Diseases by their [specific]


 
     
                                    


41.
Symptoms, a symptom is a sensible effect of a peculiar action
Symptoms are either to be referred to the mind or to the senses. The
former only known by the Patient as pain &ca. the latter Perceptible
to the Physician as the state of the Pulse &ca.
When the symptoms are not expressive of the disease we
call them Anomalous symptoms & are either local or universal.
190. In simply local diseases a part may suffer, the General
health of the Body still remaining unaffected, in the Mind both apart
& the constitution are affected. –
191. Diseases may be originally local, or originally constitutional,
& again they may be constitutionally universal or constitutionally
local, or lastly they may be originally local, & at length affecting the
General system become constitutional.
192. The originally local (191) & the Originally Constitutional may
arise in the same person at the same time independant one of the     
other.
193. Dispositions as above said must be formed previous to the
Existence of disease, so that there will be a disposition to produce
originally local effects, an universal disposition to produce local Effects
&ca. –
194. An originally local Disease may take on a part of the Constitutional
one when the former has only been common diseased action
but a local specific disease will not take on a part of a specific constitutional
disease unless the latter has superior powers, in which case
the former local action will be suspended during the presence of a new

10
195. This should seem to refer only to common diseased action
of this we have an instance in fevers curing or increasing an
Ulcer, or a sore increasing.
☿. 201. A – as in diseases of the hip, where it is no uncommon
thing to have the patient complaining of his Knee.
B – as when a stone in the Kidnies produces Sickness & vomiting
as an impression given to the Urethra produces often a
swelling of the Testicles though the Urethra at the time the Testicles become
swelled shall be free from Complaint.

42.
Specific Action.
195. A Constitutional disease may be the cause of increasing or
diminishing local disease & a local disease may be the cause of increasing
or diminishing constitutional disease.
196. It frequently happens that a local diseased appearing some
other will appear.
197. A diseased action once formed will go on increasing, until
either it is destroyed by a new action being induced in a part or
constitution, or until the parts to which it is spreading lose their
susceptibility of the disposition to that action or until it produces
an Abolition of Life.
198. Diseases will be either common or specific.
199. We cannot increase specific diseases, unless we can increase
the susceptibility of the constitution of these diseases. Every
specific Disease will have two modes of Action, the Specific & the Common.
200. If the constitution or a part is susceptible of impression
from a peculiar stimulus & a peculiar disposition is Excited then
a specific disease may be produced & that specific disease may be
either local or Constutional.
201. When A an Impression is given to any part susceptible
of action, & the action is not produced in the part to which the impression
was given but in some other part, or B when an Action
formed in one part produces an Action in another part, or when an
action is formed in one part & the sensation resulting from that action
is felt in another part, sympathy takes place. ☿.



   
     
                                    


43
202. the part (201) receiving the impression is the Sympathent, the
part in which the new consequent action, or the sensation arises,
is the Sympathizer.
203. A...Sympathy is simple or Compound.
B...Similar or dissimilar.
C...Regular or irregular
D...Natural or Unnatural.
E...Real or delusive.
F...Partial or universal.
G...Contiguous, continuous, or Remote.
H...Common or uncommon.
204. The more simple the structure of the being, which is the
subject of the operation of sympathy, the more simple will the
sympathy be found, even some Vegetables are susceptible of it,
as the sensative plant, whose leaves successively dropping on
approach of the hand arises from this simple sympathy between
the different leaves, in successive order sympathizing with one
another. –
205. In the more compound being as the perfect animals the
sympathy may be more complicated, for an impression being given
to one part becomes the cause of action in another part, the action
in the last part becomes a cause of action in the third part. & that
again in a fourth part, hence in many Animals sympathy may
become exceedingly complicate.

206. If one part is affected with pain & another part by
sympathy gives the same sensation then the sympathy is similar
& vice versa – A pain in the Testicles producing by
sympathy sickness in the stomach. the sensation & action in
the latter being different from those of the former the sympathy
is dissimilar.
♄. 207. We observe affections of the brain produce sickness and
Vomiting & this almost invariable here we have an example of
common or ordinary sympathy by attending to this division of
sympathy we learn a knowledge of the symptoms of diseases,
some common sympathies though but few arise in consequence of
disease only & are therefore unnatural, such is the sympathy between
the shoulder & the Liver between which in health there
seems to be no sympathy.
♂. 210. The Father of the great Lord Chancellor Clarendon, had
a stone in his bladder he was affected with it many years & it
was painful, it was always accompanied with a pain in his Arm.

44
206. When a part receiving an impression, an action is formed in
it, & a like action is consequently produced in another part the Sympathy
is similar, but when the action in the one or sympathizer is
different from the action in the other or symphathent, the sympathy
is dissimilar.
207. When an action of a peculiar kind in the Sympathiser has always
been observed to follow an impression & action of a peculiar
kind in the sympathent, such an action in the sympathiser arising
consequent in the impression & action in the sympathent, is called
common sympathy, as also where a particular part being the sympathent,
another particular part, has been observed, to be constantly
the sympathizer. ♄.
208. When an action of an unusual kind arises in a sympathiser,
or when the sympathiser is a part unused to action consequent on
an action in a given sympathent, uncommon sympathy is said
to arise.
209. Sympathy is natural when the sympathent receiving an
impression not productive of disease, & healthy consequent action is
induced in the sympathizer, thus the breasts of Women are affected
previous to coming on of Menstruation.
210. Unnatural or diseased sympathy is when an impression
given to the sympathent produces an affection of the sympathiser,
inconsistent with its healthy or natural action so scratching
an Issue in the Thigh which itched has produced a difficulty of
breathing & a pain in the breast. ♂. –

🜖 211. Delusive sympathy. A Man in a fever & delirium,
when he wanted to go to stool, always signified to the By standers
that some other Person whom he talked of or pointed out wanted to
Ease himself referring his sensations to some other individual. –

45
211. Sympathy is real when the mind refers to the affection or Sensation
produces to the proper sympathiser, & delusive where the mind
refers the Sensation, Action, or Affection, to a sympathiser between wch.
& the sympathent no possible connection can exist. Thus when a
Man under Idiotism or Delirium, has an impression given to any
part of his body, & his mind believes the sensation consequently
produced not to exist in himself but in some other person, he is
under a delusive sympathy. 🜖.
212. Sympathy is partial where one or more parts of the body
are sympathisers, some given part being also the sympathent.
It is universal when an impression, being given, or an action
Excited in any part, the whole constitution sympathizes with it
so a wound being made in the Knee, a fever which is the action of
the constitution sympathizing with a part will often arise. –
213. Sympathy is continued when a part receiving an impression
& a consequent action arising in it, the parts immediately joining
& connected with it are also thrown into action, thus when an Inflammation
arises in a part, as the Skin, & spreads wider & wider
the parts of the to which Inflammation spreads from the first point,
are suffering by continued sympathy.
214. Contiguous sympathy arise where an impression being given
to or an action excited in a part or parts contiguous to, but not
joined & immediately connected with the Sympathent, becomes the
sympathiser, thus an affection of the Integuments of the Abdomen
will produce consequent affection of the bowels.

☽︎. 219. I must remark on the text that the strength of partial & regular
sympathy will be in the Ratio of the powers of life. I think
here we must make a distinction between a readiness or susceptibility
of sympathy, & a strength of sympathizing action, perhaps debilitated
& most irritable persons & those in whom the powers of life are weakest
are the most ready to fall into sympathy of every kind, but the strength
of the sympathizing action in them will be but little, because the
sympathiser can have but little powers of Action.
♃. 220. The Brain Sympathizing with some other part, convulsions,
Epilepsy, or a sudden abolition of the visible Life, may be the
Event, the action in the sympathiser being here more violent than in
the sympathent.

46.
215. The sensitive principle the principle of Life & the Mind
mutually sympathize with each other so that affections of the one,
will produce affections of the other, or of both the others.
216. Remote sympathy is where the part which is the sympathiser,
is distant from the part which is the sympathent, as when a
diseased Testicle shall produce a sickness at the Stomach.
217. some parts are more particularly disposed to become sympathizers
than others, the stomach will sympathize with any part
of the body.
218. Particular habits are more disposed to universal sympathy
than others, the less determined in the disposition to partial sympathy,
the greater will be the disposition to irregularity & universality
of sympathy. Thus Infants are peculiarly subject to universal
sympathy, because when an impression is given to any part of
their body their partial sympathies, not being yet settled, or determined,
no particular part is disposed to become the sympathiser,
but the constitution takes up the sympathizing Action.
219. The strength of regular & partial sympathy will be greater
in proportion to the strength of the powers of Life & vice versa. ☽︎.
220 The affection of the sympathiser will often be more violent than
the affection of the sympathent, but this will depend on the number
& nature of the part & parts taking up the action of the sympathent
& thus becoming the sympathiser. ♃.
221. The vital parts are particularly disposed to partial sympathy
between one another, the further parts which are the sympathents

♀ 221. Thus in Diseases of Extremities, the Constitution is Exceedingly
ready to run into hectic Fever, as in white swellings of
the Knees, Arms or Ancles; but the latter part of the Text in this
Aphorism can only refer to the non vital parts for the constitution
is always most disposed to sympathize when a part necessary to
Vitality is affected. –
☉. 222. Instances of mutual sympathy are but few, the Stomach
will indeed sympathize with the head & the head with the stomach
but the liver is perhaps never the sympathizer when the Shoulder
is affected, though a Morbid change in the Liver produces very commonly
an unusual sensation in the Shoulder. –

47.
are removed from the heart, the greater will be the disposition of the
constitution to sympathize with them ♀.
222. Sympathy being only a secondary Action will cease when the
first part is destroyed, thus if a diseased & Ulcerated joint is attended
with hectic Fever, quick pulse, restless nights &ca. almost immediately
after its removal by amputation the pulse grows slow & calm
& the Patient recovers his sleep. ☉.
223. Sympathy is of many & important uses in the Operations of
life, it connects the principles of different parts, it enables one
part to assist another in the performances of its Operations possibly
when one part is affected with pain by enabling another part to take
on pain also, & thus diffusing the sensation it lessens its violence as
the same quantity of Pain concentrated in one part might be insupportable
to the Animal, but by its being diffused over other parts
the Animal is enabled to endure it with less injury.
224. Sympathy leads us to the knowledge of the causes, nature
& seat of diseases by observing in what manner one part becomes
affected from a prior indisposition of some other part, we learn frequently
from the sympathiser, the state situation & manner in wch.
the sympathent is affected.
225. But sympathy often leads us astray, & causes our judgement
to err, when the sympathiser is only sensibly affected we
refer too frequently the Disease to it entirely, over looking or not suspecting
the affection of the sympathent. (see the notes) We are moreover
often led to imagine from considering the Phenomena of Sympathy,

♂. 225. Thus a Man, having been used to fits of the Gravel if
seized either with a pain in the back or from any
other cause refers his pain to a Nephritic Affection (see symptoms)
228. How can it be proved that water is present in all
animal fluid, so as to act as water in the solution
of substances? for though in the analysis of animal [flu??]
water may be found, yet the process of that analysis
may be separated this water from combination in [wh?]
the nature of water was totally different. Consequently
water in this combination cannot act as it would other
do as a solvent.

48.
Sympathy, parts to be Sympathent, which are free from the action
in question, so also when the mind of the patient has been long
habituated to a particular Idea, it frequently but falsely refers
many sensations to the same cause, that had given rise to that
particular Idea, which sensations arise from the Causes. ♂.
226. When Medicine or Artificial means are employed for the removal
of Diseases, produce either a partial or universal effect,
it is to be considered as a kind of Violence done either to a part
or to the constitution. –
227. Before a Medicine can produce any, except Mechanical effects
upon the constitution, it must be reduced to a state of solution.
228 There is one property only in all the Juices of an Animal
body which is common also to one fluid out of the Body & by the
solubility of substances, in which fluid we can judge of their solubility
in the Animal juices, now all our juices are more or less
of a watery nature. Hence substances soluble in water will also
be soluble in the Animal juices.
229. But not only the substances (219) are soluble in the Animal
juices, almost all substances are so in a greater or lesser degree &
most of them are so in the mouth, as we know by their giving their
impression by the Taste, previous to their doing which they must
be in a state of solution, no substances having any but a Mechanical
action on a part which are insoluble in the juices of that part (228)

232 may not different degrees of galvanic action
be the cause of the separation of the various juices
for what[ever] other cause is so probable.

49
230. many substances are soluble in the Stomach though insensibly
as Earths, which are neither soluble in water, nor in the Saliva
& consequently are insipid. –
231. For a Medicine to produce universal Effects it must be dissolved
in ye Blood.
232. The Blood is a kind of Universal Menstruum for Substances
being found incapable of solution in it. Its properties
of retaining at once so many substances in a state of solution,
may arise from its heterogeneous nature, for it is well known
that a fluid that has dissolved one substance, tho’ it will perhaps
take up no more of that Substance, yet will even by means of that
substance be enabled to dissolve a second Substance for which it had
otherwise been an improper Menstruum; thus Water when pure
will difficulty dissolve Corrosive sublimate, but a saturated aqueous
solution of Sal Ammoniac will enable the water to dissolve abundantly
more of the sublimate, than in its Elementary state it
would have done, so also water impregnated with fixed Air to Saturation
will still dissolve other substances, & even such as unmix’d
it would not have acted upon.
233. Medicines dissolved in the Animal juices have a power
of influencing both the Nervous & Living principle.
234. Medicines perform their operations by their
(a) Stimulating
(b) Irritating or
(c) Sedative powers, & by the Animal body having

are not the stimulation the irritating & the sedate
all chemical.

50.
a susceptibility of that Operation but never produce any change
unless when they act as caustics by any Chemical Operation. –
235. The powers a.b. (234) are to be found in the same Medicine,
the quantity in which it is applied only making the difference.
236. Stimulating Medicines only produce natural action or
increase one already present; Irritating Medicines diminish action
whether natural or unnatural, each of these may produce
both partial & universal effects. –
237. The influence of stimulants, will be as the power of the stimulant,
& the nature, & powers of the part taken together. The same
will also be the influence of an irritation. –
238. The influence or operation of the same Medicine on different
parts will be extremely different, so also the action of Medicine on
a second part will differ from its action on the same part when
in a state of disease.
239. In order to understand aright, the influence of Medicine we
must consider parts as capable of suffering four actions Vizt.
1st. The Action of Health.
2d. The Action of irritation on health.
3d. The Action of Disease.
4th. The Action of irritation on Disease.
240. Irritation acting upon health produces diseased action, Irritation
acting upon disease produces or restores health.
241. As parts are susceptible of a variety of diseased actions the

🜔v 247. Friction can be applied to a larger surface than pressure.

51.
removal of one diseased action by medicine will not always produce
a return of health, a disposition to some other diseased action
may have been formed, & wait only for a removal of the present diseased
action, to go on to its proper Action. One action can only exist
at one time in one part ( ).
242. The irritation of medicine on disease, may although it removes
the present disease, even induce a disposition to some
other diseased action, which as soon as the first action ceases, may
go on to its action.
243. From (241-242) it is evident, we should be careful to discriminate
the consequence of disease, from the consequences of Cure,
we may otherwise persist too long in any mode of Cure.
244. The powers of the living Animal may also be affected by
mechanical means The operation of the application of mechanical
means may be reduced to two Species. Vizt.
A. That of Pressure
B. That of Friction.
245. Both A. & B. (244) produce the same ultimate Effects as
Medicines. –
246. Pressure seems to impede action, it is also of use as a stimulus,
if applied more forcibly it irritates.
247. Friction does not seem to impede but excite action, if
violently applied it irritates, if gently it stimulates. 🜔v.
248. Medicinal applications may produce their Effects either

  
         
     
                                    


52
simply by contact, or by exciting sympathy.
249. It is rarely Medicines act simply by contact, their influence
being carried by Sympathy generally much further than the
parts to which they are immediately applied. –
250. The effects of medicines acting by Sympathy, may be thrown
into the same divisions as the actions of Sympathy particularly
they will act by continued, contiguous, or remote sympathy.
251. In directing the administration of medicines it is necessary
to have respect to the strength & weakness of the part or constitution,
& to the too great or too little action of the part or constitution.
252. As in health the action of a part must be always in due
proportion to its strength ( ) so in your Endeavours to restore
health when impaired, we must always endeavour to proportion the
degree of Action to the strength.
We must never increase action when strength is deficient
without endeavouring to increase strength likewise.
253. A. Strength & Action may both be diminished or Increased
B. Action may be increased, & strength at the same time be
diminished.
In one case A., it must be our care to increase both
strength & Action.
In the other B., we must either reduce the action to the
strength, or increase the strength so as to level it with the action

at the moment of act of solution what change
takes place, does an electric action accompany the chemical
if it does the new solution may acquire new properties of
electric matter, & then modification may effect the animal
the modification too may effect growth of the different
vegetables for how can you account for the same plant
acquiring properties different from in another & the
same situation is then the effect of different organization
or different galvan action.

53.
254. Weakness & want of action are not the same, a part may
have Weakness, & yet too great action, we judge more readily of
too great or too little action than of strength & weakness, because
the former are effects, the latter are often causes.
255. Medicine may act by contact (249) or by Sympathy ( )
256. Medicine may also be absorbed (see absorption (1)) & when
absorbed will again exert their action by sympathy or by Contact,
by contact they may affect either the Lymphatics of the part, or
of as much of the Lymphatic system as they pass through, or again
when mixed with the Blood may by contact affect the constitution
in general.
257. There are also applications which penetrate beyond the surface
to which they are applied, as heat, cold, Electricity
258. Heat [sometimes] increases the Vital & involuntary actions
though it is considered as penetrating it cannot produce that
effect beyond a certain degree because the animal is incapable
either in a part or the whole of receiving or containing a certain portion
of heat.
259. With respect to cold, also the same reasoning will apply the
Animal powers whether in a part or in the whole, will neither
receive nor part with more than a certain quantity of heat, that
is without destruction of its principle of life.
260. Electricity indeed in every capacity of the Animal is Universally
penetrating, as no circumstance or difference in the capacity

more electricity than the natural quantity increases
action.

54.
of the Animal can obstruct its passage.
261. Cold, heat & Electricity are capable of powerfully Exciting Action,
we must therefore be extremely attentive to the circumstances
& degree in which they are applied, least we sometimes excite
an action superior to the strength.
262. Cold applied to the surface of the body may become a Stimulant
& Rouser, or a seadative & weakener.
263. In the first instance (262) it produces heat, in which it
agrees with the warm Bath, with this difference that the latter in
some measure gives heat to the Animal the former obliges the Animal
to produce its own heat, here the powers of generating heat
are increased the Pulse quickens the actions of health are in general
increased. these Effects show the Animal is in full
powers of restoration.
As the cause of these effects is instantaneous, so the Effects
will be but temporary therefore the cold applications must at due
intervals be repeated.
264. In the second instance (262) it proves a sedative & weakener
where the parts to which it is applied either can give no
Alarm to the constitution or the parts, or the constitution have its
power of generating heat diminished here all the consequent
actions will be the actions of weakness.
265. Cold may produce various effects by sympathy even local.
266. Heat is either absolute or sensible, the latter we shall here
notice.

♁. 269. For the general properties & effects of heat & cold, in Animal
Bodies, see the Text & Notes on heat, Cold & Climate. –

55
267. We judge of the sensible heat by our senses, or by
measurement, this sensible heat is either Native or Foreign.
268. Foreign heat in its application will produce different effects,
as it is applied simple, or compounded with  bodies capable
themselves of exciting action.
269. Foreign heat is applied with two intentions. Vizt.
1st. to increase the warmth of the Animal
2d. to act upon the principle of Life.
Heat has the general property of increasing the violence of the
involuntary actions. ♁.
270. According to the degree in which it is applied it will be
either irritating or sedative.
271. Substances compounded with that heat are applied either in a
dry or an humid state.
Heat in dry vapours can be medicated with Essential
Oils, Spirits, &ca. The warm bath is an example of humid bodies
compounded with heat.
272. The Bath ( ) is generally used with a degree of heat
something below that of the Animal, or in a degree above it, the
former is called the tepid Bath, the latter the hot Bath.
273. The former seems in general to soothe the Skin & by Sympathy
to affect other parts with an agreable sensation, hence it
rarely depresses nor does it in general Excite any increased action
further than simply freeing a part from disease.
274. The hot bath produces more powerful effects, by exciting

🜔. 276. Muscles heal or are restored to health more readily
than bones or ligamentous parts, the cellular substance will
take on the healing process more readily if placed about Muscles
than if placed about Tendons or bone &ca. taking on in general
the disposition of the parts it is subservient to.

56
an increased action on the surface it may produce relief to the
internal parts if continued for a length of time it produces weakness
but not commonly a permanent one.
275. It is observed above ( ) that different parts will be more
or less able to resist disease. In the same manner in different
parts when diseased there will be more speedy or slow advances
towards health, & this from the same Cause. Vizt. the difference
in strength or weakness.
276. Parts in which actions are excited with the greatest difficulty,
fall into diseases more slowly, & when diseased are more slowly
restored again to health. 🜔.
277. Touching the slowness or readiness with which parts diseased
recover their health much will depend on their situation in
the body.
278. The power of healing or the facility with which parts diseased
recover their strength or health will also be different during
different ages, other circumstances being similar.
279. This power (278) will be greater [more or less] or more active,
during the growth of the subject than after the growth is
stopped, during the middle age or that which is called stationary
( ) though this is not well ascertained / the power of healing
is less Active, but it will be the least active of all during the state of
decline when [Life] the System seems to take a retrograde motion
& nature begins to unbuild. ( ). –

🜔🜹. 282. A scrophulous Joint, an ill conditioned Ulcer, an
ulcer in the Lungs, or any other similar cause may produce
a constitutional affection & these existing in such a state the Constitutional
affection cannot be removed.
♎︎ 283. Thus the Cranium is at first membranous, it afterwards
in due time becomes bony, or its bones shoot in membranes
if by fracture or other violence a part of it is removed, in the
restoration first membrane is formed & afterwards bone so in
the cylindrical bones as they were at first cartilaginous, when
restoration in consequence of injury becomes necessary, the Union
is first by Cartilage afterwards by Bone.
☿ 284. If a part of a tendon is destroyed as by a Wound &ca.
the injury extending in other parts as Skin, Cellular Membrane
&ca. the Process of restoration being begun, the Union will not be
formed by means of a regeneration of Tendon.

57
280. It frequently happens that one disease will prove the cure
of another. –
281. One local disease being produced may remove a prior
local disease, a constitutional Disease arising may prove the
cure of a local disease ( ) & a local disease arising may
cure a constitutional one. ( )
282. Constitutional Diseases cannot be cured whilst parts are
continually adding to the constitutional affection. 🜔🜹.
283. When loss of substance happens in any part & that loss
is to be restored, the parts which restore the loss or which regenerate
the substance to fill up the loss, in their action for that
purpose [produce] preserve the same disposition with which they
were at first formed. ♎︎.
284. The law (283) does not however universally hold good
as circumstances being present may prevent its operation. ☿.
285. Inflammation, is an increased action in a
part, it is difficult to determine whether it differs from common
Action in a part except in degree.
286. Inflammation is the first principle in Surgery, it is the
cause of many local diseases, it is the means of preventing the
increase of many local diseases, & it is often a powerful instrument
in their Cure, it operation are chiefly performed by the small


  


 
   
    
                                  


58.
Vessels, the larger ones doing more than bringing the
blood to them.
287. It may be divided into
1. the Healthy
2. the Unhealthy.
The first that which is attendant on any healthy
state of a part of the constitution, the other that which attends
on an unhealthy state of the part or Constitution.
288. It may be divided into.
1. Single
2. Compound.
The first the Action of Inflammation alone
the second the Action of Inflammation with the modes of
action
289. It may be divided according to its Effects into
a. The adhesive.
b. The suppurative
c. The Ulcerative
290. The parts Subject to Inflammation are
a. The cellular membrane & circumscribed Cavities.
b. All the Canals & outlets of the body.
291. The three Stages or States of Inflammation may have
a fourth superadded. Vizt. that of a specific disposition to Scrophula

▽. 293. By the effusion of coagulable Lymph & its gluing
up the Cavity, or confining the extent of the inflammation
& in fact a Cyst is formed to contain the purulent matter
when formed, hence we see how matter is confined to one
spot instead of being widely diffused, by it also is formed
a Cyst round Musket Balls, pins, Glass & ca.

59.
Scrophula.
292. In the order (a. 290). The adhesive generally begins first
the suppurative & ulcerative are its sequels. In the order (b. 290) 
The suppurative begins & the ulcerative or adhesive follows.
293. In the adhesive inflammation coagulable Lymph as by
the increased action of the Vessels speedily thrown out between
the surfaces of the Cavities one to another, & thus entirely obliterates
them. ▽.
294. Inflammation is frequently carried no further than
the adhesive (293) & then it may terminate by what is
called Resolution.
295. The adhesive inflammation often prevents an increase
of local disease, it sets bounds to its own progress & it
prevents the diffusion or extent of the suppurative inflammation
when it takes place.
296. The coagulable Lymph thrown out in Inflammation
(293) always partakes of the nature of the solids, which seperate
it.
297. The termination (294) does not always take place when
it does not happen if in the violence of the action the
death of the parts does not ensue the suppurative stage
takes place.


 
 
  
  


 
   
    
                                  


60.
298. The suppurative stage will arise when the death of a
part has actually taken place, but the surrounding parts
have not suffered the same absolution of their vital principle
here indeed the dead part may be considered as a foreign
substance & as a Stimulus to inflammation to those that
surround them.
299. Particular circumstances arising in different parts
of an animal body, the parts may be disposed to absorb
themselves & so to produce a solution of continuity, the Inflammation
attendant on this action is the Ulcerative (289 c)
300. This is commonly the sequel of the suppurative Stage
& therefore may for the most part be rather considered as a
consequence of that stage than as the affection of an original
disposition in a part.
301. This (300) is however not always the Case, it sometimes
arising without a part previously undergoing suppurative
inflammation. –
302. The general order in which inflammation proceeds
in the cellular membrane (290 a) is
1st. Adhesive
2d.. Suppurative
3d.. Ulcerative.
303. But this order is not always observed. The suppurative

☽︎☉ 304. When inflammation attacks the canals, it rarely
goes beyond the suppurative affection as those parts do not
readily fall into Ulceration, adhesion will arise still more rarely
the ulcerative inflammation being in these parts so uncommon,
granulations of course will as seldom be found to take place.
309. This arises from a particular original disposition in the
part brought into action by the fever or by a part taking up an
Universal disposition.

61.
Inflammation will sometimes arise without the adhesive previously
taking place, here the Disease & the extravasated fluid
will be widely diffused this is the Case in all the Erysipelatous
suppuration.
304. In the Canals or outlets of the Body (290 b) the suppurative
generally begins, the ulcerative follows to which the
adhesive succeeds. ☽︎☉.
305. The Erysipelatous affection attacking the parts the order
is here also disturbed, the adhesive or Ulcerative arises
first & the suppuration succeeds.
306. Whatever can increase the violence of the action of parts
may be called a cause of common inflammation.
307. A part will take on the affection of the constitution,
that is an universal affection may become a local one, hence
therefore a cause of local inflammation may be traced.
308. The abscises arising after the termination of specific
febrile constitutional diseases, as Small pox, Measles &ca.        
have nothing specific in their nature, they only arise in consequence
of the common disturbance the constitution has suffered
from the fever if the disease.
309. Simple inflammatory fever may be followed by an Abscess
in a part (308).
310. The remote causes of Inflammation are four Vizt.

  
 
 
  
  


 
   
    
                                  


62
1st: From accidental Violence.
2d: From irritation applied to the part.
3d: From a particular disposition to the part itself.
4th: From a general state of the Constitution affecting
some particular part.
311. Many constitutions have a disposition to specific inflammation,
& will fall into it whenever any exciting cause shall
arise as in Scrophula & in habits subject to Erysipelas.
312. Many parts of the body have a greater tendency to specific
diseased action than others, so any constitutional Affection
arising these will readily take on a diseased specific action.
313. Specific inflammation may be.
a. Specific & healthy, or
b. Specific & unhealthy.
314. Different parts more or less readily take on different Inflammation.
External parts are more inclined to the suppurative,
internal parts take it on less readily suffering [them]
even the presence of foreign stimuli a longtime without going into
this Stage; Vital parts do not readily admit of the suppurative
Inflammation tho’ they willingly take on the first & most simple
inflammation.
315. When a part is inflamed that is not essential to Life the
Constitution does not necessarily sympathize with it, unless from

♀. 316: There are two powers which can produce a change in
the state of the pulse, that of the heart, & that of the Arteries,
the regularity or irregularity will depend upon the heart, the
hardness, fullness, softness & smallness will depend upon the Arteries.
🜔🜹. 317. The effects of Inflammation on different parts.
Stomach. Quick small & hard, sometimes low
pulse, nausea, dull heavy pain, depression of mind.
Small Intestines. nearly similar
Large Intestines: pain more acute, general depression
less nausea:
Liver. This procures besides its own peculiar
symptoms effects somewhat similar to inflammation of the Stomach.
Heart. Its motions are confused & irregular
the pulse quick & lower than common.
Uterus. Great oppression, nausea & obtuse pain.
Lungs the heart frequently sympathizes 

63
the long continuance & violence of the inflammation for here the
operation of inflammation may be carried on without interrupting
the functions of the Vital parts
316. But of the constitution of the patient is very irritable &
readily takes on sympathy nearly the same Phenomena will
arise as in inflammation of the Vital parts; the Pulse will
grow small quick & hard; blood drawn off will be sizy but loose
& its superficies flat, the violence of pain will however be greater
than in the inflammation of the vital parts. ♀.
317. All parts supplied with their Nerves from the intercostals
& par Vagum when attacked with inflammation give symptoms
of lowness, & depression. 🜔🜹.
318. The termination of Inflammation will take place the quicker
the nearer it is to the heart.
319. The pulse growing quick after the commencement of inflammation
is a proof of the constitution becoming affected on
sympathizing.
320. On the commencement of inflammation Rigor is frequently
felt, this is not simply from the debility induced into the constitution,
but also from the Novelty of the action which it performs
but weakly because it is not prepared for, nor accustomed to
it.
321. In Rigors & Syncope the blood is collected about the

preventing a full diastole; when the Muscles are inflamed the
pain is acute, the pulse full & strong. Inflammation of the
bones & Tendons produces a dull heavy pain & the Stomach generally
sympathizes.

64
internal parts, & the External are left in some measure empty.
322. Every new Action in the Constitution must tend to induce
weakness in it, its Effects will however vary in different constitutions,
in the strong it will excite the general powers of action &
an hot fit will soon succeed, in the weak the hot fit will not always
be produced but only a clammy sweat succeeds.
323. Rigors are not attendant on the commencement of Inflammation
alone every new action in the constitution may be accompanied
by them.
324. Life cannot go on always in the same state it must have
its stated seasons of rest & action, hence even in the most continued
diseases, & when the cause is unvaried there will be intervals of Alleviation
& exacerbation, nature observing her general Law rests even
in disease.
325. Exacerbation may be considered as the renewals of the commencement
of diseased action, & so a kin in some measure to
Rigor...
326. Disease may exist & yet the constitution may be insensible
to its action, it may want power of keeping the constitution in
action beyond a certain time in ague the disease exists as much
between as during the Paroxysms.
327. From ( ) it is evident that a change arising in the constitution,
a change in the Blood as partaking of and possessing
the living principle may take place also.


   

        
  
 
 
  
  


 
   
    
                                  


65
328. The appearance of the Blood will not be always the same
under given symptoms of constitutional affections, such as the
state of the pulse &ca.
329. Inflammation begins at a point at first, all the local
symptoms being confined within a small compass, afterwards
it spreads according to the state of the surrounding parts wch.
may be either local or constitutional, as the surrounding parts
are more or less in health they will be more or less disposed to
continued sympathy, at length the inflammation & redness will
be gradually lost in the surrounding parts.
330. Inflammation is attended with a swelling of the part
the more healthy the more the swelling will increase at a
point.
331. The swelling of a part arises from the Vessels of the part
being more distended with fluid than natural from the Extravasation
of coagulable Lymph, & of some serum, which is
known from the Oedema of the surrounding parts, the less extensive
the Oedema is & the firmer the Margin of the Inflammation
is the more healthy inflammation will be present for here
more coagulable Lymph & less serum is thrown out.
332. The colour of the inflamed parts (329) will also be altered
the nearer it approaches to a pale scarlet redness the more healthy
the inflammation will be, the less healthy the inflammation
is, the colour will be less of the scarlet & more of the darker red

♂. 337. Mr. Hunter threw Tartar Emetic qts. iij into the Veins of
a Bitch, it soon vomited her, she became Convulsed & died, she
was astonishingly Cold during Vomiting & upon opening her immediately
after Death the heart & lungs were found remarkably Cold. –

66.
inclining to purple & sometimes to a blueish hue
333. The changes of colour (332) will arise.
a. – from Vessels which naturally contained only Lymph
or Serum, carrying red Blood.
b. from either containing more blood than circulated
through the parts in its natural state according to the Law of
the Animal Oeconemy, the the more a part has to do, the more
blood will be given to it, the colour is that of Arterial blood.
c. from New Vessels being formed in that partly
coagulable Lymph becoming organized. –
334. When inflammation attacks parts near the surface of the
body, heat of the parts will be considerably increased.
335. But the heat of the inflamed part will not be increased
above the standard heat of the Animal, though compared wth.
the heat of other parts of the surface it will be greatly increased.
336. An increase of heat in a part does not always arise from
an increase of its power of action, it may arise from increased
action though attended with weakness. –
337. Coldness in a part is however in general arising from weakness
& want of power of action; but a part may have its degree
of heat lessened by its sympathizing with the affections of other
parts as the stomach, changes in the Mind &ca. ♂.
338. The source of heat is probably in the Stomach from whence

♃. 338. The Stomach sympathizing with any part of the constitution
is the probable cause of Rigors, Rigors are not only produced by
constitutional affections but even by local ones as the Pricking of a
finger, also by affections of the mind as fear, horrid sights &ca. the
absorption of any Contagions or putrid matters into the System is
attended with Rigor, Rigors probably do the same thing in the Constitution
as Vomiting, rousing the constitution to greater action, the
heat of the Blood cannot be altered by the Sympathetic Fever, a
constitutional affection can only produce a change in it. –

67.
by means of circulation it may be conveyed to every part of the
Body. ♃.
339. Inflammation is commonly attended with a painful sensation
communicated from the affected part to the mind, in the
adhesive state it is rather of a dull heavy kind, when proceeding
to suppuration it becomes more acute, when suppuration has taken
place it abates, when Ulceration begins it again increases,
but during the latter state it rather gives the idea of soreness.
340. Every time the Arteries dilate there is an increase of pain hence
the sense of throbbing, the cause of the pain is the distension of Nervous
& sensitive parts.
341. The disposition of inflammation, will sometimes cease before
even adhesions are produced, [& This], after a part has begun to swell,
[this] is called resolution.
342. As the increase of pain was a proof of the progress of Inflammation,
so its diminution is to be attributed to the cessation of the
inflammatory state, when the uneasy state is removed, the disturbing
cause is taken away, & the parts return to their state &
ordinary functions.
343. The Constitution will not only be differently affected by the
different situations & functions of parts inflamed & greater or lesser
extent of the Inflammation, but it will also be differently affected
by the different stages of the inflammation present, thus the suppurative
inflammation will affect it much more than the adhesive
or Ulcerative by where action in general the constitution is but little

♄. 348. Thus if small pox matter is applied, if the constitution
has a peculiar susceptibility of a putrid disposition, the disease will
partake of the constitutional disposition, as in the confluent small
pox. So Venereal matter shall in one person produce a Chancre
surrounded with common inflammation, in a person of a different
constitution it will be accompanied with an Erysipelatous Inflammation
which may spread to a wide Extent.

68.
disturbed.
344. The vital parts subject to inflammation may be divided into
a....Those which readily take in Sympathy. &
b. – Those which do not.
Of the latter, the Lungs, of the former the Stomach are instances.
The Pulse will generally be harder though smaller under
the affection of the former than the latter. –
345. Whatever can obstruct the natural circulation through the
minute Vessels will produce inflammation its causes therefore
may be very different & various. ( ).
346. When a part perceives an alteration in its structure or a
change in or obstruction to its natural functions the Stimulus of imperfection
arises.
347. The stimulus of perfection exists in parts new dispositions
where consequent actions are either processes of restoration or destruction
according to the strength of the parts & their facility in the art
of healing. (252).
348. Irritation of whatever kind being applied may produce inflammation
peculiar to the constitution or condition of parts.
(311-314). ♄.
349. The disposition for restoration of parts injured is the most
simple, (165), that from necessity is more complicated, but the disposition
for disease is the most complicated of any.
350. The stimulus of imperfection may arise in parts from different

🜔. 352. To the first may be referred bruises, strains simple, fractures
&ca. To the second, Wounds of all kinds opening Externally.

69.
different causes, as obstruction to their natural actions, or from an alteration
in their structure by external violence, the latter becomes
chiefly the object of surgery though the former may also fall within
its province.
351. The effects of external Violence will be different according
as that violence is applied to sound parts, or to parts diseased.
352. Mechanical injuries on sound parts may be divided into
two heads
1st. Those which do not communicate externally
2d. Those which do. 🜔.
353. The first division may by circumstance be changed into the
second, & the second may be brought back to the first.
354. The effects of the first division on the constitution will be
different according to the state of the constitution & the nature
of the parts injured & the power of healing in a part is strong,
the part injured not vital, & the constitution not highly disposed
to Sympathy, no material change will take place in the constitution
& the process of restoration will go on with only local effects.
355. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the
parts injured, the kind of violence inflected, & the degree of that
violence.
356. The second division is much more complex & its varieties
will be numerous depending upon the nature & situation of the

🜔^. 359. When wounds are inflicted it is evident from the Text
that when the first mode of union is to be effected the Surgeon
should bring the lips of it in close contact & retain the blood in the
Wound, then defend the part from the action of the Air, no foreign
matter should be introduced, hence the suture must in general be
objected to.
Union will not only take place between divided parts of the
same body but also between parts of different bodies still retaining
their living principle when brought in contact with each other
Thus Mr. Hunter introduced the testicle of a living cock into the Abdomen
of a Hen, the testicle became united to the liver of the
latter, & sometime after the Hen was killed, Mr. Hunter injected
the Testicle from the body of the Animal.
Again he fixed a Tooth recently extracted on the Comb of
a Cock & on injecting the Animal the Membrane lining the tooth
was also injected.
Upon this Mode of union depends the cure of the hare
Lip from this arises the unnatural cohesion of fingers one to the
other when the Cuticle has been destroyed by burns &ca. from this arises
the union of the Chin to the breast when ulceration has
proceeded &ca.

70.
parts injured, the kind of violence inflicted, & the degree of
that violence.
356. Its effects on the constitution will be determined by the same
laws as those regulating the effects of the first class.
357. When vascular parts violently separated from each other is
accomplished either by
a. The extravasated blood being the Bond of Union
b. The adhesive inflammation, or
c. Granulation.
359. It has been already observed that the blood is a living fluid,
when extravasated it does not immediately lose its living
principle. In  the separation of parts by violence when the
blood is Effused. the first mode of reunion is effected by the red.
particles & Serum being absorbed, & the coagulable Lymph being
left. the Lymph becomes vascular & nervous, & thus readily reunites
the sides of the Wound together, this process is accomplished
with more ease in the first class of injuries than in the second
because the blood by coming in contact with atmospheric Air
the sooner loses its living principle. &ca. 🜔^
360 – But a variety of circumstances may prevent this mode
of union taking place. The second process or that by adhesive inflammation
is next excited – Coagulable Lymph being still the
necessary medium of reunion is supplied from the Vessels of the side

♀ 362. Hence when a Cavity is exposed & the Wound does
not unite by the first or second mode of Union the whole
Cavity still will often escape running into the suppuratory
process, the contact of the Edges, or the part near the Edges
of the wounds with some of the containing parts setting bounds
to the process of the new action.
The parts taking on Sympathy may however produce
an exception to the rule in the Text.
♄. 363. This is illustrated by dissections of Women dying
with the puerperal fever when Inflammation had produced
adhesion between the Peritoneum & some of the contained Viscera,
while the suppuration had generally diffused itself over
the parts of the Abdominal Cavity.

71
of the wound by the first or adhesive inflammation arising,
this becomes organized & again fills up the breach.
361. But many circumstances impede this process also such
as the death of the solid parts receiving the injury, hence their
becoming foreign bodies, the too great violence of the inflammation
(360) producing suppuration; the interposition of foreign bodies &ca.
& here the process of restoration cannot be accomplished without the
third mode of union (348) Granulation.
362. When an internal Cavity is exposed the whole of the cavity
would run into Inflammation unless some part of its surface is
in contact with some other living part, that simple contact will
set Bounds to the spreading of the Inflammation. ♀.
363. The adhesive inflammation is sometimes imperfect not answering
to the final intentions, & this is when the violence giving
rise to it has excited too rapid an Action to admit of the adhesive
process taking its full effect, this however seems rather to belong
to the Erysiplatous Inflammation. ♄.
364. The Cure of Inflammation is by resolution ( ) but before
we attempt the Cure of Inflammation artificially, we must enquire
into the constitution of the patient, as whether he is disposed
to irritability or indolence, his former habit, temper of
mind &ca. & also the situation & other circumstances of the affected
part.
365. The time for attempting the cure of inflammation by

    
      
  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


72
resolution is before the suppurative process has taken place
366. We must consider whether the inflammation is of the true
healthy kind, or has the Erysipelatous disposition, or any other
specific disease mixed with it, We must also consider whether
there is an increase of life or only an increased disposition to
make use of Life; a distinction very necessary to observe.
367. We have noticed (332) that a change of Colour in parts is
produced by inflammation, when inflammation is seated in
parts near the Skin & its action is violent, vesications will arise
the Cuticle being seperated from the Cutis, this arises from the action
producing death of the connecting Medium between the Cuticle
& the Cutis.
368. The Coagulable Lymph (319) fulfills not only the intentions
(290-359-360) but also when the third mode of Union, or as it takes
place becomes the basics of the future Granulations.
369. In the Cure if the Inflammation is of the true healthy kind
we have only to remove whatever cause keeps it up.
370. An increased disposition to make use of life (366) or too
great violence of circulation is to be lessened by weakening with
evacuations & the exciting of nausea, & by soothing or Anodyne remedies.
371. When there is both an increase of Life & powers & an increase
of action weakening the System becomes necessary.
372. The System is weakened by bleeding, if only increased action

🜺 373. Topical Bleedings however [considerable] desirable cannot
always be had recourse to, for instance in increased action of
the Vessels of any of the internal Organs.

73
action is present without increased powers bleeding is only to be had
recourse to from particular indications: Vizt.
a. When it is desired to lessen the present Action in order
to give the disposition time to wear itself out without destroying parts
by its violent action.
b. When the parts affected is a Vital one.
c. When it is near a vital part.
373.. Unless the powers of action are great or the exigency of present
circulations requires that blood should be drawn from
the System. Topical blood letting is to be preferred & that from
or as near to the inflamed part as possible. 🜺.
374. Topical bleeding should be particularly insisted on when
there is a disposition in the habit to form but little blood, & when the
part inflamed is distant from the source of Circulation.
375. When the action only & not the powers are increased it is to
be desired that the constitution should perceive the loss of blood as
little as possible. Topical bleeding give less Alarm to the constitution
than bleeding from the System.
376. In our choice of bleeding we are in a great measure to be regulated
by the Pulse, but as the pulse is differently affected by the inflammation
of different parts we cannot be absolutely determined for or
against bleeding by any one general state of the pulse, for the most
part however, it is to be considered a quick & hard pulse generally
indicates bleeding.
377. An other general indication of Blood letting is the state of the

♃. 381. In weakened habits a single stool frequently produces fainting
may it has even caused an Abolition of the powers of Life.

74.
Blood but this can be only an after proof.
378. If state of the Blood is [only] Sizy & the Coagulum flat & its
texture loose bleeding is contraindicated, or at least to be sparingly
employed.
379. Another general indication of bleeding, is Urine high in Colour
& small in quantity.
380. A comprehensive view of all the Symptoms of health & weakness,
present violence of action, the nature & situation of the parts
affected, can only enable us to decide on the rectitude of using or omitting
bleeding. –
381. Purging weakens universally, it is to be had recourse to
with the same Caution as bleeding & in irritable habits still greater
caution is necessary. ♃
382. Sudorific may be proper when the Constitution Sympathizes
much, because they do not so much diminish strength.
383. Nauseating medicines lessen universally the powers of Life.
Vomiting ones rouse the spirits & powers; for Vomiting seems an
action intended to relieve weakness. (338 note).
384. Soothing remedies. Opium is the principle. Opium will only
lessen actions not alter them, as the disease sometimes consists almost
entirely in increased irritability by lessening the latter it may
diminish the disease.
385. We also endeavour to promote the intention (370) by topical applications;
of these preparations of Lead appear to lessen the power
as well as lessen the action, they are not therefore universally to be

389. Upon this principle we use blister plasters to remove deep
seated pains, upon the same we apply sinapisms to the feet when
the Brain is affected. Vomits when the Testicle is inflamed.

75.
had recourse to (366).
386. Cold powerfully weakens action, from its use therefore great
effects may be expected, the degree & length of applications of Cold
is however to be considered (262). –
387. The effects of topical remedies will be either.
a. Immediate
b. by Repulsion
c. by Revulsion & derivation.
d. by Sympathy.
388. The first order (a) seems to require no Explanation, applications
acting by repulsion only produce their effect upon a part when
the Inflammation has arisen from a parts taking on the disease of the
Constitution, & the disease from a Constitutional has become a local one,
as Gout.
389. Revulsion & derivation are not well defined the distinction between
them is perhaps Ideal, by them we must understand a cessation
of action in one part produced by an increase of Action in another
part this does not depend upon the humours but upon a change in
the place of action, or irritation.
390. Repulsion is the cure of the part, be the consequences of the Cure
what they may.
391. Sympathy. the cure of a part by local Sympathy is when the
same effects arise in the part diseased from an application used to
some other part as if the application was made to the diseased part

☿ 391. Hence it is that Mercurial Ointment applied to the Skin Covering
a Node, will cause the node to disappear in the same manner
as though the Mercury had been applied to the Node itself without
the medium of the Integuments.
🜔vmss 392. Vomits curing inflammation of the Testicle after sedatives
&ca. had been used in Vain, Caustic behind the Ears curing
Ophthalmia which had resisted all applications to the Eyes, elucidate
the truth of the Text.
The Cure of the tooth ach by burning the Ear is to be referred
either to derivation or Sympathy.
Derivation seems to be the reverse of Sympathy We cannot
however always distinguish one effect from the other. The cure
shall often be effected by Sympathy, thus blistering one part will
remove pain existing in another part tho’ the action excited by the
Blister may be of a different kind.
☍ 398. Among the causes of this effect are wounds not uniting by
either of the two first modes of union & the 3d. or Granulation becoming
necessary for their cure, violence having produced the death of parts to
the removal of which suppuration becomes necessary. Violence having
Exposed internal surfaces.

76.
itself. ☿.
392. A cure of local inflammation by derivation or Sympathy
will often take place when sedative applications have proved ineffectual.
🜔vmss.
393. Topical applications may be divided into.
a. Fomentations.
b. Steams.
c. Lotions.
d. Poultices.
394. The order a. & b. are of shorter duration in their actions,
but may afford relief during the application, the order c. are
more lasting in their actions & are only substitutes for the order
d. which of all application produce the most permanent action
395. Poultices will be either.
a. Simply warm & Moist, or
b. Medicated.
396. The effects of a Poultice will be immediate on the parts
to which it is applied, but by sympathy they will be extended
further.
397. Medicated Poultices will be formed according to circumstances;
[of] with Lead, Opium, Mercury &ca.
398. When Inflammation however excited exceeds the adhesive
state, & gets beyond the point of resolution, Suppuration is produced ☍
399. The cause of a parts running into Suppuration is, its

🜍 400. The application of Air to internal surfaces as the Cavities
of the Thorax, Abdomen & Joints, has been considered as the cause of
suppuration but this is evidently not the case, suppuration would
take place even in vacuo. In Emphysema where Air is diffused all
over the body we have no such effect until an Opening is made, but
in case of suppuration from an Opening the stimulus of imperfection
takes place the Cavity being an improper one to prevent this
imperfection as much as possible we observe in a Wound of the Abdomen
of a fowl that adhesion takes place between some of the Intestines
& the edges of the Wound, if this does not happen general
suppuration succeeds, another proof that Air in internal Cavities
is not the Cause of suppuration is that in some Animals the Air
has a free communication from their Lungs into the cells of their
bones & into the Abdominal Cavity without producing suppuration
as in the Case of many Birds.
🜖 404. This we readily account for, knowing that suppuration
is the first ordinary process in inflamed Canals, whereas adhesive
Inflammation is the prior action in the Cavities.

77
perceiving the stimulus of imperfection, & being thence necessitated
to begin a new & unusual process.
400. Communication with the atmospheric Air is not necessary
to suppuration. 🜍.
401. Great violence of action is not necessary to suppuration
it is rather productive of gangrene, suppuration is sometimes
produced in a part without any visible violence of action in the
part which takes it on.
402. Although it sometimes arises without any visible violence of
action in a part, yet in healthy constitutions it is generally found
that the inflammation is considerable.
403. The action producing it is most violent when it arises
spontaneously. –
404. Suppuration takes place more readily in internal Canals
than in internal Cavities. 🜖.
405. It is not necessary to forward Suppuration even in Inflammations
arising from the constitution, the constitutional disposition
seeming to have produced its full action in the Inflammation
or inflammation is to be considered as the disease taken on by the
part from the constitution, & so curing the latter & suppuration is
only the sequel of the disease. –
406. The adhesive inflammation going on to the suppurative,
in the latter stage, the general symptoms increase, the pain becomes
more acute, the sensation arising from it is as much as possible


 
 
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


78
that of simple pain, the redness is more intense, new Vessels being
formed & old ones more dilated, hence a more violent throbbing
from an increased dilatation of the Arteries the swelling of the
parts increases from a still greater effusion of coagulable Lymph
& Serum, the surrounding parts become Oedematous.
407. One, two, or more parts lose the power of resolution & take
on a similar state to Cavities exposed ( ) a Cavity is formed in wch.
pus is secreted, at first mixed with coagulable Lymph.
408. A return of the adhesive inflammation checks the progress
of suppuration.
409. When the progress of suppuration is not stopped, the matter
will be carried onwards to the Skin, the parts between the
cavity & the surface of the body are gradually absorbed the Cavity
becomes daily enlarged, the Skin becomes thinner & thinner, at
length Ulceration from pressure takes place & the abscess bursting
a natural Exit is given to the contained matter.
410. When the suppurative inflammation is going on Rigors
frequently Occur, a common attendant on new actions of the constitution.
411. When suppuration cannot be stopped the progress of the
matter is to be carried as towards the skin, hence the utility of
stimulating plasters &ca. Poultices can do little until the Inflammation
has invaded the Skin, they then keep the surface moist
& soft. –

☍ 415. to 423. Observations on Pus.
Pus cannot be formed from the melting down or waste of
the Solids, otherwise how could the human penis in the virulent
Gonorrhea furnish pus many times exceeding in quantity
the substance of that Organ, some have denied the discharge
from the Urethra & certain other canals to be purulent & affirmed
that it was only Mucus, but it has every characteristic
of Pus, no injury arises from the absorption of pus into the Circulation
otherwise how may those fare who have large sores, as patients
undergoing Amputation whose health is often disturbed
through the whole of their cure, Pus may become offensive by
being mixed with other fluids as putrified Blood & hence its factor
when its discharge attends a diseased Bone. Pus is a bland
unirritating fluid we see it makes its way in psoas & Hip Cases
from the Loins & Hip low down into the thigh without producing
the least sense of pain unless merely from its weight & distention
of the parts amongst which it is seated. Pus cannot
change Animal [matter] Solids into own nature by any fermenting
process. Chemistry cannot irritate the process of nature in
forming pus in the Animal body any more than any of

79.
412. Suppuration sometimes goes on without previous inflammation.
here parts suddenly fall into it without allowing the previous
action of the adhesive inflammation as in the Erysipelatous
suppuration, or it goes on slowly without pain as in some
scrophulous Cases.
413. When an healthy Abscess is opened, [& its cavity become exposed]
the parts readily take on a disposition to heal, but in the
collection of matter (412) when the abscess is opened & its cavity becomes
exposed a general inflammation takes place & a perfect suppuration
is formed; but the constitution is generally much affected by
this process, for here the Inflammation is to arise in a part already
in the habit of disease.
414. The matter contained in the Abscess formed without inflammation
will be different from that in the common Inflammatory
Abscess, in the former it will be a curd like substance mixed
with a thin purulent fluid..
415. The fluid produced by the healthy suppuration is Called
pus, which is quickly & readily formed on the surface of Canals ☍
416. To the formation of pus a particular organization of
parts seems necessary though we do not exactly know in
what the nature of that organization consists, any more
than we do that which is necessary for the different secretions.

the other secretions, nor can Chemistry decide on the nature of
Pus the conclusion drawn from the precipitations of it from
Vitriolic Acid &ca. are irrational & unsatisfactory; the precipitate
from any other Animal Substance so dissolved will give equally
the same appearances.

80.
417. Pus is to be considered as a secretion & the parts secreting it
to be glandular, it does not arise from a destruction or dissolution
of the Solids by fermentation &ca. the solid parts may die, slough
& be found in it, nor is it a mere straining of a matter from the
Blood.
418. Pus is a fluid which in its perfect state has certain peculiar
qualities as Colour & consistence, it is somewhat sweet and
mawkish to the taste. it consists of a number of large whitish
Globules swimming in a fluid resembling serum, of which Globules
it will have a greater or lesser proportion according to the
health of the body that produced it, like serum the fluid is Coagulable
by heat.
419. It is perfectly mild & inoffensive in its natural state incapable
of irritating the most sensible sore.
420. Pus when absorbed into the habit & mixed with the blood is
productive of no ill effects unless it is the vehicle of specific Poison
421. Pus is less disposed to Putrefy than other Animal fluid wn.
in certain situations & in contact with Air, it readily takes on
putrefaction & becomes offensive, but this is probably from other
substances as blood &ca. being mixed with it.
422. When an Abscess is first opened portions of Coagulable Lymph
mixed with pus are commonly found. These are parts of that Lymph
which had been employed in making the Cyst to contain the matter.
becoming loosened from the internal surface of the Abscess & being

🜔vuss. 🜖. 426 Pus may be of use to Sores to keep them Moist &ca.
but this does not explain why it is formed in natural Cavities it
may also be useful as a vehicle in the removal of extraneous substances,
this however can be only a secondary intention with its
final use we are still unacquainted.

81.
blended with Pus. –
423. Chemical experiments cannot explain the nature or manner
of the formation of Pus. (see last note).
424. The formation of Pus is to be considered though a New, yet as
a Process of Health, parts taking on a diseased action, the secretion
of Pus is interrupted, & it is no longer generated pure & possessed of
its peculiar properties.
425. Pus like all other fluids thrown off from Solid Parts will
always partake of the nature & properties of the parts from which
it is secreted & according will have occasionally the specific properties
of the Lues, the Cancer, the Small Pox &ca. –
426. The final use of Pus, or intention of nature in producing it
is not known. 🜔vuss 🜖.
427. Ulcerative Inflammation is that action into which a part
falls from a disposition to absorb itself Even to the solution of continuity.
428. The cause of this Ulcerative absorption will be an inability of
parts to support themselves under present circumstances, these
circumstances will be
a. Irritation.
b. Weakness.
429. These Circumstances give rise to
1st. a consciousness in the parts of the necessity to be
absorbed. 2d. a consciousness in the Absorbents of the necessity of
commencing the absorbing process.

🜔vuss. Φ. 436. When a collection of pus makes its way to the Skin
we find the cellular substance adipose membrane & even Muscles to
a considerable extent ulcerated while the Skin ulcerates only so as to
form a hole for the exit of the matter.

82.
430. Irritation will be given by
a. Pressure (246)
b. Contact with dead or foreign matter.
431. Weakness or a want of power in parts to carry on their natural
functions may be a cause of the ulcerative Absorption.
432. pressure considered as irritating is of two kinds.
a. pressure from the surface inwards.
b. pressure from within outwards.
433. parts strongly resist the action of the pressure (a) but readily
yield to the action of the pressure (b. 432).
434. From the above then we may infer that when the irritation
of the pressure, (a. 432) is applied to produce ulcerative Absorption it
must be very violent in proportion to the strength of the parts, for it
is not sufficient to destroy the power of resistence in the parts pressed
it only produces a thickening of them.
435. Nature resisting the entrance of foreign matters into the
body thickens & thus as it were strengthens the parts to give them
a greater power of resisting the admission of what would prove
injurious to them.
436. In pressure from within outwards (b. 433) the internal parts
as cellular Membrane &ca. fall more readily into the ulcerative absorption
from the Skin. – in irritation from external pressure & from
contact with foreign matter the Skin falls more freely into it than the
other substances. 🜔vuss. Φ

🜔vmss. 🜔. 437. [(When a collection of pus makes its way to the 
Skin we find the cellular substance adipose membrane & even
Muscles to a considerable extent ulcerated while the Skin ulcerates
only so)] If Inflammation attacks the external coat of an intestine
adhesions are produced between it & the peritoneum, & if the
inflammatory action goes on an abscess is formed in the middle of
the adhesion after which the matter contained acts as an Extraneous
body; Ulceration takes place only in the side next the Skin, between
which & the matter (even in the most corpulent person) the
Muscles, fatty Membrane & Cellular substance will be dissected by
the Pressure of the Matter & that fluid eliminated before by so thin an
interior substance as the Intestine will fall into Ulceration (Sidran
gives several cases of this kind but does not explain them).
🜔vuss. 🜖. 439. When living tumors are brought to the Skin, in their
progress the intersticial absorption only goes on until there arises a
necessity for the ulceration in the Skin, many other substances also
are brought to the skin without producing the ulcerative Absorption.
440. Suppuration very commonly & in some parts always attends
on the Ulcerative absorption, of this we have abundant instances
in the Muscles, Cellular substance & skin, we have also instances
of its proceeding without producing pus, in bones when sustaining the
pressure of aneurisms &ca. in the absorption of the alveolar processes after
removing a Tooth & in the removal of Callus after fractures. In Jordansons
Voyage we find that several of his Crew who had been severely

83
437. When the pressure is from within outwards, tho’ all sides are
Equally in contact with & compressed by the body making the
pressure yet that side only will accept of ulceration which is the
nearest to the Surface of the Body. 🜔vmss. 🜔..
438. When bodies making pressure from within outwards are
to be carried to the surface in the natural process the adhesive inflammation
of the neighbouring parts precedes the ulceration of the
Skin, for nature finding exposure must take place by the former
process provides against that inconvenience & renders its extent as
small as possible. (439 🜔vuss. 🜖.
439. When absorption is to take place of the parts between a surface
lodged within & the surface, in order to the removal of that substance
there is always a mixture of the ulcerative & intersticial Absorption.
440. Ulcerative Absorption goes on either with or without Suppuration.
441. Bones as well as soft parts become open to the Ulcerative
Absorption from pressure & irritation but the cuticle is incapable
of irritation & of the ulcerative Absorption.
442. An exception to (437) will arise, when the irritation from
the pressure is violent, & the adhesive inflammation has not duly
taken place in the parts behind, within or on one side of the irritating
substance. 🜔^
443 The difficulty with which the Cuticle (441) is removed for

affected with the Scurvy which occasioned the spontaneous dissolution
of old Cicatrices & even of the Callus formed after Fractures.
442. Hence it is that matter sometimes bursts into the Air
cells of the Lungs when a suppuratory inflammation of the Pleura
& Lungs had happened instead of making its way thro’ the intercostals
Muscles to the Skin; for the same reason pus sometimes in
Abscesses of the Liver makes its way internally, bursting into the
Intestinal Tube or the Abdominal Cavity.
444. A change in the constitution will often occasion a sore
to spread more in one nights time than we can procure in a fortnight.

.84
the expulsion of matter is the cause of the pain in suppurations
where the cuticle is very thick, as in the whitloe, abscess in the sole
of the Foot &ca..
444. The Ulcerative Absorption but little affects the constitution
although the constitution has powerful effects on the ulcerative absorption.
445
As ulceration consists in the division of parts naturally united,
or in a particular made of solution of continuity, so its cure is effected
by a reunion of them either by adhesion (358) or by Granulation,
the third mode of union (358) when the first & second modes of
Union will not take place in parts violently separated the third mode
is preferred or pursued in the process of restoration, this is by means
of Granulation.
446. Granulations are formed by coagulable Lymph, effused from
the surface of the Ulcer becoming vascular, Vessels from the original
parts pass to the basis, & also to the surface of the granulations
& would almost seem to terminate there.
447. Granulations are always of the same nature as the Parts
they arise from.
448. Granulations will be healthy or unhealthy, the more Convex
they are seen, & the smaller their points, & the more florid red
colour they are of the more healthy. The flatter their surface, the
paler or the more they approach to a livid hue the less will they be
found healthy, & the more slowly will they admit of the parts

🜔🜹. 448. By attending to the appearance of a sore, we may judge
whether it is healing or disposed to ulcerate farther, if the latter the
edge will be irregular, inverted, or hanging over the ulcerated surface,
the discharge is in general thin, the surface in the whole or in many
parts concave whereas, when there is a disposition to healing they are
convex, the margin purple covered with a whitish semitransparent
membrane.
☉. 449. In the irritable constitution mostly, the Granulations will
be large & flabby.
☽︎. 450. Mr. Hunter saw two granulations one from the scalp, the
other from the Dura mater arising after trepanning united so firmly
together that they could not be seperated without an hemorrhage.
♂. 451. A Man aged 50, broke his Thigh bone & the attempt of
a reunion both by the first & second intention failed; for the fracture
(which was simple) did not unite after being bound up for a considerable
time, at length the Man died, Upon examination it was
found that Granulation between the ends of the fractured bones though
without suppuration had taken place. Scratches & slight wounds in
the Skin though they unite by the first intention do not always require
suppuration, they heal frequently under a scab.
☿ 456. The contraction of granulations perhaps goes on in some
degree until the cure is compleated, but after a certain time they
contract not sufficiently to oblige the Skin to stretch itself & hence there
must be a necessity for the formation of New Teguments. +

85.
being healed. 🜔🜹.
449. By the appearances of Granulation we may judge in some
measure of the state of the constitution. ☉.
450. When Granulations are healthy they have a strong disposition
to unite one with another. ☽︎.
451. Granulations are in general the consequence of suppuration,
but granulation may sometimes take place without suppuration preceding.
♂.
452. To perfect the Cure of an Ulcer it is necessary that the Granulations
receive a covering, or that the process of Cicatrization takes
place.
453. Cicatrization is performed partly by the elongation of the original
Skin, & partly by the formation of a new Skin.
454. The Original Skin is necessitated to Elongate or stretch itself
by the contraction of the Granulations.
455. Cicatrization is always in view when granulations are formed,
when the Granulations have been carried to a sufficient degree, the
Contraction of the Granulation begins at every point as the contracting
process goes on the Skin on all sides is drawn nearer to the center of
the Sore.
456. When the contraction of the Granulations has been carried
so far as circumstances will admit of; & the consequent elongation
of the Skin has been carried to its greatest point, from the
Margin of the original Skin, the new skin shoots. ☿.
457. The contractions of the granulations or their effect in + elongating

+ When the original is unfit or cannot give the disposition for the
new one to form then there is sometimes a disposition in the Centre
of the Sore to produce it hence it is why we sometimes see sores
begin to cicatrize in the middle.
♃ 457. We see that if the Wound or Ulcer takes place on soft parts
as the Buttocks &ca. & when the Skin is loose, the quantity of new
Skin formed in the healing is very little, but in ulcer in had parts
as on the head; the skin is enabled to stretch but little hence in
Wounds of the scalp, the new formed Skin is nearly of equal extent
to that of the lost Substance.
♀. 458. Hence it is evident that Surgeons cannot be too cautious
in saving Skin, when it becomes necessary for them to remove parts
as in amputation of the Leg &ca. & especially where the wound is to
be inflicted on bone, the natural covering of which is little binds
the Skin, as in the Tibia &ca.
♄. 459. From part of this aphorism it must be evident of how
much utility motion & friction must be to a part stiffened from
having undergone granulation & cicatrization, Mercurial Unction
& Electricity both conduce to this End & seem very properly indicated.
🜍. 461. As in the Negroes who when they are burned or blistered the
Cicatrix formed after healing wants the black tint.
“But even in Negroes the Rete Mucosum is formed as I have
found on examining the Cicatrix of a Negroe adult from which by maceration
I turned off the Cuticle & found the Rete Mucosum perfect”.

86.
elongating the original Skin is impeded by being seated on hard
parts as bone, & where the Sore is circular instead of having considerable
length in proportion to its breadth. ♃.
458. The formation of new Skin is a process nature forms with
difficulty & with more difficulty in the lower Extremities than in the
other parts of the body. ♀.
459. The new skin is a very different substance from the old,
whether it consists of the granulation altered in their structure
or is a new and distinct substance from them is not to be ascertained.
It is less moveable than the original Skin, appears to be
on the stretch, as if a small piece of Skin was stretched & sewed
into a larger hole, so that the sides of the old Skin seem puckered
it gradually however is subjected to Mechanical motion & becomes
[less] more lose & flexible. The young Cutis when first formed is
very full of Vessels, but these are either afterwards taken away
or changed into absorbents until at length the part becomes
quite white. ♄.
460. Whenever a New Cutis is formed a cuticle is found also
the Cutis forming it, more readily than the granulations forms
Cutis, every point of Cutis is forming Cuticle.
461. The Rete Mucosum is always late in forming Cicatrices
between the Cuticle & Cutis, sometimes it is never formed at all. 🜍.
462. The Cicatrization is sometimes materially affected during
the giving on of the processes of restoration above described by certain

🜁. 467 & 468. Thus we see affections of the ligamentous parts
more readily bring on hectic than those of the muscular parts.
Disease of the joints very frequently produces this constitutional
Sympathy, & the larger the joint the Earlier this effect will
take place, An affection of the Knee or Elbow brings on Hectic
speedier than a disease of the Wrist or Ancle, again backwardness
of parts to heal depends much on their situation in the
body (277). In the lower extremities the power of healing
will be less than in the upper, & we see a disease in the Knee or
Hip produce hectic sooner than a disease of the Elbow or Shoulder.
Hectic will arise from Affections of parts whose natural  
powers of healing are not weak, as in large abscess in the
Muscular parts, but it still depends upon the same principle,
a Disease which the Constitution can neither conquer nor get rid
of. (464).
∇. 469. It will arise in affections of the Vital Parts & Joints
even before suppuration has taken place. Did it arise from the
absorption of Pus it should take place in one large Ulcer as well
as another, for it does not appear that there is a greater disposition
for absorption in one ulcerated surface than in another it
should arise from Venereal buboes where the matter is often even
poisonous.
In large Abscesses the Hectic disposition comes on after

87.
Actions.
463. The most ordinary actions are.
a. Hectic
b. The action of dissolution.
c. Spasms.
464. Hectic is a remote constitutional sympathetic affection
taking place in a constitution weakened by a long continued local
disease, which it can neither get rid of nor cure.
465. It will be caused either by an affection of a vital or a
non vital part.
466. It is produced earlier by the affections of a vital than of
a non vital part.
467. In the Non Vital it most frequently arises from affections
of those parts which have a backwardness to, & small powers of
healing. (275-276-277).
468. The more extensive the seat of the diseased Action in
parts of equal powers of healing, the earlier will the Hectic be induced
in the constitution. 🜁.
469. Hectic does not arise from the absorption of Purulent
matter into the System. ∇.
470. Hectic then depends on a part being irritated beyond
its powers of acting for restoration & beyond the power of the Constitution
to overcome the Disease: 🜺.

opening & when the Matter has been discharged.
If the Constitution can heal up these Abscesses, no hectic
arises large suppurations have taken place & the matter been
absorbed again without opening yet without the rise of hectic.
We readily conceive why it should take place sooner in vital
than in non Vital parts because the former gives the alarm
sooner to the constitution (22. Note) Hectic commonly arises from
Lumbar or Psoas abscesses, Scrophulous Joints, white swellings
&ca.
🜺 470. Whatever then will long & Obstinately teize the Constitution
may become the cause of Hectic.
🜔🜹 476. The action of dissolution seems different from Hectic,
it is infinitely more rapid in its progress it is incidental
to opposite Constitutions it is uncurable by the removal of any
part, & therefore seems to be an act of the constitution.

88.
471. It is however sometimes doubtful whether the hectic is
not an original disease of the constitution, we see that it arises
when there is a sore in a part which has no impediment to
healing, & here the Hectic must in general be cured before the
sore will heal.
472. Hectic is a kind of slow diminution of Animal Life, even
to gradual dissolution, its Symptoms are in general slow fever
with great debility, & languor, want of appetite, paleness of the
Skin. Sweats easily provoked, & indeed arising spontaneously
frequent sickness & vomitings, in habitual purging, clear Urine.
473. The administration of internal Medicines can only be useful
in order to the cure of hectic by somewhat strengthening
the constitution & enabling it to support its struggle longer than
it could do unaided.
474. Its cure can only be affected by the removal of the local
Disease either by taking away the part or by inducing in it
a disposition to heal.
475. The constitutions most disposed to Hectic are the weak
& irritable.
476. The action of Dissolution is different from Hectic when the
constitution seems to have every thing in its power having gone
through & supported the processes of inflammation & suppuration
its powers will suddenly sink & the destruction of Animal Life
be readily accomplished. 🜔🜹.

🜖. 481. If a limb has its bone or bones fractured the Muscles
will no longer act in obedience to the Will, the same in the Case
when a joint is rendered useless, if the patella is fractured the
patient cannot voluntary act with the Rectus Muscle.
It is extremly curious to observe that voluntary Muscles,
when the final use of their being no longer exists, become
no longer the Instruments of the will, & they then waste in
bulk, strength & firmness & become soft flabby. -

89.
477. The Symptoms are an universal affection of the Stomach
shivering, Nausea, & frequent vomiting, small quick pulse
Hemorrhage from the surface of the Ulcer, excessive spontaneous
sweatings soon succeeded by Death.
478. The Habits most disposed to it are the Robust & full.
479. For its Cure nothing seems to be effectual.
480. Muscles lose their power of action not only when the
Nerves leading to them or which are their immediate Instruments
of motion, are compressed or destroyed, but also, when
there is no longer a necessity for their propriety in their acting
(53) & here they become though naturally voluntary inobedient
to the Will.
481. They also become open to Intersticial Absorption & waste
in size & firmness. 🜖.
End of the first Part. –






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


90.
Illustration of the Doctrines contained in
Part the First. –
482. In the circumscribed Cavities when taking on inflammation,
the adhesive it is observed ( ) is first to take place
if the progress of the complaint is not checked, or put a stop
to by the adhesion, the suppurative or the ulcerative stages
are the necessary sequels. ( ).
483. In cavities containing Vital parts, the Ulcerative stage
is seldom produced for before the complaint proceeds thus far
it generally kills, to produce adhesions between contained & containing
parts it is not necessary that the surfaces of both
should be inflamed.
484. According to the degree or extent of the adhesions the suppuration
in a circumscribed Cavity will be greater or less, if suppuration
comes on in a Cavity where no adhesions have previously
taken place the whole surface of the Cavity will become the






    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


91.
seat of the suppuration.
485. The contents of an inflamed Cavity will not always partake
of the Inflammation of the containing parts, for the
Lungs, or the Intestines may remain uninflamed, though a
Pleuritis or Peritonitis may be present.
486. The preceding doctrines will be illustrated by observations
on the inflammation of the following Cavities.
1st. The Thoracic Cavity or Inflammation of the Pleura.
2d. Inflammation of the Pericardium.
3 --- of the Peritoneum, as contain of the Abdominal
Viscera. 4 --- of the Bladder
5 --- of the Joints & Sacculi Mucosi.
6 --- of the Eye.
7 --- of the Veins.
8 --- of the Encephalon.
9 --- of the Tunica Vaginalis.
also by injuries & diseases of bones, by Wounds in soft parts
& lastly by common & specific diseases of the constitution and
parts.
487. The pleura is more subject to Inflammation than any
other membrane lining [the] a cavity in the body not far from
its particular nature, but from its particular circumstances,
as being much exposed to the action of Cold &ca.
488. The pleura becoming inflamed adhesions are formed,








    
     
  



  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


92
between that Membrane & the Lungs sometimes with but
little pain if any. Sometimes the adhesion is throughout the
whole of their surfaces, sometimes in parts only, these adhesions
frequently terminate the Complaint.
489. But it frequently happens that the Inflammatory Action
goes on to suppuration if the whole Cavity becomes the seat of it
then the true Empyema takes place, if the suppuration is by
means of the adhesions confined to certain parts, then the spurious Empyema
or collection of matter not communicating with the
general Cavity of the Thorax is produced.
490. The Empyema will be preceded by violent pains in the
Thorax, difficult respiration, quick pulse, rigors, &ca. –
491. The Empyema when present will have symptoms peculiar
to itself together with the common Symptoms, & Symptoms from
Sympathy of a Fluid contained in the cavity of the Thorax.
492. The common Symptoms of a Fluid Extravasated in the
chest are difficulty & frequency of Respiration.
Breathing easiest in some particular situations. If the
fluid be in one lateral Cavity only, the Patient lies chiefly & most
easily on the affected side, if in both cavities, then he will only
lie on his back & that not horizontally, the head & chest will be elevated,
otherwise he feels a sense of impending suffocation, there
is a sense of weight in the Diaphragm, there are patients who
perceive the fluctuation within them; frequently Anasarca, & 

🜋 496. Emphysema will often remain a considerable time,
Interior parts do not fall so readily into the adhesive Inflammation
as the more external parts, hence the wound continues
open so long & admits of the egress of ye Air.
I believe the presence of pus, or water extravasated in
the Thoracic Cavity will be alone accompanied with the anasarcous
Symptoms, blood or Air, not producing there appearances.

93.
sometimes Ascites is present.
493. The peculiar Symptoms of the true Empyema are a
great difficulty & uneasiness in expanding the Chest, great
lowness & depression of Spirits, frequent sense of seemingly impending
dissolution, the fluid accumulating Gradually.
494. The Sympathetic Symptoms are great irregularity of the
Pulse, palpitation of the heart &ca..
495. Water may be Extravasated in the Cavity of the Thorax
& the Disease then becomes Dropsy of the Chest, to the common
Symptoms (492) & the Sympathetic (494) may be added the circumstance,
that the fluid is so suddenly collected.
496. Air may be extravasated in the Cavity of the Thorax by
a wound in the Lungs from the end of a fractured Rib, here the
Pleura being also wounded the Air will escape into the Cellular Membrane
& produce a partial or general Emphysema.
497. Blood may be extravasated in the Cavity of the Thorax [by a]
[wound in the Lungs] & will occasion the common & probably several
of the other Symptoms.
498. For the discharge of Extravasated Fluid from the Thoracic
Cavities, the operation for the Empyema or the Paracentesis of the
Chest becomes requisite.
499. This should be performed as rarely as possible because its sequel
(as being an Exposure of & rendering the Thoracic Cavity

🜔. 499. [Emphysema will often remains] When Pus is present
in the Cavity of the Thorax, no objection to the operation
can arise for the part is already in a state of suppuration.
☿. 502. If you make the incision upon or near to the fractured
Rib, with respect to the bone you place it in the state of a compound
fracture & may induce all its consequences, besides rendering
the Chest an Exposed Cavity, the sequels of a compound
fracture will be hereafter shewn.
♁. 503. This must be obvious from considering the text (502) the
scarification need not be more than half an inch long (501) but sufficiently
deep to make exposure of the cavities of the cellular substance,
when much blood is extravasated (497) the Paracentesis of
the Thorax must be generally necessary, from the great danger of
suffocation that must attend its continuance in the Cavity.
Mr. Hunter has sometimes seen patients recover from injuries     
of the thorax, even when suppuration has taken place (as
after Gunshot of Wounds) he finds it difficult to Account for the means
of the Recovery, but thinks it must be by a kind of Resolution for
the Lungs in exposure of the chest are generally collapsed, so that
adhesions between this membrane & the Lungs in those cases cannot
be effected. –
Φ. 506. To such symptoms [for] the name of Angina Pectoris
has been given. –

94
imperfect) is an universal suppuration generally ending in
death. 🜔.
500. When Emphysema (496) in consequence of a wounded
lung arises & extends to a considerable degree the cellular membrane
may be scarified to discharge the offending Air.
501. The scarification should be made at some distance from
the seat of the fracture of the Rib.
502. The Lung on the Opposite side (if only one is wounded) should
not have its action confined nor should the escape of the Air from
the Cavity of the Thorax into the cellular substance be impeded. ☿.
503. In the case before as tight bandage applied on the Thorax
& compressing the parts which received the injury is improper.
♁.
504. It will be difficult to distinguish the Inflammation &
Suppuration of the Pericardium, from that of the Pleura, or Thoracic
lateral cavities, the heart sympathizing with affections
of the latter & the latter with those of the Pericardium.
505 If adhesion takes place between the heart & pericardium,
the Patient generally recovers, if the Inflammation goes on to
suppuration, the patient always is destroyed.
506. The adhesion of the Pericardium to the heart is attended
with palpitations of the heart, irregularity of the Pulse, frequent
& difficult & oppressive breathing, pain in the Sternum, frequent
syncope, debility &ca. Φ.

🜔v 507. By spontaneous inflammation is signified an Inflammation
arising without any visible cause.

95
507. The Peritoneum is the largest inverting membrane in
the body, it is subject both to Spontaneous inflammation & to
inflammation from external injuries. 🜔v
508. The Peritoneum taking on inflammation Runs through
its actions sooner than any membrane or Cavity in the body.
509. The Inflammation may be either Common or Erysipelatous
(303) at the onset it is difficult to determine its nature.
510. Whether it is of the common or erysipelatous kind it will
at first be accompanied with a violence of action of the constitution,
which is powerfully roused, but if of the Erysipelatous kind
the strength of the patient will soon sink.
511. The peculiar symptoms will be a pain in the abdomen not
of the cholicy or spasmodic kind with a sense of soreness of the
abdominal Region, greatly increased by pressure or by stretching
the peritoneum.
512. The Intestines will also from Sympathy take on an unnatural
action, Costiveness in some cases, in others a Diarrhea
will be induced.
513. The inflammation of it does not go off by resolution, or
unless adhesions taking place prove its cure will produce suppuration.
514. The suppuration will be
A. partial of adhesions taking place, limit the extent of it
B. universal if the adhesive inflammation is insufficient 

♂. 520. The Uterus on dissection is generally found sound
& free from inflammation, the disease does not arise then from
an inflammation of the Uterus. But the Uterus conscious of
some change effected in its nature will give the same stimulus
to the Peritoneal Cavity as would arise were the Uterus removed &
thus the abdomen be made an imperfect Cavity, parts may retain
their life & yet give a stimulus productive of death to
other parts.
“This seems to be the action of the Sympathiser becoming
more violent than that of the Sympathent.”
The dissection of Women dying of this disease proves
in general the fatal affection to be a suppuration of the Peritoneal
Cavity.

96.
sufficient either in the time of its duration or degree, to produce
adhesions of the membrane to the contained parts.
515. If the Suppuration is universal it always destroys the patient,
the prevention of this state is therefore to be diligently
prevented.
516. Bleeding seems the only means we have of preventing
suppuration, & therefore should be had recourse to, it should seem
to be improper in the Erysipelatous Species, but even there we
know of no other means of warding off suppuration.
517. When universal suppuration of the Cavity happens,
trial might be made of opening the Cavity with a Trochar
evacuating – the fluid as much as can be, & washing the part
well by injecting warm water.
518. When the suppuration is partial (a. 513. 482. 362) the
matter frequently points outwardly, like any other abscess, either
ulceration takes place, & it bursts, or it is opened & the patient
does well, here is a striking proof of the utility of the
adhesive Inflammation
519. The lying in or puerperal fever is a Sympathy of the
constitution with an inflammation of the Peritoneum.
520. The Cause of the Puerperal [fever] Inflamn. of the Peritoneum arises as
well as every other Inflammation of this part from a stimulus of
imperfection, which in this case is given by the Uterus. ♂.

Δ. 521. [Here] Mr. Hunter supposes the broad & round ligaments
of the womb most affected.
522. This most commonly takes place in Patients with
unsound viscera & Peritoneum, & in whom the disease has been of
long standing, rarely the first time of tapping, but not uncommonly
the 3d. or 4th. time. Mr. Hunter has seen on the second day
after tapping, the inflammation spread over the whole cavity of the
abdomen yet proceed no further, in which case it does not kill,
hence we should be cautious in our Prognosis of the event of tapping.
On dissecting Patients who have died after tapping
the same morbid appearances have occurred to the Examiner, as in
Women dying of puerperal fever & the Symptoms have been the
same during their illness. Mr. Hunter mentioned the Cases of
two men who died after tapping & the appearances on examination
after Death.
🜔🜹. 524. The suppuration of the Peritoneum after the operation
of the Bubonocele & Femoral hernia do not happen because
the sides of the Sac are brought together & closed before the alarm
is given to the Cavity. In the umbilical Hernia, after the operation
the external parts do not adhere, [to the] but the Union must
be formed by suppuration & Granulation.
Here the Omentum should be made the basis of the Granulation
that uniting with the external parts it may prevent

97.
521. Sometimes after lying in the adhesive inflammation will
prevent the suppuration from extending itself far, & an abscess
will form at the lower part of the belly & do well. Δ.
522. The Peritoneal Suppuration will sometimes succeed to
tapping or the common operation of the Paracentesis of the Abdomen.
523. From what has been said it must appear that whatever
can produce in the Peritoneal Cavity the stimulus of imperfection,
whether the death of one of its contained Parts, external violence
or penetrating wounds not healing by the first intention,
or by adhesion formed near the opening between the membrane
& some Viscus, may occasion the Peritoneal suppuration.
524. The Operation for the Bubonocele & Femoral Hernia, the
Cesarean operation, may all be productive of the Peritoneal Suppuration,
because they all occasion an Exposure of the Cavity, to
which suppuration must succeed, if the exposure continues long
enough [after] for the Cavity to take Alarm. 🜔🜹.
525. After the Cesarean Operation & other cases of Wounds into
the Abdomen, care should be taken to bring the Lips of the Wounds
in Contact, but not to pass Ligatures (if suture is used) so deep
as to penetrate the peritoneum. 🜔^

prevent the general inflammation of the abdominal Cavity.
🜔^. 525. A.B. A Crooked Woman was with Child & went her
full time, her pelvis was so narrow & deformed that she could
not have been delivered even by the Crotchets. Mr. Hunter delivered
her of a living healthy Child by the Cesarean Section immediately
on its contents being removed, the Uterus contracted strongly, the
Lips of the Wound was brought together by the uninterrupted
suture, the Woman died soon after, on dissection the small intestines
were found adhering about the Wound, the Uterus was
very much contracted, there was a quantity of extravasated blood
likewise in the abdomen, it should seem from this latter circumstance
that in similar Cases the wound should not be closed until
the bleeding ceases.
☉. 526. Of this we have abundant Evidence in observing what happens
during the cure of Patients, who have undergone Lithotomy
☽︎. 528. Joints as consisting of Ligamentous & membranous
parts have their processes carried on slowly, we see the worst consequences
follow suppuration of the Joints, the loss of limb & even
the Life of the Patient, is no unusual sequel, if a cure is effected
it is by granulation, & the granulation afterwards for the most
part, becomes bony & thus the Joint is rendered motionless.

98.
526. The internal coat of the bladder is liable to Suppuration
on exposure, though not very susceptible of it. ☉.
527. The Doctrines (482-483). are further illustrated by the common
consequences of the Exposure of Cavities of Joints by Penetrating
Wounds, which if they heal not by the first mode of union
( ) a general suppuration takes place, for here there being no
Contained solids, as in the abdominal & Thoracic Cavities, where adhesion
forming might prevent the general action of suppuration
an universal suppuration of the Cavity must be the Event.
528. Joints becoming diseased have a great backwardness in recovering
health (275-277) hence when suppuration has taken
place & the third mode of union ( ) becomes necessary, granulation
goes on with difficulty & slowness, hence also agreeably to what
is observed (427) we are enabled to understand, why Hectic is no unusual
consequence of joints falling into Suppuration. ☽︎.
529. Granulations forming though they effect a Cure, alter the        
structure of the part hence its Utility as a Joint is lost, motion is
destroyed, an anchylosis takes place.
530. Hence it is Evident that Surgeons when they intentionally
cut into a Joint, for the purpose of removing an extraneous body
as a loose bone or

🜖. 530. Therefore Sutures penetrating the Cavity of the
Joint should be avoided.
♀. 531 & 532. The Sacculi Mucosi are found between bone & Tendon,
between Cartilage & Tendon, between Bone & Skin, or between ligament
& Skin. So between the Patella & Skin, the Olecranon
& Skin, the Annular Ligaments of the Fingers & the Skin, &ca. &ca.
(532) Obliterating their Cavity &ca. this is done by opening them
preventing the Lips of the Wound uniting by the first intention, &
so making suppuration & granulation necessary, on the same
principle is the dropsy of these parts to be cured, as that of the
Tunica Vaginalis, or Hydrocele which will hereafter be explaind.

99.
531. The Sacculi Mucosi are similar in their nature & use to
joints & contain a fluid to facilitate motion, the consequences of
injuries done to them will be similar to those inflicted on the Cavities
of Joints.
532. They are subject to dropsy, & when affected with it are to
be cured by obliterating their cavity, this is generally followed by
a weakness & stiffness of the parts to which they belong but this
is soon relieved by giving them motion. ♀.
533. The Chambers of the Eye are subject to the suppurative inflammation,
which may have its seat in one chamber (as the
Anterior) only.
534. The causes of this may be whatever can give the stimulus
of imperfection to the Cavity, whether spontaneous inflammation not
terminating by resolution, or a wound not healing by the first
mode of union, hence it may follow the extraction of the Cataract.
&ca. –
535. By inflammation of the chambers of the Eye the Iris may be
made to adhere to the Chrystalline Lens.
536. The formation of pus in the anterior chamber of the Eye
will obstruct the passage of the Rays of light, similar to an opacity
of the Cornea.        


♀. 541. A Gentleman had an inflammation of the Sclerotica,
but the Cornea, remained clear, he had darting pains in the
back part of his head, with lassitude &ca. A white speck appeared
on the Cornea, which being a collection of pus gradually
increased, at Angth the suppuration filled the whole anterior
chamber & the matter was let out by an incision similar to
that for a Cataract. 5th. day the Eye appeared flat, the Iris &
Pupil could hardly be seen 6th. day the cornea was rendered

100
537. It will produce an appearance of an opake cornea with
which indeed it may be complicated, or it may be single, no
opacity of the Cornea being present.
538. When single it may be distinguished from an opacity of
the cornea by the pus forming in the Anterior chamber, in a section
of a Circle, a straight line forming its superior side, as the accumulation
of pus encreases its figure approached nearer & nearer to a
perfect Circle, till at length it entirely covers the pupil, however when
fully confirmed it is not to be ascertained whether it is complicated
with an opacity of the Cornea or not.
539. In general if the Disease is of long standing, the cornea
is opake.
540. The Removal of the Pus is obtained.
A. by absorption into the System
B. by Ulceration of the Cornea Evacuating it.
C. by an artificial opening.
541. (a. 540) is the most desireable mode of Cure, as if the Cornea
is not opake, Vision is readily restored.
(B) is the worst mode of all being invariably followed
by blindness from the cavity becoming obliterated (as in other
Abscesses) from the injury it may do to the Chrystalline Lens & from
the sprinkling or washing of the Eye – Therefore

full by a thinner & more transparent fluid 8th. day matter
was visible at the bottom of the Cornea in the End his
Eye was lost as to its vision & diminished in Size.
🜍. 543. The internal coat of a Vein may inflame from
the Puncture made in bleeding should it not heal by the first
intention.
Therefore in bleeding the Surgeon should always be careful that
his Launcet is very sharp & that after stopping the Blood he will
closes the orifice. When the Arm bleeds a second time after Venesection
from the same orifice, a sore arm is no unusual Consequence,
this arises from the Orifice not healing a second time without inflammation,
Linnen or Lint is a better application after bleeding
than sticking plaister for obvious reasons, there are more sore arms
after bleeding where sticking plaister is used than where lint.
Sore Arms after bleeding have been commonly attributed to the wound
of a Nerve, but Mr. Hunter thinks they more commonly arise from
an inflammation attacking the internal Coat of the Vein, if when
Horses are bled the Farrier is not careful to produce union between
the edge of the Wound a suppuration not unfrequently
attacks the internal surface of the Vein & if it extends as it sometimes
does to the Heart the Animal dies, adhesion, suppuration
& ulceration may all be going on, in a Vein at the same time

101.
(C) is to be preferred though even from this mode
small hopes of restoring vision can be Entertained. ♀.
542. The Veins are not to be considered as Canals but as Cavities
& like other cavities the internal Coat is liable to
the adhesive as well as the suppurative & ulcerative inflammations.
543. The Causes of the Inflammation of Veins will be the same
as those of inflammations of other Cavities whatever can
produce the Stimulus of imperfection in them will bring on
inflammation. 🜍.
544. If the adhesive Inflammation takes place in any part
of a Vein its Cavity is obliterated & a cure is performed.

as mr Hunter found in Examining the body of a Man in St Georges
Hospital who died after bleeding, we sometimes observe a chain
of Abscesses in the Course of Veins after bleeding in the Saphena
when suppuration takes place a compression on the Vein, above
the seat of the suppuration both to produce contact between the
sides of the Vessel & obliteration of its Cavity & to prevent the blood
from carrying Pus onward to the heart.
♁. 547. This we see by observing the effects of a Ligature put
round an Artery. Mr. Hunter has never seen an Artery suppurate
except once & that was the immediate consequence of mortification. –
🜁. 549. This being the case it is to be observed that when the
cure is attempted by Seton the water being suddenly evacuated,
the Tunic collapses, now though the Seton as a foreign body
may excite inflammation, Yet the Tunic at the time of producing
the Inflammation being in partial contact with the
testicle, it is not certain that the inflammation will extend over
the whole cavity, but it must in general have its progress bounded
by the contact of membranes. (362).

102
545 Suppuration arising, if the means of adhesions taking
Place above the point suppurating a simple abscess will be formed
& no ill consequences arise, but (546)
546. The inflammation & consequent suppuration may Extend
(in default of the adhesive inflammation setting bounds to it)
throughout the whole course even to the right Auricle of the heart,
or pus may be formed & Carried with the blood to the heart; either
of which circumstances taking place, kills the patient.
547. The internal coat of the Arteries is not liable to suppuration
they will however take on the adhesive inflammation.
♁.
548. Brain. We should be extremely cautious how at any
time we open or wound the dura mater, as the exposure of the
pia mater & brain is in general productive of fatal consequences,
the brain will inflame, swell & protrude through the openings
of the dura Mater, as the Cutis throws out a fungus
through the opening of the Cuticle in the whitloe, suppuration
will take place, but the Patient will be destroyed before
a Cure can be effected.
549. Hydrocele.. The Tunica Vaginalis is a circumscribed
Cavity, when exposed the same local circumstances, as
in the exposure of other circumscribed Cavities takes place (362) 🜁
550. It is necessary we should carry this idea (549) in our

🜖. 552. Mr Hunter in his Lectures took notice of the Anasarcous
Hydrocele, but as that is a mere Symptome of Anasarca
& has nothing to do with the doctrines we are now illustrating,
it becomes not an object of our present attention.
A diseased Testicle is frequently the Cause of the first
kind of Hydrocele, we shall have occasion to speak of the diseased
Testis hereafter.
554. Whichever mode of Operation is chosen, Suppuration
is to be expected, since we cannot promise to ourselves
a certain Cure by adhesion only, no one can have any great superiority
in point of utility over the other, different Men will
have different opinions in making their choice.

103.
Minds, when we prepare for the radical Cure of the Hydrocele
or proper dropsy of the Tunica Vaginalis.
551. The Hydrocele is of two kinds.
1. Where the fluid is collected between the Vaginal
Coat & the testicle.
2. Where the fluid is contained in an Hydatid adhering
to the Tunica Vaginalis.
552. We know little of the cause of the first kind if Hydrocele
& of the cause of the second we are totally ignorant. 🜖.
553. The Radical Cure of the Hydrocele is to be obtained by
no other means than the obliteration of the Cavity which is
the seat of it - this obliteration is accomplished by.
A. Inflammation by which the surfaces of the
Tunica Vaginalis & Testicle must be omitted, so that the Cavity
between them shall no longer exist, or
B. A total removal of the membrane of forming
the Cavity, that is the Tunica Vaginalis.
554. The first purpose is fulfilled by one of three operations.
a. Caustic
b. Seton & Tent.
c. Incision.
555. The second (B./554) by the excision or dissecting out of the
whole Tunica Vaginalis except where it adheres at the back

🜔. 555. This must be a certain mode of Cure for it is not
only removing the disease but taking away the very seat of it.
The seventy of the operation however together with its being
follows by more violent Inflammation & greater danger has
brought it generally into disrepute.
Φ. 556. 557. / Mr. Hunter experienced the truth of these aphorisms
in a Patient upon whom he performed the operation for the Radical
cure by Seton, soon as he evacuated the Water, the tunic Collapsed,
the Inflammation excited by the Exposure was not general,
consequently the Cavity was not obliterated, within two
Years the disease returned, stimulating injections have been
practised to bring on the adhesive inflammation & thus obtain a
Cure, but here we shall be too frequently foiled, & on this mode
we can depend but little.
🜔🜹. 559. It has been usual to divide the Cure into the Palliative
& the Radical, of the former unless when it accidentally becomes
the cause of the latter we have little to say since it teaches
nothing respecting the exposure & inflammation of Cavities, it
is needful only to observe that the palliative Cure consists in
Puncturing the Tumor with a launcet, or small trochar & thus
evacuating the fluid but it is rarely that this mode does not
require repetition throughout the Life of the Patient.
The palliative Cure should not be attempted unless the

104.
part of the testicle. 🜔.
556. No certain cure can be performed unless the whole cavity
is obliterated, if any part of the Tunica should not adhere to the
Testicle the disease will return. For
557. In this as in all other circumscribed Cavities the adhesive
inflammation may take place only in a few points & thus the
Perfection of the cavity may still be preserved & consequently the
stimulus of imperfection will not be given to the internal surface
of the Cavity. Φ.
558. The adhesive inflammation will rarely affect the Cure, in
general an universal suppuration must take place before the
purpose of the Surgeon will be accomplished.
559. Tapping for the Hydrocele, the wound not healing by the
first intention may also accomplish the desired effect, the same
circumstances here take place as in the Peritoneal Cavity, after
tapping for the ascites, or accident, as a bruise producing a Rupture
of the Vaginal Coat, & a diffusion of its contents throughout
the cellular substance of the adjacent parts if followed by inflammation
of the Tunic may also effect a Cure. 🜔🜹.
560. It is to be remembered that the operation for the Hydrocele
is not necessary for the preservation of the life of the Patient,
or the support of his health, but only for the removal of
an inconveniency, therefore the danger of the operation is to

Patient can lie by for sometime because sometimes Inflammation
succeeds & the Radical Cure with all its Circumstances
take place when the palliative was only intended.
🜔^ 563. Inflammation arising in Consequence of any Operation
is no unusual circumstance for a considerable quantity
of Coagulable Lymph to be thrown out, surround & give the appearance
of enlargement to the Testicle, this effusion of coagulable
Lymph also forms the sloughs that are thrown off in the processes
when suppuration takes place, & which were by the Author
of a late Publication considered as sloughings of the Vaginal
coat, to which he imputed the Cure by caustic, but the Vaginal
Coat rarely sloughs, the slough discharged being in general
false membranes made from coagulable Lymph now & then
however when the Tunica Vaginalis is in a diseased state a
partial sloughing of it may take place.
The Circumstance which may give an appearance of
an enlarged & diseased testicle deserve particularly to be attended
to as otherwise a surgeon may be induced to remove it
shirrous & incurable, the testicles requiring no such operation.
Case. A Man laboured under an Hydrocele, the tumor inflamed,
suppurated & at last ulcerated, the Surgeon enlarged
the opening & finding the Testis apparently enlarged & supposing
it schirrous was about to remove it Mr. Hunter was desired

105.
be ballanced against the extrication of the Patient from present
trouble.
561. If a Radical Cure for an Hydrocele is resolved upon we are
then to consider in our choice of a mode of performing the Operation
1st. The Comparitive danger of the different methods.
2d. The Comparitive certainty of success of the difft. Methods.
3d. The State of the Testicle.
562. The greatest Comparitive degree of danger attends the Operation
by Excision ( ) which is therefore perhaps never to be advised,
this danger will arise from the Sympathy of other parts
& of the Constitution with the Testicle in this mode of Operating
so rudely handled & so entirely & suddenly exposed.
563. The mode by excision is most certain of success, next to
that the mode by incision, the Caustic & Seton are less sure
in their Effects. 🜔^.
564. All the modes of operating give us an opportunity of
examining into the state of the Testicle, that by Caustic alone excepted,
the mode by excision gives the best opportunity.
565. The mode by incision being the most simple of all, more

to attend the operation, he found the suppuration of the Tunica
Vaginalis too general, for the complaint (in his opinion) to be
Cancerous, the history of the case confirmed this Opinion, the
Patient being extremely timid, there was no difficulty in getting
the Operation put by, it was deferred & he recovered from his ailment
by very simple means.
Further respecting the state of the Testicle it becomes
necessary particularly to attend to it, that if the disease requires
it may be extirpated without the necessity of a second operation,
care should be taken to distinguish a swelled Testicle from a
dropsy of the Tunica Vaginalis, if the tumor consists of the latter
it will be mostly pyriform, if the former it will be flatted,
this attention to the appearance added to the assistance of the
feel, will mostly preserve the Surgeon from an Error.
Again in the Hydrocele the situation of the Testis should
be ascertained, that we may not if we have Occasion to tap the
tumor be in danger of wounding it.
Mr. Hunter by accident wounded a testicle four times & yet
no ill consequence supervened which is somewhat singular
as so much mischief frequently follows the slightest bruise
of this Gland.
A pulpy Testicle will be very apt to be mistaken for an
Hydrocele.

196
certain, yet not more dangerous than either caustic or Seton
& more safe & easy than that by Excision is probably to be with
justice preferred, it is performed by making an incision three
inches in length, or throughout the length of the tumor into
the Cavity containing the water, which being evacuated. Poultice
or Crumb of Bread is to be introduced every where between the
two Tunics & kept in by means of Lint stuffed into the mouth
of the wound. Rags welled in Brandy or Spirits of Wine should
be kept on the Scrotum & often renewed to prevent the too sudden
coming on of Inflammation & the Scrotum should be suspended
in a Bag truss.
566. The advantages of knowing whether a testis is diseased or
not is that if found so in a considerable degree it may be removed
without the patient undergoing a second operation.
567. We cannot perhaps a priori determine whether the disease
be a Hydrocele of the Tunica Vaginalis, or the Water be contained
in an Hydatid, nor is this knowledge of consequence in
the Cure, as in both the same mode of treatment is to be observed,
but the consequences of an opening into the tunica
vaginalis will be different from those of wounding an hydatid.
568. In the former (567) the sympathetic affection usually following
an exposure & inflammation of the Testicle, will come on
such as Rigors, Nausea, vomiting dull pain in the back & Loins

Again respecting the state of the Testicle, we should take care
to distinguish, a Scrophulous Testicle from a cancerous one
Mr. Hunter never saw a Cancer of the Testis follow the Radical
cure of the Hydrocele.
The best means of ascertaining the situation of the
Testicle, & whether this Gland forms the Tumor, is the Sensation
the patients experience in squeezing the Tumor, if it be a diseased
Testis the pain is the same in every part, if only an
Hydrocele, pain is felt on pressing that part alone in which
the Testis is situated. –
∇. 568. In cases where the Hydrocele has been tapped we
should be led to suspect that the Cicatrix left after the Puncture
would be the proper part to perform an operation again, either
for the Palliative or Radical Cure, but this is not always the
Case for the Testis sometimes adheres to the Cicatrix & if this Rule
is observed would be wounded in consequence after the Symptoms
following the radical Cure abate, an enlargement of the parts
always remains, which is not an enlargement of the Testicle
but only a thickening of the Tunica Vaginalis &ca. this gradually
subsides & the parts return almost to their natural size
which diminution may be forwarded by Rubbing in the Mercurial
Ointment.
Hœmatocele is an Extravasation of Blood into the Tunica

107.
great sense of lassitude, swelling of the Testis &ca. these
will generally come in twenty four hours after the operation
but when an hydatid is opened as the body of the Testicle is not
exposed, these will not arise but only the common circumstances
of inflammation as heat, soreness of the Scrotum &ca. ∇.
569. The treatment of both (568) will be the same as in Inflammations
in General, but the Scrotum must necessarily be suspended ☍.
Note Continued.
Tunica Vaginalis, it is not of much consequence to distinguish
it from the Hydrocele as the same treatment is advisable
but it should be carefully distinguished from an enlarged Testis,
sometimes the contents is only Coagulated Blood, & sometimes
coagulated Blood, mixed with Serum, & sometimes the Coagulum
will be found to have become Vascular.
☍. 569. Farther Remarks on the Cure of Hydrocele
by Seton or Tent & by Caustics.
If the Seton is used Care should be taken that the Skain of Silk
or thread be large enough to fill up the Wound made by the
lancet or Seton needle, & thus plugging it up, prevent the Escape
of the water until a general inflammation has taken
place for the water keeping the Tunic every where distended
partial adhesions will be prevented & the influence of the operation
become general (566-567). The Seton should be passed

in the perpendicular Axis of the Tumor, but the Tent about midway
the water should not be suffered to escape before the tent is
introduced for the same reasons as the confinement of that
fluid is recommended where the Seton is used Sponge Tent
is preferable.
Caustic. There is an uncertainty how deep the Caustic will
act, should it not penetrate so as to include the Tunica Vaginalis
in the Eschar, we shall be under the necessity of
making a Puncture through that membrane & so shall gain
no advantage from the use of the Caustic.
When the Eschar is sufficiently deep the inflammation
of the Cavity takes place before the Water is discharged which
here also prevents partial adhesions & an Imperfect Cure, but
the uncertainty of the action of the Caustic is an objection to its
use. It may happen that the Testicle may lie in
the fore part of the Tunic & its situation not be known, or not
attended to by the operation, if in performing the radical cure by
incision he finds that he is cutting into the body of the Testicle
he should carry his Knife more to the lower & outer part of
the Tumor in finishing his incision for fear of wounding the
Spermatic Artery, an accident That has occasioned

108.
570. Fractures. The bones as well as the soft parts
are subject to every stage of Inflammation either arising spontaneous
or being induced by external violence when their continuity
is divided they are reunited by processes somewhat similar to
those which we observe to take place in the soft Parts.
571. Bones are liable to Solution of Continuity from external violence,
solution of continuity in bone is called fracture.
572. Fractures in bones are either
A. Simple
B. Compound. [simple]
C. Compound Simple
D. Simple Compound.
By a simple fracture is meant a solution of continuity
in a bone without a wound communicating Externally.
573. By a compound fracture is meant a solution of continuity
in a bone, with a wound communicating Externally which does
not heal without suppuration & granulation.
574. By a Compound simple fracture is to be understood a fracture
which has a wound communicating Externally but which
Wound heals either by the 1st. or 2d. Mode of union & without Suppuration.
575 The Simple Compound fracture takes place where originally

♄. 578. It has been usual to distinguish all unnatural
states of the Bones, by the name of Caries. Caries was divided
into moist & dry; moist seemed to imply a diseased state of
the Bone, dry the bone becoming dead. By converting the
moist into the dry state a cure was frequently accomplished,
why this happened will appear from (587. 597. 632).
The term caries signifies a Rottenness in the bones it is
evident this was improperly applied to bones becoming [diseased]
dead, because a dead bone is generally thrown off without the
least appearance of Rottenness, indeed it is much more firm &
solid than the margin of suppuration in the living bone which
had thrown it off.

109.
there was no Wound communicating externally, but where in
consequence of some parts losing their living Principle from any    
cause Ulceration of the Integuments is rendered necessary & the circumstances
of a Compound fracture induced.
576. Previous to our entering upon diseases, or mode of restoration
in bones it is necessary to consider the five following aphorisms.
577. Bones consist of an inanimate earthy matter attached to
a living organized substance.
578. Bones may either be in a dead or a diseased state, between
the death & disease of a bone it becomes necessary carefully to
distinguish. ♄.     
579. Bones fall into disease more slowly than soft parts, &
when they become diseased are proportionally slower in the act
of Restoration for all processes go on more slowly & difficultly in
bones, than in soft parts.
580. It will be necessary also to consider the doctrines advanced
in (352. 358. 359. 361. 362. 482.).
581. Also that bones receive their Nutrition & means of support
chiefly from the Periosteum or membrane covering the
bones (382) different Bones varying much in their structure
(577) their diseases will vary, as well as the readiness with wch.
they undergo the process of restoration.
582. When a solution of continuity happens in a bone by External

     

  
    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


110
External violence, productive of simple fracture (572) the cure may
be effected by the first mode of union ( ) without either Inflammation
or Suppuration. In simple fractures though accident
produces a Rupture of several blood Vessels & an immediate effusion
of Blood into the Cavity made by the division of the bone
if the Œconomy of the Parts is not very much disturbed by this
violence, the bloods retaining the living principle, the red part
& serum, are soon absorbed & the coagulable Lymph alone remaining
becomes Vascular the Cure is accomplished with little
pain & without disturbance of the General System.
583. If so much injury is done to the parts, that a considerable
& unusual action is necessarily Excited in them, the first
& most simple mode of union will not take place, but the Ossific
Inflammation or that which is perfectly similar to the adhesive
Inflammation in soft parts arises. Coagulable Lymph
is poured out into the Cavity (now similar in its nature to any
natural circumscribed cavity) which is to form the callus this
becomes vascular at length Cartilaginous & lastly ossific matter,
as in the first formation is deposited ( ) & thus the cure is accomplished,
here pain, tumefaction of the circumjacent parts
& the common symptoms of the adhesive inflammation takes
place.
584. In the compound fracture ( ) the Cavity made by the division
of the ends of the bone becomes an Exposed one, from the


    

  
    
            
   
   

        
  
 
 
  
  


 
   
    
                                  


111
fracture being complicated with a communicating Wound, the
blood effused does not as in (582) retain its living principle, the
stimulus of imperfection obligates the Cavity to set up a new process
suppuration takes place & the only means of reunion left are
those of granulation.
585. As in wounds made into circumscribed Cavities, if the
lips of the wound come in contact & unite either by the first or
second mode of Union, before the Stimulus of imperfection gives
the Alarm to the cavity, a suppuration of the whole Cavity does
not necessarily take place, so in the Compound simple fracture
if the external wound is thus made to unite before the blood effused
into the Cavity has lost its living principle & the stimulus
of imperfection has given rise to a new process, the Cure may be
accomplished, with the same case as in the simple fracture.
586. But it may occur that either a splinter of Bone being
detached & dying, or the extravasated blood losing its living
principle, or from a misplaced end of the bone producing ulceration
of the integuments, or an irrecoverable injury being done
to the parts covering the bone, that Ulceration even to the Exposure
of the Cavity is produced, in this case which we term a
simple Compound Fracture the same circumstances will take
place as in the Compound Fracture (584).
587. When a part of a Bone becomes dead, Exfoliation or the throwing
off the dead part from the living must take place, In what

🜖 588. It can rarely happen that any large portion of Periosteum
shall be destroyed, or become dead without a consequent
death of [the] a portion of the subjacent Bone, if only a small extent
of Periosteum is destroyed, exfoliation of the Bone does not always
follow, because its Life will be still supported by means of its
Vessels anastomosing with those that pass from the Periosteum
nearest to the exposed part.
♀. 592. Of this we have instances in Anchylosis of the Vertebræ of
the Spine especially in Horses, between two or more of the Vertebræ
of these Animals it is Common to have an Anchylosis formed.

112.
the Process of exfoliation consists we will hereafter shew.
588. When a surface of a Bone is exposed, it is very common for
a portion of it to become dead & a necessity for the Process of Exfoliation
to take place. For the Bone receiving its nutrition from the
surrounding periosteum, that being destroyed or becoming
dead a part of the Bone must lose its means of support. 🜖.
589. The Union of broken bones is more slowly accomplished than
that of the soft parts, because in the former two processes are to be accomplished
Viz the formation of soft parts & then the formation of
bone.
590. The Ossific Inflammation arises when there is an increased
disposition in a part to form Bone.
591. It consists in the Vessels of the Bone, or the parts covering
the Bone, taking on the same action as the Vessels of the soft parts do
in the adhesive inflammation.
592. The consequence will be similar, for it will produce tumefaction
& enlargement of the Bone, if extending from one Bone to
another between which & the other there is a natural motion it
will produce Anchyloses, like as the adhesive Inflammation produces
immobility in the soft parts to which it extends, it will
be followed occasionally by suppuration & ulceration. ♀.
593. The Causes also of the Ossific Inflammation will be similar
to those of the adhesive; External Violence, as exposure & pressure,
a necessity for action in the Vessels of the bone or its membrane &ca.

♃. 593. Pressure will not uncommonly occasion ulceration &
absorption of Bone, but it may also Excite the Ossific Inflammation
& a thickening of the Bone.

113.
may give rise to it. ♃.
594. The final intentions for which the ossific Inflammation
may be employed, are first to produce restoration of parts & reunion
in a diseased Bone, & secondly to strengthen weak parts.
595. The seat of disease in bone can only be in its living part.
596. The more spongy & soft the Bone is, or the more living matter
it contains the more liable it is to disease, the harder the Bone
the less ready it is to fall into disease, but a death of some of its
parts is more easily Induced.
597. When a bone becomes diseased it is our business to endeavor
to get the better of the disease, but when a Bone becomes dead nothing
can be done but to produce exfoliation.
598. The treatment of diseased bone is rendered difficult by
the impossibility in general of discerning the extent of the disease
599. The inflammation & suppuration may have its seat either
in the surface of the bone, or within the substance of the
bone, or in the medullary substance.
600. Hard bones becoming diseased are more difficult of cure
than soft One’s, & when cured are more liable to fall again into
a diseased state.
601. Bone is liable both to ulceration & intersticial absorption.
602. When a portion of bone becomes [diseased] dead the process of
exfoliation is performed by the dead Bone giving a stimulus to
the living Bone in contact with it & to which it adheres by the attraction
of Cohesion, the living parts immediately in Contact with
the dead bone are absorbed, & a Cavity between the dead – living

🜔vmss. 🜔. 602. The first appearance of separation in order for exfoliation
is a springiness in the living bone now becoming more vascular,
then a Grove is formed in the direction of the fibres that surround
the dead Bone, the living Bone becomes softened & more porous, part
of the dead Bone seems to be sometimes absorbed for it has the appearance
of having undergone ulceration, it is certain that absorbents have
a power of taking up dead bone. The absorption begins at the circumference
& is continued to the Centre. In the Skull they become first
membranous, nature observing the same order in the repair of bone
as in its first formation, a pulsation in the Granulations often attends
the exfoliation of bone. Granulations will sometimes arise
shoot over the edges of the bone to be exfoliated, & prevent it being
thrown off so soon as it otherwise would be in this case it excites
new Inflammation & Ulceration.
🜔vmss. 🜖. 603. The Granulations forming bone irregularly become
often a considerable obstacle, to the cicatrization of the Ulcer after the process
of Ossification &ca. is finished.

114.
surface is formed, the former now being a mere extraneous body
is according to a law in the Animal Œconemy ( ) carried from within
outwards, & at length thrown off from the body, ulceration of
the integuments having made way for its exit, the cavity is filled
up with Granulations which become New bone. 🜔vmss. 🜔.
603. Granulations will arise from the Surface of bone without Suppuration
having preceded, but this only where that surface has
not been exposed by a penetrating Wound. 🜔vmss. 🜖.
604. A thickening of the Periosteum & integuments has often been
mistaken for an enlargement of a bone.
605. A Bone may be enlarged without any alteration in its original
structure, by bony matter being formed in its natural surface,
this laying on of new Bone will arise from the Ossific inflammation
taking place in the periosteum, or on the surface of the bone, we
call this adventitious Bone.
606. Or a Bone may be increased by the Ossific inflammation taking
place in its substance, which causes an alteration in its
structure & enlargement of its dimensions.
607. A Bone may be increased in size at the same time that
there is an absorption going on in its substance, for the ossific
Inflammation may be laying on New Bone on its surface at
the same time that absorption is removing portions of its more
internal substance thus a bone may at the same time be increasing
in its dimensions & losing in its Quantity.
608. Suppuration may take place either on the surface or in the

  
   
   

        
  
 
 
  
  


 
   
    
                                  


115.
substance of a bone.
609. Matter when formed may be confined, if in the substance of
the Bone, by the natural bone remaining unulcerated through its
substance, & thereby preventing its exit, or if on the surface of the bone
by the ossific Inflammation forming a Case round it of new or adventitious
bone, but in the latter Case the progress of the suppuration
must be rapid, otherwise there will not be time for the bony case to be
constructed & the matter will make its way to the Skin as in a common
deep seated Abscess.
610. Matter may be also confined on the Surface of the bone for a considerable
time, simply by the thickening of the Periosteum just as it
is confined by a fascia in the whitloe.
611. The periosteum & the cellular substance connected with it may
take on the Ossific Inflammation.
612. Suppuration taking place in the substance of a bone, & the Ossific
Inflammation being also taken on by the surface of the bone & the
parts covering it, the matter will produce a disposition to the ulcerative
absorption which will be continually removing large portions of the internal
surface of the bone, the ossific Inflammation at the same time
depositing new bone on the outside, thus the Bone may be enlarged
to any size & there two processes, absorption within & Ossific disposition
without going on together the dimensions of the Bone shall be wonderfully
increased at the same time that perhaps the original
bone shall be entirely removed, & even some of the internal parts of the
New bone shall be taken away & at last instead of a Solid bone only


          
   
   

        
  
 
 
  
  


 
   
    
                                  


116.
a large bony Case shall remain from which at length the matter
shall be evacuated. Ulceration within may however go on even after
the matter has made its escape.
613. Ulceration is the Sequel of suppuration it removes the Effects
of the Ossific Inflammation, when ulceration has gone through the
surface of a bone it affects. 1st. the periosteum next the Muscles and
lastly the cellular substance & Skin.
614. Bones when the first & second modes of Union fail are, as heretofore
observed / cured by the formation of Granulations & those taking
on the [diseased] ossific disposition.
615. But it sometimes happens that the ossific disposition shall
not be taken on by the granulations between the Ends of the bone,
so that there shall be no union by bone, the restorative process going
no further than the production of granulations or the change of them
into Cartilage.
616. It sometimes happens that no union at all is formed between
the separate ends of the Bone even after a simple fracture in
this Case, a New Joint is formed, the ends of the Bones become covered
with a Cartilage, & as in all other Articular Cavities a power of
secretion Synovia is given to it, & it is in every respect similar to any
other Joint Except the want of the proper moving powers, that is
corresponding Muscles, these not being generated the new joint becomes
Extremely inconvenient.
617. Ossific Inflammation may terminate in a Suppuration, or the

☿. 620. Here nature seems to be counteracting her own Ends, but
the final intention of this bony case seems to be an hasty attempt
to obviate the weakness in the limb that might spring from the
extent of death in the bone.

117.
bone may remain swollen, but Indolent.
618. Exfoliation of Bone is of three kinds. Vizt.
A. External.
B. Internal.
C. Mixed Exfoliations.
619. The process of Simple external exfoliation has been already
considered (602) It happens also that an internal part of a bone
shall become dead, becoming dead it gives a stimulus to the surrounding
living parts, as an Extraneous Body, it must ultimately
be thrown off, for all parts, / as has been shewn ( ) admit readily of
the passage of foreign substances from within outwards, hence from
its stimulus & the ulcerative absorption is finally produced in the
surrounding parts & a passage is given at last to the dead bone,
In consequence of the stimulus Granulations also arise & fill up
the loss occasioned by the seperation of a part of the bone & these Granulations
becoming bony the Case is accomplished.
620. The mixed is when the External Exfoliation becomes an internal
one which is accomplished as follows.
At the same time that the process of absorption goes on for
removing the dead bone from its Contact with the living parts, the
parts in the neighbourhood take on  the ossific Inflammation & in
the End forms a bony Case round the dead piece & prevents its Exit. ☿.
621. Bones commonly become painful before a swelling of them
is perceived.

622. This happens 1st. because it is the matter of diseased
parts. 2d. because the Continual irritation of the
bone like other irritation induces a flow of matter.
3d. because there is commonly some Blood
mixed with it, which soon becomes putrid.
♂. 626. The quantity of Mercury to be used may be somewhat
less than that fitted to Cure a Pox.

118.
622. The matter discharged from diseased Bone, or where the process
of exfoliation is going on is seldom laudable pus & is extremely disposed
to putrefy, tinging the probe of various colours.
623. When the Skin is affected, that is when the Inflammation
of the bone is communicated to the Skin, suppuration commonly
takes place.
624. The periosteum becoming inflamed & its internal surface
taking on suppuration, a disease or death of the more external
parts of the bone may be induced.
625. The hard bones having fewest living parts, & of Course fewest
Vessels have their life soonest destroyed by any destructive
cause whatever, it is scarcely possible to lay them bare to any considerable
extent without death & exfoliation being the consequence.
626. Where the ossific Inflammation, or the Inflammation of a bone
requires the assistance of Art it is to be treated by antiphlogistic
remedies & by limiting upon rest being given to the part affected,
& if the lower extremities that the Patient lie in an horizontal
position.
When the swelling of the bone becomes indolent, the parts
are to be rouzed into action, & if possible intersticial Absorption excited
by the administration of Mercury both internally & Externally.
The Mozeron Root has been much recommended as
a specific in the Enlargement of Bones. ♂.
627. If the seat of suppuration is the surface of the bone, or the
internal surface of the Periosteum the matter should be evacuated












 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


119.
as early as possible & this by simple incision through all the integuments
down to the bone, but without removing them & more
especially in case the Cranium is the object of our consideration.
628. sometimes in this Superficial suppuration bones are so
much diseased that they have not a disposition for restoration
& the bone will not exfoliate unless the actual Cautery be used.
629. In case of suppuration in the substance or medullary substance
of the bone, (which is the worst case by far) the matter is
to be evacuated by the actual or potential Cautery, or by the trepan.
630. Bones which have undergone external Ulceration often fall into
an indolent state in which Case stimulating dressings are to be used.
631. When the actual Cautery is applied we must [not] use an Iron
of a thickness sufficient to give a degree of heat in proportion to the
depth of the bone. The time of continuing its application must be
also directed by the same Rule.
632. Cauteries may produce a Cure of diseased bones by inducing
a Death of the diseased parts & so render the process of exfoliation
necessary, but in order to have this effect their action must produce
the Death of the whole diseased Part.
633. The [whole] Actual Cautery induces not only the death of
the diseased parts but an inflammation in the sound parts &
this hastens the seperation of the part to be exfoliated. The potential
Cautery rarely does more than producing the death of
the diseased bone.

☍. 637. Mr. Hunter has seen patients who have fractured their
legs in whom firm union would not take place until they were
set upon their Legs, the fractured bones being well supported & defended
by splints &ca. 

120.
634. However [an] a natural or spontaneous exfoliation is much more
to be desired than an exfoliation produced by Art because of the
uncertainly of our endeavours to extend our operation to the whole
of the diseased bone.
635. Of Specific diseases producing disease in bone & consequent
exfoliation, the exfoliation goes on more readily & kindly from the
venereal disease than from Scrophula or others. In Scrophula the
extent of the disease is more considerable, whereas the venereal is
more partial & confined to a narrower Limit.
636. When after a solution of continuity in a bone the cure proceeds
no further than the soft union, the rest of the Limb should
be discontinued to excite if possible a further disposition to the act
of restoration in the parts.
637. When the fracture with the circumstances (636) is in the lower
extremity care must be taken by means of splints & Iron work,
that the whole weight of the body does not rest on the fractured bone ☍
638. When a new joint is formed (616) the observation & Precautions
are also to be attended to.
639. But it may sometimes be desirrable to attempt the destruction
of the new formed joint & procure firm union between the Ends
of the formerly divided bone, in this Case we are to consider the doctrine
of Inflammation of Cavities & particularly that of the Cavities
of Joints (528) &ca. –
640. The mode of accomplishing this purpose will consist in producing

🜍. 640. It must be evident that the less time has elapsed since
the formation of the New Joint the more readily its destruction
will be accomplished.

121.
producing in the new articular Cavity the stimulus of imperfection
by making an opening into the Joints & introducing some foreign
body to prevent healing of the Wound by the first or second mode
of union & excite universal suppurative Inflammation which
being followed by Granulations & those Granulations becoming
bony, the ends of the bone will be immoveably united. 🜍.
641. Diseases of bone may have powerful influence on the constitution,
we may readily conceive the effects of a constant & long
continued pain, want of Rest &ca. which are their attendants we
also know they will bring on hectic & this is accounted for by considering
what is advanced on hectic (479 & ).
642. When ulceration has removed so large a portion of the bone,
that the remainder on account of its weakness shall be unable to
support its necessary actions, or where disease extends through a
greater part of the substance of the bone, than art can restore to
health, or procure a seperation from the sound parts, or where there
is an inability of the constitution to support the disease, or the
processes necessary to healing.
Amputation becomes indispensable.
643. In simple fracture if the patient be healthy the union
of the Bones will be generally accomplished in about three Weeks
but something sooner in the upper than in the lower extremity.
644. Rest – retention of the bones in their natural position,
freedom from pain, & the prevention of Inflammation are the general

   










 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


122
general indication in all fractures of the Extremities, whatever
position of the limb best fulfills these indications is the position
to be recommended.
645 To prevent the displacement of the Ends of the bone we
use splints & bandages.
646. Of the different species of fractures enumerated (572) the
Compound is the most dangerous, & frequently attended with
troublesome, if not fatal Symptoms, as Fever, Symptoms of
dissolution, Gangrene &ca.
647. We can rarely keep the bones perfectly at rest, in bad
compound fractures, hence constant irritation, pain, &ca.
648. The same indications are to be fulfilled in the compound
as in the simple fracture (582) we should move the Limb as
rarely as possible. Poultices though they should otherwise seem
desirrable applications in Compound fractures, become injurious
by their admitting of motion in the ends of the fractured bones.
649. The simple compound Fracture is attended with less danger
than the compound fracture, although the former also may
produce troublesome & dangerous symptoms.
650. The treatment of the constitution when affected by the
consequences of compound Fracture will be but understood
by recurring to (462 od 479.)
651. From what has been said it must be evident that when
a fracture of a bone is complicated with a communicating

   









 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


123.
wound of parts that cover it, as Muscles, Cellular substance
& Skin, it must be always the duty of the Surgeon to endeavour
to render the Case a simple of a compound Fracture,
to which End he will be careful to remove extraneous bodies wch.
may hereafter produce the Stimulus of imperfection, to place
& retain the bones in their natural site & prevent their irritating
the soft parts, to bring the soft parts into contact
one with the other, in short to observe the rules laid down
in cases of Wounds into Cavities & the doctrine (682).
652. In bones as in soft parts the observation that all new
formed are weaker than original parts holds equally good.
653. In bones as well as in soft parts, the process of restoration
goes on more readily in the upper than in the lower extremities
Compound fractures therefore considered as injuries done both to
the bones & to the soft parts are more dangerous in the leg and
thigh, than in the Arm or fore Arm.
654. Fracture of bones, which communicate with Cavities of
joints, whether simple or Compound require peculiar attention
& peculiar treatment, as
1st. the fractured Patella
2d. --- Olecranon
3 --- either Ancle
655. Also when a fracture happens near a Joint, the bone may











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


124.
be so splintered as to communication with it.
656. In case it be a fracture attended with a wound of the Joint
communicating externally, the Wound must be healed if possible
without suppuration, which arising, will occupy the whole
Cavity of the Joint & too often produce a necessity for amputation.
657. If a simple fracture communicate with a joints cavity
the Bond of Union will escape into the Cavity of the Joint
& form a Case similar to Compound fracture.
658. The fracture of the bone will be here united by the third
mode of union or granulation. (the first & second being lost
by the escape of the Bond of Union into the Cavity of the Joint)
except that here there will be granulation without suppuration
preceding (603) In case of fracture communicating with a
joint, it is apt in the cure to produce a stiffness & loss of action
in the joint from the blood escaping into the Cavity & becoming
organized, in this Case as soon as the fractured bones are united
by the Callus it is necessary to give passive motions to the joint
often repeated them & when the callus is confirmed the patient
should diligently exercise the part affected by constant motion
of the proper Muscles.
659. When the Patella is fractured the union of the fractured
parts will be either by bone or ligament.











 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


125.
660. If the fractured parts, remain in contact or very near to
each other, the Union may take place by bone as in the fractures
of other bones; but if the fractured portions are at a distance from
each other, Union by the formation of Ligament will be the mode
adopted.
661. For the Patella being employed in the formation of a Joint
a Union by lengthening the bone two or three inches must have
been extremely inconvenient to the patient & incompatible with
the future motions of the Knee.
662. The Patella being the point to which the principle extensor
Muscle of the Leg is inserted, when fractured transversely the
Muscle being now no longer confined contracts itself & draws the
superior portion of the fractured bone to a considerable distance
from the inferior.
663. When the union is formed by ligament as is always the
case, when the fractured portions remain at a considerable distance,
asunder, the patella is very much lengthened & the two
points of attachment of the Rectus Muscle being therefore brought
much nearer together, the Muscle must be considerably shortened.
664. As the original length of the Muscle is diminished its power
of contraction must be diminished in proportion, for the two
ends of the Muscle have in consequence of the accident approximated

♀. 668. Lady B. broke both her Patellæ, they were reunited by ligament
& she lost entirely the use of her Legs, consequently was [n??]
able to walk, she has been in this state 2 Years when Mr. [H?a?] 
her: conformable to the principle laid down in the Text, he set
upon a Table with her Legs hanging inflected over it, he desired her
think attentively of extending her leg & try by the powers if the will
to raise it forward, at first her mind had not the least [influe??]
on the Leg by repeatedly determining the influence of the will to 
the Muscles & repeating this endeavour several times for two
three days she gained a trifling power of Extending her Legs, by persisting
in the same means she increased that power so as to
be able to extend them compleatly, she was then directed to raise
he Leg with a small weight affixed to the Toe, this weight was
gradually increased, at length she was set upon her feet & obliged
by an attempt to walk to Exert a greater force, by daily exercising
the Muscles in this manner & gradually increasing their labours she
was at last restored to the use of her legs, which were formerly considered
as irrecoverably lost.

126
approximated themselves nearly entirely as much to each other as
they were accustomed to do in voluntary action, hence it is evident
the powers of extending the limb must remain lost unless the
Muscle acquires a new action, thus accommodating itself to the
present Circumstances.     
665. The Muscle will acquire however a new action in time &
moreover will in time be enabled to shorten itself, so that by its
contraction the power of extending the Limb shall return to the
patient.
666. This power will be the sooner restored if the Surgeon & the
patient join their endeavours to induce in the Muscle an habit
of Acting.
667. This is to be done first by giving passive motion to the limb
& then by the Patients exerting attentively the influence of the
will upon the part.
668. For the Muscle being originally under the influence of
the will, if the powers of volition are resolutely [& powerfully] & industriously
exerted, will in time recover its pristine action & voluntary
motion of it will be restored. ♀.
669. If the Union is formed by bone from the irregular formation
of the Callus, a bony ridge may be raised on the internal
surface of the Patella which may impede the future actions of the
Joint.
670. It must be evident that the knee should be kept straight

☍. 673. The Triceps Extensor Cubiti being fixed to the Olecranon
when a fracture of that process happens, the superior portion
of the bone will be drawn upwards by the involuntary contraction
of the Muscle, in the Cure the superior is to be brought
downwards, the Arm for sometime kept extended until Union begins
to take place & the action of the triceps is to be checked by
Bandages, when Union is partly formed, as after a fortnight it
mostly will be, then passive motion is to be given to Prevent stiffness
of the Joint, & lastly when union is compleated a voluntary
motion as in the Case of the Patella.
It is remarkable that in general the luxuriant Callus
of a bone is on the outside if its internal surface is exposed to the
action of Moving parts. Thus a ridge from a callus of a fractured
Rib, is never on the inside of the Rib.
After Muscles have acquired a new action the next step
is to give them strength, which must be done by frequent Exercise
It is to be observed that the greatest possible Contraction of a muscle
is somewhat more than a motion of the Joint which it serves admits
of, hence when the Patella or Oleacranon is fractured – the Extensor
Muscles will be shortened more than they were in voluntary
action.

127.
X that in order to the retention of the bones in their approximate
state we must apply a bandage rolling the thigh from above downwards
to prevent the involuntary Contraction of the Rectus Femoris
also that rest should be insisted on, the Surgeon should repeat his
motion of the Limb once in two or three days, afterwards more frequently,
until at length the proper time comes for the Patient to
Exert self-motion (Sec Lady B's case 667).
671. The union of the Bone will be much sooner accomplished
by bringing the seperated portions of bone near together & retaining
them in that situation, for by this means the Muscle will not lose
its original Length & of course its power of contraction, consequently
less difficulty will hereafter arise to the patient in Extending his
Limb & the Evils of irregularity of Callus & Stiffness of the Joint may
be prevented by the attention of the Surgeon
672. When the Cure has been attempted, as soon as reunion has
begun to take place a slight degree of passive motion should be
given to the Limb, & as soon as Union is perfected, Voluntary or self-motion
should be insisted on.
673. The Olecranon is to be considered as a fixed Patella & the same
principles allowing for that difference will apply to a fracture of it.
674. When the Ancle bones are fractured they are only to be considered
as bones making Joints, & not as liable to be influenced by the action
of Muscles, none of which are inserted into them, they are therefore
to be returned if any displacement has happened to their natural

🌕︎+. 679. Mr. Hunter has once seen a Cartilage die become black
& be thrown off with a portion of bone lying under it, this is also
the Case in White Swellings the Cartilaginous Ends of bones being
observed, the bones are removed together with the Cartilage.
Mr. Bromfield Amputated the Arm of a young Woman
at the shoulder joint, she recovered several years afterwards she came
into St. Georges Hospital where she died on dissecting the shoulder on
which the operation had been performed it appeared that the Granulations
& soft parts were not the least adherent to the subject Cartilage
which they covered loosely like a purse, the same thing happens
when fingers are amputated at Joints. Mr. H has seen the Cartilages
of the Larynx & ribs exfoliate but they have previously ossified & become
a spongy bony substance

128.
natural situation & retained in it by bandage &ca. & when union
has begun to take place between the divided portions of bone passive
motion should be given to the Joint, (675).
675. Cartilage is an animal substance intermediate between the hard
& soft parts, approaching very much in its nature & properties to horn
It has very few Vessels is insensible; has little or no power of absorption,
does not swell from pressure, is not liable to exfoliate even when
exposed & scraped, never goes into the suppurative Inflammation, nor
ever becomes the basis of Granulations.
676. Cartilages may be divided into two kinds.
A. the permanent
B. the changeable.
677. The order A are such as remained unaltered during Life
such are those of the Nose & Ear.
678. The order B. (676) are two fold.
1st. Those which at a certain time become bone for which
before they served as a substitute, such are the Epiphyses of bones wch.
in the Infant are Cartilaginous, in the Adult are bony.
2d. Those whose change into bone to her place at an uncertain
time of Life, & sometimes are never changed into bone, as the
Cartilages of the Ribs, & the ends of the Cylindrical bones.
679. When Cartilages are exposed they do not exfoliate; like bones       
nor do Granulations arise from them, but granulations arising from
the circumjacent soft parts on all sides shoot out & meet over them,
thus losely covering them without adhesion. 🌕︎+.

🜖. 607. The lower Jaw seems an exception to this, the depressors
are always attempting to dislocate the Jaw, but the Elevators keeping
it firm in its socket, opening the Mouth does not give firmness
to the Joint; We see in immoderate Yawning the Jaw will be sometimes
dislocated the Elevators here either for a time losing the power
of action or being over come by the power of the depressors, the latter
are not inserted near the Centre of motion.

129.
680. When the permanent Cartilages are divided the Reunion is
formed by Cartilage, but when the changeable Cartilages undergo
solution of continuity, they are consolidated by bony union.
681. When the changeable Cartilages inflame they take on the ossific
disposition , when they fall into disease they also become bony.
682. Cartilages seldom admit of the ulcerative process, they are
however liable to undergo Contiguous absorption from the Lymphatics
of the surrounding parts.
683. Joints. If we judge of them by the Laws of Mechanics are
in general very ill formed, but this deviation from mechanical
principles, fits them for a vanity of actions, which had the Rules of
Mechanics been strictly adhered to would have required a greater
number of additional Joints.
684. In considering the structure & properties of Joints we are
also to take into account the ligaments & Muscles
685. The Ligaments in general serve as Pivots.
686. The Ligaments of some joints regulate the motion of the
Joint, but there are only such as are moved in one direction only as
the two upper Joints of each finger, others they only serve to sustain
& support.
687. The powers that give force & firmness & direct the Actions of Joints
are the Muscles, the Muscles support the joints in the motions they
have to perform. 🜖.
688. From knowing that the strength & weakness of a joint depends

🜔. 688. 689. These aphorisms require considerable attention
it is observed (48) that the voluntary Muscles may occasionally act
of themselves & independent of the will, & this may be either from disease,
or in spasms, or from a kind of consciousness in themselves of
the necessity of acting when a Man is descending from an eminence
as when he is descending down stairs, the Muscles are all prepared to
support the Joints of the Knee & Ancle, so as to prevent their giving
way, & of course being strained, or any Jarring between the bones
that compose them, & this without any direction from the will, but
seemingly from a kind of attention in the Muscles to the security of
the Joint, but if a Man in walking a longer plane suddenly steps
down a descent which he is not aware of the muscles being unprepared
for the exertion & off their guard do not give firmness to the
Joints, & in this sudden action a jarring & strain of the parts composing
the Joint takes place, hence why strains so often accompany
falls – When a Man falls from an eminence it being uncertain
what part shall immediately receive the shock no particular
set of Muscles can prepare themselves to support a Joint against
Injury.
We gain much information on this Subject from considering
the Cooperation of Muscles. This will enable as to learn why a
Man shall jump from a considerable eminence to the Ground with
out injury, yet from a slight fall shall violently strain the parts
subservient to some of the Joints of his body if we but eagerly clench

130.
depends in a great measure on its muscles we are enabled to account
for several Circumstances otherwise inexplicable.
689. Joints are capable of motion either passive or Active by the
former we mean motion given to a joint by external force, by the
latter that motion derived solely from its proper Muscles. 🜔.
690.
Note continued.
our fist we find not only the Muscles of the hand in motion, but a degree
of rigidity pervades the whole body, the general System of Muscles
cooperating so as to give additional strength to the primary ones
or those immediately concerned in the action of the hand, this is a familiar
instance of the Cooperation of Muscles, so when a Man is about
to jump from an Eminence not only the Muscles of the Legs prepare
themselves to give firmness to the Joint & resist violence but all the Muscles
of the body Exert themselves likewise to give general firmness &
by their general cooperation to assist the Muscles of the legs, in overcoming
the violence of the Jar.. if we suddenly raise an Animal
(as a Cat) upwards the body being elevated its muscles are relaxed, but
the moment we begin to let its body sink towrds the earth the whole
Muscular System becomes in action & a degree of rigidity is sensible
throughout its body, the same holds good with a Child: if in playing
with an Infant (though ever so young) we toss its body tow’rds the
heavens its Muscles whilst it is going upwards remain lax & at
rest, but as it descends towards the Earth they all become Rigid &
firm, prepared as we may say to receive the shock of violence
If

If a Man intentionally Jumps from a considerable Eminence
to the Ground as from an house loss his Knees or Ancle Joints are
injured because the power of the Muscles although prepared to resist
violence & give firmness to the Joints is less than the force with which
his body comes to the Ground & the greater overcomes the lesser.
If a Man jumps out of a Carriage in quick motion he generally
injures his Knee or Ancle Joints from the same cause, for although
he does not in this case jump from any great height, yet the projectile
force of the Carriage (out of which he is thrown as a Stone from a
sling) added to the weight of his body combine to give a greater shock
than the resting power of the Muscles can support, in these cases the
degree of violence, forcing the Joint to passive motion & that perhaps
in an unnatural direction is superior to the power of the muscles to
give firmness & resistence to the Joint.

131
690. Strains always arise from a weakness of the Muscles in
question, or from an intention in them to the task they have to
[ex??ite], being then taken by surprize.
691. If the force of passive motion given to a Joint be greater than
the power in the Muscles to give firmness to that Joint then a Strain
or some other injury to the Joint will ensue (687/689).
692. The Muscles themselves as well as the Joint suffer from strains,
& this from the Causes, being obliged to act unprepared, or being obliged
to resist a force superior to their powers.
693. Dislocations arise from the same Causes as Strains & it is not
impossible but fractures of bones may also be produced by them.
694. Crookedness of the Spine may also originate in a deficiency
of muscular powers, the Muscles of the back not being able to sustain
the trunk in its erect posture.
695. The same Cause likewise, probably gives occasion to Knocked
Knees, we rarely see very muscular People fall into these states.
696. The power of the Muscles in preserving joints being overcome
by the Violence of the external force applied, the joint gives way to
this violence as far as its ligaments will allow, there are stretched to
that side to which the Joint bends & these Ligaments are not unusually 
torn.
697. The joint being thus injured the following circumstances may
arise Vizt. Tumefaction of the Joint & this almost instantaneously.
Ecchymosis.

🜍. 701. When Joints after an injury recover their health it is Probably
the ligaments are injured & not the Cartilages.
702. If dislocations are not easily reduced the parts receiving
the dislocated bone adapt themselves to it.
☿. 703. In speaking of dislocations we say the bone farthest from
the trunk is dislocated, thus when there is a dislocation at the Elbow,
we say the ulna is dislocated not the humerus.

132
Heavy dull pain in the part ( )
Sickness ( ).
698. The tumefaction arises from an increased Secretion of Synovia
added to the other Common Causes of tumefaction from external injuries.
699. The parts which are the seat of pain though in their natural
state insensible now acquire great sensibility, this sensibility
leads to a natural Cure by incapacitating the patient for motion
& so necessitating him to remain in a state of rest.
700. In the treatment of strains & injuries of the ligamentous parts
of Joints, the indications are
Rest.
Topical bleeding, as by leeches.
The application of cold water, Vinegar, Spint; [Oari?]
&ca, or Fomentations.
701. But, the powers of restoration here being weak, the cure will
in general be tedious & too often imperfect, the joint sometimes never
recovering its original health. 🜍.
702 the common causes of Strains (690) will be also the causes of
Dislocations.
703. When a bone is dislocated, its end is thrown beyond the Articular
surface of the bone with which it is naturally conjoined. ☿.
704. The bone being thus displaced the action of the Muscles inserted
into it draws it upwards, so that the limb (if one of the Extremities
is concerned) appears generally shorter than its fellow & if

♁. 705. Here then retrograde motion is to be observed, & the last actions
in the dislocation is the first to be overcome, the last action is that of
the Muscles drawing up the dislocated bone & their force being overcome
by distension, in a proper direction & by it the Head of the bone being
brought to the edge of its receiving articular Surface is then by lateral
pressure to be forced into its place. The humerus is the bone that is
most frequently displaced & its reduction is rendered difficult among
other causes by the Scapula being a moveable bone, it is of the last
consequence sometimes to make the Scapula steadily fixed, a great
variety of motion & a great degree of mobility is incompatible with great
strength, this is a cause why dislocation of the humerus so frequently
occur how far the Ligaments are lacerated in dislocations is not yet
ascertained.
☉. 706. This happens most commonly in irreducible dislocations
of the thigh bone, for its head comes in contact with the Os Illium 
this may also take place in certain dislocations of the Os Humisi
where its head happens to be placed against the Scapula, these necessitous
joints are very similar, to simple fractures not uniting (616).
♂. 708. When a joint inflames it swells & becomes Extremely Painful;
Inflammation of a Joint always requires great attention.
Inflammation arising spontaneously is in general more dangerous
than Inflammation produced by external injuries.

133.
suffered to remain long so the reduction is frequently impossible.
705. In attempting the reduction of a dislocated bone the indications
are.
1st. to make the naturally most immoveable
part a fixed point.
2d. to overcome the action of the Muscles
which draw up the dislocated bone & resist its recovering its natural
situation. –
3d. then by making lateral pressure to force
the head of the dislocated bone in its proper place. ♁.
706. If a dislocated bone remains in its unnatural state a considerable
time & in contact with a bony surface by degrees it forms
to itself a new socket, the bone against which it presses undergoes
absorption, & the adhesive inflammation Arising in the parts around
a new joint is formed, these may be called necessitous joints. ☉.
707. Joints are more subject to fall into diseased habits than
any of the other circumscribed cavities & this from the nature of
the materials of which they are composed, some Joints are more
frequently the subjects of disease than others from being more exposed
to Injury as the Knee.
708. Joints are subject to the adhesive, suppurative & ulcerative
inflammations & to specific diseases as scrophula. ♂.
709. Scrophula may be brought into action in Joints having
a disposition to it by any external violence.



  
       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


134.
710. The adhesive Inflammation is not carried to the same extent
in Cavities of Joints, as in other circumscribed Cavities, because
adhesions being produced, would render a joint useless, but the Inflammation
runs into suppuration, or the Inflammation becomes
of the Scrophulous kind.
711. Inflammation of Joints whether arising spontaneously or
from violence requires.
Rest. Topical Bleeding, sometimes Blistering & general
Antiphlogistic Regimen but as soon as the disease becomes Stationary
it is to be considered as falling into a Scrophulous state &
the treatment of scrophula had recourse to.
712. If a joint takes on Suppuration every point of its Cavity falls
into it, Abscesses in the Joints should always be prevented if possible,
as they are productive of the greatest Evils.   
713. The suppuration here rarely goes on kindly, it is a mixture
of the adhesive & suppurative inflammations, the parts want power
to carry on readily any process, even ulceration goes on very slowly &
a considerable time is taken up, in bringing the matter to the Skin.
714. The ends of the bones forming the joint here become ulcerated,
indeed the bones seem to accept of the ulcerative Absorption more
readily than the other parts employed in forming the joint.
715. From the backwardness or inability of the parts to commence
the process of restoration & the constitution being long teized by an incurable
local Disease Hectic ( ) is produced & the patient is destroyed, unless

719. As between two ribs, this is seldom inconvenient but may
if it is taking place between the Radius & ulna, hinder the pronation
& supination of the hand, it happens when two Bones are within the
reach of ossific Inflammation arising in either of them.
Φ. 719. Here circumstances are similar to a fractured bone being
united by Granulation as in Compound fracture.

135.
saved by a timely Amputation which in general is best performed
early.
716. Diseases of the joints more readily produce Hectic than diseases
of the Bones in which joints are not affected, should circumstances
more kindly arise, & the suppuration & ulceration go on quickly,
it may happen that granulations may arise & a cure be obtained
without the loss of the limb & only with Abolition of motion in the joint.
717. If when motion is lost in a Joint, Anchyloses is said to have
taken place.
718. Anchyloses is produced by two Causes Vizt.
1st. By an immobility of the bones produced by a
change in the soft parts forming or surrounding the Joint.
2d. By an immediate Union between the Bones
themselves.
719. Anchyloses are of five kinds. Vizt.
1 Lateral Anchyloses.
2 Surrounding parts becoming bone.
3. The Capsular Ligaments of Joints taking on the
ossific Inflammation & becoming bony.
4 Granulation arising from the Soft parts in
a joint & afterwards becoming bone.
5. The ends of bones forming a Joint becoming
ulcerated & Granulations taking place, these granulations renting
becoming bony & in fact forming the two bones into one. Φ.


  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


136.
720. When in consequence of proceeding inflammation, or any
other cause, a stiffness & partial loss of motion in a Joint takes place
the Joint [persevering] preserving its original structure or at least
with little alteration, we can often restore its use by giving it a
passive motion frequently repeating it as advised after fracture of
bones communicating with Joints. (658).
721. The powers of Flexion are more easily restored to a limb than
the powers of extension.
722. When joints communicate or are in contact with each other,
as those of the Tarsus & Carpus. Suppuration beginning in one
joint will generally extend itself throughout the whole & all of them
will equally fall into disease.
723. A loose Cartilaginous or bony substance is sometimes found
in the Cavity of the knee Joint this may be formed in the following
manner, some blood being extravasated into the cavity of a
Joint may become organized & at length Cartilaginous or bony, not
being an original formed part, it may in the motions of the Knee
[be] broken off, from the part on which it had been formed, & thus
be found loose in the Cavity of the Joint.
724. Gun shot wounds, are to be considered in general as
wounds accompanied with contusion, they are followed by the same
effects & require the same mode of treatment.
725. These wounds being made by a projectile body driven wth.


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


137.
violence against a part, the extent & degree of the injury will
be in proportion to the magnitude of the projectile body & the Velocity
with which it is driven against a part.
726. The danger of Gun Shot Wounds is to be estimated according
to the nature of the part or parts injured & the degree & Extent
of the part injured.
727. Many circumstances will depend on the degree of velocity
with which the projectile body is driven against a part, as
1st. The greater the Velocity of the projectile body as
a Ball the more the Wound will be made in a straight line.
2d. The greater the Velocity of the ball the more the
Wound will approach to the nature of an incised Wound.
3d. The greater the Velocity of the ball, the greater
will be the danger of Hemorrhage.
4th. The Velocity of the Ball will decrease in invers’d
proportion to the obstruction given to it.
728. Gunshot wounds as all other Contused wounds are attended
in general with less hemorrhage than Wounds from incision
& gun shot wounds are in general slow in taking inflammation.
729. These wounds being attending with a destruction of the life
of several parts, cannot heal by the first or second intention, the dead parts
must slough & be thrown off, so that the process of suppuration
is necessary.


   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


138
730. The slough will be larger where the Ball enters than where
it goes out.
731. We divide Gunshot Wounds into Simple & Compound.
732. By simple we mean where the Ball passes into or through
soft parts only as Muscles & Integuments & which are not attended
with the effects enumerated in the following Aphorism.
733. The Compound [we] subdivide into
1st. Those in which a bone is fractured.
2d. Those attended with the division of some large
Artery. 
3d. Those penetrating some Cavity.
734. The penetrating wounds (733 3d) are either
A. simple penetrating or
B. Those also wounding some contained Viscus.
735. When a Ball passes through a part the most depending
orifice will heal sooner than the superior one.
736. The healing of Gunshot Wounds is always more slowly
performed than the healing of incised Wounds.
737. The degree of mischief done by Gunshot wounds is not
always Early to be ascertained, because parts may suffer violence
without any proof of the kind of injury appearing until sometime
after the accident for.
738. An Artery may be so injured that a portion of it shall become
dead, yet the seperation of the dead portion shall not

🜖. 741. As when a Ball, Bone, or any extravasated fluid presses
on the brain we may remove a portion of scalp to prepare for
the Trephine. As when the intestines come out through the
wound & cannot be returned without dilating it.

139.
take place at the time of the accident, but sometime afterwards,
so that though some hemorrhage happens when the injury is
received, yet a violent one may come on when the dead portion
of the Artery sloughs away – or.
739. A Ball penetrating the abdominal Cavity may bruise
even to death some portion of some Gut, yet the Canal shall
for the present remain entire, nor the exit of faces through its
side take place, until the seperation of the dead from the living
parts is affected.
740. Dilation of Gunshot wounds is not in general necessary
& therefore not to be practised, however the same indications
which require the dilations of other contused Wounds may also
direct us to enlarge these.
741. Dilatation of the Wound, or even the removal of a portion
of soft parts may be necessary when a Ball or other foreign
substance presses in any vital part, a large Artery, or a Nerve,
likewise in case a large Artery is wounded or can be taken up
also when a part is displaced & can be restored by dilating in all
these Cases it is right to enlarge the Wound. 🜖.
742. When a ball is lodged in a part where its continuance may
be the Cause of danger, if we can extract it, it is right to
make dilatation.
743. It is wrong to dilate simply, because a Ball is lodged

🜁. 743. Balls we know, often remain in parts for years
without producing any inconvenience & sometimes they are
never found, with regard then simply to the ball being
lodged in the body, the Surgeon need be under but little concern,
he has only to take into consideration, the other circumstances
present, as the seat of the Ball, the nature of the Part
injured &ca. –
♂. 745. Four Frenchmen were badly wounded by gun shots at
Belisle, two through the Chest, one through the Elbow & one
through the Deltoid Muscles, Scapula &ca. All the Patients did
well without dilatation of their wounds. If the surgeon makes
dilatation, the consequence is that the cure will remain unaccomplished
equally as long as if nothing had been done, The superficial
parts will heal to a very small hole & the deep seated
ones remain open, so that a fistula will remain, incurable untill
all the dead or foreign matter is come away, as exfoliation
of bone &ca. Again in gun shot wounds where the Ball cannot
be followed, as when it has entered the bones of the face, dilatation
must be entirely useless. A Reason given for dilatation
has been the preventing or taking off inflammation & tension,
but has not the incision made in dilating rather a tendency

140
in a fleshy part, or with a view to Extract a Ball, where the
circumstances similar to these (741-742) do not indicate the dilation
of the wound. 🜁.
744. In simple gun shot wounds no advantage is gained by
their dilatation, for the wound made by the knife of the Surgeon
will heal much sooner than the wound made by the Ball
so that dilating will not alter the nature of the Wound or
hasten the Cure.
745. Moreover if an Extraneous body, as a Ball splinter of a
bone &ca. is to be thrown off, the wound though dilated or treated
in any other manner will not heal until the foreign matter
is thrown off, so that, all attempts tow’rds a Cure must be fruitless,
until that Event takes place, the wound will heal so as to
leave a small hole only, open, which will remain unhealed until
all the Extraneous matters, which are to be thrown off
are come away. ♂.
746. In examining Gun shot wounds the probe should never
be used where the finger can be admitted, & forceps &ca is never
to be introduced but when the Ball &ca. is within our reach.
747. If a Ball passes some way under the Skin, & again
passes out at a considerable distance, an opening should be
made midway between the two orifices to prevent the formation
of an Abscess.

to induce these affections.
🜔vmss. 🜔. 751. Balls that do not go through & through are
generally Spent balls, unless it happens that a ball strikes
against a bone; a Ball shall sometimes enter the breast obliquely
& afterwards go almost round the whole body & be directed
by a rib until it pier as the Skin & makes its way outwards.
The Course of some balls is really surprising, Mr. H has seen
a ball enter on one side the Shin bone, go across it & raise up
the Skin from the Periosteum & make its exit on the opposite side
without doing any injury to the bone, now had the Ball struck
the part with great velocity it must have gone directly across the
bone & carried away a Portion of it. A Soldier had a Ball
enter the Biceps Muscle of the Arm & pass out under the Scapula
close to the Spine.
🜔vmss. 🜖. 752. It is difficult to say on what this red line depends,
it seems to be neither the effect of Inflammation nor
of Extravasation.

141.
748. If a Ball passes through & through immediately under
the Skin, the orifices not being far asunder, it might be right
to open the sinuous wound it has made through its whole
length, for the Skin does not so readily unite with the parts
underneath, as muscular parts do with each other.
749. If a Ball is lodged under the Skin & can be felt & the
integuments are bruised & threaten to slough away, it may
be right to incise the Skin & Extract it, for the mischief will
not be increased by taking it out, & it will be giving satisfaction
to the patients mind.
750. If the Skin appears to remain quite sound & free from inflammation
or disposition to slough the immediate extraction
of the ball is by no means necessary.
751. The Course of the ball will be ever extremely irregular it
will vary from the perpendicular or Horizontal direction to Oblique
or tortuous & sometimes its Course will make a considerable
section of a Circle. 🜔vmss. 🜔.
752. A red line appearing on the Skin will in general merk
the Course of the ball. 🜔vmss. 🜖.
753. It is unnecessary to dilate a Wound penetrating a Cavity,
as the Abdomen, or Thorax unless, some other Object requires
the attention of the Surgeon than the simple penetration of the
Cavity.

     

 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


142.
754. Compound Gunshot wounds in which an Artery is divided,
or a bone fractured, as there is nothing specific in their nature
so the general principles of Surgery will apply to their
treatment.
755. Penetrating Wounds (733 3d) are divided into
a. Simply penetrating wounds.
b. Wounds penetrating some contained Viscus.
The containing Cavities will be the abdomen, the thorax & the Cranium.
756. Wounds simply penetrating the Abdomen will in general
do well, provided the first or second mode of union takes place, so
as to exclude the Stimulus of imperfection from giving a general
alarm to the whole Cavity.
757. Compound penetrating wounds of the abdomen will again
divide themselves into two kinds
1st. Those which penetrate some containing Viscus
as the Stomach, small intestines, large intestines, Bladder &ca
2d. Those which penetrate some non containing
Viscus as the liver, spleen &ca.
758. The Compound penetrating Wounds (757 1st.) will have different
Symptoms according to the part receiving the Injury.
759. The Symptoms of wounded Viscera will be either
1. Immediate or
2. Secondary.

🜔vuss. 🜖. 760. A Young Gentleman received two or three Shots
in his abdomen, one of which went through his body, entering
before & coming out near the Spine, his stools were natural, from
which Mr. Hunter pronounced his bowels unhurt, his urine was
bloody, which shewed either his Kidney or his Bladder to be wounded,
he recovered.

143
By the first is meant peculiar Symptoms arising immediately
from the injury done to the Viscus.
By the second, those which arise from the consequences of that injury
& not from the injury itself.
760. The immediate Symptoms of wounded Stomach will be
sickness, Vomiting, great depression of Mind &ca.
Wounded Intestines --- Bloody Stools.
--- Liver --- Pain in the right or left Shoulder,
according as the right or left lobe of the Liver is wounded, discharge
of pure Blood by stool.
Kidneys or Bladder --- Bloody Urine, & here the Ball if it
remains unextracted may prove a nucleus for a future Stone,
a wound of the Spleen will give no particular symptoms, it is
in general followed by a profuse extravasation of blood into the Cavity
of the Abdomen.
In general wounds of the Liver & Spleen will have none but immediate
Symptoms. 🜔vuss. 🜖.
761. It will however be very different in Wounded containing
Viscera or those which naturally contain quantities of foreign secreted
matter, as the Stomach, the Intestinal Canal, the Bladder
the Gall Bladder &ca. the Intestinal Canal being wounded, considerable
time may be elapsed before the seperation of a Slough
gives an opportunity for the fœces to escape, these getting into the
common Cavity of the abdomen, at what distance of time soever from

🜔vuss. Φ. 762. A Gentleman in Duel had a Ball passed through
his Belly, he had no particular Symptoms for 13 days, on the 14th
fœces came through the Wound nothing further indicating mischief
Mr. H pronounced him, out of danger forming his prognosis
on the principles laid down in the text.

144
the injury, will become the cause of general inflammation
of the whole Cavity with all its consequences, as suppuration,
Gangrene & Death. A Wound of the Gall Bladder, ductus Coliducus,
Parceaticus, or Urinary Bladder, if communicating with
the common cavity, may produce the same affects though probably,
more slowly, see ( ).
762. In general Wounds of the containing Viscera will destroy
the Patient, but it sometimes happens that previous to the
appearance of any secondary Symptoms adhesions shall take
place between the Wound in the intestines & the wound in the
peritoneum & common integuments, so that when the slough comes
away the fœces &ca. will escape, not into the Cavity of the Abdomen
but through the artificial Canal formed by the adhesive inflammation,
& which as an artificial Anus or Urethra, will
give an exit to the Substances to be evacuated, when this circumstance
takes place no other ill Symptom forbidding us, we may
offer a favorable prognostic. 🜔vuss. Φ.
763. The time which may elapse before the secondary symptoms
appear may be, 10-12, or 14 days (762 Note).
764. The Artificial Canal (762) will sometimes close & heal up.
765. Wounds simply penetrating the Cavity of the Thorax will
be only so far dangerous, as they may produce exposure of the thoracic
Cavity, if the first or second mode of union takes place before



 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


145.
before the alarm is given to the Cavity no mischief arises.
766. Wounds of the Lungs are not always fatal, those made
by a Shot are less frequently destructive than those made by
a sharp instrument, as a Sword or Bayonet, for
767. One great cause of the Mortality of Wounds in the Lungs
being excessive hemorrhage into the Cavity of the Thorax, the
hemorrhage following a Gun shot wound will be much less than
that produced by a cutting instrument.
768. Symptoms of a wounded Lung will be Bleeding from the
Larynx, Cough, pain, in the side, fainting difficulty of breathing.
Diminution of motion in the muscles of the Thorax because
the Muscles of one side cannot act without those of the other
side acting likewise.
769. The Wound being in a Vital part the pulse will grow quite
hard.
770. The Patient will not lie in an horizontal posture but is
desirous of sitting Erect that his Diaphragm may be as freely
expanded as possible.
771. A profuse Extravasation of blood in the Thoracic Cavity may
be judged of from the sense of weight complain’d of by the patient,
from the lowness & faintness which must attend so sudden & copious
evacuation from the Lungs, & the common Symptoms of a sudden
accumulation of fluid in the Thorax. ( ). –

🜔🜹. 773. Penetrating wounds of the cavity of the head will be
considered among the diseases of the Encephalon (785).

146.
772. A Gun shot wound penetrating the Lungs, the wounded
Lung, commonly collapses & therefore an adhesive of the
wounded part to the pleura cannot take place
773. Gunshot wounds not healing without suppuration soon
will be left for the matter, which may be collected in the Chest
to drain off, but this will be attended with the inconvenience of
making the Thorax an exposed & imperfect Cavity, if the quantity
of Blood Extravasated is small it may be absorbed, but if there
are Symptoms of a large quantity being collected in that Cavity the
operation for the Empyema should be performed as early as possible,
because if the Blood coagulates it will adhere to the sides
of the Cavity & not be got out without the greatest difficulty, or in
some cases it may suffice, or be best to enlarge the original
Wound. 🜔🜹.
774. Gunshot Wounds may so far injure a part, that the process
of restoration cannot take place in it, & therefore the Wound
is rendered incurable, in this case the removal of the part becomes
necessary, & when a part, as are upper or lower limb has been
so much injured that its removal is necessary, we must determine
in what case Amputation should be immediately performed or
in what it may be deferred to some future Period.
775. Should a part, (as an upper or lower extremity) be so far       
nearly seperated from the body, as only to hang by a small Portion


 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


147.
Portion of soft parts, it may be immediately removed.
776. Should an hemorrhage from some Vessel, which cannot
be restrained endanger the Life of the Patient, amputation of
the Limb should be immediately performed.
777. But in most other cases, it is adviseable to defer the Amputation
until the Inflammation is gone off.
778. If a Cavity is wounded & any of the contained Viscera protruded
they should be immediately replaced.
779. Bleeding is not indiscriminately to be had recourse to in
Gun shot wounds
780. We are always to be directed in our opinion with respect to
this Evacuation, by the nature & situation of the part injured, & its
powers of action, & the general strength of the patient in proportion
to the general action of the Vessels.
781. Excessive bleedings having been employed, Patients have
sunk suddenly.
782. The use of the bark becomes highly proper after Inflammation
has subsided, & even during the presence of Inflammation if
attended with weakness of the System, it is however necessary sometimes
to accompany its use with small bleedings.
783. After the sloughs occasioned by Gun shot Wounds have been
thrown off, though the Ball or other Extraneous matter remains
in the body, the ulcer will granulate & continue to heal so long

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


148.
as the extraneous matter remains quiet & does not stimulate
784. When an Extraneous body remains unremoved, the ulcer
may become fistulous, or a fistula may even be formed when the
foreign body has been extracted, in which case it is to be treated
as another fistula.
785. Tents are however always improper.
786. Diseases of the Brain are of two kinds, Vizt.
a. Where the imagination is affected, from various
causes as in Mania &ca.
b. from Mechanical Injuries.
787. Mechanichal Injuries (.786.b.) may be either. 1st. concussion
2d. Compression, 3d. Wound or loss of substance 4th want of due compression.
788. The three first may exist seperately, or any two, or all three
together, their Symptoms will be nearly similar, there are as cessation
of sensation, & voluntary actions, the Muscles of the mouth &
throat becoming flaccid, froth being discharged from the mouth
with the appearance of fullness of the Vessels, the Symptoms
of the 4th. will be restlessness & insensibility.
789. Vomiting accompanies all these affections of the brain & arises
from Sympathy.
790. Vomiting however never takes place during the time of perfect
insensibility. –

  
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
791. Injuries done to the Brain diminish sensibility, Injuries
of other parts increase it to a certain degree.
792. Concussion (787) may depend upon a displacement of parts
of the brain, the degree of concussion will be in proportion to the
violence with which the blow is given, whether the head falls
against any Body, or any hard body is driven against it.
793. Compression ( ) may follow accidental Violence immediately
or arise sometime after.
794. Compressions may be owing to any of the following causes
Vizt.
1st. To a depression of the Scull from Fracture
2d. to pressure of some part of the Cranium from the
thickening of a diseased Bone.
3d. To water in the Ventricles
4th. To distention of the Blood Vessels.
5th. To Inflammation.
6th. To the formation of Pus
7th. To the extravasation of Blood.
8th. To a Tumor in the substance of the Brain itself.
The causes of Wounds or loss of substance in the Brain must be
sufficiently obvious.
795. Concussion will be either.
a – Simple – b – Compound immediately or
c – Compound secondarily.
796. Simple Concussion is where there is no fracture, compression

   
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


149.
or Extravasation, we must endeavour to distinguish between Concussion
& the effects of intoxication. The effects of simple concussion
will soon be carried off by plentiful bleeding &ca. but if it is
Complicated with Compression the effects will not be diminished by
time, but rather increased, Compression may instantaneously follow
Concussion, in which case it is said to be compounded immediately,
or Compression may arise when the effects of Concussion would
be naturally going in which case is said to be compounded
Secondarily.
797. Fractures of the Scull may always be considered as compound
Fractures, they are either made so intentionally by the Surgeon,
or are found by him in that state.
798. Fractures of the Skull are of three kinds. Vizt.
1st. Fracture of the Outer plate
2d. Fissure
3d. Bone broken in several places
These may be complicated with each other.
799. The 1st & 2d. (798) may be the remote Cause of Compression (793)
& the third may in itself become the immediately Cause of Pressure on
the Brain.
800. Bleeding from the Nostrils or Ears, is a common though an equivocal
Symptom of a fracture of the Cranium
801. The concussion will be in general less, where the Bone is much
shattered than when otherwise, for the force being spent upon the Skull
less shock is given to the Brain.

       
 
  
    

       

  
        






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


150.
802. Gun shot Wounds of the Head & those made by other Bodies
moving with great Velocity do not produce for the most part great
concussion.
803. Fissures of the Scull will run in very different directions along
the Cranium, across it, & even across the Sutures. –
804. If the Scull is soft & yielding there will be often depression of the
bone without fracture.
805. When there is fracture & depression of both tables, if the fracture
detaches an entire piece of bone from the undepressed Cranium & that
whole piece is driven downwards, then the fracture of the internal table
will always be larger than that of the External.
806. If the fractured bone is depressed on one Edge only, & through
both Tables, the inner table will still go shelving off beyond the outer.
807. hence (805-806) will appear the difficulty of elevating depressed
portions of bone, so as to make the seperated pieces, fit themselves
to the undepressed Cranium perfectly smooth, hence also the utility
when a portion of bone is to be removed, to make the margin of the depressed
piece a part of it.
808. The indication in all fractures of the Scull, is to prevent or remove
pressure on a Vital part, that is the Encephalon, therefore it is
necessary whenever there is a fraction with depression, when a piece
is detached & driven inward to remove it entirely, or if one edge only
is depressed to take care to elevate it properly, the operation employed
for the purpose of elevating or removing depressed Bone, or for making

🜔vmss 🜖. 814. The situation of the extravasated fluid will be very
different in different Cases & hence the great uncertainty of our Release
the Patient, who labours under compression from some cause independent
of depressed bone, it may be between the dura mater of the Scull,
between the dura & pia mater, between the pia mater & the brain,
or it may be in the Ventricles, & even in the substance of the brain itself.

151.
an opening for any necessary purpose into the Cranium is called
trepanning & the instrument used by Surgeons for that end is called
the Trephine.
809. When a fracture is discovered it should in general be traced as
far as possible throughout its extent, & therefore we are sometimes Obliged
to remove the Scalp freely.
810. Fractures of the Scull are so often complicated with the immediate
or secondary symptoms of Injured brain, that few cases will
offer in which the trephine will not be necessary.
811. It is never necessary to apply the Trephine either in Cases of
fissure or fracture of the outer table only, unless there are also Symptoms
of an injured brain, & those not of Simple concussion alone.
812. In all cases of Compression either immediate or Secondary of Concussion,
complicated with compression, & in all wounds of the brain
it is necessary to apply the Trephine.
813. It may sometimes be impossible to ascertain the exact situation
of the Compressing matter, yet here, as the patient must undoubtedly
die if not relieved, it is justifiable to operate at Random.
814. The situation of extravasated fluid will sometimes be opposite
to the part where the blow was received. 🜔vmss 🜖.
815. The dura mater should never be divided unless from the
greatest & most evident necessity (as when matter or blood is visibly
lodged beneath it) for penetrating Wounds of the dura mater (which
exposes & renders imperfect a Cavity containing the Brain) will in general

♀. 815. Mr. Hunter computes that not more than one in 20 persons in head
would recover from a penetrating wound of the dura mater.
♂. 819. In health we know the Strength is always greater than
the actions.

152.
general be mortal. ♀.
816. The Trephine must be applied (one, twice) or as many times
as the Extent of the Injury shall require.
817. The Trephine may be applied in any part of the arch of the
Cranium where an accident may render it necessary, or eligible, if the
fracture is circular it will be right to repeat the application of the Trephine
until it is surrounded by the perforations.
818. As life consists in the properties of preservation & Action, so
Death is the loss of both.
819. The immediate Cause of death in a part would appear in most
cases to arise from a total loss of Circulation, but this must be the
effect of some remote Cause. ♂.
820. Mortification of a part differs much from common universal
Death, in the latter case the Vessels can be injected & the Structure [cross out]
of the parts examined, but this is not the case with the former its
Vessels cannot be injected, its structure is changed, is destroyed.
821. The immediate cause of mortification, will be whatever can
excite the actions of a part so as to render them superior to its strength,
or reduce the strength of a part so as to be unequal to its actions.
822. Debility Can be only the predisposing Cause of mortification it
cannot immediately produce it, if a part is ever so weak while its
actions, do not exceed its strength it will retain life.
823. From (813) it is evident that a part may fall into mortification
either with or without previous inflammation, in the former Case the

∇. 824. The greater the distance from the heart the more liable are
parts to mortification.

153.
inflammation is the immediate cause of death.
824. Heat should always be in proportion to the living principle otherwise
it produces a necessity of Exertion, which the strength of a
part is not equal to, the exciting of heat then in a part where powers
are very weak may induce mortification.
825. When parts are extremly weakened as to their principle of Life,
by Cold (as when people are frost bitten) the application of heat must be
gradual & Slow, otherwise it will necessarily induce mortification ( ) as
the principle of Life increases the heat may be increased.
826. from (819) we are enabled to discover why scarifications in the
legs of anasarcous patients, or wounds made in their extremities,
either by Art or Accident, why Blisters applied to persons in whose
Systems there is great debility & a disposition to putrefaction should be
followed by [Putrefaction] Mortification.
827. Also why Persons who have suffered severe famine, long exposure
to intense cold, are in extreme old Age, or who have the Circulation
obstructed through a part, or those of tall stature are subject
to Mortification, especially of the feet & Toes.
828. In the Cure of mortification, or restoring parts falling into mortification,
it must be evident that as the cause is a diminution of
powers in proportion to the actions of a part whether common or increased
so the Cure must consist in lessening Actions & in increasing the
powers of the part.
829. Whatever then stimulates a part to action without increasing its

☽︎. 830. The temperature of the atmosphere in which patients to
be cured of Mortification are best placed, should be neither very
hot, nor very Cold, that the natural actions may neither be impeded,
nor hurried on too fast. –

154
strength & powers, must be contraindicated.
830. Hence also it is evident why bark should have so much power
in checking some inflammations, & that opium may prove a very
useful remedy. ☽︎.
831. The Causes will be either (819).
a. Mechanical, as a Blow, or
b. Chemical as a Caustic
832. The less vascular a part is the more readily its Life, is destroyed.
833. Also the weaker the powers of Life in a part are, the more easily
will they be acted on by Caustics.
834. No substance can act chemically but in solution, in order for
the Caustic to act chemically it must be moistened, this is effected
by the serum produced from the vesication which arises from the irritation
caused, by the application of the caustic substance, which Serum mostens
the Substance & thus after the Life of the part is unable to Acts for its
preservation, Operates chemically on the Skin &ca.
835. The action of a caustic when applied to a part produces an
abolition of Life & then the Caustic acts chemically upon its substance
coagulating its Mucilaginous parts & changing its texture.
836. Mortification on the death of a part is often induced with
a view to destroy a diseased or even a sound part (in order to enable
us to make application to some diseased part otherwise out of our
reach) or to give an exit to some foreign substance retained under

 



 
   






 
          
   
   

        
  
 
 
  
  


 
   
    
                                  


155.
the Skin, as pus &ca.
837. The Effects (834 &ca.) will be produced by a variety of substances
artificially & intentionally applied of these the principal are
Caustic Alkalies
Concentrated Acids & Metallic Salts.
838. Of the Metallic Salts Arsenic is the most powerful, whose action
is different in some measure from that of the other Caustics,
as it produces mortification simply by its exciting violent actions in
parts which they cannot support, & not by any chemical process.
839. The application of these substances to sentient parts is attended
with violent pain, that is to be diminished
1st. By the administration of Opium by the Stomach.
2d. By mixing opium with the substance to be applied
3d. By applying plaisters of Opium to the part for some
hours previous to the application of the Caustic.
840. The natural sequel of mortification is a sloughing of the
mortified part, or the process by which it is thrown off from the living
parts immediately in Contact with the dead & the ulcerative absorption
of them is necessary (449).
842. As in the Exfoliation of Bones, so in the sloughing of soft parts
the absorption begins at the external edges of the dead parts, the dead
part becomes dark Coloured & dry, the ulcerative absorption beginning
at the Edges & going through the whole surface of Contact of the living
with then dead parts, the slough is ultimately thrown off like any

☿. 846. We know with some certainly, how far the parts of the body
the Brain excepted & with what comparitive facility they go through
the process of Sloughing, the nearer the heart Cotises Paribus the
more readily the process of seperation will go on, the common integuments
& Muscles will throw off a dead part sooner than a Tendon
Ligament or Bone, as to the Brain it has not been ascertained
whether it will slough or not, for before the seperation of the dead
part can possibly take place, the Patient in general dies.
🜔^. 847. Thus if a Limb is mortified throughout its substance
we may cut off a portion of the dead parts to lessen the Stench
arising from so large a mass of Putrid matter, & render the patients
situation more comfortable, but we must not proceed to amtating
in the living Parts until a compleat seperation has taken
place.

156.
other extraneous Body.
843. As the weaker the part is the more easily is it Acted upon by Caustic,
so the greater the strength of a part, the more readily the seperation
of the slough will go on.
844. New formed, being weaker than original parts it is evident
they will suffer their Life to be much sooner destroyed by Caustics.
845. From (844) we are enabled to learn, why in new formed parts, Mortification
is so Easily induced, as in larger cicatrices &ca.
846. Also why Caustics so easily destroy the fungous Excrescenous
of Ulcers &ca. ☿.
847. In a mortification no incision or wound is ever to be made,
into living parts, at least until the process of seperation is begun,
a portion of the parts quite dead, may however be removed at pleasure.
🜔^.
End of Volume the First.

INDEX
Aphorism Page
A
Animal actions of---39---10 
Arteries---51---13
Absorbents---53---13
Absorption the final end of---56---14
___ulcerative----61, 440---15, 83
Actions voluntary---75---18
___two different cannot exist &ca.---169---35
Air affecting animals---147---31
Anchyloses---718---135
B
Brain and Nerves &ca---69---17
Blood living principle of---110---24
Bladder inflammation of---526---98
Brain inflammation of---548---102
Bones disease in---595---113
Brain disease of---786---148
C
Cicatrization---452---85
Cesarian Operation---525---97
Cartilage---675---128
D
Disease---154---32
Diseases division of---185---38
___local---190---41
___Constitutional---195---42
Dissolution the action of---476---88
Dislocations---693---131
E
Empyema---493---93
Emphysema---500---94
Eye inflammation of the Chambers of---533---99
Exfoliation---618---117
F
Fermentation in Animals---22---7
Fractures---570---108
___communicating with Joints---654---123

G
Granulation---445---84.
H
Habit---98---21
Heat---122---26
Hectic---464---87
Hydrocele---549---102
I
Ideas---71---17
Inflammation---285---57
___Cure---364---71. 
___Topical applications to---387---75
___ulcerative---427---81
Joints---683---129
___& Sacculi Mucosa exposure of---527---98
Joint Cartilage in---723---136
L
Life principle of---24---7
M
Matter---1---4
Medicines---226---48
___their mode of acting---234---49
Mortification---818---152
P
Part the actions of---239---50
Pus---415---79
Pleura Inflammation of---487---91
Pericardium Inflammation of---504---94
Peritoneum Inflammation of---507---95
Puerperal Fever---519---96
Patella fractures of---659---124
S
Stomach---44---11
Senses---70---17
Sympathy---201---42
Suppuration---398---76
Strains---690---131
Scull Fractures of---797---149
V
Vascular System---49---13
Veins---52---13
___Inflammation of---542---101

Aphorism Page
V
Viscera Wounded---759---142
W
Will---74---18.
Wounds Gunshot---724---136
___Penetrating---755---142.