N1
Dr Dorsey
Hugh L

Dorsey
Notes on the materia medica.
Being the substance of a course of Lectures
delivered in the
University of Pennsylvania
by 
John Syng Dorsey. M.D.
Taken during the winter of 1816 '17 and enlarged
during that of 1817 '18 by Hugh Le Hodge.
Vol: 1st

 
 

A. HL Hodge.
Avena-gruel-laxative-17
Arrow-root 19. Mode of dressing 
it-19. Apple-roasted-22.
Animals-25-Mammalia-25
Carnivorous-Gr omnivorous-Wild meat-
Poultry-27. Ova or Egg-29.
B.
Bread-9. Leavened-Unleaven-7. & 11.
State-Fresh bread-9.
Rye Bread, useful in-for-Cataplasms 
-13. Beet-25
Beef 27. Beef Soup-Beef tea-49.
Bleeding 77 See M-
local-Bleeding 103. Cups leeches 65.
103
C
Cupping-103. Dry Cupg 102.
Cerealia-page 7.
Cucumbers-23. Cherries-23-
danger of swallowing stones-23-
Cabbage-Cauliflower-25-
Capon-27. Clean-33-Crab-23-
Cheese-39 useful in Diarrhœa-oil
of cheese 39.
Culinary Processes. 43
Salting-Smoking 45. Pickling-
boiling-47. Condiments 51. Roasting
Baking 51. Broiling-Frying-Herring 52.
Cyder-55. Coffee-67.
D
Dumplings-11
Ducks-27. Drinks-53. Water 53
Fermentd & distilld-liquors-55
Diet. 61-In Inff Disea-61. In a
low Disease 63. in Scurvy 63. Dysenty
Cholera. Dyspepetic-Gout-Consumt: Leprous
E
See the next page
F
Farina-7. Fagopyrum-not
hurtful-17. Fruits-Summer-
21- Laxative-not very nutris-
Properties-pulp indigeste-juice easy
of digestn-useful in Scurvy-21. The
Skin-pulp-juice-Sweetmeats
22-

[cross out]
[cross out] 
F
Fruit-dried-23
apples-melon-cucumber-
cherries 23 Gs apes-Figs-Prunes-
Raisins-25-
Fowls-27. 
Fishes-29-intermediate 
31-not favour
Generate-Sptic-31. Shell Fish-33
G-
Gum page 7-Grapes-25. hurtful
in Dysentry-25.
Geesee-27
H
Hardeen-antiseptic-use in
Fevers-Pearl barley not superior
page 15.
Ham-47-hurtful in Cholera-47
J
Jelly-calf's Foot.51.
E
Emetics-105-
Action of Vomiting-105-

L
lamb: 27-Lobsters-33.
M
Bleed [cross out] in Opthal 
Mania-Cynanche tonsil:maligna-advantges of-85
sq. tracheal: Parotid: 91- Pneum:91
Phtthesis-Hepat-&c-Gout.93. Eruptive
Vine: Hemorrh 95 Apoplexy-97. Palsy-
Tetanus-Convulsion [H??tuia] Tunca 99
& pilep Charea-in Asthma &c. reeles-
Colic
M
Materia Medica-page 1st
-Alimentaria-1st
-a general rule-2. Change
of diet. Vegetable Food-5 See
Vegetables-
Maize-hurtful when green- very
Nutri- use of the herbs 4.
Melons-23-
Animals-See A-page 25
Fishes-See 71-29
Milk-3 5 in Dyapep a 25 leeves. V.e.
Cancer-Phthesis-27. The lead of 39.
Whey.41.milk punch-43.
M
Malt liquors 55.
Materia Medica- 69.
Division of Stimulants Food all
Question concern of nature of 69-
Modus operandi of Med: 71. Blood 77.
not as a preventive- 77 in old people &
children in acute fevers- in Lynoshous 7
in yellow fevers when hurtful-81. in Phlegmolica
advantages of 85.
O
Oil page 5 Orya-not astringent. 
Rice water useful in- Rice
milk- useful in chron: dysenty-7.
Ova-29. methods of drying-
oysters-33.
P 
Pastry-77-Potato-25-Puk 26.
Poultry-77
R
Rattle snake-34.
S
Sugar-page 5-Starch-5-
Sceale-12 Sago-19. Salep 19
Sheep-27. Tr Smallpox-32.
Soup-49. Vegetable Soup-51.
T
Tritium-7. Toast-11 Tapiaca
19. Turtle green 33. Terrapain 33.
Ted-67

V.
Vegetables-page 5-Hast Sugar
Oil-5- Gum-Cerealia 7
Farina-7. Fricticeom-7. Sceale 13.
Hardum 15-Oayga-15. Averna 17.
Fagapyrum-17. Tea or Maige 17
Sago 19. Salep. 19. Tapiaca 14.
Arrow Root-19. Summer fruits-
21 Cabbage-25- Cauliflower 23
Carrot-But-Potato-25-
Veal of Vegetable Soup 51.
W
Whey-of milk-useful in Farms-
41-Wine Whey-41
Wines-55 maderia-57
[cross out]
[cross out]

Part. 1st
Materia 
1.
[cross out]
Materia Alimentaria
[cross out]
In delivering a course of lectures, it has not been at
later years customary to pay much, if any attention to
the materia alimentaria or those substances which
form the ordinary diet of mankind. The importance
of this part of the subject cannot but be acknowledged.
The [cross out] remedies for disese especially in this country are often inert, if the patient
pursues his ordinary mode of living; in much depends
upon the regulation of diet as upon the administration
or remedies, & a Physician who is ignorant
of the properties of the articles of diet is incapable
of properly practicing his profession. Without
entering further into the consideration of this point
we will commence by noticing the properties of 
the several articles which are employed as food in

2.
Under the head of Nutrientia must be arranged- all
substances employed as food or drink & also those articles
which are taken along with them- known by the name of 
condiments altho' strictly speaking, those afford but little 
nutriment.
I will not consider the ultimate principle of substances
carbon: nitrogen &c- as nutrite articles, as I doubt whether
it would be of any practical utility- Aliment may
be considerd under the two heads of Vege & animal [cross out]
products- altho' some few minl substs must be noticed
as afford nutriment.-
* Some substances are nutrits to some animals, but
fatal to others- Thus the horse will eat cicuta what 
is a poison to man- the stramonm is [cross out] devoured
without injury by goats-
Some substances in their recent state are acrid- but 
when dried or otherwise prepared are mild- As is the
case with the Indian turnip- Most subst that are
aromatic are used as condiments- not as [cross out] aliment
& but little as medicines -

3.
the United States X
As a general rule we may observe, that those substances
which are bland & inodorous are mild & nutritious
in their effects on the body & that acrid butter substances
are stimulating medicinal & give but little nutriment.-
To each of these there are exceptions as sugar is a very
nutritious article & yet possesses very considerable
sensible properties.* The question has been agitated
whether man is a graminivorous or a carnivorous animal.
There can be but little doubt, that he originally
lived upon vegetable substances. That these are sufficient
for his maintenance & will keep him in health
& strength, is evinced by the fact, that several nations still
live entirely on [cross out] vegetable food as the Persians on dates, Chinese on rice
& several others. But animal food is almost solely
employed by other nations & it is observed, that man
may easily & immediately change his diet from one
to the other with [cross out] comparatively little inconvenience, whilst other one 

4.
Boeerhaave to show on how [cross out] small a quantity man can live,
supported a person entirely on pease for many months-
Stark- made many expers of a similar kind on himself-
Many nations live solely on animal food- In 
some parts of Africa- fish is the only article of diet- in
Greenld- Iceland- &c- the Inhabits are supportd during
their long winters solely by their [cross out] game 
Syrians-[cross out] formerly lived wholly on animal food
& their descends The Tartars nearly imitate them. The Patagonians
live on the flesh of wild animals exclusively-
The dwellers on [cross out] some of the islands of
the Archipelago live solely on shell fish- Anatomy shows
that man may subsist on one or both- he has the incisors of
the carnivs & the grind of the vegative animals- his intess
are also of a medium length- [cross out] not as short as the 
former or so long as the latter-
* Debility of the digestive organs & bowel compls frequently
result- from a diet of vegets- An animal diet- often induces 
eruptions scurvy Leprosy &c &c-
x There are some exceptions- there is much nourishment in cauliflrs-
Leeks- & other articles- containing none of these ingredts -

5
animals must change very gradually. 60c or It is therefore probable,
that man is capable of living in health & strength
upon either vegetable or animal food, but that a mixture
[cross out] is perhaps the best adapted for his support. 
In some instances a change of diet produces disease [cross out]
especially, when from a vegeteb to an animal diet. *
Vegetable food is the most healthy. The Chinese who
employ [cross out] rice as their sole food are very little subject
to inflammatory diseases. & it is observed that every little
inflammation occurs after a wound or other injury. this
may depend in some measure upon other causes but a
great deal must be ascribed to diet.
Vegetables are more nutritious in proportion to the
quantity of starch, sugar & oil which they contain.
The sugar is most nutritious; sugar & starch are
very easy of digestion, it has been supposed, that oil
is more difficult. Oil when joined with substances
which require mastication & when not taken in very 
large quantities is very easy of digestion as is manifest

6.
Farinaceous seeds change from a mucilage to starch & finally
to sugar- [cross out] the more dry that seed
is the more starch it contains- how this occurs is unknown -
what connectn there may be- between sugar- & the sweetness
of the chyle is doubtful- but there can be no doubt of the
nutrits properts of sugar- How far- Acid is nutritious
is very doubtful- Dr Cullen who maintains that it is- has 
given no satisfactory reason that the Stomach can digest almost
anything there can be no doubt. whether it can digest acid
so that it shall afford chyle- we have no reason to believe-
Oil is very nutritious as has been proved by Cullen- Stark 
lived 14 days on Olive oil & flower & in that time gained 5 lbs.
[illustration] Gum is a secretion from the plant- is insoluble in alcohol-
The Gum Arab: is an article of diet among the Eastn nats 

7.
from the custom of eating butter with bread, when mixed
with mucilagious substances it is [cross out] easy of digestion
& is very Darwin nourishing. * Gum or mucilage (which is only a
solution of gum in water) may be considered as a third
substance containing much nourishment 1. Gum Arabic
is a pure specimen of gum & in some diseases, especially
in those of the bowels may be made the sole article
of food. In the cholera Morbus of children I have
found [cross out] it very useful, confining my patients [cross out] solely to a
meal sweetened with leaf sugar of Gm. Arab. The mucil. is an excellent vehicle 
[cross out] for other medicines. Lime water & milk is a common
prescripn to check vomiting; but in many cases the 
milk disagrees with the patient & is immediay rejected-
the mucilage in such cases is an excellent substitution
The first class of vegetables to be noticed is the
cerealia. which comprehends all those seeds, the powder
of which may be made into bread. Their nutritive
properties are owing to the farina they contain- the
farina has been considered as a mixture of oil & sugar
but it is useless to make the distinction.
Of this class we first notice the wheat or triticum of 

8.
forming flour. This
* [cross out] consists of a mucilaginous substance, soluble in
cold water- of starch- which is insoluble in cold but easily
soluble in hot water- & of Gluten- insoluble in ardent spirit-
water- oil- or æther-
+ Bread made with leaven is acid- that made with
yeast is not-
8. Dr Penington has denied that any fermentn takes place-
he says- that yeast contains large quanty of carbonic acid-&
much more when it is cold than when warm. [cross out] A Moderate
extricates this- which penetrates the dough- by the viscidity of
which large quantities are retained- When heat is greater a
crust is formed- the gas is infain in larger proparts & the
[cross out] moisture driven off-
It is probable that the ingredients- during the process leave
their old combinate & enter into new ones-
A an advantage of each is that they are detained so long in the mouth
& are so well masticd- that they convey large quants saliva
to the stomach-

9.
Botanists- This contains gluten, starch & farina. The
seeds of this plant are ground to powder * [cross out] [cross out] When
mixed with water & baked, it forms the well known article 
bread but in this way it is called unleavened, The
more usual process is, its excite fermentation in the flour
by means of yeast or leaven, the fixed air penetrates
every part of the mass & being in some measure detained 
by the viscidity of the dough, gives it spongy appearance
the fermentation must be checked by baking before the
flour has become acescent. By the operation a crust is
formed, which more effectually prevents the escape of the
air & increases its spongy appearance It has been disputed
whether bread is more healthy & easier of digestion in its leavened or unleaved
state, this must be determined by experiment.
Unleavd bread in the form of crackers, can be taken by dyspeptic 
persons in many cases where the stomach refuses
bread- but in other cases leavened bread is preferred- The
preference cannot be given to either, but must be decided
by circumstances. Bread should be well baked- stale
bread is more healthy than fresh. [cross out] Fresh bread & bread when
partially baked, has excited convulsions & tremors &

10
The crust is easier of digestn than the crumb-
this however is denied by Fothergill- it cannot however 
be doubted-
* He observes that unfermentd bread is much used in Asia- in
America- & in some parts of Europe, No injury results from it- In
Scotland 9/10ths of the people live in unleavd bread- & at the
same time, there are none more healthy- To these observats 
of Cullen we may add, that boiled flour sweetd with sugar is a very common aliment for
children & is [cross out] never injurious-
+- Sailors are said to grow weak, when they derest their biscuit-
perhaps one reason inferd bread is more nutrits than
fermentd- is that a greater quanty of flour is contd in [cross out] a given
bulk-
[illustration] We will often be able to cure chronic diseases, merely by
forbidg the use of pastry & we should there fore always
inquire whether our patient indulges in these articles-

11.
should always be forbidden in disease + Toast or bread again
subjected to heat is very [cross out] easy of digestion & is much used as
an article of diet in violent diseases- In some cases the pateint
is entirely confined to it- & even his drink consists of an infusion
of this toast in water- This is to be sure very low diet but it
sometimes necessary.
Lecture 2nd Nover 12th
[cross out]
Van Swieten & Boerhaave upon whom he comments Consider
unfermented bread as productive of disease: Cullen advocates a contrary opnion
& maintains that it is as least equal to fermented bread. Hippocrates considers it, as not
so easy of digestion to some persons but that to those who
can digest it, it is more nutritious than fermentd bread. 
The several articles of pastry made of wheat flour are general 
difficult to digest as they are but partially baked; in all
cases of dyspepsia, they are to be forbidden especially that
paste which is termed the under crust-nothing is worse-
Dumplings or boiled dough are also hurtful. A great objection 
to all those articles is that they are usually made

12.

13.
articles of dessert- after the stomach is [already] filled, it thus 
obliged as it were to perform double duty.-
The next grain is rye or Secale- This very much resembles
wheat, but has more sugar. It is capable of undergoing
the process of malting- & this affords a large quantity of ardent
spirits- Most of the Whiskey used in this country it produced
from rye, which has thus become a very pernicious article-
It is more [cross out] liable to the the acescent fermentation
than Wheat & this requires more care in making 
bread. Rye bread owing to its acescency & to other circumsts is gently laxative- keeping up a slight
discharge without any purging. In some cases of obstinate 
costiveness, which resisted the use of various medicines, I have
succeeded by the use of rye bread; It should therefore be
omitted, when diarrhœa is present & prescribed in the opposite
state of the alimentary canal- In prolapsus ani where costiveness
would aggravate the disease & where purging would produce
too much laxity of the parts- a diet of rye-mush, morng & evening 
is of very great service- Dr Physick first employed it with this
service- It has also been employed in cataplasms, to give
them proper consistence & as being slightly stimulant.

14.
* It is susceptible of the malting process- The flour may be
made into bread- but it is better to join it with other articles
of the cerealia- 
+. As to drinks in infl diseases- the following may be used 
beging with the mildest- Water, toast & water- barley water-
mucilage of G. Arab:- & either of the above with sugar-
The idea that it induces Opthala is altogether unfounded-

15
The next article to be noticed is barley or hordeum- This has
more sugar than the Wheat or Psyl * but Cullen considers
it as less nourishing, as it contains less oil. It is considered
an antiseptic. A decoction of the seeds, under the name of
barley water is very mild & nourishing & is much used in
febrile diseases; but I have found, that in higher inflammatory 
diseases- especially at their commencement the large
& free use of diluents keeps up the disease when the symptoms
begin to abate, then they may be useful. Pearl barley
or that which is deprived of its bark or shell is considered preferable
to the common- but in my opinion erroneously; as it is apt 
to become mouldy & bad & in its best state communicates
to the water something more than its mucilage; this last can
very easily be extracted from the common barley- by warm water
Oryza or Rice is the next article- This has less sugar & less acescent milk than the
former but is very nutritious-it is very slow in undergoing 
the acescent formentation, as is proved by Percival- Vis more susceptible 
of putrefaction. It is not astringent, as has been
supposed- When well boiled, dyspeptic persons in general bear it
very well. Rice water is very useful as a demulcent in bowel
complaints & mixed with loaf sugar is quite grateful- Perci 

16
[cross out]
+ Mr Davy has given us a table exhibiting the different
properts- of extractd & nutritive matter in 1000 parts- What he 
says in 1000- contains 955 or extract: matter-
[cross out] barley- 920- rye 729- oats 743.

& milk- rice soup are also good preparations- In the diarrhea
which frequently remains after dysentery I have found
nothing more useful than Rice & milk. ℥ss being given g.h.
Oats or Avena- is not much used. The powder of the seeds is
used to make a gruel which is nourishing & pleasant- an
ounce is boiled in [cross out] 3 quarts of water till reduced to 2 quarts & then strain all stimulating
ingredients should be omitted. [cross out] It invariably has
a laxative effect, & often therefore debilitates instead of nourishg part
Buckwheat or Fagopyrum native plant of Greece is a nourishing article & under
the form of cakes is much used. These have been considered
hurtful but are not, when properly raised. The large
quantities of Butter used with them, are certainly injurious
Indian corn - Zea or maize nature of Ameria contains farina & a sufficiency of sugar
for the process of malting- When in its green state, it is
flatulent & very indigestible, as is evident from its being
discharged almost unaltered. Dr Barton considers it as the 
most nutritious of the cereal. The mush made of the  
flour is very useful. From the husks of the ear excellent
mattresses may be made [cross out] inferior only to the hair
they are very pleasant & are much used in the navy of G-
Britain. x This finishes the class of cerealia

18.
* [cross out] It is the fith as rather the faucla of the fith of the
cylas circinalis-
X It is prepared by scraping off the bark of the [cross out] root then baking it so
as to become hard & dry- The operation of scraping is of 
no service it increases the expense of the article without rendering 
it any better-
* [cross out] It is prepared by macerating the root- It contains an
acrid subste & should be well boiled for one or 2 hrs-
otherwise it is very indigestible- If any hard lumps are
left it is very hurtful

19.
Sago [cross out] as containing-a considerable proportion of
farina may now be noticed*- It is readily soluble in boiling water
so as to form transparent jelly. It is insipid. It has been ranked among
medicines but it possesses no medical powers, [cross out] must be
considered merely in [cross out] nutriment- in which class it stands
high. Very similar to it is jalep or the root of the Orchis
Mario [cross out] 
The powder yields a gelatinous substance which has been considered very
nutritious Tapiaca is brought from South America * The 
[cross out] powder is dissolved in boiling water & forms a trans-parent
jelly which is very nourishing.
Arrow root is procured from the miranta arundinacea of
the W-Indies- it contains much mucilage. In preparing it,
a little cold water should be added to form a paste-afterwards
a sufficient quantity of warm water to form 
a jelly- Milk is sometimes used instead of the water & 
very properly, but in some cases the milk does not agree
with the stomach or bowels as in diseases of the 
parts- Arrow root is very nutritious & highly useful
to convalescents, also in bowel complt cholera- diarra- &c

20
They are useful in all inflamy diseases- where the
stomach & bowels are unaffected-

21.
Lecture 3rd Nov 14th
Without adhering to any particular arrangement we shall
consider the other articles of diet which remain. First of the 
Summer Fruits- These have some general properties which are
common to nearly the whole class. They all have a peculiarity 
of taste which cannot be described- but which results form
a combination of the acid & sugar. Dr Cullen has stated that 
they quench thirst, & that they correct the putrescency of the fluids
this last is not the case the human fluids are incapable of 
putrefaction & there are no such substances as antiseptics as the term is above used.
x [cross out]. They are gently laxative & do not possess much nutriment.
When taken into the stomach the acid excites unpleasant
symptoms in [cross out] dyspeptic & particularly in gouty persons. Severe
attacks of the gout in the stomach - violent spasms have been brought on merely by the smell
of an apple. These fruits have also an acid & acescent matter, which
renders them susceptible of fermentation. The juice of is very 
easy of digestion, but the pulp frequently passes through
the bowels undigested- this is true especially of the grape; I
have also know the pulp of melons discharged by vomiting
on the fourth day after being swallowed. They are very useful
in many diseases, especially in the scurvy- but sometimes

22.
X Some fruits are not used in a raw state- as the quince & 
the crab-apple- but are useful when preserved- Sweet meats
of the Peach- quince- raspberry- strawberries are easy of digestion.

23
they produce flatulency- colic- vomiting- diarrhœa- [cross out] especially,
[cross out] when the fruit is not fully ripe. Different
parts of the fruit possess different properties. The skin is indigestible,
as also is the pulp- the juice is more useful as has 
been observed. The pulp, however, when roasted & sweetened
with sugar is very innocent. When boiled & preserved in sugar 
forming sweet meats they are very useful in some febrile
disorders-X Fruits, when dried preserve a good deal of their sugar 
& prove slightly nourishing & laxative, these should
always be boiled, as also should the quince otherwise they
are injurious. When low diet is enjoined a very excellent substance 
is the roasted apple- which is bulky, soon satisfying 
hunger, [cross out], containing but little nutriment & proving laxative.
In many uses Melons- cucumbers &c produce violent cases
of colic, yet they are much used with impunity. This is not easy to
account for & experience must determine for each individual -
In eating cherries, it is customary with some to swallow
the stones to promote the digestion of the fruit. this is an erroneous
& dangerous idea- violent cases of colic & death itself 
have been produced by this practice. In these last cases larger
masses of these stones have been found obstructing the canal.
Dr Physick examined a person who died under similar circumstances

24. 
idiosyncrasies
X In the late calamities of Europe this observatn has been
fully verified especially in Ireland- where those of the Potato
were considerd as nourishg as thy of wheat bread- Davey states
that it contains 1/4 of extractive matter- it is one of our safest
articles- & exceptg rice [cross out] is the least flatulent- There are howr
some idiosyncrasies which it is nesesy to examine-
In convalescents from bilious fever it is observed, that all vegetables
frequently pass thro' the body unchanged. It is also singular that, even the
healthy stomach is offended by every new vegetal, [cross out]
after 40 yrs- or Rush says, it rejects all new ones entirely- this require limitn

25.
circumstances from eating persimmons & he found the stones of this
fruit collected in the same manner. Dr Cullen thinks
that grapes are the best of our fruits- this is hardly the case
in this country- the grape has been much celebrated in dysentery -
but the peels & skin are evidently very hurtful, the juice in
its fresh state may be employed. The dried fruits, fig, proune,
raisin, [cross out] are very useful as refrigerants in fever & as gentle laxatives
& are much employed in this country. The Cabbage & 
caliliflower are with many persons very difficult to digest
after being boiled. & should never be given in weak states of
the stomach. Cold slaw as raw cabbage with vinegar, not 
so apt to prove disagreable. the Carrot [cross out] is nutritious &
easy of digestion as also the Beet. The Potato [cross out] contains
large quantity of farina so much starch can be procured from 
it, it is very nutritious X & is therefore frequently mixed with flour
in making bread. It has some acescent matter. In some cases
of dyspepsia- gout & fever it is very indigestible & should 
therefore be forbidden-
We will now pass to the consideration of animal food
If these, the quadrupeds of the class of Mammalia are 
much used. & by Dr Cullen are supposed to be very nourishing 
because their flesh so much resembles our own. This cannot be

26
X The reason of this is doubtful- That carnivs animals will 
afford sufft nourt is certain, as some nats live solely upon them-
the idea as to their alkalesy & putrescency was formerly much dwelt
upon- even Cullen admits it - Leybert- has found that no putresy
takes place in livg body-
* veal is more difficult to digest than any other meat- except pork.
Pork is fatter & more nutritious than any other meat- is
hard of digestion & will not therefore answer for sedentary
persons-
* Venison is not productive of any disease & may be sooner allowed
than other meats-
+ Birds- Their flesh resembles very much that of animals The
carnivorus are seldom used- Those that live on fish has a sati'd
disagreable taste- None living on insects are preferred. The omnivorous

27.
a proper reason, as we know that vegets of the class of
the urealia are fully as nourishing, yet nothing can be more
different, than farina & flesh. Much attention has been paid
to the essential qualities of animal food- but these [cross out] afford very little
guide; experience is much preferable. Dr Cooper says
that fat is more nourishing, than muscle. that the fat part of meat is more
nourishg, than the [cross out] lean is certain; but that this is merely owing 
to the fat present is doubtful. The gluten Void are very nutritious.
The flesh of carnivorous animals is little used. X the graminivarous are
supposed to be less dense & tough. There is a real variety in this respect- This also depends on sex, age &c,
males which have been castrated become more tender & pleasant.
Lamb Veal are more difficult [cross out] of digestion, than the sheep or ox: [cross out] veal
is by no means easy of digestion-*& Cullen's practive of giving veal
soup- & meat will not answer in this country, but would be fatal.
Every part of the animal has been used, even the bones, & have been
found more nutritious, than an equal quantity of vegetables; but at the sametime
more stimulating & difficult to digest. The flesh of the ox [cross out] is easier to digest
than that of the cow or bull. Mutton, when six yrs of age, is easier than
veal. but it is more stimulating. Most meats, but especially
veal is more easy to digest after being kept for some time. Wild
meats are in facility of digestion. superior to tame, especially venison-
* bear's meat is very nourishing- X Poultry is very excellent
food & easy to digest- the Capon in this respect is superior to the 
cock or hen- the goose & duck are more stimulating. They should be used young.

28.
omniverous are also much used. The Turkey in this country's
superior to what they have in Europe- & is very excellent &
easy of digestn - If poultry [cross out] be kept it is always better than 
when eaten immedy - The common fowl- is also very [cross out]
easy to digest- Chicken broth has much nourishment- & is very
much used in sickness when roasted [cross out] it becomes hurtful -
chicken is not equal to the full grown foul- The Capn of 
Gefray show that an old inch contains more nutrative 
matter than any other fowl - The Hen is more tender, capon
is best- The poultry having black meat is more stimulag &
harder of digestn they are however good food for the healthy
The wild birds are more easy to digest than the tame- The 
Pheasant & partridge are like the turkey & fowl & wild goose 
resembles the tame-

29.
Lecture 4th Nov 13th
Ova or eggs have always been considered the most nourishing as the least stimulating
& the easiest digested food derived from animals. They are very nourishing & when 
raw or slightly boiled are easy of digestion & are very early
allowed to convalescents. If they are boiled till the yolk is
firmly coagulated, their properties are entirely changed & they become
very difficult to digest. The albumen, when well boiled & dried
becomes so indurated, as to scratch glass. That eggs are nourishing 
is evinced by those who during lent are very much confined to
them. They are frequently poached for convalescents the hard
coagulated parts should be removed. An egg, when boiled for 
two minutes & a half is sufficiently coagulated. Eggs are
subjected to several culinary purposes, which sometimes render
them very indigestible. Thus mixed with butter & fryed with
oysters & or veal they are every injurious. Yolks of eggs mixed up
with wine & sugar form a very nourishing, stimutaling drink
which has been very useful in the typhoid pleurisy that has
been so prevalent in the U. States. The white & yolk are both
nourishing. but should always be used when fresh.
Fishes are next to be considered. The shad, herring & mackerell
is a salted state & a great variety of fresh fish are much employed
in the U. States. The flesh of different fish do not

30
[cross out]

31.
differ, as much as that of animals: it is considered as intermediate
between animal & vegetable food- being less stimulating
& nourishing than the former & more so than the latter.
It has been supposed to favour generation but this is not the case
as is evinced by the Esquimaux Indians & by the Greenlanders
who live almost entirely on fish & yet consider it extraordinary
if a female should have more than six [cross out] children.-
I think, that a fish diet is favourable to longevity,
although I have not collected a sufficient number of 
facts to establish the point. It has been considered as septic
or that it renders persons more subject to putrid diseases. Putrefaction
never takes place in the living human fluids- but if
it is meant that they are more subject to inflammatory diseases
we answer, that they are more subject to these diseases than persons
living on vegetables, as has been mentioned in the case of the 
Chinese but not more so than those who live on animal
food. Haller thinks, that they are less nourishing than meat,
& gives the case of Catholics during lent becoming weak but
this may be owing to their being confined to a particular diet-
Cullen opposes this opinion & thinks that fishes are equal 
in their nutriment to meat- compare salt fish with salted 
pork which is the most nourishing?

32.
The hard tendiness portion or as it is called the heart should somets removed- as being 
more difficult to digest. 
X It is usually made with the addition of many condiments
which evidently render it improper for convalescents. There is
much fat in the turtle which is nourishing- & when eaten with a 
sufficient quantity of bread proves easy of digestion- The 
French make a broth of the turtle- which is much used by them in 
disease- I do not think it in any degree superior to our weak chicken soup. 

33.
Shell Fish- Oysters in this country are superior to those of
any other & are much used- They may be allowed to convalescents 
in their fresh state- uncooked, or stewed in their own liquor.  
when fryed they are very indigestible- chiefly from the butter
& coagulated egg joined with them. In some low cases
When patient has been confined to a vegetable diet for some
time. bread soaked in the liquor of the oyster is a great luxury
& may be allowed, as the juice is very easy of digestion. 
The Clam is very similar to the oyster but not so easy to
digest- the part in the belly of the clam is tolerable easy to
digest- when boiled in soup they communicate an agreable 
flavour & some nourishment- Lobsters & Crabs- between
them, Dr Cullen thinks, that little difference exists, & that lobster
is more frequently seen on the table than crabs on account of
their beautiful colour. The lobster however is beyond doubt
the most indigestible of all our food. frequently an efflorescence on the skin producing,-
colic, flatulency & after diseases of the bowels- while crabs
are very generally by the physicians of this city allowed to convalescent 
patients, but the lobster never.
X The Green Turtle affords a nourishing soup easy of digestion. 
The snapper is frequently used in soup, but it is not superior
to any of the common soups. The meat is very tough & indigestible.

34
X I may here observe, that the rattlesnake is very easy
of digestion & is considered by some as a great delicacy &
It is however not used in this country & they are too dangerous
[cross out] a creature to encourage its propagation-
X No medicines were administered- The patient having been frequently salivated.

x 35
The terrapin when well boiled is often easy of digestion
Before leaving the substances derived from the animal kingdom 
we must notice Milk, which forms the first food of many
animals. The milk of different animals has peculiar properties.
That of the cow is generally used as diet. It consists of 
three parts an oily, a coagulable & serous part known by the 
[cross out] names of cream, curd, & whey; each of these possess more
or less nutriment. It will be proper to notice in the first place
the properties of fresh milk or of milk before its constits have seperated-
In this state, it is very nourishing- this has been attributed
to its resemblance to chyle- this is mere sophistry, we might as
well say, that blood would be the most nourishing substance
because [cross out] it is already composed & does not need the 
regular process of digestion. It is as necessary, that milk should
be digested as any other substance. It is however easy of digestion 
& nourishing; [cross out] it is considered as intermediate between an animal
& vegetable diet. [cross out] In early life, milk is very useful. & should 
be much used, it has the advantage of never cloying the stomach.
In advanced life milk is sometimes found to disagree
with the stomack & is less used. In dyspepsia- it is sometime useful 
& sometimes hurtful- In chronic diseases it is used in some cases
as the sole food- In a severe case of syphilis a milk diet was 
successful in promoting a cure. It was continued for sevl months.

36. 

37.
Lecture 5th. Nov 18th
We proceed in the consideration of milk. Dr Cullen & others
have attributed to it, the property of correcting vitiated fluids-
this is the remains of the old humoral pathology, but it nevertheless
has led to a successful practice, Milk in the lues venera
& cancer has been much celebrated & very deservedly- I know a
lady who is afflicted with cancer- which proved very painful, depriving 
her of comfort & rest- even opium procured her, but part, unrefreshing 
sleep. Being restricted to a diet of milk with vegetables
the pain left her for a considerable time & when it recurred
was more moderate & was relieved by small doses of laudanum, she 
continues the same diet- her disease being evidently retarded. In
consumption milk has been much celebrated, especially asses milk.
Galen recommends human milk; Van Swieten relates a case of a 
consumptive young man recovering under the use of human milk,
but modern experience gives no superiority to human milk in
this disease & allows equal credit to the milk of the cow.
Milk must not be used indiscriminately- it is hurtful in the inflamy 
stage of Phthisis, by filling the blood vessels & proving a stimulus 
to their action. The whey is to be preferred under such circumstances.
There are many diseases in which [cross out] milk may be used, but which

38
X The proportion of this varies in the milk of different animals
* This is effected by fermentation & or course the whole becomes 
sour-
+ they are therefore proper articles of diet for the labourer &
not for the sick-
* Nothing is less soluble in the gastric juices- than toasted cheese 

39.
need not now be specified- Is a general rule, it may be used when
there is but little fever & where there is considerable debility
present- Milk, when suffered to stand in stone vessels,
for a short time seperates into two parts- the cream or oily 
part rises to the surface. It is however not solely the oily part
but contains some of the curd & whey. The oily part may be seperated
by churning & then obtains the name of butter, this is similar
to the expressed oils of vegetables & is in many cases mild & nutritive
By rest for several days the milk seperates into the curd &
whey * this seperation is more speedily effected [cross out] by adding to it, a little of the infusion
of the inner coat of a calfs stomach, known by the name of 
runnet. this [cross out] infusion is best made in wine as it can then be kept.
This curd is a soft white glutinous mass & is formed into cheese- which like animal substances
is capable of putrefaction [cross out]- Cheeses vary very much in their
properties. they are all nutritive & stimulating & the difference
depends on the proportions of the oily & coagulable part present.
That made from cream is the easiest of digestion. [cross out]
if diet of cheese is very useful in obstinate diarrhœa- Case at
the hospital of a patient with a diara which has resisted several 
remedies effectually checked by using cheese. When toasted it becomes
more stimulag & difficult to digest. * The oil which 
exudes is a very useful application to many chronic ulcers- especially

40
X It seldom becomes acid in the stomach- but as it contains
sugar- it is capable of the acescent fermentn & in some few 
cases may be troublesome from this circumste.
The wine should be added when the milk is boiling- the whole
is to be briskly stirred & [cross out] the temperature is to be again
raised to the boiling point.

41
especially of the nose & Dr Physick & myself have been attending a gentleman- 
who has an ulcer of this description which had resisted
many & various applicats both stimulg & caustic. it yielded to 
the application of the oil of cheese- There are many instances of
a similar nature- The third part of milk is the Whey.
this according to Young is about 7/8 of the whole. It contains some
of the oily & cheesy matter & also sugar. It is [cross out] mild &
very nutritious & is very useful as a drink in many febrile diseases.
In the inflamy stage of phthisis where the pure milk is hurtful
the whey may be employed. In some cases if dyspep it may be
used- but in many it is rejected immediately. * Butter milk consists
chiefly of the whey- in an acid state but contains more of the caseous part; this has been much
used in consumption- Dr Chippen related to me a case in
which a patient recovered under its use. It is less digestible than milk. Milk coagulated
by wine affords the wine whey, which is much used- the best
method of preparing this is to boil the milk & to add half
the quantity of wine (madeira is the best), which quantity is
necessary to seperate all the curd- When the parts [cross out]
have seperated remove the curd without breaking- as it is indigestible
& strain it through fine muslin- Sugar or nutmeg or any other
article may be then necessary. It is necessary to have it weaker it
is best to dilute it with a thin mucilage of Gum Arabic or with a solution of loaf sugar

42

43. 
Wine whey is a gentle stimulant & very nourishing. It is not so
stimulant as wine- but may however produce intoxication.
Milk punch- is made of milk & rum or brandy with sugar; This is more
difficult of digestion & is often rejected by the stomach- In cases
where the stomach is much debilitated- the milk punch [cross out] is
coagulated in the stomach & quickly rejected- For such cases
I have substituted the brandy toddy with wine whey with [cross out] a further addition of wine with good effect. Milk
punch has been much used in the typhoid pleurisy, & when the stomach
has been able to digest it has been useful. but in many cases
from its being difficult to digest it has proved hurtful.
We have [cross out] now concluded what we had to say on vegetable & animal
substances. There are some substances which do not properly belong
to either kingdom which have been mentioned as nutriments. such
as calcareous earth by Professor Barton- carbon oxygen &c-&c-
The assimilating power of the digestive organs can no doubt act
on various substances- but these will certainly afford but little nutriment-
It is sometimes necessary to attend to the [cross out] 
several culinary processes to which the articles of diet are subjected
As a general rule heat renders vegetables more easy of digestion the
cabbage perhaps is an exception; & I also think that the turnip
is more easy of digestion in its raw than in its boiled state, as it
in this state often produces indigestion. The properties of vegetables are 

44 
X There can be no doubt that some of the fluid parts also become
solid but the particular changes are unknown
X They are not therefore used in sickness- When long kept salt
meat- acquires a condensation & hardness rendering it very
difficult of solution.
It also induces thirst- & thus proves injurious by rendering
it necessary to drink freely.

45 
changed by heat, this is evident even from the taste- for an instance
the roasted apple. What chemical changes take place, it is not
necessary to inquire- it may be observed that the volatile parts
being dissipated some substances become milder as the Indian
turnip. X On animal food heat produces greater changes. There are
however some processes preparatory to cooking which should be
noticed. If the food is kept, till the commencement of the putrefactive 
process it becomes more tender & easy to digest; this is remarkably 
the case with poultry- venison also is much better for keeping-
when putrefaction has actually commenced- as in common words
when it is tainted, it becomes unwholesome. In fatty matter rancidity 
occurs which is hurtful; on this account the goose & duck
should not be kept so long as the fowl. Salting is a preparatory
process much used & is very valuable as an antiseptic or in having
power of preventing putrefaction out of the body for putrifn never
takes place in the body. Salted provisions with a proper admixture 
of vegetables are very nutritive & healthy, but more stimulating
than in the fresh state. X Smoking [cross out] is useful- smoked beef 
mutton, venison &c are chiefly used as condiments, but they are difficult
to digest & must be forbidden in weak stomachs- Bacon 
is more stimulating, than the fresh pork- & as it stimulates the appetite
too great a quantity of other food is taken & in this way it proves
hurtful. Salted fish is less nutritive than ham- In many

46. 
X especially as a little soon satisfies the appetite.
X Dr Rush considered Pickles, as vinegar in a solid state the
vegetable matter is very small & being spongy- serves merely to
absorb the vinegar-
Boiling is the most economical method of using meat according to 
Count Rumford- as the soup [cross out] is very nourishing- & the boiled meat
is still very useful- The Potato is best prepared by boiling- as it is
then found to lose but 2 pr ct which by roasting it loses 40 pr ct

47. 
cases these articles may be allowed, especially when the stimulus of
animal food is wished for [cross out] a little ham
may be allowed. Dr Rush used it in many chronic cases with advantage-
ham in cholera Morb. even when this disease is chronic
is very hurtful- I had a patient who was gradually recovering
on milk & vegetable diet- nearly killed by eating a little ham &
I have reason to believe that it is frequently hurtful in this 
[cross out] case. When used it should be very well boiled 24 & otherwise
it is difficult to digest. Meat when broiled becomes more stimulating
& less nourishing: to a person in health it is useful in 
warm weather- but in disease it has been too much extolled-
salted fish- such as shad, herring- are not very nourishing but are
useful to labourers as condiments. as also when smoked.
Pickeled in vinegar they are stimulg when the vinegar is much
used- it is injurious to the stomack. vegetabls pickd are also
hurtful: there is a spongy matter very difficult to digest. X
Boiling renders meat more tender & soluble in the stomach;
Labourers & the Indians, who require that their food should lie
long on the stomach & afford nourishment slowly; [cross out] frequently
use it in a dry state or but partially boiled. The tendinous
ligaments & membrans parts of bodies dissolve into a jelly-
containing also part of the gluten- it is therefore, that soups
are nearly if not quite as nourishing as the meat itself. [cross out]

48 
All nations employ soup more or less- particularly the French
For the sick it should be made from lean meat= This being
boiled in ℔s:viij of water- it should be suffered to cool- & the fat
should then be skimmed off- After which it may be again heated

x
[cross out] 
[cross out] When a strong soup is wanted
merely evaporate the water; to obtain it as a jelly evaporate it
'till a drop falling on a cold surface immediately congeals.
In using soup in diseases of the stomach & bowels no vegetables
not even flour should be added. it should consist only of a solut.
of the beef with a little salt or pepper. In this manner beef
soup is a very excellent nourishment. Beef tea is also very excellent.
the preparation of it consists in first scalding a piece of lean beef [cross out] to
deprive it of its blood. & then pouring boiling water on it & 
standing it by the fire, closely covered. In the same way are
prepared various other soups; chicken soup is very nutritious
as much so as the chicken in its solid state; but these soups 
in diseases should be used with caution I have known a
case of yellow fever in which chicken broth aggravated every
symptom - the patient died. when not properly administered 
it will prove as hurtful as arsenic itself.

50

51.
Lecture 6th Nov. 19th
Many condiments are employed in soup - these do not alter its
nourishing properties, they only render it, more stimulating & should
therefore be omitted when stimulus would be hurtful. There is a
preparation of a nature similar to soup which is frequently used.
I mean calf's foot jelly- or the tendinous parts of the foot boiled
[cross out] a jelly & numerous spices frequently added. This beyond doubt is
a most pernicious substance, is very indigestible & should always
be forbidden in disease. Bones are sometimes made into 
soup by means of Papin's digestor but it always possesses an
empreumatic taste, which renders it hurtful in delicate states of
the stomach. There is a vegetable soup which in low states is
very grateful to the patient & which may be used when others are
too nourishing as stimulating. Take 3 large potatoes- an onion- a
large piece of bread- boil them in three pints of water- & add a
little salt with a piece of toasted bread.
Roasting is a common method of preparing food. The watery parts
are dissipated by heat, where small pieces are used but when large pieces are
subjected to the process the exterior becomes hard & dry, confines the
watery parts & renders it very pleasant. Roasted meat is nourishing
& more stimulant than boiled. Baking is not equal to roasting

52.
The fatty parts are burnt into an empyreumatic oil which
is very indigestible & hurtful-
x as is evident from many nations using it as their sole drink-

53.
although it is an analagous process- The parts are not so equally
heated- & the watery parts are more dissipated. Broiling or
placing the meat immediately on the fire has the advantage
of preserving the juice by a crust being quickly formed thus rendering the meat savoury & tender. Frying
is more stimulating than roasting as the oily parts are very much
confined- this is a rich manner of preparing food & is hurtful in
dyspep. especially when as is usually the case it is mixed with eggs
& flour as in frying veal- oysters &c. Stewing is intermediate
between boiling & roasting. 
Condiments- such as pepper, aromatics of various sorts, stimulate
the tongue, salivary glands, & stomach, & should therefore be forbidden,
whenever stimulants are hurtful. In preparing these
condiments vinegar is much used; very little should be taken as
it is apt to injure the stomach. ketchup. which is a collection
of numerous spices, should be cautiously employed as its stimulating
powers are very great. Capsicum is very useful both as
internal & external remedy in many diseases of this more here after.
Drinks. Of these water is most used & is the most healthy x
although our spring water is usually impregnated with various
saline substances yet it does not possess any peculiar properties
on this account; & to persons in health is a very excellent drink.
In disease it is customary to impregnate it with various substances

54
x so little- that intoxication can hardly be indured by it-

55
substances- such as sage-balm, Bolia tea, green tea &c these
are useful as gentle stimulants, & when diaphoresis [cross out] is required.
Fermented & distilled liquors are perhaps more fatal
to man than any disease to which he is liable they are much
used as drinks & in this light we must consider them. Cyder
is one of the most innocent as containing but little alcohol - x it in
many cases produces an acescent state of the stomach & should
never be used in [cross out] gouty cases in the habitual colic or in any disease 
of the stomach or bowels. Malt liquors are chiefly prepared
from barley- which is moistened & exposed to a slight increase of temperature 
when it germinates, sugar is thus produced from the fæcula in considerable
quantity: warm water is poured on the barley in this state &
set aside to ferment - by a variety in the process porter ale, beer
&c are obtained- An infusion of the hop is added to most of 
these which is very useful. Of these porter is the best as it
possesses great uniformity of strength, which can always be
depended on & from its bitterness it possesses a tonic property
all of them contain a large quantity of fixed air & are very available 
in many low diseases. but should be avoided whenever there
is any flatulency in the alimentay canal. 
Wines contain alcohol, acid, water & sugar with other substances

56
x Its effects are very evanescent- & active- I was successful
in the case alluded to- There is nearly the same difference
between it & Madeira- as between æther & alcohol.
# There are many home made wines in use among us- made
with sugar- & the formented juice of different fruits- They are
very acescent- & hurtful- & of course to be forbidden in disease

℞. Pulv: G: Gambog: gr:i.
Calomel:-gr:ss
Pulv: Jalap-gr:ij
P.G. Opii. gr:ss
Migs G: Arab:g.s-
ft-pilul:-
℞. Pulv: G:Gambog:2ij.
Calomel:-2.i.
Pulv:Jalap:2iv
P.G. Opii.-gr:viij
Sap: pur:g;s-m-
ft pilul:ss4.-

57.
substances of less importance. From the sugar they have some nourishing 
properties- but the alcohol is the most active ingredient.
Of this Port wine according to Mr Brande contains about 22 pr Ct. Madeira- 21 pr Ct
Claret varies from 12 to 16. Sherry has 18. Red Champagne 11.
White Do 12. Burgundy 14- Hock 14. Porter 6 pr Ct
cyder & Perry in this country cyder contains much less than porter ale 8.88
perry 9. brandy 53-rum 53-gin 51.
The Madeira is the best in disease- if it cannot be procured
the London Teneriffe. & the Sherry may be mixt used as less to prove
acescent than the Lisbon. Champagne is a very diffusible
wine, acting very quickly. X on the account I have employed it
in typhus & I think with service. Port wine possesses much 
astringency & is therefore much used in chronic dysentery- diarehœa
intermittents &c. It is very apt to be adulterated.
The French wine- Claret. Burgundy &c contain more acescent
matter & are to be forbidden to gouty persons. The low French
wines are about as strong as our cyder- & are much used in
France, Hock & Rhenish wines are too acid. # Distilled spirits
contain much alcohol about 51 or 53 pr Cent. so that
rum, gin, whiskey are about as strong as brandy.
We will conclude this division of the subject less a short

58
* Celsus has shown much knowledge of the animal system
by observing- that we should occasionally violate all
rules- respecting diet while we are in health- Young persons
should be able to eat every thing- & we can only strengthen
our constitution by occasionally exposing it to danger-
In the various circumstances of life it will be impossible
always to adhere to any particular mode of living-
X & by the existing condition of his system-
# Some have maintd that one meal is [cross out] all that is natural
Fordyce considers every additional meal as luxurious- This principal
meal [cross out] is taken at any time in the 24 hrs. But nations in
a savage state always have more than one meal- & from the universality 
of the custom we may conclude that this is natural- Suppers

59.
practical application. As man can subsist either on animal
or vegete food or on a proper mixture of both. he is
rendered a fit subject for any country- In a state of health *
little attention to the kind or quantity of his diet is necessary,
these should always be adabted to his feelings & should be
regulated by his experience. In infancy the mother's milk
is no doubt the proper food. after which a mixture of milk
sugar & flour is a very excellent diet. the cerealia may be generally
allowed. Of late is has been customary to use the arrow root.
it should be boiled to a paste in water- & then milk & sugar is
to be added. It is now the general opinion, that children
till the age of puberty should live chiefly on vegetable; with
water for their drink. after this time, more animal & stimulating
food may be allowed. When fermented liquors may be
allowed is doubtful, the longer deferred the better. It is a 
more difficult task to say, When they should be ordered. This
must be regulated by the previous [cross out] constitutn of the patient, x
As to the number of meals- it is generally the custom to have
one principal meal & one or more moderate ones in the 24 
hours #- from the universality of this custom we must conclude
that it is the best. To have several moderate meals will be

60
are less proper as the principal meal-
X He increased in weight upon using ℥xxxvij- of bread- So that
we should regulate the quantity- as well as quality of the
food- &c when the patient [cross out] has a good appetite it is to be restrained.

52
always most serviceable to convalescents- When there is
a fourth meal- this should be light- & taken two or three
hours previous to sleep.
Lecture 7th Nov 21st 
In a state of disease an attention to diet is of the utmost importance
& on this account we will cursorily examine the diet to be
allowed under different states of the system. In all inflamatory 
diseases stimuli of every kind are to be avoided, but as
these are of different degrees of violence, there may be several degrees
of low diet in inflammats of the brain a diet of toast 
& water is sufficient: this perhaps is the lowest diet, [cross out] although
it is not ascertained, how long it would be safe in these diseases
to abstain entirely from food- yet it is certain, that patients in
violent inflams can subsist for a long time upon a little toast
& water- Starks by an experiment on himself found that he lost
weight when he lived upon ℥xx of bread & ℔iv. of water in
the 24 hours- so that the diet we have recommended actually
depletes. X Perhaps under this grade we might allow weak infusions
of sage- balm- Bohea tea &c- In the second degree of
low diet we may allow panada remember without wine &c &c- or bread boiled with sugar
barley water- this however should be thin for when [cross out] it is thick

62.
x the liquor of oysters- & clams- the whey of milk- milk
itself- oysters- chicken soup- beef tea- soft eggs- These are
equivocal & are only employed as disease is going off - never
during its continuance.
# He should soon resume the regular hrs- of his meaals- such as
he has been accustomed to- as he will then digest better-
* Be careful not to overload the stomach- let it be never
empty & never full-

63.
it becomes very nutritious & hurtful- the same may be observed
of other mucilages- here chocolate may also be allowed-
taking the precaution to seperate very carefully the oily part the remainder
is very easy of digestion. Infusion of the shells may be sometimes
substituted for the chocolate. Bread, rice, arrow root
the summer fruits may be allowed. In the 3rd degree of low
diet we may give the mildest animal food x [cross out]
[cross out] & gradually we may allow fish, birds except goose, duck, &c
when we wish to satisfy with a little animal food- a little
salt fish or a little ham will be very excellent. #
In a opposite state of the system we will gain a great
deal by proper nourishment. all animal food is to be allowed
with the various condiments, fermented liquors- wine whey
with spices animal jellies milk, punch &c. * There are however certain
diseases which do not come directly under either of these general 
heads, in which an attention to diet is very essential.
In scurvy no animal food should be allowed- vegetables only are
to be given which act as a specific- of these the acid fruits, as oranges
& lemons- & acescent veget- are the best- If the patient
lives 48 hours after commencing the vegete diet he usually
recovers. In the choice of vegetas those are preferable which may

64.
* Scurvy has occurred when the diet was purely vegetable-
this arises from there being more remote causes than one -
thus the filth & the confined atmosphere of ships- & the digestion of 
spirits & weakness of the mind as well as the body may be
likely to endure it-
X In children ℥. So. will often be rejected [cross out] while ℥i-
will readily be retained & afford nourishment-
# Frequently it is necessary to wake the patient up- to give them
his food & medicines- In many cases of Typus fever- the pulse
flags- becomes irregular & tremulous- when stimuli are not regularly
administered- Much depends on the nurse-

65.
be eaten raw- as the sallad- Mr Smyth in the British navy
found raw potatoes with vinegar very serviceable. Vegetables are
best when fresh. * In Dysentery all acid & acescent food is to 
be avoided- animal food is too stimulating. those vegets are
therefore to be chosen, which are not apt, to ferment & which
will not irritate the bowels, such as sago, rice: G. Arabic- Tapioca well boiled & arrow root
In cholera Morbus diet is very useful- In the early stage nothing
is so useful as a sweetened mucilage of Gum Arab. given
in small quantities. X In dyspepa experience must determine
the proper diet in general animal food with vegets which
are not acescent [cross out] is to be prefered. Gout is sometimes cured by
low diet- A remarkable case occurred in France, where a person
was imprisoned & kept very low for 20 yrs- when he was liberated
he was entirely free from the gout- which had before rendered him
a criple. It has also been serviceable in Epilepsy. Consumption
& Cancer.- As to the temperature of our diet 
a medium should be observed, Dr Rust considered heat, as a 
condiment exciting the appetite. Hot teas &c are very hurtful-
Ice creams & cold water have produced death. In hemorrhagies 
a cold diet should always be given- The intervals between 
meals to convalescents should be short- & food should be
taken frequently. # There are many cases, in which convalescents

66
x It is therefore somewhat nutritious- especially as commonly
used with sugar & cream- In this state it is supposed to be
less astringent than the raw coffee- the raw is said to contain
the Gallic acid but no tannin-
# as is shown by followg expert- a quantity of mutton &
bread mixed with Saliva was divided into 3 equal portions
to one was added ℥i. of Infus:/coffee- to the second same quality 
of Infus:tea - & to the third - an equal quantity of water- 
The temperature of all was preserved the same near the fire-
The materials in the water became acid in 48 hrs. while that 
in the coffee was free from any acidity of the entirey 4 days.
T- Tea is used very freely by chinese & other nations- with no
evidence of a narcotic power -

67.
loath food. In such cases the sight of another person eating
directly has been of service- Dr Physick had a friend when he
was a student, who was very weak but could take no nourishment.
he was induced to take some by seeing [cross out] friend devouring 
with great satisfaction the leg of a turkey- A remarkable case
accused in a French Officer who had taken the resolution to 
starve himself- he persisted in his resolutn for some time but
the sight of a child eating overcame him & he determined to live.
Coffee according to Percival is slightly astringent, & has a little
extractive matter. it is also considered as antiseptic #- a
strong infusion according to Percival relieves headach when dependent on the stomach, is grateful to the stomach &
promotes digestion- In delicate constituts it produces watchfulness.
tremors & various nervous affections. In Asthma
it has been highly recommended by Pringle & after opium has been taken
in [cross out] large quantities, The infusion should be strong- ℥i to a cupful- it is very useful- Tea is a pleasant 
beverage. is slightly exhilarating, but possesses no remarkable
properties. It has been ranked by Dr Cullen, under 
the head of Narcotics- how [cross out] correctly is doubtful.X
We have now concluded what we had to say on the subject
of the Nutrientia- & he shall now proced to the Materia
Medica as to the consideration of those substances which are

68.
X much difficulty has always occurred in arrang the
articles of the Mata Media many different methods have been
preferred- & again abandoned- The only aim in a lecturer should
be to present them in such a manner that his hearers will be able
to understand- & remember what he says. I shall therefore
follow those who treat of medicines- [cross out] according to their effects
placing them together which are nearly allied in their effects-
without any reference to their Botanical or Chemical characters=
The knowledge of the articles of the Materia Meda has
in a great majority of cases been accidentally acquired- &
those are only to be received whose virtues are tested by experiment-
Expero cautiously made on brutes- on the healthy
human system- & an [cross out] the diseased body are to be received- remembering 
that the first requires much caution- as [cross out] some
articles [cross out] innocent to brutes are poisonous to man-
# Ardent Spirits is a good example of a Stimulant- It is
not easy to give an example of a sedative we must conceive of it
as directly the reverse of the former- If the definn of a Stimut be correct
I can boldly declare all medis to be stimuls. No impression can
be made on the body unless it produces a change of action in the part 
This implies a new mode of action in fibres which acted before in a different way,
This new mode of action is a new action- we cant conceive of the same action
being modefied. Since any action can only be produced by a stimulant it follows
that all medicants which produce an impression are stimulants- See next page- *-

69.
employed as medicines. X In treating of these we shall notice together
those which are nearly allied in their operation. Thus those medicines
which remedy deficiency of action, we shall consider under the head of
stimulants & those which moderate action, sedatives. Stimulants 
have been defined, to be anything which excites the action of the
moving powers & also by Dr Cullen which produces sensation. Sedatives are those
medicines, which directly & without evacuation diminish the motions
& powers of the human system. # [cross out]
[cross out] There are many affections of the mind
as grief, fear, &c. & also cold which have been considered as sedatives.
yet if we attend to the operation of these causes we shall see that they
possess a stimulating operation. An increase of secretion is always
occasioned by them. Look at the phenomena of cold. At about 60°
degrees little or no sensation is communicated, as the temperature decreases-
sensibility increases- the skin begins to contract, forming
the cutis ansorina- it also becomes pale owing to the contraction
of the vessels- Diminution of perspiratn- rigors take place- palpitation & finally death-
often there, show a stimulating operation, it is by the stimulus of
the cold, that the contractile power of the vessels & of the skin is in
increased- it is by the same power that the muscles contract spasmodically.
that palpitation ensues & by too great a contraction death.

[cross out] 70
It has been customary to consider as sedatives certain passions of the
mind- as grief- fear &c so also cold. There can be no question that
debilitg effects are produced by each of these but are there no new actions
excited- Fear produces a discharge of urine & an increased secretion 
skin becomes contracted as [cross out] cutis anserina- now these are unquestionably 
new actions- In Grief the mind is enervated- & the body enfeebled
but [cross out] there are still some new actions- the tears are secreted copiously,
& the intercostals contract rapidly. Cold has been much relied on
by the advocates of - direct sedatives: but cold is a stimulant. At 
60°- there is to a middle aged man no unpleast sensatn of heat or
cold- but any deviation above or below this temperature is productive of
uneasiness- Cold produces pain- the skin becomes contracted- its
vessels are diminished- thus paleness is induced- the perspiratn is suspended-
there are rigors- shivering- the pulse is somes more frequent-
somes diminished- Cullen states that it is diminished in
frequency, becoming firm, regular & small- Dr Hock- on the contrary
states that it is uniformly increased in frequency & strength. 
I believe that its frequency is generally diminishd its fullness undoubtedly
is. Remember now [that] the definitn of stimulus- as x being
that which excites [cross out] the moving powers- here we have a contraction 
of the vessels- & muscular motion sufficient evidences of a 
stimulant impression. Many causes evidently stimulant- & acknowld
as such produce the same effects as cold- [cross out] each should of
course be ranged in the same class. Thus the cutis anserina is equally
& as certainly induced by immersing the feet in hot water
as in cold- When extreme heat & cold induce precisely the same

71. [cross out]
Lecture 8th Nov 22nd
In continuing the subject we may remark, that there are certain
conditions of the system, in which, it is at rest; & [cross out], if
these conditions are altered, either by stimulant or sedative means
certain new actions take place. Thus there are number of medicines,
which act as evacuants. such as Glauber salts, but this first
stimulates the mucus & serous secretions of the intestines & thus depletes
by exciting [cross out] this increased discharge. Thus also local irritants produce sedative in half. A bougie passed into 
the urethra greatly stimulates that canal- yet it often produces
great paleness & even syncope. So also in operating for the cure
of hydrocele by injection- the patient often faints. Thus [cross out] certain 
circumstances change the character of medicines & there is no such
thing as a direct sedative. But as there are many medicines
whose action indirectly & ultimately is sedative- & many whose
action is generally & primarily stimulant we shall continue 
the use of those terms- but always liable to these exceptions.
We will explain those cases where circumstances are likely
to alter the effects of the medicine.
As to the Modus operandi of medicines much has been said-
& this is a point, not merely of curiosity but of real importance
in our employment of medicines. Anatomy & physiology are
essential in the investigation of this subject- & Chemistry is

72.
sensation- I am aware that in this case the cold is considered as
acting indirectly- the result arising from the natural stimuli- (as
in this place the blood,) acting as an increased excitability. This
is specious- but false- the changes being direct- there is no time
for the reaction of the system & for the increase of the irritability-
every thing happens immediately- There are many authorities to
be advanced on either side- To mentn but one- Dr Cullen considers
cold as a stimulant or sedative according to the circumstances
under which it is applied- When cold is applied to the stomach, heat
is induced in the skin- Cold [cross out] certainly has a stimulant assertion
when thrown on the face in asphyxia; when the principle 
of life remains but action has ceased - here whatever produces action
must be a stimulant. So also it has an astringent effect- a
cold key- applied to the neck or cold water thrown on the scrotum
will often stop epitaxis- the scrotum is not only contracted & corrugated-
but a contractn is induced in a remote part.
I granted that cold diminishes the frequency of the pulse- this is no proof of a
sedative impressn- Brandy often has an similar effect- Dr Kuchen
has known a draught of this Liquor bring down the pulse from 
140 to 73. Enough has been said to prove that Cold &c have
a stimulant or a debilig effect- according to the circumsts under
which they are applied- This is not mere sophistry- but is [cross out]
very useful. [cross out]. Every thing which causes a deviation from a natural, healthy condition
of the body produces a new action & hence is a stimulant-
Thus too much or too little heat- too much or too little food- too much 
or too little oxygen- any minus or plus whatever- induce new action & are
stimulants- This [cross out] evacut is a stimut. & all evaciants- as Glauber salts. See page
71.-

73.
also very serviceable- but even with these helps we can advance
but a little way. The present theories, consider medicines as operating
solely on the fluids- or on the solids. That some medicines as opium
act primarily on the the stomach cannot be denied [cross out], as its effects are visible
before it can possibly be absorbed. It acts on the stomach
& by a sympthetic action, (conveyed in some manner), on other
parts. Thus a person has been immediately killed by a large
draught of ardent spirits; & also by drinking freely of cold water
when heated, convulsions and a bath have taken place.
But are there any medicines, which act by being carried into 
the general circulation? Digestion is a function marked by this 
singular circumstance, that it converts all substances into
one fluid, the chyle; which is always very nearly the same - it
is true, that the wild drink has a peculiar taste from the food on
which it lives; madder by being taken into the system colours
the bones of animals- & when large quantities of soda have
been taken- some experiments have shown, that it was to be
detected in the serous part # of the blood & in the urine. I think
no credit [cross out] is due to the visionary theory, that bodies are decomposed 
in the stomach & bowels & again compounded in the 
different substances in which it is detected. Neither [cross out]
believe such facts as these- that mercury has been found in
#-Note next page-

74. 
See last Page-
# Dr Bostach mentions case of a young lady- who took the 
enormous quantity of ℥iss- of soda daily- this alkali could be detected
in the Serum of blood- & it required gtts.xx of muriatic acid 
to saturate the quantity in ℥i of blood.

75 
the bones, lead in the saliva &.
We cannot therefore introduce active medicines into the circulation
at pleasure; but even if we had our medicines in the blood 
vessels what do we gain? consider the phenomena of mercury-
it produces, fever an increased flow of saliva inflamn of the face
gums & throat &c. now those phenoma are not more easy of
explanation because the mercury is absorbed: we can as well conceive
that by a sympathetic action with the stomach these should
take place as by a sympathetic action with the lining membrane
of the artery- for this is the only surface which the medicine can actually
touch- Their contiguity explains nothing. The muscular fibres
of the artery contract by sympathy as much when the [cross out] medicine
in their cavity as when it is contained in the stomach. As to 
the particular mode by which medicines act we know nothing-
but it is by Sympathy or consent of parts.
In noticing the several articles of the Mata Meda we shall
divide them under two heads Evacuantia & Stimulantia-
Under the first we shall consider blood letting- Those medicines
which excite the secretions as emetics, cathartics, diaphoretics, diuretics,
emmenagogues- also sialagogues- anthelmintics- epispastics-
Antilithis. Under the second head we shall notice Tonics
Astringents- Stimulants more properly so called- Narcotics-

76. 
* The abstraction of blood as a cure for disease is said to have
been first attempted by Podalyrius, the son of Asculepius.
#. V.S. should never be employed [cross out] during health- It 
is said that where there customary evacuatn as the menses or
hemorrhe- [cross out] discharge is suspended- it becomes necessary-
This may often be true- but I contend that in instances
the system is not in a state of health-

77.
antispasmodics. 
Under the head of Evacuantia then, we shall now notice
blood letting; which is the most powerful evacuant we possess
x Although many theories of the operation of blood-letting have
been suggested yet these have led to the free employment
of this remedy. Hippocrates made a practice of bleeding once
a year - this has become customary with many & is often practiced
even at this time- but as to its beneficial effects no physician
now subscribes. # In disease, blood-letting has been variously
employed- Battellus used it in every disease, Van Helmont
in no disease- The last fell a victim to his own theory
which fell with him. The quantity of blood in the body
is from 25 to 30 ℔s. To what extent, this may be augmented 
is uncertain but that it is sometimes too much increased is
shown by apoplexy- hemorrhagies from the nose, lungs &.
Blood letting is not now employed as a preventive to disease
when persons have been accustomed to this evacuation at stated
periods, it would be hurtful to abandon it, as the constitution
becomes habituated to it, as it does to opium. In injuries 
of the head- it is used to prevent inflamn when any customary
evacuation as the hemorroids, menses &c are suspended

78.
X Dr Physick in an alarming case- where all the premonitary 
symptoms of Apoplexy were well marked, took ℥ 90.
from Dr Davies of this city-

79
suspended it may be necessary but these cannot be called
healthy states of the system- disease is actually present which
demands the evacuation. There is a prejudice against the remedy
in old persons & children- I have no hesitation in declaring
that age should not prevent our using the lancet when it is indicated
by the disease. The uses of bloodletting are evident
in an acute fever. It reduces the action of the heart & arteries- it
may frequently be repeated for this purpose, if the prior evacuations
have not been successful. In an attack of the yellow
fever Dr Physick lost 176 ℥ in 10 days. X In an injury of the
head W Cline took 320 ℥ in 20 days. By frequent bleedings
the blood becomes thinner & paler- the crassamentum is
much smaller, this ought to take place in several acute diseases
before the practice is relinquished. As the object of
bleeding is the diminution of the diseased action, it should be
employed during a paroxysm of that action- It is used more
frequently in remitting than in intermitting fevers, in several
chronic cases of the last, I have succeeded by bleeding when 
pounds of bark had failed. In continued fevers it has been 
much employed, especially in synocha- Dr Cullen has
hesitatingly used it in synochus- afraid of the debility which
ensues- this has misled many- The best method of preventing

80.
X or the pulse is slow & laboured- very much as in Apoplexy-
which state no less than the former [cross out] requires the persevering
employment of the lancet-

81
this debility is to moderate the action of the vessels by bleeding
for this action will produce a much greater prostration of strength
than the bleeding.
Lecture 9th Novr 25th
In the yellow fever, which has prevented in this city with great
malignity, bleeding has been a very important remedy. In the early
stage that fever is accompanied with a tense & full pulse which
imperiously demands the remedy-X By it the pulse is depressed but
it quickly rises, when the operation must be repeated until this
ceases it take place until all the inflammy symptons have ceased.
It has been observed by Dr Rush, that it is better not to commence the 
practice of bleeding unless it is resolutely persevered in, till the fever is subdued
due regard being paid to the existing state of the pulse.
There are certain states of the system when bleeding becomes injurious.
1st Bleeding is not to be employed, when the predominant
circumstances indicate, debility- In the typhoid pleurisy there
is frequently a deceptive state of the pulse which might indicate
bleeding to the inexperienced but it may easily be distinguished after
a little practise from the tense pulse of inflammtn as the 
former can always be easily compressed- & is stopt by slight pressure

82.
X It is improper at the conclusion or during the advanced stage
of inflamy diseases.

83.
There are however in this disease very often strong inflamy symptoms
for which bleeding should be ordered- it is absurd to wait, till the
system sinks at it will infallibility be more reduced by the violence
of the action than by the bleeding. 2nd In that state of the system
in which (to use the French expression) the brain or any important
viscus is engorged while the action of the heart & arteries is very low.
Here bleeding would destroy the patient. The practice should be by
slight stimulants- by rubefacients to the extremities & by frictions
to excite the [cross out] action of the vessels, then a little blood may be taken
by cupping &c. & afterwards bleeding will be serviceable; as to 
the theory of congestion of any viscus while the rest of the arterial
system is diminished in its action- it is very doubtful- but
the practice is very useful- 3rd X [cross out] I have been told, that in malignant
fevers bleeding should be very sparingly employed. Dr Rush
limits it to the 3rd day & then trusts to purging & blistering: this
is absolutely wrong: No matter what is the day, bleed when the 
pulse is tense & full, as it often is after the third day. Let the
pulse and the state of the system be our guide, no exact day can be fixed. 4th Bleeding
is hurtful at the dose of a paroxysm of fever- if employed in remitting
or intermitting fevers it should be during the violence of the
paroxysm, otherwise the succeeding debility is greatly increased.

84. 
X. It is an observation made by all practitioners- that Tetanus
seldom occurs when there is much fever & infn. This is the 
reason why the above rule is given- but there are some excepts-
to the fact- I have known a case of Tetanus [cross out] from a gun
shot-wound destroying the patient- altho' there was previous to its
accession much febrile action.
#. It will do more to diminish the morbid action of the 
vessels & to restore them to their healthy functions, than any 
other remedy whatever-
#. By it, in the 7th place,- we remove that particular state
of the system- which Dr Rush & the French have attributed to
an engorged state of some of the viscera-

85
5th The inflamn consequent to various injuries- as wounds, fractures &c. 
usually require active bleeding- this should not be employed, without
great evacuation, in warm weather, as tetanus might ensue; X this is more
likely after punctured & gunshot wounds; 6th It should not be employed
in intemperate persons, who are very [cross out] frequently in a 
state, demanding stimulants such as opium brandy vol. alkali &c
7th Neither is it to be used, after suppuration has taken place or after any
secretion of the inflamed vessels- Occasionally secondary inflamn
occurs, which of course should be met with the lancet. The pulse
gentlemen is the grand guide- These will answer as general rules
but the pulse must in most cases direct you.
In all the class of phlegmasia, after removing the remote causes
bleeding is to be used freely. # the advantages of it are 1st To relieve 
the local pain- which often is the case while the blood is flowing.
2nd It abates the morbid heat of the part. 3rd It diminishes the
dis-ordered state of the functions, 4th It prevents that high action
which so often produces gangrene. 5th By it suppuration, effusion
of serum & of coagulable lymph. & hemorrhagies are prevented- which
so frequently destroy the functions of the affected part & produce dangerous
& incurable diseases. 6th It prepares the system for the 
action of other remedies, which without it would have been ineffectual.
It is by it - in the language of Dr Rush - we reduce the system to the sweating point
to emetic point- & &c &c &c &c &c #

86

87. 
When it is employed for local inflamn it is often necessary to
take more blood than for general inflamn In ophthalmia & hernia
humoralis- the general bleedings must be very frequent, aids - 
besides which local bleeding must be vigorously pursued. I have
bled in such cases every day for one week & then every 48 hours
for two weeks- it is the particular diseases we may observe, first
that in Ophthalmia general & local bleedings must be early & 
promptly employed: it is the chief remedy & in the early stage
may be considered as the sole one, as other evacuants have very
little effect on it. A few weeks since I was called to see a mechanic,
who was much injured by pouring some melted brass into a 
receiver, into which a child had accidentally thrown a little water.
The sudden evaporization of the water threw the metal in every direction-
some of the particles struck the eyes of the man- & were so
fixed, that some force was employed to extract them. I immediately
bled him to ℥xvi & applied ice water to his eyes- the bleeding was
repeated ad deliq. anim- the same day & was afterwards much used.
The man recovered the sight of both his eyes. General Bleeding should be
employed early & frequently after which cupping, leeches & scarifications
are to be used.- Phrenitis- or inflamn of the brain
or its membranes must be boldy met with the lancet, whether
it arises from accident as [cross out] whether it is an an idiopathic disease. It has been recommended

88.

89 
recommended to take the blood from the temporal artery or jugular vein
little or no advantage is gained by this; the arm answers full as well.
In mania Dr Rush has very successfully employed bleeding-
especially in that kind, which arises from high arterial action. The
practice in the hospital has evinced the superiority of this remedy
to every other- It has been recommended to keep the head erect during 
the bleeding but no advantage is gained by this unless the patient
is kept constantly in that position but if he is allowed to be
down he should be bled in that state, as more blood can then be
taken. The frequency of the bleedings must be regulated by the 
symptoms- 200℥ have been taken in 7 weeks & ℥470 in 10 
months, in both cases the patients recovered. In mania a potu general
bleeding is seldom required. topical bleeding is preferable
Lecture 10th Nov 26th
In all the inflammatory diseases of the throat bleeding is of 
great importance. In the early stage of cynanche tonsillaris, it presents
suppuration, schirrous &c especially when it is followed up 
by rubefacients to the throat- & purgatives. Some cases are so severe that
it also necessary to bleed from the throat by leeches &c-
Cynanche maligna occasionally requires bleeding in its early stage
but in this disease bleeding cannot be considered as a remedy as

90 
X In Europe the lancet is not so often required as in this
country- Cullen afraid of the Septic tendency of the disease
[cross out] condemns V.S. even in the early stage- but remember what
I have often told you that putrefn cannot arise in the living
human body- & Also- that the pulse with the genl State of
the system should be your guide.- It is not a disease
of the Stomach as has been maintd

91. 
it is seldom demanded. X This is not the case in Cynanche tracheales.
where it is of the utmost importance- it should be used even in
young children- when however they are under a month it is very inconvenient
to bleed, here leeches applied to the throat are of great
service I have seldom known them to fail, some disadvantage
arises from the coldness of the leech applied to the warm neck. this 
must be avoided by washing the part in warm water & keeping it
[cross out] poured during the operation with warm flannels. the leeches also should be dipped in
warm water. In cynanche parotidea- bleeding is of service relieving
the pain & it prevents the inflamn, which often takes place in
the breasts of woman or in the testicles of [cross out] men after this 
disease. In pneumonia bleeding should be very copious. It is
the only remedy to be depended on- the fever- difficulty of breathing
& pain are to be subdued by it. The distinctions which have been
drawn in this disease, as it affects different parts is of no importance
in the employment of the lancet. Look at Dr Cullen on this subject
in his First Lines; which are the best rules, that can be given
on this subject. The sum of which is, that bleeding should be
employed freely & frequently the quantity of blood taken to be regulated
by the symptoms- [cross out] When after repeated bleedings any difficulty
should be found in taking blood from the arm & especially

92.
X In some cases it may be preferable to take blood
by cups- these may be appd to any part of the thorax- I do
not think any advantage is gained by applying them between
the shoulders- as has been recommended

93. 
if the difficulty of breathing has ceased & only pain remains cupping
should be employed & is often very useful under the circumstances.
In other inflammatory diseases of the breast, even in Phthisis blood-letting 
is of service. In this last a small bleeding will often prove 
very useful in mitigating pain & fever & we are not to be deterred by
the apparent weakness of the patient, when the pulse is active. X
In hepatitis it is of great importance & indeed in every other inflammatory
disease even in odontalgia it is to be regulated by the principles already
laid down- wherever the object is to diminish a morbidly
increased action by evacuants, bleeding is the first remedy. On 
the inflamn of the gums arising from operations on the teeth- a few leeches have
been very useful when applied to the gums themselves.
In gout bleeding has been sparingly employed- Cullen uses it only 
in young & vigorous persons. In many cases however it is very powerful.
I have known sudden relief from pain, obtained by V. Section-
when opium & every thing else had failed: it has proved effectual
in one case, when ℥ij of laudanum procured no remission. The advantages
of it in this disease as stated by Dr. Rush are - 1st To relieve pain 2nd To prevent 
those congestions, which produce apoplexy- hemoptysis chalky concretions- calculi &c-
3rd It supports to the system, in as much as it prevents the effects
arising from the too great violence of the disease & 4th It greatly

94. 
X The Humoral Patholy were afraid of V.S. in ruptive 
diseases- waiting for the concretion & evacuation of the 
noxious humours: but now we act here on the same principles
as in other infy diss.

95. 
shortens the duration of the fit. Often by its use the patient is about
in 2 or 3 days. In eruptive diseases as small pox, measles &c
it is often highly useful: X & the prospect of debility ensuing should
not deter from its employment. In these & other contagious diseases
although the morbid action is lessened, it is not altered by it
the mode of action remains the same.
In hemorrhagies of an active kind, it is very generally employed
but not when they become symptoms of a malignant fever or 
of debility. It should be employed whenever there is an inflamy
diathesis present. But as hemorrhage has taken place, why bleed?
the answer is - that the hemorrhage is often too small or too large
or it [cross out] occurs in improper places. Thus in bleeding from the nose
the blood lost is not sufficient to relieve the system- often in hemoptysis
it is so excessive, as to injure the patient's constitution, [cross out]
& we often find it taking place in the brain, lungs & other important
[cross out] viscera- to prevent therefore the effusion in such 
dangerous parts & to regulate the quantity; blood letting is highly 
serviceable- It is not proper however, to [cross out] induce a habit of
bleeding to prevent any expected effusion of blood, as its advantage
in then lost. & the habit itself becomes a disease. Hemoptysis
often occurs with violence from the rupture of some large vessel-
& has [cross out] occasioned death in a few minutes.

96

97. 
in general it is preceded by some uneasiness in the breast accompanied 
with a slight cough & a tickling at the larynx. a little frothy mucus
is brought up, tinged with blood. here bleeding is very useful in
conjunction with other remedies the patient should be kept in
a cold room that he may inhale cold air & his body should be warmly covered. Bleeding is
equally proper in hemorrhagies whether arterial or venous.
In hemorrhoids general bleeding is to be used in conjunction with
local. leeches and punctures are the two methods of the latter kind, which are
employed, I prefer the punctures as making a clean incised wound which
speedily heals. In menorrhagia blood-letting is useful- It is usually
accompanied with pain in the back & loins with fever which symptoms
are often prevented & when present are rendered more moderate by V.S.
In hæmatemesis bleeding must be regulated by general symptoms,
as in these cases by the quantity discharged the system is often quickly reduced.
This may be distinguished from hemoptysis- by the blood being of a 
dark grumous colour- being brought up by vomiting & mixed with 
the contents of the stomach. In hemopts the blood is frothy & generaly
of a bright arterial colour it is mixed with mucus & brought up by 
a slight cough. In using the lancet in hematemesis the pulse will
be the best guide. In Apoplexy- bleeding is the remedy. This disease
consists in a loss of all the external & internal senses & of voluntary

98 
X There is a state analagous to apoplexy (how correctly names 
is doubtful), arising from the condition of the Stomach- Bleedg 
here also is demandd Dr Physick took ℥.x.c. at one bleedg
from Dr Dewes in an attack of this kind- After General Deflam
local evacun by Cupg & leeching are useful- these remedies
should be assisted- by cold application to the head- & if the 
patient becomes able to swallow he should be kept in a 
very low abstencious diet- blisters be applied to the neck &c &c

99. 
motion. The action of the heart & arteries & respiration continuing.
From whatever cause it takes place, the lancet should be freely used -
the blood should be taken rapidly so that it is often necessary to puncture
veins; the head also should be kept in an erect position & all
obstructions to the free return of blood from the head be removed.
No advantage is gained by bleeding in the jugular vein. X
In palsy which is very analagous to the last disease bleeding & 
purging are very important. In the other stage, when all the head
disease has subsided, stimulant be applied to the limbs & are taken
internally. this is no exception, [cross out] they are not employed when the head is affected.
Lecture 11th Nov 28th 
Bleeding has been employed in spasmodic diseases. In some of 
these however it is hurtful. It is never [cross out] to be employed in Tetanus- as far
as my experience goes- all who have been bled in this disease, die. In
wounds occurring in warm weather, I bleed only when the febrile action is
very great. as I conceive that such action is incompatible with tetanus-
I knew however one exception to this, of it taking place while
the fever was high, & the patient died but as a general thing this is not
the case. In convulsions it is often useful, in a case of hysteria
in which the convulsions were so strong, that several persons could not
restrain the patient, a large bleeding entirely removed them. In luxations

[99]. 100 
X The Remote causes of this disease are numerous & diversified
we know very little of its nature- & our remedies must be
employed very empirically. Dr Chapman has lately effected
a cure by keeping his patient to a very low abstencious diet.
I imitated the practice & perseverd in it for 2 months- my patient
grew horse- the fits recurring much more frequently
I revised my plan- allowing a generous diet- the disease
has been greatly alleviated- the fits recurring- but once in 
6 weeks. So opposite must our remedies be in different 
cases-
# It abates the Spasm- prevents Inflamn & [cross out] facilitates
the action of Medicines-
Ⓧ- Here cupping is very useful after succeeding- when
all the usual remedies have failed.-

108. 
luxations. Dr Physick has introduced the practice of bleeding. In the first 
case in which he employed it- several strong men with the aid 
of a pulley had attempted in vain to reduce it. the patient was bled ad.
deliquium when Dr P [cross out] succeeded without assistance. It has been
several times repeated & always with success. That as little blood
as possible may be taken & that the patient should faint soon, he
should be kept erect, he bled from a large vein or what is better
from large orifices in two veins. While the patient is in a state
of syncope the reduction is generally very easy.
In epilepsy it has been much used & in cases, where the vessels
of the head are full, it has been of service- but the practice in this
disease is various. X Some practitioners have found it useful in
chorea as Dr Rush; Dr Cullen has found it generally hurtful. In
various spasmodic affections of the breast, as asthma, palpitation, dypnœa,
it has been occasionally used. here we may be regulated very safely by 
these rules- 1st It may be employed when respiration is very difficult
& 2nd When the pulse indicates a great febrile action & there is much
pain.- In colic, it is often very essential, especially in violent
cases. # I have seen large quantities of opium given to relieve the spasmodic
actions with no effect when a V. section has become immediately successful.
In Nephritic colic it proves very useful- [cross out] in affections
of the bowels the pulse seldom proves a sure guide. we must be

102. 
X Celsus recommends it in local inflamy-
††. & by producing considerable internal irritation -
#. Dry Cupping is often very servicable- Dr Physick first
employed it in many cases of local disease with advantage- it
produces much irritation- the pain is often considerable- this two
somes form & ecchymois is often induced- Dr Caldwell has lately
handed me a case of incipt Phthisis cured by it. His Patient was
a young lady of a delicate slender frame- Feeble health, who, from exposure 
to a current of cool air- during the flow of her catamenia- &
while she was in a perspiration- took cold- she had great irritatn in
the trachea- fever came on- which was constant - soon profuse night
sweats [cross out] ensued- respiration became short & laborious, cough was
very troublesome,- she became very much emaciated- These symptoms

103. 
directed by general symptoms.- By the principles laid down
the use of bloodletting in various other diseases, may be regulated As a
remedy, it is one of the most powerful we possess, & must be used with
discretion & at the same time with boldness. The want of discretion 
in its use has brought it into disrepute & that excited prejudices
which should be removed by the prudent practitioners. Bleeding
is usually performed in the arm which is the best place- arteriotomy 
is of no surface does harm, & should never be performed.
Local bleeding has some advantages in many cases. Clearifications
are often used in local infls to unload the inflamed vessels by dividing
them. The advantages of this practice are in many instances very great although
it might be difficult to explain [cross out] the modus operandi- Scarifications are chiefly 
used in Ophthalmia, Synanche tonsillaris. Cupping is an old practice X &
a very useful one in many cases- it is often used in gout- rheumatism & 
in phlegmonous inflams with advantage. It should be employed
after general bleeding- & is often useful taking blood very slowly. X It
may also be employed when the strength of the patient is not sufficient 
for general bleeding. It is of service in hemicrania- pleurisy & in every 
case of local pain especially when bleeding from the arm has been preserved.
In the typhoid pleurisy I have often used it with great advantage
I never in any case knew it to do harm- it may therefore by used to determine
whether the system would bear general bleeding. #
Leeches are very useful in taking blood & may be used when circumstances

104. 
came on very rapidly- in 6 or 8 weeks after her attack- every
symptom indicated the affront of [a] confirmed consumption, which
was likely to prove very rapid- Bleeding blistg &c had been
tried with no effect- Dry Cupg was then resorted to save the 
whole breast, 20 or 30. cups were applied 2 or 3 times a day
as they could be borne- The patient immediy began to improve
& by the 10th day- all the unpleast dangerous symptoms had
vanished- debility only remaining. During this time, no
other remedies were employed- except occasil laxatives & injections.
This was a case of great hazard- & the cure was remarkable-
X- Cupping is more painful especially to inflamd parts: the scarification
also leaves scars which circumstance is very unpleasant
when occuring about the face- in such cases leeches are preferable-
The quanty of blood taken by Leeches not easily, tolerated-
20 will perhaps draw from ℥.iv. to. vj.
# There is a prejudice against bleeding infants- Childn
bear the operation of all meds (mercy perhaps excepted) with
as much ease as adults- The prejuds against V.S. are wholly unfound
# Vomiting has been considered as unnatural but that can
hardly be considered in this light- which is the mode by which
Nature on a variety of occasions endeavours to relieve the stomach
of irritating matters-

105 
prevent the cupping. As in violent inflams of the joints where the
skin is tender- also in ophthalmia & hemorrhoids - there directly in accuatg infd vessel. X Often useful in young children
especially when they are fat & their veins cannot be easily found &
also when they are very young. #-
Emetics
Our second head of evacuating remedies are emetics or those medicines
which excite vomiting [cross out] an inverted peristaltic motion
of the stomach. Emetics have been among the earliest remedies & are
very important; prejudices have existed against them as against all
powerful medicines, but they are not dangerous as daily experience demonstrates.#
The physiology of vomiting is now pretty well ascertained-
It was formerly doubted whether the stomach itself acted,
or whether [cross out] vomiting is induced by the action of the expiratory muscles. That this last
is not the case, as these muscles frequently act violently without producing
vomiting as in the evacuation of indurated fever. M Haighton opened
the abdomen of an animal, during the act of vomiting & found the
stomach contracting violently. Some persons have as much disgust
for those medicines, that they absolutely cannot swallow them being
prevented by the contractions of the œsophagus without the abdominal
muscles being exercised. In the case of acid & flatulent emultions
the stomach only acts. The duodenum is often affected also, as is
evinced by the presence of bile &c in the substance discharged. That
the stomach acts violently in such cases is shown by the fallen

106- 
X The Dudenum was more injured than the Stomach- now
no one can contend, that these effects were induced by the
action of the abdoml muscles- the Stomach & Dudm being
quiescent.
# Even this is a question- it is very probable that the 
gall bladder contracts in order to discharge it contents.

107. 
feet. Chevalier examined a man who died in consequence of
violent vomiting excited by some spiritous liquors. The inner coats
of the stomach & duodenum were torn in several places & very
extensively especially about the pylorus. X By the action of the
abdominal muscles, # the gall bladder is emptied of its contents
which at the close of the vomiting may [cross out] be [cross out] discharged-
showing that the bile did not previously exist in the stomach.
Dr Darwin supposes vomiting to take place from a diminished
action of the stomach. this is not true for certainly the stomach
& duodenem are acting more powerfully than naturally, they are
performing double duty- they are in reality stimulated by the 
substance which excites the vomiting- yet a sedative or [cross out] debilitating
effect is produced on the system.-