Notes on the Material 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 & enlarged
during that of 1817 '18 by Hugh L. Hodge.
Vol: 2nd.




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 and duodenum are
acting more powerfully [the?] [illegible], they are performing
double duty they are in [??ulity] stimulated by
the substance which excites the [vomiting?] yet a sedative
or debilitating effect is produced on the system.
Note: It has been said that emetics are violent remedies
that they are important, and remedies suggested
by nature, is proved by their use among the 
savages, Dr. Barton in his research concerning
the use of this class of remedies among the Indians
of our country ascertained that fifteen vegetable
emetics were used by them, and one mineral - 
the sulphate of Iron

Lecture 12th.. November 29th..
Vomiting takes place in many states of the system
as well from Stimulating as debilitating causes, all 
of which act however by stimulating the stomach.
It is excited artificially by various medicinal 
substances, presently to be noticed, which act as
local stimulants. When any of these are taken
into the stomach no effect is apparant for some
time, in about 10, 15, or 20 minutes some sickness 
commences; the patient becomes pale; the action
of the heart and arteries becomes more feeble,
frequent and irregular; a slight chill and coldness
is felt, the sickness increases and vomiting
ensues, the face and skin now become red and
flushed the pulse little more active, this gradually 
ceases, and the skin again becomes pale,
the vomiting is repeated [generly] generally 2 or 3 times,

After this sleep takes place, the pulse remains feeble 
for a short time but gradually returns to its former
state; accompanied with a gentle diaphorasis -
In some persons, vomiting is mild [cross out] & easy,
[given very early after these articles have been taken]
[into the stomach] with others, it is verry severe and,
is [cross out] in some instances attended with [cross out] violent spam
and [cross out] alarming hemorrhage Bourte- relates a case in which vomg was fatal Some have employed
Emetics [them] in health; this is wrong; but in various 
diseases they are useful - In some of there, vomiting 
is easily excited, as in fevers accompanied with increased
billious secretions, in others it is more difficult, 
as in mania, tetanus croup, epilepsy &c. after
large quantities of opium have been taken, they are
nearly inert, as the stomach is rendered so torpid
The is also the case with other poisons. 
Dr. Cullen or McMurray which? thinks, that emetics possess a different 
degree in their nauseating power - some

Some nauseating much less then others, yet exciting
vomiting equally will Thus Sulph: Zinc: produces but little nausea tobacco a great deal this will be some practical 
importance. The action of emetics on the stomach 
produces by the general law of sympathy; important 
effects, on other parts of the system; thus 
by them debility [crosed out] the muscles is induced
weakness of the pulse; paleness of the skin, sweating
&c. All which are important in a medical view
and can only be accounted for, by the consent of the 
stomach with these parts - 
Mr. Murray has said, that emetics, if they 
do not operate on the stomach, produces a laxative
effect; this is true, as to the mercurial and antimonial 
emetics; but [cross out] I doubt whether it is generally true; the laxative
property of Ipecacha.. has not been clearly shown.
Emetics have been used in a state of health, 

allow that they may be moderately used
Dr. Cullen [cross out] but does not advice
their frequent exhibition In perfect health they should never be used
it is certain they are hurtful. & on this point common sense is the best guide
[cross out]
meds. as prophylactics are [cross out] useless [illegible]
Hemorrhage has taken place and the person has
died in some instances; besides, if repeated frequently
the stomach becomes weakened and digestion impaired. 
In various diseases they are very valuable,
In fevers, they have been extolled, & in some
are certainly very useful. They are indicated especially
in bilious remitting & intermitting fevers, when there
is much uneasiness, at the stomach, and in the board:
They are more demanded [if] in hot countries than in cold ones, as [there] in the diss. of the Jeshies [illegible] is
usually [in them] a greater secretion of bile. If much 
febrile action, be present VS is to be premised, Dr. 
Fothergill in cases, where there is much fever, strongly 
recommends previous bleeding; for the momentary
tetanus produced by vomiting is often hurtful

without this precaution; [cross out]
by determining the blood to parts too weak to withstand
its impetus, as to the brain producing apoplexy to the breast induceg hemopt [&c.]
The emetic is most useful immediately after the
bleeding - These observations should be remembered
and never exhibit emetics in a hightly 
excited state of the system; /Lec on emetics Dr. Cullen
[cross out] paragraph 171st.. in his first lines which I think
are the most valuable observations that have ever
been published on the subject,
In the yellow and billious fever in this country
emetics are but little used, unless there is a great
[dead] Accumulation of bile in the stomach. I [often] believe they see [illegible] as this organ is
[gennly] generally in an inflamed state, the cure here is entrusted
to, bleeding & Cathartics If there be much pain
in the back and head, & if much naused be present
without vomiting, the we first bleed & afterwards we may 
administer an emetic,[ In bilious fever Pure
them, when the bleeding and Cathartics do not

afford the expected relief In the proper intermitg & remitg fevers emetics are much used It is fashionable here to
administer them, before the bark; the emetic operates by its own 
powers, but the bark will cure without premising
the use of it [cross out]
[cross out] When there is much inflammaty 
[cross out] action; bleeding should be employed & then 
the emetic as they prove most effectual when the 
system is a little reduced. In mild cases, the best 
time is just before the paroxysm; the reason of this.
according to Fordyes, is that the opperation of an [e]
emetic favours the foundation of a crisis. whether this
be true, the time fixed is no doubt the best During
vomiting, the vessels of the head are greatly distended;
on this account, Sydenham usually premises blood letting
[so that] thus emetics may be used with impunity & even [also]
with advantage in diseases of the head as in epilepsy.
[and when] the fits of which when they are regular in their return [were] may 
[cross out]
Hoffman often be obviated by adminisg an emetic.

Dr. Fothergill has even employd them in apoplexy,
upposing this to depend on the Stomach but not independently bleeding; I give the preference
decidedly to Cathartics in these cases & am
rendered more timid by observing in one of my
patients who had been trepanned some time previously 
a dangerous hemorrhage result from the 
wound during the action of vomiting which was 
accidently excited: [which] this proves that the distension
of these vessels in vomiting is very great.
There is however a case of apparent apoplexy;
from indigestable food or excess of food; in which emetics
are of great service; this may be distinguished 
from genuine apoplexy, first by the cause being
occasioned by overloading the stomach 2ndly by 
the absence of [stert???] breathing 3dly by the pulse
being low, small, and frequent, very different from
the slow laboured pulse of genuine apoplexy & 4hly
by the distension of the stomach and bowels. These
will not fail as [a] diagnostic symptoms.

[cross out]
[cross out]
[cross out]
In this form of apoplexy emetics with other remedies are of importance;
the patient should be kept erect his cravat loosened and
bled very freely; emetics are then to be given, if he can swallow
and if not, the fauces are to be irritated with a
feather, & also the intestines by stimulating glysters
[cross out]
In hydrocephalus, the use of emetics is to me
very questionable; they cannot have any effect in 
promoting absorption and may prove injurious from 
exciting [the] a determination to the head; [(] but given
so, as only to nauseate, they are useful by [cross out] deminishing
the action of the heart and arteries. Dr. Chapman
thinking, that this disease depends upon a disorder'd
state of the stomach, recommends them, but this

condition of the stomach has not been sufficiently 
[should] demonstrated; my dissections in this disease show nothing
of the kind. In the phlegmasia, they have been 
employed. [(] They act by evacuating the contents of 
the stomach by removing all irritating matters by diminishing the action of the
heart and arteries [&] by producing diapherosis & also often by [cross out] emptying the bowel: thus
depleting the system [)]. Dr. [Cullen] Barton recommends 
them in acute rheumatism, especially when it [which] arises from
marsh miasmatta: in this, he is supported by Dr.
Chapman: having no practice in this particular form 
of rheumatism, I refer you to those autherotics: in the common
form of rheumatism, however, I prefer gentle [diaphoratics?],
to emetics. In Gout, Dr. Barton recommends
them from his own experience, especially, when accompanied 
with Vertigo &c. In retrocedent gout I 
have no doubt, they are very hurtful. [(] In gout, when 
symptoms indicate the presence of bile in the stomach
emetics are then useful. This practice was recommended 
by Dr Cheyne. Fothergil advised that they
should be given between the paroxysms.

In ophthalmia I do not much use them as we have many
more powerful evacuants [ I have known a lady to
have the vessels of the admata ruptured by vomiting,
of Course they must determine the blood very much to the eyes
and are therefore [cross out] to be employed with the hesitation. In some chronic cases,
they have been very useful; they were very much
used & with success in the French army, while in Egypt; where they
suffered [cross out] severely from this disease. [cross out]
In the various inflamatns of the throat and fauces they 
have been very useful as in Cynanche tonsills & Cynache.
Maliga.. were I asked to give an example of a disease,
which was completely under the power of a mede..
it would be the Cynanche Tracts or Croup which is 
often immediately relieved by an emetic [cross out]
In infants [when] in whom this disease frequently occurs, an emetic is first to be [cross out]
given. & then V.S. is freely to resorted to;
[cross out]
[cross out] the stomach [cross out] is usually & little influenced
by medicines. large doses are required Dr. Chapman has given 15 grs Tarsmetic 

to an infant. I have seen a remarkable exception to
this in which vomiting was excited by 1/30th of a grain
By these means, the sonorous and difficult breathing quickly 
subsides & the violence of the dise. is speedily subdued. It is of importance in all diseases, to resort
quickly to active remedies & in none more then this 
[?] for in a few hours the disease extends to the [trachea] lungs 
the simptoms and treatment becoming the same as in
peripneumonia. Bleeding [of] emetics & Cal with other auxiliary 
means are to be immediately resorted to; not in
my opinion, to evacuate the membrane from the trachea
but to relieve the spasm of the glattes; I do not think
that a membrane in the trachea is the sole cause of 
the dificulety of breathing; for in all my dissection 
[cross out] I have seen it, but once; besides, when it does exist, it never, 
renders the trachea as narrow as the opening of the 
glottis: [cross out] Also 
when large bodies [cross out] become fixed in the esophagus [cross out]
[something for] they do not close it up, but merely

thus imped of respiration, but not inducing the sympts. of 
distend the membranous portion of the trachea. there craus thin
we have not a sufficint explnt of the [??emsonena], which 
[cross out]
we must refer to a spasmodic consta of the glottis
[cross out]
[illegible] by some irritt- cause prodg suffernd & finally death
That it should be referd it to a spasmodic action of the muscles
of the glottis is also showndry its being relieved by [the] bleeding, vomiting
&c, I am strengthened as this supposition, by the
following case, I was called to an infant in this disease
who was apparently dying, I commenced the operation
of tracheotomy, the pain of the incision reliev'd my 
patient in 5 minutes, it breathed as well as in perfect 
health, this could not be attributed to the blood lost
by the incision as that was trifling and the patient 
had been leeched from the same place without any effect
no membrane in the trachea could be so easily dissipated 
[cross out]
[cross out]

Lecture 13th.. December 2d..
In the various pulmonary Complts emetics have 
been much employed & often with great service.
I have lately received a letter from a practr in Vinga
stating that he has found an emetic a specific remedy
for Catarrh, that he never fails in the use of it. I believe it will however not always answer, In
asthma, pertussis and in certain stages of consumption
these meds have been useful, but in the more advanced
stage, when debility is very great they are hurtful. 
In pulmonary diseases it will generally be found to be
most advantageous to give emetics in nauseating doses
only so as to act as diaphoratics - In mania they have 
been much used & as a depleting remedy with advantage;
[(] in these cases larger doses are necessary. [)]
I had a patient, whom I kept several weeks under a 
state of nausea & have no doubt, but that it contributed
greatly to the recovery which took place.

The mania apotu, Dr. Klapp has lately introduced
the use of emetics & with marked Success, he has
been very successful in quickly relieving all who
fell under his care. note of 30 cases, which were under
the care of Dr. Klapp every one were cured The
doses of tart emetic were large amounting sometimes
to 30 grains, I have known 50 grains given in
a case of mania potu. J Moods Studt at the Alms Houuse. I have no doubt
this is a great improvement; but there are certain 
states of the system, which must preclude the 
use of emetics, especially, where with great debility as
when there is a severe injury to any part of the body as in
fracture &c. In a case, which I had sometime since 
of traumatic titanus in a child of [cross out] about 8 years of 
age, by the advice of Dr. Physick, I used an emetic
[cross out] the simptoms which resulted
from [the] its exhibition [of the emetic] were such
as is to alarm me, the convulsions were at first increased
and the relaxation, when it took place was so great

as nearly to destroy the patient. The child recovered,
but I confess, I should be very unwilling to repeat 
the practice, as I have seen such ill effects in this
disease from the use of evacuants. In a case of 
Idiopathic Tetanus Dr. Chapman has succeeded by
the use of Injections of antimony &c. I believe that the five forms of Tetanus tho apparently pimilae are really different: the latter being of a rheumatic nature.
In the year 1800 Dr Physick first employed emetics to relieve the 
rigidity of muscles, which prevented the reduction
of dislocated bones. This plan is to be followed where
bleeding is from any circumstance contradicted 🜋
In hernia also they have been employed with the
same object: they have been very useful, in those
cases also in which foreign bodies have been lodged in 
the Œsophagus & retained by a strong action of that
tube: [even] when the emetic cannot be swallow'd 
Dr Physic recommend, that a solution of it should
be held in the mouth. In two cases, where a quack
🜋 I would use the tartar emetic or tobaco

stone was fixed in the asophagus & had resisted the
ordinary means, the Dr used this remedy, it produced 
relaxation and vomiting & the stone in each instance was thrown up.
In one case, it failed in consequence of the tobacco
or tart emetic, in the mouth not producing any nausea
in this case the warm bath & a large dose of opium by injectn .
proved successful. Upon the same principles Emetics have
been employed, to facilitate the passage of biliary & 
urinary calculi ~ 
In the sick head ache remedy is so effectual 
as an emetic, Dr Barton prefered Ipecacha..
There is a is chonic painful affection of the head originally 
produced by a blow altho' there may have been no fracture or concussion which has resisted every mode
of treatment, which has hitherto been attempted; nothing
however has been so effectual as emetics which have
relieved several persons of this tormenting disease:
the cures have been speedy and effectual * [?]
They were exhibited 1818 at first every day & afterwards every other day.]
*In some late cases this practice has been very successful

In puerperal Fever at the commencement, where
the symptoms require depletion, emetics have been
highly useful: this fever has a great resemblance to
the yellow fever and is sometimes attended with a black
vomit; under these circumsts. depleting remedies and especially
emetics have been serviceable. In Hemorrhagies
they have been much used. In hemptysis they have been recommend by Dr. B. [Nobini?]: Dr. Cullen
used them once, but not again as this operation appeared dangerous. I am affraid of them 
in this disease, but make much use of nauseating doses of emetics.
Dr Cullen recommends them in uterine hemorrgs.
& from the little experience I have had in this
case I suspect they are useful. Dr. Barton in such
Cases recommends Ipecaca. a with opium as also in
hematuria; Some consider the Ipecaca. as acting the
[cross out]
espially in this case. but I suspect more is to attributed 
[cross out]
to the opns which is given in combinatn - 
In Hernia humoralis, they have been much
used, but here bleeding is the grand remedy emetics
[cross out] are valuable [cross out] auxiliaries. ~

The disease has been often cured by sea sickness;
Remember, that frequent small bleedings and occasional 
cathartics, together with a low diet & rest, [another]
form the grand outlines of its treatment.
In obstinate Buboes, emetics have been serviceable, 
but blisters are more powerful in discussing 
these swellings ~ In Dropsy, they have been
used with the view of promoting absorption: we have 
not much reason to believe, that this is the case, for 
when given in small doses they may be serviceable by 
exciting diaphorisis & diuresis without having direct act on the absorbent
When dropsy depends upon visceral obstructions, they may 
be more useful. In anasarca from protracted intermittents
or arising from marsh miasmata, they have 
been found advantageous, & with the mercurial Cathartics 
[cross out] are the best remedies.
In Hydrocele, I do not think emetics or 
any other internal meds to be of any service, this 
disease is cured only by the surgeon. In the acute inflamm..

[of these parts] of the testicles & their appendages
they are more useful,
In hydro thorax they are never to be used.
In Diabetes arising in marshy countries, Richter
recommends them I cannot judge from my own experience.
They have been employed by Sydenham in
Dysentery. This I believe to be a fibres introversa, & it
should therefore be treated as common fever: when there is nausea,
pain in the head and back, and other symptoms, which 
requires an emetic give it, disregarding the bowel affection.
I have seen dysentary exist as a symptom of yellow
fever and have cured my patient with copious bleeding
I took 68 ℥ the first day.
In Diarrhoea arising from a foul stomach [and]
[cross out] as occurring as a catarrhal symptom, they are very useful; in this last
flannel should be worn next the Skin, to restore & keep up
perspiration. [which the stomach in foul by which is meant in]
[digestion emetics may be used with great advantage]
In Dyspepsia, they are sometimes to be employed

Dr. Fothergill recommends them in weak stomachs & to 
Sedentary persons: this is certainly wrong, they should take
exercise not emetics. In Rachites, they are likely to prove
useful, because it is connected with visceral diseases [for] in 
which emetics are [cross out] often serviceable [cross out];
[cross out]
[cross out]
[cross out] In this country, this disease is 
[cross out] very rare, I should confide in the cold bath, in sea
bathing, and in tonics. In fluor Albus & Chlorosis they have 
been used. The Tic Doloureux [Irifmes dolorefecus^ dolor
facei creecilus] has lately engaged much attention: the 
first case occurred in 1773 & was treated [cross out] with cicuta
Dr. Fothergill is the first, who takes much notice if it
he describes 14 cases all in persons some what advanced 
in life; this conforms with my own experience. It commences
with pain near the eyes, [cross out] on the molar &
sometimes on the temporal bones. It comes on suddenly

and at intervals; which are very irregular; [it] the pain is very
excruciating, but lasts only for a moment; the kind of
pain has been variously described: it is excited by the 
most trifling irritations, as eating, speaking &c. it 
occurs often during the day and night; it differs from
the toothache in appearing in persons, who have lost
their teeth; in being always above their teeth, & seldom
if ever, in the lower jaw, it is generally, in the course of the 
infra arbitar nerve; it is different also from [cross out] rheumatism
of the face; by this last being more general and recovering 
at regular intervals & also at every period of life
Dr. Fothergill has [cross out] attributed this singular disease to a cancerus
condition of the fluid; [cross out] but on what grounds we cannot
discover: there is no inflammn.., never any swelling of the 
glands or any ulceration, nor indeed any one character of cancer.
Various remedies have been employed. Cicuta was the
first, but this and the whole tribe of narcotics are of no service

The French recommend that an erechar be parmed by the burning of moxa
I saw this operatn. performed by Dubars at Paris but it is cruel &
barbarous & is seldom successful 
In 1798 Mr Haighton first cut the infra arbitary
nerve, in this: he has been followed by most of the
London Surgeons; in some cases it was completely sucessful,
in others, [it] the disease recurred and in many it was of no service.
[It has been treated by the French surgeons to form]
[a large extra on the jaw by burning wax on it a cruel]
[practice and one which augt not be be used] [cross out]
Mr. Abernathy first disected out 1/2 an inch of the nerve 
but to no better purpose. Dr. Physick having tried this 
[cross out] operation & also the various remedies, which have been 
proposed unsuccessfully, has thought, that emetics might prove as useful
in this as in other nervous affections: he has made trial 
of them & has every reason to be satisfied he has not 
failed in any of the few Cases, which he has lately seen
in effectually curing this dreadful disease. They are to 
be given daily for some weeks. & then every 48 hrs, for 
[cross out]
two or 3 months.

Lecture 14th.. December 3d..
Emetics have been used in eruptive disseases with 
the same object as in fever; there are many of this 
class which depend very much on the stomach as
the urticuria; where the best remedy is, that, which
evacuates the stomach of all indigestible matter.
There are some persons, who cannot without great 
injury eat any particular substance. This idiosyncracy
frequently relates to shell fish: A person [cross out] who was troubled
[cross out] with this peculiarity as to oysters; wishing to overcome 
it, he eat a hearty supper of them; he died before morning.
When from this or any cause of a similar nature alarming symptoms are induced;
the remedy is an emetic to evacuate the content of 
the stomach. From what has been said, it must
be seen, that emetics are a valuable class of remedies
& therefore should be well known.
As to the time & manner [mode], in which they are to be exhibited,

we must attend to the particular circumnts. of the case. When Poisonous matters
are taken into the stomach; they must be given 
promptly and in large doses. They are never to be used 
in hemorrhages for thout great caution [cross out].
[cross out]
[cross out] They should not be used in the
advanced stage of pregnancy for obvious reasons; they
are also generally improper during menstruation. ~
I would not employ them during the paroxysm of a 
fever. In hernia great caution should be used; if they 
are ever employed the patient should press on his truss
while he is vomiting. In many chronic disease, they are to be used daily & for a long time. They are not to be used in
cases of plethora, unless bleeding has been premised. 
Care should be taken to regular the violent operation 
of emetics. This is to be done, exhibiting [illegible] in by divided
doses. [This is] It is however not always practicable, and  [cross out]
[cross out] their excessive operation is to be remedied by mild drinks, fomentations
opium, blisters & sinapisms to the epigastric region,

injections of stimulating & anodyne substances especially of laudn
In urgent cases opium is very valuable.
In administering emetics drinks are very much used. they render [cross out]
their operation more mild [cross out] - they [cross out] should not be given 
till after the Contents of the stomach have been 
evacuated by the first vomiting; then they are useful
in filling up the stomach, & rendering the
following [cross out] efforts easier. [cross out] Children can not 
be induced to swallow large quantities of warm 
drink & it is seldom necessary, as they generally vomit
very easy. Large portions are better then small ones, altho' frequently repeat 
when we wish that the emetic should act powerfully
on the stomach and system no drink is to be allowed
We now come to speak of the individual Articles
under this head. Of these, some are much more
mild in their operation, than others; from which
Circumstance [cross out] the writers on the mata: med: have arranged
[cross out] under many different classes; this I believe is of no practical utility will simply

Consider them under the heads of vegetables & mineral emetics,
and first of the vegetable articles. 
It may be proper previously to observe, 
that there are many other methods of exciting
vomiting; such as by giving warm water, and Teas
of various kinds; also water sweetened with honey; by irritating the fauces,
[cross out] by motion, as in a ship
carriage &c. &c. The first vegetable emetic to be 
noticed is the [cross out] callicocca Ipecacuanha; or Cephailis Emetica, it is some what
singular, that this medium should have been so
long employed without its natural histy.. being
known. Botanists now generally call it the Cephalis 
emetica; of the class [pentan??]a. It is procured from
Brazil & Peru.
Dr. Lewis has given the best account of this
plants He says, that it is a slender root consisting of
several short pieces which are [cross out] variously bent & contacted,
marked by numerous wrinkles & fissures -

Our apothecaries do not consider it so good when covered
with a number of filaments. It if composed of two
parts the cortical & ligneous, the cortical is of a grey 
ash Colour, brittle & of a smooth resinous fracture,
that from the Brazils is brown, that from Peru
of an ash Colour: this last is supposed to be the best.
Dr. Cullen attributes its emetic properties to the 
resin in the Cortical part; but it is so involved 
in a gummy matter, as to be taken up by a watery
menstruum, Dr Lewis prefers a mixture of one part alcohol 
to 2 or 3 water; wine therefore affords a very excellent menstruum.
Dr Cullen does not think, that the ligneous
or medullary part is emetic; but it certainly is, but
in a less degree, being in proportion of 2 to 1. Its
Active properties are taken up by proof spirit, wine, 
water, and vinegar; it is however most used in
powder. Its medicinal properties [are very] appear to tie

volatile therefore it is never to be [cross out] given in [d] decoction; &
it should also be kept in bottles well closed.
The dose of this medicine is variously directed.
Some have stated it at grs 1. Dr Cullen at grs 2. In
S. America, the inhabitants take from ʒss to ʒi. I never
use it in small doses to vomit, but always give
at least grains [illegible] XV.
Dr Chapman gives XX.
Dr Barton ~~~ XII. this is too small. As it is
mild in its operation; to render it more powerful
it is usually given with gr: i. or ii. of tart emetic so
that [cross out] a more permanent impression is on add. Warm water is very
useful [cross out] after nausea has commenced in pace [illegible]
its operation.
[cross out]
Sir Geo Fordyes observes that the reasons why
authors differ as to the dose of [Ipeca?] , is that no matter how
large the dose, the effect is much the same
as the whole in rejected during the first vomiting

& that the stomach has not been so [effected] strongly affected, as to act
after the cause [cross out] is removed. But, this is not always
the case as the impression made. sometimes prduces distressing conseqe.. Ipecacuanha is useful, in those cases
of disease, where we do not wish violent vomiting.
Dr Cullen & Sir Geo Baker have stated, that it
is often laxative & to this attribute its good effect in
dysentary: some say, that it has an astringent power,
which renders it useful in this disease. It is no doubt
true, that this medicine has sometimes a constipating
effect. In this disease, it has been much used
in Europe; & in S. America, it is considered, as an infallible 
remedy. Dr. Moseley who practiced considerably
in the West, Indies & in England, says, that it acts
by producing a diaphoresis; this may possibly be 
the Case; he gives it in doses of gr. xv.xx.xxx while the patt. is in
bed & find it most useful, where sweating is excited;
thus frequently curing his patient at once.

This practice [cross out] however sucessful in Europe will not answer in this country.
I think that it is useful in this complaint by combining 
the several properties mentioned & I have employed
it in small doses of one or two grains frequently 
repeated. Dr. Clark recommends ʒiii of the root to 
be boiled in a quart of water down to a pint to be given 
as an injection twice or thrice a day. This has no advante. over the powdr. Dr Barton
used it often in dysentary in the following way - 
[cross out] ꝶ. P. Ipecac: gr: xij
[cross out] ". P. G. Opii. gr: ij
Cret: ppl. gr: xxiv:
m divided into xii
powders one to be given every 2 Aro. In Diarrhoea, where the bowel are very 
much irritated [cross out] it is as useful [cross out] as
dysentary. [cross out] Dr. Fothergill has recommended it in a
Chronic form of this complt. [cross out] Many persons have an habitual diarrhea
arising from a [cross out] weakness of the bowels, & attended with lassitude, a [slight] fever
by which they are greatly exhausted
tongue, a little fever &c. In these chronic cases
a speedy cure, has been effected by giving 1 or 2 grs of

Ipecaca every morning which often acts as an emetic & as a laxative & an opiate at night
[cross out] These are, at first, to be repeated
every day & afterward every other day [?]
In Hemorrhagics Ipeaca. has proved beneficial
In Hemoptyses, uterine hemorrhagics &c.
small doses of this medicine have been [cross out] very useful
when nausea only was produced if vomiting ensued, the [discharge?] 
It is [cross out] advantageously combined with sacch sat. & opium
as in the following ꝶ Sacch sat gr: iii
Opii - gr: Iss ipecac gr i.m
to be taken q.s.h when there is much fever present
Opii & Ipecac are useful in exciting diaporosis.
Dr Cullen has employed it to keep up nausea
in intermitting fevers. It is also useful in consumption,
according to Drs. Kuhn & Barton: the latter 
gave a gr, with 6 or 8 grs of Chalk. I do not see the 
use of chalk & have my self prefered the nitre.
[cross out]
[cross out]
In Dyspepsia it is sometimes advantageously

employee with other remedies in the dose of gr: j. every 2 hours. It operates without
producing any sensible effects, [cross out] like the metallic
emetics; [cross out] many Suppose it acts as a tonic - which
is probably correct.
In Asthma during during the [cross out] paroxysm
Dr [cross out] Aikenside recommend grs xx to be given: in the 
chronic [stage] form of the disease [cross out] he gives it in doses
[of] from gr: iij to v. only. Five grains usually produces
vomiting but after nausea only - when it is equally 
effectual as relief does not depend an the vomiting.
[cross out]
In Dropsy I have no experience of its virtues. In small doses
[cross out] it has relieved the dyspnela of [hydro????] over powder has been useful in anadarca]
In Casses where persons have been taken [cross out]
[cross out] Ipecaca from its quick operation [it] is useful it should be given in doses ʒj to 
ʒjv or ℥j with plenty of warm water. It is also useful
in facilitating the operation of purgatives gr: ij to xv. with jalap render this part astute twice as powerful, The
preparations most frequently employed are the powder,
the wine, and the infusion: the dose of the wine is 
from ℥ss to ℥j, it is made in the proportion

of an ℥j to the pint: the infussion is ℥j to ℥jv; one
fourth being given every 15 minutes, I always prefer
the power, there are various mixture, with other
substances which will be noticed,
Gillenia Stipulaceaet Trifoliata or Ipicaca Trifoliata Indian Physic grows
in all parts of our Country from Canada to Florida;
chiefly in shady and mountainous places. [chiefly] It is of
the class Icosandria; & is known by the name of 
Indian physic as well as several others. It is an
herbaceus plant growing to the height of 16 inches
or 2 feet; the root is the part employed which is
small slender and irregular. Its medicinal properties
reside chiefly in the cortical part, Dr.. Barton
thinks it very similar to the Ipecaca of the shops from 
which it is difficult to distinguish it, its dose is
from ʒss to ℈jj, which is a serious objection to its
use. It has no advantage over the Ipecaca, so far
as has yet been discovered & therefore is only to be

employed when the latter cannot be obtained
[Dr Dorsey spoke of another species stipulation,
this however in its medicinal properties resonable
precissely the one already spoken of, it is said
to be more powerful in its operation, it is verry 
similar to the gillenia Trifoliata.]
Hugh L. Hedge. 1818. Pennsylvaa.
Lecture 15th.. Decembr.. 5th..
Nicotiana Tobaum Tobacco. this is a very active
emetic & as it possesses many other properties I shall defer speaking minutely of it,
till I shall notice it under some other head,
It is a most powerful emetic. Dr Cullen is
opposed to its use, as being very harsh in its
operation, but its effects, [being] altho' violent [and] continually, 
for a [long] short time. Dr Steadman [not given] considers grs vj of snuff or the powder of 
the leaves [is considered] as equal to grs ji of tart emetic;
& being in want at this last article at the hope of

Good hope he prescribed the tobacco to the Hottentots in their 
[cross out]
intermittents fevers with success. In small dose it has been employed
among maniues, who are generally fond of it; but the 
stomach soon becomes as much reconciled to it as
the nose, & I hope, it will never be employed in such
cases. My two last predecessors recommend it, when 
poisons have been swallowed; but I have always found
the system in such cases too much prostrated for its
use The Ipecaca as the Sulph: of zince is preferable.
[cross out]
[cross out]
[cross out]
[cross out]. Its operation is [cross out] similar to [the] 
digitalis [having] leaving the patient much debilitated. Dr Barton 
often [cross out] prescribed it in the form of cataplasm to the 
pit of the stomach, which is perhaps the [last] safest
method: but as I will hereafter tell you, we have 
much more effectual means to evacuate the stomach

much when poisions have been taken.
Scilla Maritima comes from Portugal, Spain,
and from all the borders of the Mediterraneans. It is 
a bulbous root & should be chosen when large [cross out] fresh and
containing a clammy juice: the surface is reddish, the 
inner part white. [cross out] It is more frequently met with in
the dry state; [cross out] as a general rule, it should not be chosen
when the cortical part is large, irregular & black;
this is full of impurities: but the cortical part
should be small and the other white. As it is
much used as a diuretic &c. in Hydrothorac by
our physicians, it is of importance to obtain it pure
and active; this is very difficult, as a great deal found 
in our shops is almost inert. It is nauseous, bitter 
and acrid, the juice when much handled will
excoriate the skin; on this account the Turks
usse it as a rubifacient & in form of a cataplasm

to phlegmonous inflamn. In its dried state it has
losst 4/5 ths of its weight, Its medicinal properties are 
not volatilized but are condensed by drying; so that according
to Dr Lewis gr: iv of powder is equal to 
gr xx of the recent squill. It is given in substance & in
infusion, in water, wine, brandy, alcohol, and vinegar, of 
which prepard we shall say more here after. It is [given] prescribed in
consumption, asthma, [cross out] Catarrh, & and other
pulmonary diseases especially [hydrotheria?]; not often
as an emetic, but with the view of obtaining its
diuretic and nauseating effects with the last view
its dose is from grs ss to grs: ij generally given in 
form of a pill. I however prefer it rubbed up, with 
nitre Four grams will [generly] generally excite vomiting.
The mineral emetics.
Antimony. This is a semi-metel, found in Germany,
Hungary, France & England. [cross out] It was used

Hugh L Hodge
many centuries ago, as an eye water, and to stain the 
eye brows black. In the 15th century, it first attracted
the notice of chemists, from whose experiments we
have obtained the valuable preparation of this metal.
It's ore is a Sulphuret of antimony; formerly called
crude antimony, when seperated from the sulphur, it 
is of a leafy texture, having a specific gravity of 7. it 
is quite brittle + The pure metal or regular has active
medicinal properties as evinced by the perpetual 
pill, which always acts as a cathartic - It loses
verry little in its passage through the bowels, which
portion is perhaps dissolved by the fluids of the canal
& is thus rendered active _ Dr Cullen thinks 
that the crude antimony is inert: [cross out]
he means the sulphuret of antimony. What is 
the mode of its operation, I cannot determine
but he is certainly mistaken -

The preperations of antimony are verry numerous I
will not even enumerate them, but confine myself
to the few that are now used, and
First the Tartar Emetic, antimonium tartarizatum
otherwise, Tartar stratum, tartrate of potass
and antimony, &c.. There are several methods of preparing
this; but the best is, to take 3 parts of the 
ox:ant. per:nit:potass: 4 parts of the [cross out] crystals of tartar,
& 32 parts of water, boil for 15 minutes, strain &
set aside to chrystalize; a triple salt is obtained contg
Anty. Tarte., acid & potass. It is of a yellowish colour, soluble
in 20 [minutes] times its weight of cold water,
but much more readily in hot water, which is the 
best method - Its dose to an adult is from grs ii to 
v; but it is best to exhibit it cautiously & in divided doses of
some persons are more easily affected by it than
others, let v grs be dissolved in ℥ii ss of hot water, ℥ss

be given every 10 or 15 minutes till vomiting is excited.
So great is the uncertainty of he dose, that when given
to children great care is required, from 2 weeks old to
2 months grs ij should be dissolved in 16ʒ & ʒj [cross out] be
given every 10 minutes, so that no more than 1/8 of a grain is administered
at a time. After the first year 1/4 of a grain may 
be given every 10 minutes, and after the fourth year, 1/2
a grain. To show the necessity of attending to these minutia,
I had ordered to a child 6 months old a few drops
of antimonial wine, double the dose was given, the 
child was nearly killed; it vomited for five or six hours
continually, was covered with a clammy sweat,
pulse depressed & extremities cold under these circumstances laudanum was
given, fomentations were applied to the abdomen, & sinapisms to the feet;
the child recovered. Nearly the same phenomena
occurred to a lady, who took grs xv. of tart emetic
instead of Ipecacd - The antimonial wine is now

much used, it was formerly prepared by dissolving the 
glass of antimony in wine, but this was found to be 
too uncertain in its operation - It is now prepared by 
dissolving ℈ii of tart emetic in ℥ij of warm water then 
adding ℥viij of white wine [cross out] This is the formula of the London 
collage so that 1℥, Contains 4 grains: [cross out] but the Edinburg 2 Pharma a diurs
but half the quantity or gr: ij; to the ℥ I prefer the solution in water, as it can always be
made at the time, is of a certain strength, and moreover
does not possess any of the stimulating power of
the wine; which under certain circumstances would 
prove injurious - The wine is sometimes convenient
where only a small quantity is to be given, as it can
be kept ready prepared. Where an emetic is of importance, 
it should be given in solution in water only. The doses  
of the wine to a child a five days old is from gtt: i to ij: to an infant of 3 or 4 month is gtts:
[cross out] X. to XX, but in Croup the watery solution is always to be prefered,
as the wine is too stimulating Dr Chapman has

given ʒi every 15 minutes. To a child Six months old
[cross out]
with success in an obstinate case of croup.
Tartar Emetic possesses all the powers attributed to emetics
[cross out]
of which articles it is the most certain & permanent. It usually
acts as a cathartic & occasionally as a diuretic & diaphoretic
[cross out]
In some cases it also expectorant Hence it is useful in those
cases where evacuations are demanded particularly
[cross out] in fevers whether Interg, Remitg or Continued.
In there, it was first employed by [cross out] the Chemists, and its utility
was confirmed by regular practitioners. All its effects
[cross out] are attributed to its evacuating properties; especially by
vomiting and stool. But it is no doubt useful when
it neither vomits nor purges.
Dr. Fordyce says, that when it excites
vomiting, it produces a state similar to crisis of a fever,
[And] and in [nauseating] small doses [cross out]
[It] it produces sympathetically an action [cross out] on the heart & arteries by
which great changes are [cross out] induced in the circulation
[cross out]
which are [??ally] attended by some perspiration.
This medicine was for a long time, in the
hands of [cross out] empirics & Dr Cullen was

probably the first regular practitioners who employd
it in continued fevers. He administered so as to induce
nausea. [cross out] Dr Fordyce observes, that it answers better effect
when it does not nauseate. But when any remedy produces vomit & it loses it specific effect [cross out]
[cross out] Dr Kuhn of this city says that it is best 
when it produces nausea, without vomiting. In 
small & [elligible] doses, the tartar emetic produces a gentle perspiratn. [sweat] 
which continues for 3 or 4 hours and leaves the Skin
moist, it is slightly laxative and generly induces
sleep. Dr Young [cross out]
[cross out] Lind attribute to it a specific
febrifuge power without any evacuation whatever - 
I do not think, that this is ever the case; some
evacuation is always produced, & I cannot think
that these gentlemen have been sufficiently attentive 
to the effects of their medicines.
In all the [phlegma??], it is a very important

important article. It is generly given with nitre & should 
never be trusted to without the more active remedies
of bleeding purging &c.
In hemorrhagies, It does not act directly,
in stopping this flow of blood; but it is useful [in]
by relieving the febrile symptoms-. 
[cross out]
[cross out] In bleeding from the nose from plethora 
it is useful - I however prefer Ipecacd.
In Small pox. Emetics & particularry tart:
emetic has been much employed to accelerate the tardy
eruption, & in small doses during the violence
of the fever. It was very much used to prepare the
system, for Innoculation & generally with very good
effect. In Eruption [cross out] depending on the state
of the stomach, & arising from errors in diet it is
useful. Urticaria is of this kind, not however the chronic as described
by Dr. Hiberden but appearing in elevated spots

Sometimes pale, especially at first & afterwards red -
raising the skin in whelts [cross out]; they [cross out] are acompanied 
with fever. & a severe itching. It arises often from eating food
to which we have not been accustomed; here an
emetic is highly important and quickly cures the 
diseases. In Leprosy & in Syphilitic Blotches it
is of no use - In some chronic eruption of the skin
it has been employed as an external application,
by Dr. Willan. I have found the mercul preparations
so useful in such cases, that I have never tried this
Dr. Roasseau dissolves a portion of Tartar emetic in a 
quantity of water, and bathes his patient with it he
has employed it effectually in many cases of chronic
eruptions. Sir John Pringle & Mr Baker have 
recommended it in dysentary, [cross out]
[cross out] but with no advantage
over the Ipecaca induced in many cases I think it must

Hugh L Hodge
prove hurtful by its irritating properties. In children
it is never to be used. Fothergill recomd it in diarrhea after evacuatns. In cases of Spasm or muscular 
rigidity occur in luxations - fractures when bodies are fixed in the [cross out]
esophagus &c. Tartar emetic is ever useful &
[cross out] 
perhaps inferior only to the tobacco..
When poisons have been swallowed it is very 
useful. If the patient cannot swallow [cross out] it may be 
injected into the rectum. [cross out]
Dr Chapman first employed it as an enema, he dissolves ʒj in a quantity of
water & produced a violent vomiting & purging. I have 
tried it in this way, but never succeeded in exciting
vomiting but it purged freely. [It] The injection may be used in obstructed
bowels with good effect; 10 grains may be
[given] thus administered every 10 or 15 minutes, till it operates [cross out]. In 
traumatic tetanus, I have found it of service. In a
case of Idiophatic Tetanus, Dr Chapman [by an]
[injection] by an injection of it cured his patient;
the locked jaw had taken place. It is an excellent

irritant to the skin in many chronic diseases.
In consumption, I have found it very useful; I 
apply it by dusting the powder on the common 
adhesive plaister & find it [very useful] beneficial as an application
intermediate between the blister and 
burgundy pitch. - Of the preparations of antimony,
Tartar emetic is almost the only one now employed
in this Country & England [as emetic].
In France, they still employ the Kermas mineral
which acts powerfully in the dose gr j to i ss.
There is also the golden sulphuret of antimony
which is very similar to it; its dose gr: ij or iij
the cerated glass of antimony has no advantage
and often operates very violently.
The [In] Sulphas Zinci is of a white colour
& is best prepared by the direct union of its constituent 
parts. ꝶ  [Zinci ℥iii]
[Acid Sulph ℥v] [mixed] 

[cross out] The  white vitriol of the shops is usually
adulterated with iron, lead and Copper; but its emetic
effects are unaltered & therefore may be used for the 
more expensive but the more pure Salt. Its dose
is from 6 to x grains. But it is generally used, when 
poisons have been swallowed & then given in
dosses of ℥ss or [cross out] ʒi the stomach [also] being [very] rendered very torpid
by the narcotic poisons. I once gave an ℥j after
℥iv [℥] of Laudanum had been swallowed & where Ipeca
& Tart emetic had been prescribed with no effect.
Dr Cullen says, it has no advantage over Antiy.. & objects to the magnitude
[cross out]
of the dose & [cross out] at it is likely to keep up the vomiting. But the size of 
[cross out]
the dose is no importance if no violent effects are produced, which is the case
with this medicine. it does no harm & is necessary - as here vomit must be quickly
induced. It is very often of service to give a table spoon
feel of mustard much diluted in the water to assist its operation, I prefer it to
any other emetic, in the eases of narcotic poisons.
Dr Mosely says, that it has also a tonic
effect, that its operation quickly commences & soon [cross out]
finishes & that it never induces spasms as antimony sometimes
does. Allowances should be made for the [hias?] of this gentlemn.

I only use it in the cases of poison but it has been much employed as a tonic & astringent [cross out],
[uses] in pertussis & in certain cases may be useful. In 
Croup, I prefer the Tarted emetic & Ipecaca to excite vomiting;
Mosely recommends the white vitl. [it] in solution, whereever
it is be used; his vitriolic solution, as it is called, consist
of ʒiij of the sulphe, ʒi of rock allum, & grs iii of 
cochineal [gr iii] & lb:j. of boiling water, to be rub in a
morter, till cool, then filtered. To this, Dr Mosely attributed 
many virtues, which his prejudice induced him 
to believe: ℥ss of this mixture containing grs: jvss [opperated] operates 
as an emetic. In the active stage of dysentary, he 
used it, but omitted the allum as to astringent, in
the chronic stages, the allum was added: he also
recommends it, in diarrhea, but I have not found 
it useful [cross out]; his treatment is to give a dose every
morning and evening. I have never used it in
Colica pictonum, but Dr Moesly recommends
it highly as always preventing paralysis. He also

uses it in the various pulmonary affections, in oppressed
respiration, & in hemorrhagies: in this I have had no
experience of its [effects] [eppicau?]. Upon the sulphate 
of zinc is a very valuable emetic where a sudden 
and powerful impression is to be made as in the 
case of poisons, But in other cases I decidedly prefer
the emetics which are more mild [cross out]
[cross out] in their operation, 
Lecture 17th December 9th..
Of the preparation of Copper. the sulphate is
the only one much employed as an emetic. It is of a fine
blue colour; its crystals are very elegant and 
slightly efflorescent, They are much more soluble in 
boiling water, then in cold ℥ij of the former
taking up ℥j of the Salt; this should be recollected

in prescribing, a saturated solution of the blue
vitriol as an escharttic, as it is so much stronger
when made with hot, than with cold water. As an emetic
it operates powerfully and promptly; Dr Heartshorn
is in the habit of prescribing it, in those cases, where 
opium has been swallowed and always with success.
he gives ℈j in such circumstances; but in ordinary cases it will
vomit in a much smaller dose; the average dose
is from gr: ij to v. but I have known even gr. ss.
produce violent vomiting; it should therefore always
be given in small doses, gradually increasing 'till 
the effect is produced, Dr Simmons who condemns
the antimonial preparations, has recommended
this in consumptions as superior to every other
remedy: he gives it, in doses of from gr:ij to
℈j: when given in such large doses, it may sometimes
produce an escharotic effect on the stomach

Hugh L. Hodge
stomach, this may be obviated by dissolving it in
water in proportion of gr iij to ℥ij. & administering
it, in divided doses, till vomiting is excited
which will always take place before any escharotic 
effect It would also be very useful to drink 1/2 a pint of warm water before swallowing the medicine. Ceretaur has particularly recommended
it in tubercules Consumption, he unites it
with the tart emetic, to produce vomiting.
But this sulphate sometimes prevents the operation
of the tart: emetic & upon the whole its combination
with the Ipecaca is the best; 5 pills containg
7 to 10 grains of each are to be given in the morning
and to be repeated every 2 or 3 days; [cross out] by
this, he has cured more persons of hectic fever
in tuberculer consumption, then by any 
other remedy, & it is certainly entitled to some
attention. Dr Cullen thinks, that it is harsh
and unmanageable & does not recommend it;

he has had no experience of it in the commencement
of consumption. I certainly think that it is an 
uncertain medicine, and therefore should object 
to its use. It operates without producing much
Nausea or relaxation of the system & on this account I 
would reject it, [cross out] as this relaxing effect
is generally the chief object in the administration of emetics.
Some of the physicians, in our southern states
have recommended it in Croup. but it is not
used in this disease by any of our practitioners, & of
its value in this case I have no experience,
It was formerly much employed in Colia pictom
but it is now neglected. Dr Marriat has recommended
an emetic consisting of equal parts of blue vit. and 
Tart emetic, which has been called the "dry vomit"
as he did not allow any liquid to be taken with it:
its dose is grs: v. It is very harsh severe.
Of the mercurial preparations several have emetic powders but they also possess [cross out]
other properties, which prevent our employing them exclusively emetic

Dr Barton recommends the corros:sub: in Croup; but it is harsh and 
dangerous in its operation. especially in young children.
We cannot increase the dose, with a view of puking
for in large dosses it produces inflammation of the stomach
& even gangrene Calomel has also been employed 
as an emetic; but it is very uncertain, [in its operation]
[generly] generally operating as a purgative. The Sub. Sulph. [Hydrflar?:]
or the Turpeth mineral is the only one to be used of all the mercurial 
preperations as an emetic. It is prepared by [disol]
dissolving ℥ji of mercury in ℥ vj of [sulph?]: acid, boiling it
to dryness & then throwing the white powder into
boiling water; by which it is changed to a bright 
yellow colour - It is an acid medacine and is 
given in the dose of grs iij to [iv] vj. It is very 
apt to salivate, unless it produces a cathartic
effect or some purgative be administered afterward
Dr Cullen condemns its use, especially when 

given with an intention to salivate as in hernia
humoralis.. Independent of the present opinion, that
hernia humoralis is to be cured without mercury,
the turpeth mineral is an improper medicine,
either to vomit or salivate; we have better emetics
and better sialagogues. It has also been used as an Errhine 
& in this way it has also salivated. [cross out]
I have no experience of its virtues in this respect, as 
this is a class of medicines I never employ. ~
This finishes my list of emetics many
more might be added without any trouble, but these
are the only ones of real efficacy & are all which
are at present deserving of some attention.
The next class of medicines to be considered 
are Cathartics or those medicines which
evacuate the contents of the Intestines. The 
importance of evacuating the Alimentary Canal

in various diseases was early noticed, and we find that
cathartics, were among the first medicines, employed 
in the cure of the numerous maladies of the body. It 
would be useless to recount the many theories, which
have been advanced to account for their operation.
All that I shall observe, is, that an increase of the
peristaltic motion is excited by medicines having a direct action on the
muscular fibres, by those which act on the exhalants; [cross out] 
[cross out] & by some, which act on both - also by cold, applied
to the extremities and by powerful emotions of the mind
as fear x these last probably operate by increasing the peristaltic motion, as they act as promptly that there is no time for secretion &c ~~~ The best division of cathartics is in
to mitiera & acriara or as Dr. Cullen has translated 
them into laxatives and purgatives - As a general
distinction this [cross out] will answer but I believe 
that any decision is unimportant in following this it should [illegible] be remembered; that an increase
dose of a laxative may operate as a purgative

and, that a purgative may only produce a laxative 
effect. To this, there may be some exceptions [cross out] jalop 
[generly] generally operates severely, however small the dose may be
& magnesia cannot be given in a dose sufficiently
large to produce a purgative effect.
The immediate effects of a purgative 
we may observe, [in] when it exhibited to a person nearly or altogether
in health. At first in stimulates the stomach exciting 
[a sensation] not uniformly but commonly [cross out]
a slight nausea; by this stimulus the stomach generally 
empties its contents, into the duodenum; sometimes
however vomiting is excited - The duodenum
is now irritated, as also probably the hepatic ducts,
the gall bladder and even the liver; producing 
an increased discharge of bile. How much the
pancreas is also affected is doubtful. At the 
same time the mucus & other fluid secretions

are increased [cross out] & by direct stimulus - & by an increase of their contents the peristaltic motion of the bowels
is accelaraed [cross out]
[cross out]
[cross out] the griping, which so often occurs, is merely
an inordinate and irregular increase of this action
sometimes amounting to spasm. These are the immediate effects of a pure but there [cross out]
are other consequences of greater importance. [They] Cathartics 
act on the [cross out] system by increasing the fluid secretions
into the intestines; thus emptying the blood vessels
and proving a powerful method of depletion.
To me it is strange that Dr Cullen does not think [cross out] them very useful in removing
the phlogistic diathesis; I do not imagine, that they 
are so effectual as blood letting; but I do believe
that next to this, they are the most powerful
evacuants we possess, superior to any other class of medicines
They also operate on the absorbent. It is only of
late years, that the importance of these vessels

has been ascertained, but they are now considered as
having great effect in curing diseases. Cathartics affect
them, either by emptying the blood vessels, and thus 
rendering it necessary, that they should be replenished
by an increased absorption, or by a sympathetic
action, communicated to these vessels; this 
last is rendered probable by this, that the absorbents
are not excited by bleeding, 
I however think, they operate by each of 
these methods in as much as the action of the arts v Absorbs are in an inverse ratio I have on a former occasion stated my ideas of the
incompatibility of two morbid actions [cross out] existing at
the same time. I therefore attribute [to this] many of the 
effects of Cathartics [an] to their inducing a new action
in the intestines; which, altho' it does not actually
destroy, get it [cross out] to a certain extent suspends, interrupts or lessens the existing
disease, [cross out] & hence cathartics should 
therefore be considered in the light of alteratives.

It is on this principle that rhubarb [cross out] operates in curing diarrhea in the 
same manner, I would explain [their effects] the operation of these meds. in
mania and apoplexy, & not to their producing 
a revulsion of the fluids from the head. 
Lecture 18th.. December 10th..
The number of stools for an adult is 'usually' one in
This is the case [??] the great majority of persons [illegible] 
The 24 hours in children they are more frequent
[cross out]
[cross out] 
[cross out] By habit however there
are great variations from this, Tolerable health may exist. to refuse there is an evacuation once in 3 days Haller has collected 
a number of cases of persons, who have gone 
a long time without any evacuation and experience 
no ill consequence. These cases of Haller's

I consider of doubtful authority, & they are some
of them too incredible. Dr Baily records a very 
interesting case of constipation of the bowel -
A Shoemaker, about 30 years of age, who had 
[generly] generally been of a [cross out] costive habit; gradually 
became more so, & had but 3 or 4 evacuations in 
the week; this continued'll till the 8th month,
when he gradually grew much worse so that for the last 15
weeks of his life he had no evacuations whatever; during
this time, he had severe pain in his abdomen,
frequently discharges of air from the stomach
but none from the rectum pain at the [un]
umbilicus after
sometime, the peristaltic motion of the intestines
could be seen through he distended abdomen. 
This appetite continued very good, till within

a few days of his death, when he vomited every
thing in [cross out] a few minutes after [cross out] swallowing - his pulse 
was rather full, but not hard, and had its frequency 
very little increased being about 84 in a minute.
Every thing was done for him, that art could suggest
In addition to the most drastic purges, & glysters
which were of no avail; he took ℥iij of quicksilver
none of which was discharged by the rectum -
Upon examination after death it was found, that a stricture existed 
at the sigmoid [flexture] portion of the colon; so small 
as not to admit a quill; the muscular fibres of the 
intestines were found to be increased in size, the 
small intestines not enlarged, in proportion to the 
others; no regurgitation had taken place, through
the valve of the colon; the fæces were of the consistance 
of soft morter; the stomach and upper 

part of the bowels were not diseased. As in similar
cases, it had generally been found, that the obstruction
has taken place, near the sigmoid flexure; 
would it not therefore be proper in such 
desperate cafe to establish an artificial anus at the caecum;
death otherwise is inevitable 
There are many milder case of constipation, 
which can frequently be relieved by art [cross out]
[cross out] Even in the case of interception
the efforts of nature are very great, portions of
the intestine in such instances have been seperated 
and discharged by the anus, + The irregularity 
of the alimentary canal, produces various
derangements in the system; of these headache 
is a very [illegible] [cross out] 
[cross out] Indeed headache is 
a rare disease [cross out] seldom existing excepting [cross out] 

excepting as a symptom of other diseases particularly of a
[cross out]
a derangement of the Stomach & bowels: which is manifested 
[cross out]
by nausea a vomiting loss of appetite, vertigo
[cross out] I have a patient, whose sight, is affected by 
a delay of his alvine evacuations & immediately 
cured by a purge, Dr Physick has [a patient] one who 
is affected with vertigo, whenever he omits for more 
than 24 hours, his accustomed discharge. [Colic?],
hemorrhoids, and various other affections are likewise 
induced by costiveness ~
Costiveness is induced by various 
causes; general debility affecting the muscular 
fibres of the intestines is no doubt a frequent 
cause; hence we see women more prone to constiveness 
then men. Cullen attributes Constiveness 
also to a vigour & rigidity of the fibres; by which the 
content of the intestines are carried more 

slowly downwards so that [cross out] the 
absorption of the liquid parts [will be] is greater; this 
occur in the hypochondriac.
I think that both these causes, viz debility & also 
vigour of the fibres- however apposisite
frequently operate. It is probable also, that the condition 
of the bile, and other fluids has some effect;
especially as the peristaltic motion is thought
to be chiefly excited by the bile. It is not necessary 
in this place to notice the mechanical means by which 
costiveness is sometimes induced as hernia - interruptis &c- 
Dr Cheyne has contributed constiveness also 
to a torpor of the secretions, into the intestines or 
to an increased action of the absorbents, so that 
a less quantity of fluid is present in the bowels. In 
[all] each of these cases Cathartics are the remedies. [gen]
Generally laxatives [might] should be first employed & those
should be chosen, which do not destroy the
tone of the intestines, a Rhubarb, magnesia,
Sulphur, but these after frequent repetition

lose their effect; They should therefore not be employed, 
'till diet has been previouly resorted to
where the liver, or other viscera are diseased the mercurial 
purges are to be prefered - In obstinate cases
salivation has been successful & it should always 
be resorted to [cross out] rather than continue for a long time the exhibition 
of the drastic purgatives.
[cross out]
Cathartics are useful in various compl. of the Stomh. & bowels. In 
the Colic they are of great use, [and] but they are not to be 
relied of entirely; in violent cases of this disease
we not unfrequently [find] have great nausea-vomitg. cold [entre?]
& when [but] they are to be used in Conjunction, with bleeding
the warm bath, glyster, [and] opium &, Mr. Hunter
long ago taught, that opium purges in Colic,
[cross out] this I do not think [cross out] should be attributed
simply to its antispasmodic fever power; some 
persons are always purged by opium but this
must be considered as in Idiasynerasy In colic
vomiting often prevents the use of opium, [It] it 
may then be given as an injection, ʒj Laudanum

being mixed with ℥iv of Starch mucilage. In colica
pictonum Cathartic are very important, even 
Mosely never resorts to his vitriolic Solution; till he has previously
employed purges; Pemberton recommends a
mixture of Castor oil, & laudanum, Dr Cheyne
recommends opium in conjunction with purges.
The only cases, which I have seen were successfully treated
by a proper attention to diet, by Cathartics and 
by opium.

I shall now notice the diseases in which purges are 
necessary & where the Stomach & bowels are not exclusively 
concerned. And First. Of Fevers 
In every form of Fever Cathartics are among our most 
efficient remedies - they operate as evacuants. thus powerfully 
copperating with V.S. - & in some cases they remote 
the remote causes of the disease - when these [are]
[cross out] defend on the bowels. Many fevers defend or arise
from the contents of the intestines - Among the power
of the system depressed by fever the peristaltic motion
of the alimentary canal is to the chiefly noticed
this induces a sense of fullness, weight, restlessness
& anxiety which greatly aggravates the [fever] disease
Hence it is necessary to evacuate the bowels, which
should always be done at the commencement of the 
complaint as the patient can then bear evacuation
much better than at a later period. - 
In fevers with local determination - or as I 
would say with local inflamn. - I use cathartics

very freely - In my opinion - fevers of the class
Phlegmaniæ are much more numerous, than is generally 
supposed dissection hear me out in supposing that
those cases "congestion" or of "local determination" as
in reality cases of local inflammatn.
In the bilious remittent - the increased secretion of [illegible]
indicates the necessity of purges - but in these cases I
often think an emetic superior to them - but still cathartics 
are not the less necessary - often the vomiting.
In the autumnal bilious & yellow finds - there is in 
my opinion always inflamn. of the stomach; all 
my dissections confirm the idea that the yellow fever
is a genuine Gastritis. Under this impression - I resort 
to the most active remeds. of bleeding & purging -
preferring those articles which produce the most liquid
stools. - In some of the milder forms of fever
[or] single purge has effected a cure ÷ when appearing
in the forms of the Dysentery & Cholera they are equally
beneficial. - Of late year - Cathartics have been

recommended in Syphus by Dr Hamilton, Dissatisfied 
with the ordinary made of treatment; & considering the 
state of the intestines loaded with fæces & [illegible] secretions 
he was led to the use of Cathartics - he at first 
proceeded very cautiously - & from his success was soon 
led to their free employment. He did not confine their 
exhibition to the commenct. of the disease - but used them 
more or less thro' it's whole course. He attributes their 
efficacy in some measure to their acting on as extensive
a surface as the whole alimentary canal. I have no 
doubt - that this has been justly observed. I also agree 
that glysters are inefficient - as acting upon a much 
smaller surface. The extent to which this purging 
has been carried, is greater, than could have been supposed,
it may however he carried to an excess- & therefore
should always be regulated by the State of the System
- In Gout. Cathartics were employed by 
the Antients [till] but were discontinued by the advice 
of Sydenham. Since [it] his time their use has again 
revived. In the regular Podargra. they were forbidden

under the idea - that this form was safe- but that by 
purges - it would be driven from the feet & fall 
[of] upon some vital parts. The patient was therefore
directed to wrap his limb in flannel. & to live well
another reason for this advice - was the [cross out] idea that
the disease was incurable. Lord Bacon long ago declared, 
that nothing was more harsh and cruel than thus
fixing the character of a disease. it destroys every hope
of the patient & renders the physician negligent & inactive. -
Dr Cullen has them hasty - in giving too much
credence to this opinion - as he soon after allows that 
much may be effected by a proper regimen. Since Syndenham - 
purges have been laid aside too much - Dr Chapman -
places the origin of [it] this disease in the alimentary 
canal - & has great confidence in our remedies: Cullen 
says that it may be prevented by restoring the tone of 
the Stomach - In a regular attack of gout in the 
foot - where the constitution is not debilitated by
intemperance - purges are important & are safe -

but sometimes the disease suddenly ceases in the foot 
& instantly appears in the head, lungs, stomach or
some other important organ. This is called the Retrocedent-
gout - & in all such cases purges are to be cautiously 
used. I have seen patients who are frequently affected 
in this way - & in such - purges are certainly 
injurious often [be] enduring a retrocession. Sometimes
however we have various premonitory symptoms such 
as nausea - indigestion, colic &c - there a purge timely 
exhibited will often prevent the paroxysm - but
bleeding is more safe & certain. - When the disease
is fully & regularly formed & [It is] is not usually retrocedent
being accompanied - with fumes - with pain &
swelling of the feet - & - purging is very valuable. The 
Saline cathartics are not to be employed - being less 
safe than rhubarb & its kindred articles - we should
avoid also the drastic articles - it is often necessary to 
repeat the purges frequently & not be content with
a single exhibition. In this way they are as safe & 
as beneficial as in other [inflamm?]

Cases of retrocedent gout have however rendered physicians
very cautious timid - as that purgg was for a long 
time discontinued. Lately the practice has been revived 
it has been extensively resorted to & with great advantage
I only fear that a good remedy will be again abused
While upon this subject I may properly notice a remedy
which in the last few years has been introduced as [a cure]
[for] effectual in the [cross out] cure of the Gout. I allude to the 
Colchicum Autumnale - This is a native plant of England. 
Germany & France - growing usually in a rich soil
[cross out] Being a poison - it with other articles of [the] a 
similar nature was investigated by Baron Stork - He
found that every part was active - but chiefly the root - &
highly recommended it as a powerful & efficacious medicine
- Nothing can exceed the contradictory accent
which have been given of properties. Some contendg.
for its active & valuable powers - others declaring it to
be absolutely inert. Its virtues are said to depend very
much an its age - on the soil - in which it grows & on the
season at which it is gathered - Stork declared, that

the mere application of it to his tongue render that organ
rigid & paralytic [cross out] his accounts are no 
doubt very unfounded: in this country it is not near as active
that it is poisonous to animals, there can be no doubt
as has been well ascertained by Perfessar Murray of Getingen - 
this Gentleman exhibited it - to several animals
which it destroyed by inducing a violent dysentery & [with]
[the] a discharge of bloody urine. It is also recorded that 
two boys who had eaten of it died -
Stork employed the oxymel in the dose of ʒi to ℥i
as an expectorant & also as a diuretic & the Germans
insider it useful in Asthma & other pulmonary affections
Specifics in medicine have always been the object
of Pursuit & [The Gout has] notwithstanding [the] innumerable disappointments,
[cross out] the 
inquiry is still made as if success could be reasonably 
expected- All the reported Specifics for the Gout have
of late years yielded to the celebrity of the "eau medicinale
d'Husson" - By some its virtues are attributed to 
its cathartic - by others to its emetic powers - there [often]
can however be no doubt as to the active powers of this

article. In the year 1771 [it] the plant was discovered by Husson, who
pretended - that it was a new article never before used in 
Medicine. The Chemists have analysed the preparation, but 
all that thay could discover is that it is a vinous tincture of 
some vegetable substance. It is nauseous & bitter to 
the taste- the smell is vinous - but has also something peculiar -
if suffered to [cross out] stand for sometime it become
transparent - This dose is from a half to a whole of a
bottle - (containg about ʒij.) A atumin water on an empty
stomach. In 1808. its was introduced into England & 
[to] soon became very famous - it no doubt produced very 
powerful effects. but still - the easy faith of the British
no doubt enhanced its virtues: [& at] & at the present period we 
[d] can divide more correct on its real value - The eau 
medicinale - is certainly an active medicine when given
during a paroxysm of the Gout in 4 or 5 hrs: it lessens the
pain, induces sleep, causes some nausea, vomiting &
finally purges - the pulse is reduced 20 or 30 strokes
& it usually operate also as a diuretic & diaphoretics the 
Gout abates & after two or three days, only a little stiffness
remains. This is a very moderate account of its virtues

[In England] I have given it to some of my patients - in 
[cross out] there it operated as a narcotic - & in a few hours as a cathartic 
V diuretic. - In England it has been recommended 
by many highly respectable characters - at the 
head of whom is Sir [Jnt?] Banks. This gentleman tried 
it in his own case - & was highly gratified with its operation.
By the Physicians of London it has been very 
extensively employed - but its use has in some measure declined -
owing to its high price - to the ignorance of its composition - 
but especially to a dread - that it might eventually 
prove as deleterious as the Portland powder -
In an excessive dose, it induces [syncope] great depression 
syncope, cold sweats - violent vomiting & purging, a [sin]
sinking of the pulse & insensibility. Ring records a case
in which violent pain was produced as in Gastritis - & also
a black vomit. My experience has been confined to a few
cases - [but] and these were most unequivocally in favour of
this celebrated remedy -
To discover the plant [which] which is the basis of this 
preparation, has been the object of much labour From

its sensible - & obvious effects the Elaterium was [cross out] selectively 
but at present the weight of testimony is in favour of the lolchicum
Autumnale or Meadow Saffron. This was first 
profound by Mr Want. This gentleman prepared a vinous
Dr. - which had a very remarkable coincidence with the eau medicinale -
℥.iv. of the root is infused in ℥viij of wine.
He details 40 cases in which this preparation was successful 
in curing the Gout [& in which there had been] so that [cross out] there was  no recurrence
of the paroxysms for several months. Home has lately
made many experiments on himself - he concludes, 
that the Colchicum is the [cross out] basis of the eau medicinale
that it is a specific for the Gout - which it cures as certainly 
as mercury cures the Venereal. As to the term Specific
I frankly confess, that all I [cross out] mean by this 
expression is that by the action of a medicine a healthy is substituted for a diseased
action - or at least - that a temporary morbid action is 
induced - which overcomes & eradicates the preexisting disease 
even without producing any sensible evacuation;
I also have made some experiments with the Colchicum 
I act I pring I [had] procured some of the root, of which

a saturated vinous Tincture was made ℥j. being infused in
℥ij of Madeira wine which [be] was the proportion used by 
Mr Waunt. This I administered to several gouty patients & 
in no instance did it fail to produce a sudden & considerable
amelioration of all the symptoms. In a severe case which
has lasted for several weeks I gave gtts [?xxx]. & after 4
hrs: I repeated the dose - by which the patient was Speedily cured
I have also given it successfully in a case of retrocedent gout
the plant must however be collected in the spring of the year, as
otherwise it is absolutely inert. a knowledge of this fact
will explain the reason why there have been such contradictory 
statements. There is another remarkable property
in this article; with the exception of the Digitalis
it is the only medicine which suddenly & powerfully affects
the pulse - On the 10th of June - I gave 100 gtts: to 
a person in health - the pulse [being] beating 80 strokes in 
the minute - in 5' it
In another
In each the force as well as the frequency of the pulse

was reduced & in half an hour the gentlemen complained of 
being very sleepy. - From everything that has been 
discovered there can be but little doubt, that the [loletn?] is
the plant, which gives activity to the eau medice: - & that at
all events. it posesses strong cathartic & other evacuating
properties - which in further trials - will [no] no doubt render it highly
useful not only in the Gout - but also in many other diss.
In Eruptive Diseases, from the sympathy which
exist between the Stomach & bowels - & the Skin - purging
is of primary importance. In the Small pox- I have not
had such experience - as this disease is no be prevented by the 
Vaccine - but it was formerly customary to prepare the system
for [cross out] inoculation by exhibiting cathartics - which was
also continued slightly thro' the course of the disease - & probably
with considerable advantage. In Erysipelas 
active purging & depletion with the lancet are necessary 
in this country. In Scarlatina [cross out] purges have been much recommended
by Dr. Hamilton - but they had been long before employed
in this country - where this disease has often prevailed as
an epidemic & in which bleeding & purging were freely

employed - a late winter has recommended Cold water - as 
the but remedy for Scarlatina & one which should supersede 
all other - It is no doubt useful in some cases - but in
all instances I would resort to purging, as the bowels are
torpid & the fæce dark & offensive, so that large & repeated
doses are demanded - œdematous limbs are frequently the
consequence of this complaint - but this symptom may be removed 
by purges & by their timely exhibition it occurrence
may even be prevented. - In measles purges
have been long used - they reduce febrile action & prevent
the pulmonary system from suffering. Some practitioners
[?] hesitate as to the propriety of employing cathartics in this
disease - for fear of the bloody stools which sometimes
occur but this is never a dangerous symptom & as Sydenham 
observes may be checked by the losing a few
ounce of blood. - In chronic Eruptions a long 
course of purging is very advantageous - but many of
these are purely local diseases. & are only to be attacked
by Local remedies. ---
I have, an [of] - a former occasion observed, that it is probable

probable, that all fevers depend on local inflamn- & that in 
all of them purging is an important remedy - This is more
evident in those fevers termed Phlegmatic, in which the 
local inflamn- is a prominent symptom. Local inflammatn-
of the viscera would be more manageable
if we could resort to local means, so that the mode of action
might be [cross out] altered - efficacy of which may 
be seen in scarifying the eyes in ophthalmia - 
In Opthalmia [bleeding &] purging is highly importt.
in chronic cases. the patient should be placed on a low
diet & be bled & purge every day alternately.
In Morb: Conarius - & analogous affections no plan
is more serviceable than a course of purging. Cathartics
given every 24 or 48 hrs: - & assisted by a carved [skit?]
will effectually stop the progress of this complaint.
What is remarkable the patient is not weakened by
this treatment - but in reality grows fatter & stronger.
Whence course of purging is undertaken in chronic 
disease - the patient at first complains of [cross out] nausea
& sickness - is pale & languid - this is sometimes the 

case for the first week or two. after which he evidently 
improves - & the treatment becomes less disagreeable. 
In Rheumatism [it] purgg is very important - in the Acute cases
its advantages are prominent -- & in the chronic forms of
the complaint - it is no less beneficial. In many instances
[the] it becomes necessary to omit the lancet - & it is in such instance
that purging is useful by evacuating the blood
vessels & by making a new impression on the bowels.
It will not be necessary to specify all the local inflammations 
in which Cathartics may be employed - They all demand
their employment - even atalgia, & odontalgia - for
which a purge is the best remedy. Some have thought that
the inflamd- of viscera. of the Chest formed an exception,
but this is not correct - in Pneumonia they may be used
with decided advantage.
In the Neuroses [they] Cathartics are useful. In Apoplexy - which consists
in a loss of sense & voluntary motion, they are very necessary.
I have already noticed the Apoplexy, which is produced by 
& disordered condition of the Stomach & bowels, which
is to be cured by emetics & cathartics - & [al] in all cases,

such is the sympathy between the brain & the bowels - that
they prove effectual - by evacuating the blood vessels, by 
inducing a new action & by exciting the Absorbents.
On the same principle they are useful in Paralysis. -
Hydrocephalus I have no doubt, originally, arises 
from an inflammatn- of the brain - which terminates
in the effusion of Serum - Those examind the brain in different 
conditions of this complaint - & in all - there have been
indication of preceding inflamn. The serous collection
is sometimes [cross out] very great. I have known the brain
so compressed, as not to be more than 1/2 an inch in
thickness. In this state the disease is incurable: in one 
instance I topped the brain with some advantages
the repetition of the operatn- relieved the symptoms for a 
short time - but they patient finally died. It is only 
in the forming stage, that a cure is to be expected, which 
is to be attempted by purging in conjunction with other 
remedies detailed in other parts of our Course.
In Mania - purging is one of the many depleting remedies
to be employed. - In Chorea St Viti

Dr Hamilton strongly recommends purgatives - he has given 
a very accurate account of the complaint & clearly shown
that in almost every instance it depends on the condition 
of the primæ viæ. Sydenham recommended T.S. this may 
occasionally be necessary - but Hamilton has shown, that
cathartics are proper remedies. He first exhibits the 
milder articles - & finally resorts to the more powerful purgatives -
In this way a large quantity of dark fæces 
is brought away to the great relief of the patient. I have
seen but two cases of this complaint - one was relieved by 
purges but in the other they were ineffectual but the experience
of Dr Hamilton is decisive out of 20 cases, 19
were permanently cured. He divides the disease into two
stages- in the first the [cross out] - intestines continue sensible
& can be acted on by gentle laxatives. In the second 
stage the intestines are so torpid & the accumulation of
fæces so great, that the drastic purges are demanded, &
they are to be used as frequently - [that] as to keep up ~
constant impression [cross out] To render this plan of
treatment effectual, the physician must be firm to 
his purpose, there must be no halfway measures - 

you have here as in many other instances to encounter the prejudice
of your patient & his friends. & if they discover, that 
you are not steady to your purpose they will certainly reject
not only your prescriptions - but also your attendance. 
The cure will of course be slow - in some instances,
where the debility is great some tonic will be required -
the best are the Chalybeate preparats - To perfect
the recovery Hamilton trusts chiefly to regimen & to exercise
in the open air - the bowels should be attended to for a 
long time after the cure. I cannot however agree with 
him in attributing the disease to intestinal torpor & the 
consequent accumulation of fæces: he has mistaken the
effect for the cause - it is probable that the same morbid
action which produces the involuntary motion of
the limbs also induces the costiveness 
In Epilepsy Cathartics are important. A correct
pathology of this disease is very desirable. It appears
to depend very much on the condition of nervous & arterial
systems, to which I would add the condition of
the intestines - the proof of this last is shown by the disease
frequently arising from acidity, from worms

from costiveness & other states of the Alimenty Canal.
Dr. Physick had a patient, in whom it was occasioned 
by a tumour on the Thumb - the removal of which 
cured the disease. Epilepsy in many instances arises from
some internal disease - as tumours in the cranium
&c - in which a cure is impossible - Purging - especially
in cases depending on the state of the bowels, is very 
advantageous- but it is to be lamented, that our
knowledge of this complaint is so imperfect -
Headache is a very common complaint - is frequently a 
symptomatic, but sometimes an idiopatic disease. It [is] 
defends on a disordered condition of the Arterial or nervous
systems or of the Alimentary canal. I believe, it arises
from a disorder of the arterial system when it is a symptom
of fever, it is nervous when the heart & arteries are undisturbed 
& digestion unimpaired - it is produced by the
state of the Canal - when acidity prevails in the stomach
or when the bowels are costive. These views should be 
attended to in all our prescriptions for this painful affection.
There is a great variety as to the seat of the 
pain, sometimes it is in the forehead - somets - in the [accipy?]

the pain is very diversified being often dull & heavy -
sometimes sharp & laminating - is attended with remission
& exacerbations - sometimes may be compared to the 
creeping of an insect and sometimes to the opening and shutting 
of the sutures. The pain sometimes resides in the scalp
but more frequently in the interior - It is generally a 
chronic complaint especially when depending on the 
nervous system - Occasionally with it the eyes will be
inflamed - the patient cant bear the light & is troubled
with vertigo & vomiting. The duration of the paroxysm
varies [from] to 6 - 24 or 48 hrs: when there occurs a disposition
to sleep. Occasionally it is periodical, returning 
daily, monthly - &c - in some instances it is constant.
Dr. Rush had a patient who for 40 years had never been 
free from the headache. The remote Causes of headache
are numerous. the most frequent [cross out] act thro' the medium of the alimenty
Canal - as intemperance either in eating or drinking, acidity. 
costiveness, abstinence &c besides those we may 
enumerate too much or too little sleep - suppression
of the menses, blows on the head - rebelled eruptions &c -

The removal of the remote cause form the most important 
part of the treatment. Hence as the disease as generally 
depends on the state of the Canal - Emetics & Cathartics are often 
useful - I have already noticed importance of emetics
when the pain is the consequence of blows on the head: but 
in all cases - the bowels at least should be kept open -
For this purpose a diet of rye-must is often sufficient -
but sometimes the habitual use of laxatives as rhubarb
& magnesia is necessary - so that a new action may be induced.
Magnesia is preferable when acidity is present - 
In chronic cases - tonics are sometimes useful between the
paroxysms: & somets & V.S. is necessary during the fit.
The neuroses - generally depend as much on the
disorder of the Arterial as of the Nervous system In 
Hysteria - the Arteries are also affected, as the pulse is often
hard - & the blood drawn is sizy - the extremities are [cross out]
usually cold - The Stomach & bowels are filled with wind
[are] the patient is troubled with acidity, costiveness, fætid 
eructations - vomiting &c - Dr Rush considers hysteria 
as a form of Gout as arises from the same causes, appears 
in the same description of person, has analgous symptoms

& a similar plan of treatment. It has been supposed to depend 
on the Uterus but this is not the case, as we have every 
[cross out] irregularity of the uterus without hysteria, & we have
the disease in the male sex. The Treatment during the 
paroxysm, consists in bleeding & purging. in one case I have 
known ℥xx. of blood taken. Sydenham [cross out] thought
purges of very little consequence during the interval, but 
Dr Hamilton conceiving the [cross out] complaint to depend on
preternatural state of Aliment if the alimenty canal resorted freely
to purges - & very successfully. He also employed the fætid 
articles & tonics as auxillary. This is correct practice
& you may remember that a disease is very seldom to be
cured by one remedy or class of remedies. put that our 
end must be usually accomplised by their united operation.
This disease - is [illustration] not unfrequently frigned -
for what reason it may be difficult to determine, but
the deceit may be generally detected by exhibiting nauseous
medis- [cross out] pouring cold water in a small
stream from a height on the upper lip - by applying
sinapisms, blisters &c &c -

H. Hodge
Lecture 21st December 16th
In Tetanus Dr Hamilton suggests rather than advises
their employment. In that, which arises from
wounds I have always found depleting remedies to do
harm, purging is never to be used.
I believe, that many cases of reputed tetanus, are in 
reality affections of the muscular system, essentially
different & in these, purging may have been useful. 
In Dropsy, they are very powerful, more so in ascites
[tes] & anasarca, than in hydrothorax; when [it] dropsy is accompanied
with a febrile State of the System & when [the]
the strength is sufficient [cross out]
[cross out] active purges are very useful in exciting absorpn. there
are some cases of dropsy accompanied with so much
organic disease, that purges are not sufficient, a salivation
in such csses often effects a cure. 

Cathartics have certainly no direct effects on the 
effused fluid, but they act by emptying the blood vessels
& thus powerfully exciting the absorbents. The [cross out]
[cross out] diminution of the effused fluid produced in this manner, is sometimes very 
great; out of 6 lbs of water poured into the cavity of 
the abdomen of a dog, all except about ℥iv was
absorbed in 6 hours. Those Cathartics, which excite
much fluid discharge & also act as diuretics must therefore be preferable,
as the saliva [cross out] articles, especially the [cremor?]
tartar, Chlorosis Dr Hamilton considered [this] as 
depending [generly] generally on affections of the alimy.. canal
as is manifested by an irregular & depraved appetite
fœted breath, acidity, flatulency, costiveness &c. There are
no doubt many affections, arising about the age
of puberty, which are not to be classed under

the head of chlorosis; but when there is a pale face,
a soft flabby skin, scanty urine, oedema of the lower extremities
a small quick pulse, acidity, flatulency & depraved
appetite, there is reason to believe, that the intestines
are considerably affected. Dr Hamilton [has] observes 
that, as in chorea, a cure may be accomplished by a 
steady use of purgatives: but here also, you have to
combat the prejudices of your patient & his friends, 
& it is only by previously instructing them in the 
nature of the case [&] & by exhibiting a firm confidence [cross out] 
in your remedies - that you can procure a fair 
[cross out] trial of this practice. In its early stage, mild
purgatives may be sufficient, but the accumulation 
of focus in the more advanced periods must be removed
by more drastic cathartics. Attention to diet, mild 
tonics, excercise, [and] change of air and company will complete
the cure. Dr Hamilton mentions the use
of purgatives in the Vomiting of blood frequently

occuring to young females about the time when the menses should be [illegible] [I have not seen many cases of this]
& which is usually attended with [cross out] costiveness. I have no experience 
in [kind] cure - but have used them and advantage, when blood 
has been discharged into the intestines from the liver.
In a slow remitting fever of children, attended with 
emaciation, loss of appetite, inactivity, listlessness,
swelled abdomen & slow belly, I have found purgatives
effect a cure more rapidly than any other
class of medicines. Hamilton describes a dissease very 
Similar to it, as also does Linneaus and Fordyce
before [cross out] I had seen the work of Hamilton, I had ussed
this method with success; when there [is] was considerable
swelling of the belly; constiveness, marasmus
&c. The articles should be of the milder kind & used
frequently; light diet & a change of air with 
exercise are very useful auxiliaries.

It would be very easy to increase this lift of the disease, 
in which Cathartics are valuable remedies but perhaps
not to much advantage. [These] Those which have been mentioned are the important
ones, in which their agency is decidedly useful. 
It may however be remarked, that the employment
of purgatives in Acute and in chronic disease must
be conducted on very different principles. In the 
former they are used merely as evacuants, and in 
the latter as alternatives: on this account in all chronic
affection they must be perserved in for a great 
length of time. in some cases even for years,
Hamilton does not appear to [comprehend this subject]
[cross out] have fully understand the principle
and which Cathartics act in curing the chronic
Complaints.

In many chronic disease accompanied with &
frequently depending on the constipated state of 
the bowels not only purgatives should be employed,
but an attention should also be paid to a proper regimen [cross out]
[cross out] A resort
to mineral waters is often very effectual. Those in Europe are more useful
as purges than as Tonics: here the mineral water are not so important -
but allowing for all the advantages of an excursion to the
springs, for the change of diet, of air, of scene; for the gayeties of the place, the
riding, the relaxation from business &c. &c. [and]
[cross out]
yet I believe the evacuation from the bowels, usually
produced by the waters, is far more serviceable
The Saratoga water in this country, owe their reputation
to this circumstance.

I proceed now to the treatment of the individuals of 
this class, Of these there have been many scientific arrangement;
[but] but as I have no partiality for that display 
of science, which does not lead to any practical 
result; I shall [cross out] arrange them as they differ in respect 
to their activity [cross out] noticing first those which are mild 
& then the more powerful [cross out];
[cross out] I shall begin with the Vegetable article
[Vegetable Laxative]
Sinapies or mustard, is a mild medium. These 
are two kinds, the sinap, alba and nigra; between
which there [are] is very little [diference] difference. The unbruised
seeds are to be employed, to obtain its cathartic
effects, as when powdered it is too stimulating 
to be given in a large dose. To procure a discharge
from the bowels ℥ss of the seed must be given.
It is useful in cases of habitual costiveness,

in epilepsy, paralysis dyspepsia. chronic rheumatism, according 
to Dr Barton [cross out] in chlorosis gout &c, I [think it] have no doubt that it may be used in
[cross out] other diseases with effect. & as Bergious observes also in intermitting and remitting fevers.
It is the mildest Purest specimen of a laxative & possesses 
one [One] advantage, [which it possesses is] that it does not
leave the bowels in a costive state. [cross out]
[cross out] The next Substance as to activity is manna. This is a concrete
juice, obtained from the [cross out] Frasunus Ornus.
It is [cross out] brought from Sicily, Calabria, [&] & other countries [in]
on the Mediterranean, It exudes from the trunk, leaves
& [cross out] branches during the month of June & July That from the leaves is the best; when it
is procured by incisions in the trunk of the Tree
it is dark and not so good. Dr Hill has given the
[but] most accurate account of this substance. It is best, when 
in oblong flakes of a yellowish colour, friable
somewhat granulate & easily soluble in water, Dr Hill
on this account supposed it, to be a true gum

but [this] it is not altogather [cross out] the same as it is also soluble in
alcohol. It is very similar to brown sugar, except perhaps 
in taste: the medical properties are the same, & like it 
[cross out] the manna is deposited in small [cross out] crystals by the evaporation
of the alcoholic solution, & by further evaporation a 
dark fluid is obtained similar to molasses. Cullen
considers it, merely, as the saccharine matter common to
[in] vegetables, & in no material respect, different from
sugar. Murray think its cathartic [effects] powers greater; its
dose is from ℥j to ℥jj: when given to children. I [di]
direct as much as they will eat, which is [generly] generally from
℥ss to ℥j. It has been thought very useful for pregnant 
women, [But] but it is now forbidden as in some instances it produces flatulency 
[cross out] colic &.. On the Continent - it is more used than
[cross out] either in England as U. States - the French employ it
[cross out] very much
[cross out] It is frequently 
given with [cross out] senna ʒij of it to ℥ss of senna, I prefer
brown sugar I think that the infusion

is no less powerful. It is often given with neutral salts as [??mart] act &c
Upon the whole, I think it about equal to the unrefined 
sugar. Tamarind, [cross out] cassia, [cross out]  Fistularis, Molasses &
the summer fruits have all been employed as auxiliaries 
[illixirries] but cannot properly be considered as
purgatives, & I have only mentioned the manna [only]
[cross out] because it is so frequently employed. In Europe they often
prescribe mutton broth to assist their purgatives; in
this country, this practice is not to be followed, as the
broth affords too much nourishment in many 
Cases where purgatives are necessary.  -------
Lecture 22d.. ~~~ December 17th..
The guglans cinerea or [Button Wood] Butter-nut. is much 
[used] used in several parts of the [Ustates] U. States. It is one of 
our most valuable cathartics & is considered by many 

as equal to the Jalap. It is the inner bark of the Tree
which is employed, [cross out] & by decoction, an extract
is [also] made [from it], which is of a deep brown colour
and possesses considerable astringency. In a dose of
grs. vi to x. it produces a laxative effect, and in that 
of ℥ss evacuates the bowels freely. It has been used in 
the several febrile diseases especially in the bilious
remittent; our farmers often give it to their cattle &
it is found very serviceable in that disease of the horse
called the "yellow waters" Pills have been made of this 
called the [cross out] butter nut pills, which are very useful in
keeping the bowels regular. Our country practitioners 
use it in many diseases, It is not however sufficiently 
active or certain in its operation. [cross out] 
The Podophyllum Peltatum or May
Apple has of late years been very much used in
the U. States. It grows very plentifully in different

different parts of the union & is known by various names 
as mandrake, Ipecacuanha, wild lemon &c. The fruit
is [cross out] excellent, but the leave are said to be poisonous,
The root is the part used as a medicine; in doses of grs xx to [cross out] ʒss.
it may be safely given, by which it purges considerably;
I have not had much experienced with this 
article. It is much used through the country. & appears 
to be a favourite, notwithstanding that it must be exhibited
[ited] in large doses and that it generally produces griping. It 
is useful in those diseases, in which cathartics are
demanded. The Indians consider it as a good anthelmintic.
It is best when collected in the autumn
Oleum Ricini or Castor oil is procured from 
the recinus communis; this plant grows in the 
E & W Indias and in the south of Europe. It is 
not [cross out] a native of the US. but flourishes with a little

cultivation. The oil is procured from the seeds, by expression
& by decoction; sometimes also by roasting them; they contain
a very large proportion of oil, sometimes near half 
their weight - It is one of the most ancient purgatives
we possess, being used by Hippocrates; it was named
Ricinus from a small insect. which frequently destroys 
[it] the plant. It is one of our safest and mildest medicines, and 
when given in large doses may be ranked among the active
articles. [cross out] The dose varies
in different persons. It is supposed to injure the tone
of the intestines, less then any other, and is therefore
given in cases of habitual constiveness; but in [such]
[cases] these instance I prefer the rhubarb. I think from two or 
three cases, which I have seen that [it] the castor oil is injurious
in cases of hemorrhoid. It has been preferred in
various affection of the bowels & with good [cross out] reason,
[cross out] altho' the theories of its operation are no doubt 
erroneous. In the West Indies, it has been celebrated

celebrated in the Colica Pictonum & is recommended in the other forms of Colic. In those cases, where large
indigestible substances have been swallowed, Castor oil
is very useful. It should not however be given when copper
has been taken, as it has some tendency to act on 
that metal. As a general rule, however, I think it
is best not to prescribe any medicine, [cross out] in these instances
but to suffer the foreign substance to be enveloped
in the natural contents of the intestines, which will
prevent in a great measure any irritating effect. 
I have put this practice to the test in a few instances; in
one as Child had swallowed the nut of a wheel - a 
piece of iron about 3/8 inch in diameter; I advised
that nothing should be done, but that the child
should live as usual, in 48 hours it was discharged
without any ill effects: when the intestine are
tardy, some medium may be given,

Castor oil is much used in dysentary & Cholera Infants
when the stomach is quiet; also in some cases of worms. Dr Calvani
has recommended it in Gonorrhæa, [cross out] but it can only act as a purgative;
no one will attribute to it any specific effects, when 
they recollect, that Sydenham frequently cured [it] this complaint by purgatives.
The dose to an adult is ℥j. To an infant immediately
after birth ʒj may be safely given; after the third month [crossed out] ʒij
may be given; after 5 years ℥ss. Cold expressed castor oil is 
less naseous than that [produced] procured by decoction, but it even
[this] is very disagreeable & is often rejected by the patient.
To avoid this, it is often given with brandy or some
spirituous liquors, These however are injurious in cases,
which demand purgative; on which account I prefer
coffee which is very nearly as effectual in destroying 
the taste. It is often made into a mixture with 
a little mucilage as in the following. ꝶ Ol:ricini ℥ji
saech: alb; et. Pulv: G. arab. āā ʒiij. Ol anisi gtb: u.. Ag. purces

℥vj m. this is a very favourite [cross out] formula [But] but the dose is
necessarily so small & must be so frequently repeated I
prefer the [cross out] former mode of exhibition. Sometimes a little laudanum
is added to each dose. Castor oil [sometimes] when long kept becomes rancid; 
but, I do not think, that its purgative or useful effects 
are in the least injured by this; it is rather more
nauseous; some of the European physicians recommend
that under these circumstances, it should be washed, [cross out] by which it is
rendered perfectly pure. Dr Chapman thinks that
[olive oil] the Oleum Olivarum is very similar to [this] the Oleum Ricini but it is certainly
less active & also by far too nourishing to be used as 
a purgative - Melted Butter, commonly called the 
oil of Butter, I have frequently given to children & 
with good effect; sometimes [cross out] as an injection, the 
pellicle covering the seed of the ricinus is also supposed

to have a purgative effect, it is not much used ~
Senna This has been hitherto supposed [cross out] to be procured in its, but
state, from Alexandria, but Mr. Nectouse has [a?own], that none grows 
there but that its comes from [cross out] He observes that in the common
Senna of the class there are three [cross out] different plants. the Cassia Sentia, [???]
Lassia [????lata] - & the cinanstum [cross out] Ole apolium
It is procured from the E. Indies, from Persia and Arabia
also from Africa & from the W. Indies- Dr Hill has 
described 3 kinds, one from Alexandria and 2d from
Tripoli, & a 3d from the W Indies. Our Apothecaries
receive two kinds one from Alexandria, the other form
India; they decidedly prefer the former. The leaf is the 
part used & is oblong & of a yellowish green colour; its
properties are extracted both by water and alcohol. [the]
The infusion in water is much used: even by individuals
without any direction, from a practitioner; this is rather
[a] singular, as it is nauseous, must be taken in large quantities, [it] possesses very active properties and generally
[raly] produces severe griping; the practice of picking
out the stalks is not found to prevent this last effect 

To obviate the griping various additions have been made to it; manna
or what I prefer brown sugar covers its nauseous taste;
fennel seeds, Carraway seeds, mint, ginger, & various aromatics have
been added, but seldom with the effect of preventing the
griping altogether. [It] The Senna is one of the most certain [cross out] cathartics
we possess and is very useful in obstinate constipation. It
is never given in powder as the dose would be too bulky,- the usual method is to infuse ℥ss
of the senna in a pint of boiling water, covering the vessel
[sel] closely sweeten it with brown sugar & let [of which] ℥ij to ℥iij [cross out] - be given every 2 hours,
till it operates. Its active properties are volatile therefore
the decoction is inert & the infusion should be made
with care. To the above formula an ℥j of the Cremor Tartar
is a useful addition to improve its taste & purgative 
properties; many other additions have been made to 
it, glaub, salt renders it exceedingly nauseous. 
[cross out] The

infusion is often used to quicken the operation of 
other purgatives. There are several officinal preparations 
- Of these - the compound Tincture of Senna
is much employed -- warner's cordial is very similar
to it - but has an addition of Rhubarb. The 
Formula of each may be seen in the Dispensataries





No medicine has varied so much in its reputation. When 
Science slumbered during the dark ages - the Chemists were
active in the expectn of discovering, how they might transmute
all metals into Gold- & how life might [be] be 
preserved. Altho' unsuccessful. they confered more benefit
on man than ever could have been derived from the 
philosops stone or the boasted elixir of life. At this time
the Galenists appeared: by them all mineral meds were
cried down, & between these two parties the dispute
was long continued. At the revival of Science - this  terminated 
in the acknowledged yt - by most physics that each
was useful. When the use of antiy- was revived in the 
15th centy- it is somewhat singular that its cathartic
powers were first developed. Pure Antimy is certainly active