Dr Dorsey.
No 3.

HL Hodge.

  

Notes on the materia medica
Being the substance of a Course of Lectures
delivered in the 
University of Pennsylvania
by
John Syng Dorsey. M.D.
Taken during the winter of 1816 '17 and enlarged
during that of 1817 '18 by Hugh L Hodge.
Vol: 3rd,,

X The Rhubd from Russia is brought [crossed out] from China also
[crossed out] across the interior of the country-

1. 
Lecture 23rd Decr 19th,, 1816.
The next medicine very much resembles the Donna, it is the Cassia
Marilandica-Dr Barton very much recommends this medicine. I have
no experience of its virtues-it is much used by our country practitioners-
& is no doubt a very excellent substitute for the senna-
The Rheum Palmatum or Rhubarb is the next one to be noticed. It 
is called also Rheum undulation & Rh. computum-That which is employed
in this country comes chiefly from China-some however from Russia. x 
Its cultivation is also attended to in Europe & this country but not in
sufficient quantities for use. It possesses a peculiar aromatic odour
is bitter & astringent- as is proved by its interior turning dark by the addition
of any of the saline preparations of iron. In chosen the root, that
should taken which has a resinous fracture, is of a bright yellow colour firm & compact-when soft
& warm eaten it is bad - more disgusting & nauseous. Dr Hill supposes
that it is a modern medicine, that employed by the antients being a different
article.-It is my opinion one of our most valuable medicines -
it is mild & gentle in its operation even in large doses & has no tendency
to debilitate but possesses a tonic power. It is therefore much to be
used in affections of the bowels-in doses of 2i to a ʒi: I prefer however 
giving it in combination with cal-x grs of cal with xv grs of Rhei.
I have found that [crossed out] grs x of Rhub. with x of cal will purge
much more certainly than the celebrated x & X of jalap & calomel-
In habitual costiveness it is more used than any other medicine. It is
given in powder or in pills-From the gummy matter it contains them
part are easily made with a little water-they should be given fresh

2
X Equal parts of Ginger & Rhubard being employed-the oil of Sassafras
is also very useful-oil of mint &c &c

made, as when hot & hard-they are dissolved slowly in the stomach & are very  
tardy in their operation. In chronic cases, it is sometimes advantageous to
shew the solid mat. In dyspepsia it will be useful to make the pills
with some aromatic substances-I think ginger from its aromatic &c carminative
powers is here very useful.X Rhubarb is useful in various chronic diseases
where a gentle operation on the bowels is wanted-It has been recommended 
very highly in Dysentery see in this Subject-Gesner-Pringle
Clarke & others-As it possesses some astringency which act after purging
Cullen does not think it useful in dysentery-It has been long & justly
recommended in diarrhœa to which it is particularly adabted by emiting
the purgative & astringent effects. Some have attributed to it a narcotic
power-especially Fordyce- but it has no peculiarity of this kind
it sometimes induces sleep like other purgatives by relieving the big excitement
of the system which had prevented the exercise of this prevention.
In jaundice it has been recommended but should always be combined
with calomel-it then proves beneficial by [crossed out] increasing the action of this
remedy. It has also been much used in high bilious fevers.
Rhubarb is a medicine of great value in all the diseases of children.
I have frequently given immediately after birth-as in the following 
formula-℞ Rhei: ℥ss-magnes-fi-Ol: Anis gtts ij. & of Water
℥ii. m-The dose ℥ii with a little sugar. One advantage it possesses, is that we can always
determine, whether it has operated by the colour of the discharge.
I prefer giving it with the magnesia as there is always some acidity present
in the bowels or stomach which this corrects. In cholera it is often
retained in the stomach when every thing else is rejected, & in this disease
it is peculiarly necessary to determine whether the evacuation is produced by

4

the medicine or by the disease-The rhubarb always stains the diapers. 
In all common cases this practice will commonly be successful, when united 
with a diet of arrow root. & the use of lime water with the mucilage
of Gum Arabic-It has also been recommended in worms but
it certainly acts only by its purgative power-it has no specific effect.
The active principle appears to reside in a gum resin or hath the watery &
spirituous preparations are active. There are several preparations
of rhubarb recorded in the Pharmasas to which I refer you-there
are however two family preparations which you will not find
there the first is the spiced rhubarb. ℞ of rhub cinna & mace
each two drams-boil in pint of water to 1/2 pint-& sweeten with sugar-
to preserve it some brandy is also added. If you are not careful
the nurse adds so much as to render it a strong tincture-It is best always
is to use it fresh-when no brandy should be added.-The second preparation 
the rhub. tea-prepared by taking ℥ijj of Rhub with the same
quantity of fennel seed-& boiling in a pint of water to 2/3. This is
a very valuable spice preparation in the early diseases of children
especially in colic, which occurs within three months-In this the
little patient suffers immensely-night & day; opium resorted to
but ineffectually-I have used this tea with great success, by giving
℥ss-two or three times a day for several days. Dr Barton has
mentioned rhub. as a diuretic. There is another preparation which
I might notice & that is the toasted rhubarb. It is prepared by 
heating the powdered rhubarb, till it melts & it should then be
removed & cooled. The fire is supposed to act on the resinous part

6

& thus to render it more mild and astringent-it gripes much less & 
is preferable in cases of diarrhœa. Rhubarb is often used as a gentle
stimulus to old ulcers-It is not easy to specify the particular cases
in which it may be useful. experience must determine this point.
Jalap-This is the root of the convolvulus Jalapa-so named from  
the place where it was first found-at Jalap or Jalap in South Ameria
The root is firm & solid - of a roundish oblong form of a dark [crossed out]
colour on the exterior but within somewhat lighter. It comes to us in 
slices & seldom in the [crossed out] entire root. The best is firm & compact-without
of a black but within of a dark brown colour-it inflames readily &
burns briskly-possessing a nauseous taste. The fracture in this as
in other roots of the resinous nature is smooth & bright-It is sometimes
mixed with [crossed out] bryony; which may be detected by the latter being of a lighter
colour-[crossed out]. The active part resides chiefly in the resin as the residuum after digestion
in alcohol is nearly inert. The resin [crossed out] of jalap acts as a drastic
purge-& when given should be finely powdered-When finely powdered
as with sugar or with some rough salt: its action less irritating-
it gripes much less but makes still a powerful impression
The dose of the root is ℥ss-but in smaller quantities it opens the bowels-
It is seldom given by itself but usually in combination in equal
proportions with cream tartari-it forms the colic powder the dose of
which is from 2i to ℥ss-It is also very useful in the hip disease &
other cases where long purging is required as its effects are not diminished
by repetitition-in such cases I add a few drops of mint to the
above powder-& give a dram every hour till it operates-With 
cal. jalap is much used in bilious fevers; in the yellow fever grs x ch

8
X It comes from L Amer; [crossed out] Europe Asia Africa-
# We seldom if ever have the Socotrine, but use the Buboes 
exclusively which is nearly as good.

each was very much employed & with the happiest advantage- 
From the quantity of fluid matter discharged by it-it has been considered
as a powerful hydrargogue & much used in dropsical effusions
The resin of jalap has been neglected from its active effects. these can
be moderated by triture & it then possesses very active powers but acts
mildly & certainly. I have frequently used it as in the following formula.
℞-of the powdd root of jalap-& of rhub grs Lxiv. of the resin
grs xxxij: with 2 or 3 drops of the oil of mint, make it into 64 pills.
Each of those therefore contain 1 gr of jalap & rhub. & gr ss of resin-
I have found it very useful to administer one or two pills at a time 
as an alterative-
Lecture 24th Decr 20th.
Aloes perfoliata or Spicata-The aloes is the inspissated, or 
pressed juice of the plant. & is a gum resin. X There are 3 kinds of
Aloes-1st The Socotorine Aloes-which is of yellowish red colour 
& when powdered of a bright yellow excessively bitter. 2nd The Hepatic or Barbadoes
Aloes-this is more dark than the former & not so good-it is more of a 
liver colour, from which it has been called hepatic-it is also bitter
nauseous & has not the aromatic smell of myrrh which belong to the 
other-3rd The Cabbaline or Horse Aloes-this is more impure of a bad
smell & should not be used. # Aloes has been early used in medicine-It
does not produce much irritation-& is slower in its operation than
any other article we possess from which circumstance it has been
supposed to act on rectum only-it has therefore been thought hurtful
in hemorrhoids: but Dr Cullen thinks that the costiveness for which it
is given is as much more frequent cause- It has been supposed to 
act on the uterus-probably from its stimulating the rectum-

10

It is generally 10 or 12 hrs before it operates-In doses of grs i to ij it 
proves laxative-but does not purge Dr Cullen observes that in a dose of 
a scruple it produces liquid stools-but always with considerable griping
& should therefore be only used as a laxative to evacuate the intestines.
It was formerly much used in the formula of the elixir properties as
Cullen observes upon the doubtful authority of Paracelsus-the present Tincture
of aloes with myrrh is somewhat similar-& is substituted for it.
This is prepared by taking ℥ij of the myrrh ℥iss of aloes to #ss of alcohol.
the dose is ℥ss. Cullen also considers aloes as a tonic & antispasmodic
Gamboge-this is procured from Cyam & Caylon-& is the concreted
juice of the Hypericum-It comes to us from the East Indies in large
masses of a bright olive colour-becoming when powdered very yellow &
affording a beautiful pigment. The taste is bitter & acrid. it has no milk,
in large doses it operates violently both as an emetic & cathartic. It is
one of our most active & drastic purges-it is generally combined with calomel
or jalaps [crossed out] It produces very liquid stools & has been used
in dropsy-as also in various cutaneous affections-& in the case
of tania or tape worm. Its dose is from two to four grains with eight 
or ten of calomel. By itself it acts powerfully in doses of grs. v or viij.
Cullen had used it by itself in divided doses-he gives 3 or 4 grs
triturated with sugar-& in this manner found it to operate mildly
without vomiting or griping-Professor Murry of Getingen has
made many experiments with a view of diminishing its properties- 
but with no effect-
The outermost is useless-as the whole salve
of the medicine depends on this property.-
If we want milder purges we have others
when severe ones are regr this is very null-

12.
X Hippocrates employed it-were I to use it-it would be
in Mania Epilepsy &c-It is safest when given in combinn
with aloes-rhub: &c-

Scammony. This is the concrete juice of the convolvulus Scammonia- 
It is procured from Syria-from Aleppo & Smyrna-
that from Aleppo is the best. This is very friable & easy poured 
it has a faint unpleasant smell & bitter taste-it contains more resin
than Gum-It has but little used in Europe but much more
among the Eastern nations-It was employed by the antients to [di??]
tumours & in tænia capitis-but it has no particular powers in these
respects-Among the objections to this remedy is [crossed out] the uncertainty of 
the dose- sometimes in a powerful manner it sits in a small dose, irritating
& inflaming the bowels-[crossed out] in a large dose it 
has operated mildly-2nd That it gripes violently-producing occasionally
bloody stools-Cullen observes that it is not very pure, its
dose is from 3 to 10 grs-
Coloquintida-or the Cucumis Colocynthides. It is procured 
from Turkey & is the medullary part of the fruit. It is nauseous,
bitter resembling bile & acrid-I have never used it-but it acts most powerfully
in a dose of grs iy to vi.X It is said to purge when applied externally 
to the abdomen.
Hellaborus Niger-see Melampodium. This was employed
in antient times even by Hippocrates-but it is a severe medicine & is
neglected in more modern ages-The root is the part employed, it is 
procured from Germany & Italy-& purges in a dose of grs X. Half 
a dram may however be taken-the purgative properly resides
in a gum resin-& can therefore be in some measure extracted by

14
X Ferrias recommends this article in dropsy-He speaks
of it very highly.-
# Carbon or Charcoal has been employed as a 
purge, I refer you to Dr Chapmans met meda for
the account of it-to which I have nothing to add-

water or alcohol. but what is rather singular. The distilled water possesses 
some active cathartic powers. It has been celebrated in Mania-there is
no reason to suppose that there is anything specific in its action. it must
be merely by its purgative power-which is no doubt very useful in high 
action of the heart & arteries. In Amenorrhæa it has been said to 
be very serviceable in the form of tincture-but it is not much employed
as it is-a very drastic purge. I might here introduce the Veratrum
album-but I shall content myself with observing-that it operates so
violently as to be laid aside even in mania in which it has been celebrated.
The dose was grs X to xv.
Cucumis agustis or momordica laterm wild cucumber
Elaterium. This is the most violent of the expressed juices-it comes
in thin plates which are brittle-& friable-It comes from South of
Europe & the plant is not to be found growing in the U States. The elat:m [crossed out] is given in the
dose of gr ss to gr i-till it operates. X It was supposed to be the active
ingredient in the ear Medicinale-but the colchicum autumnale
as already mentioned appears to have the best title. #
This concludes my list of Vegetable Cathartics-to which I had
thoughts of adding others-but as they are not employed but very
slightly at the present day I thought it would be useless to notice
them-I now proceed to the Mineral Cathartics-these
are not so numerous as the former-but many of them are very valuable-
and first-Calomel-known by various other names as the 
mild muriate of mercury-the salt muriate &c-Those are various 
modes of preparing it but the results is always very similar-be careful
however that the corrosive sublimate is in no case present. The

16
X-This is very much lessened when given in combination,
[crossed out]

usual method of preparing it is by triturating ʒiv if the corros-sub-with
ʒiij of the pure metal-untill the globules are destroyed-it should then
be sublimed-powdered & washed with warm water to remove any of the 
carros sublim, which might have been reformed. There is some article
so much employed-It doses from gsvi to fi. There is a peculiarity
in its operation which should be further noticed-& that is the little
difference in the operation of a large or small dose. Then known 
grss to purge freely-& also that a scruple ʒji or 2ij produce no greater 
effect-Dr May made the follow experiment on himself while
in perfect health he took grsiij of the medicine it purged him-2
weeks after he took 2iv. it did not purge [cross out] any more than the 3 grains.
This is an important fact as it shows the safety of the medicine. As a 
cathartic it stimulates the exhalants. it is slow in its operation by itself
& generally nauseates, X to some persons it is so irritating that they cannot 
take it, I am one of these-I have fainted from taking grs iij
of this medicine & suffered the most violent pain I ever experienced-
This does not lessen [crossed out] its value-From its slow operation it is very useful
to be given at night so that the patient need not be disturbed, till
the morning-it very seldom fails in evacuating the bowels-In 
the Southern States, it is much used in the bilious complaints which
are those prevalent for which it appears to be well calculated-It 
is generally combined with other medicines, as with jalap-&c
It is sometimes used with nitre-as in the antimonial powder-℞ Nitre
ʒi-cal grs viij-tart-emot-gri. m-div. in dose iij-As being easily 
given it is used in many infantile diseases-it is best in such cases with
some mucilaginous substance-or where there is any difficuly, [crossed out] put it on

18
X It is insoluble in water or alcohol but soluble
in oils.

bread previous to its being spread with butter. Be careful in giving it
to children that ptyalism in not induced-which is very dangerous at an 
early age-The dose at 6 months-is grs ij-at 3 yrs-grs iij or iv.-After
5 yrs-10 grs may be given-I have known grs x in a young lady
produce a violent ptyalism which lasted for a fortnight-such idiosyncrasies
sometimes occur. In cramp it is a very valuable remedy
after bleeding & emetics-grs ij of cal-should be given every 2 hours
till it operates-large quantities in such cases are frequently employed.
Dr Hahn has given upwards of a 2i to an infant of a few months.
Lecture 25th Dec 23rd,,
Of the mineral cathartics Sulphur is the next to be considered, This is
far inferior to calomel-it is light, inflammable of a straw colour-it is
found in pure state or combined with metals-It is freed from those by
sublimation-It is found in the neighbourhood of Volcanoes. it is said 
sometimes in the pure state of flowers of sulphur-but this is almost incredible
as the heat in the atmosphere necessary for the [crossed out] formation of these 
would probably convert it into sulpuric acid-It is crystallizable-& emits
with the alkalies, carths & Metals-X It has been long used in medicine
Hippocrates used it in cases of catarrh Asthma &c-& also in cutaneous
diseases-In doses of ʒi or ʒij it proves laxative acting chiefly on the
large intestines increasing their peristaltic motions producing the evacuation
of feculent matter with very little increase of the fluid discharge.
It has therefore been used in cases of torpar of the bowels. In hemorrhoidal
effections-In diseases of the skin it has long been considered

20
X Lancisci 1st noticed it in 1717. Black gave some account  
of it. but Henry 1st noticed its Chemical Histy
It is procured by precipg [crossed out] it from the Solutn of the Sulph.
maga, by the carb: pot:-In preparing the calcind
magnesia-be careful that no lime is present as the caustic
lime would be very dangers
Its use in calculous affect-will be hereafr noticd
it is said long contind use not safe as concret have been
formd in the alimy canal-This however is a solity 
case-

as specific especially in Psora-Dr Chapman recommends it in tinea capitis 
but I have been disappointed in it, as indeed with most other remedies in this 
disease-One of the best I think is the salted butter. In gout & rheumatism
sulphur has not answered in this country-In remittent fevers-the flowers
of sulphur have been useful, I prefer giving it two or three times a day in
small quantities say a dram-Dr Granger recommends it just before the paroxysm 
from which I think are advantage can be obtained, Mcales advising
it to be given in brandy, which is a powerful stimulant not to be used in
our febrile diseases at least. To prevent spasm of the muscles, it has
been grasped in the hand upon the supposition that its electric properties
would relieve the spasm. I have never seem it of any effect in this way &
consider this practice as one had with other popular superstitions.
Combined with Cremor tartari it is a useful purge which is very popular
Cullen observes-that it produces very fœtid discharge-& therefore
should not be much used in genteel families-The opinion that it is apparent
in the perspiration is without foundation.
Magnesia is an earth much used as a laxative-It is found in
the shops in two states-in that of a carbonate & calcined. these may be
used indiscriminately except where there is great acidity or much flatulency
when the calcined is preferable. The magnesia was first known as a secret 
remedy-X but when it became more generally known it was adabted as a mild
& useful medicine. Combined with rhubarb it forms a useful laxative for
children-as also with cream of tartar, When the bowels are to be moved
& acidity is present magnesia is preferable-chalk is to be chosen when
no cathartic effect is wanted-
The Neutral Salts- There have been considered as intermediate 
between laxatives & purgatives, but there is little foundation for

22.
X This is made by Saturating the cremor tart with 
soda-

the opinion, as by a variation of the dose they act either as laxatives or purgatives-
They all promote more or less the secretions into the intestines, they
must therefore be well calculated for evacuants. It are much used in febrile
affections. whence they have been called refrigerants. The Chemist supposed
that this was owing to the cold they produce during solution in the stomach-
but this was our train by the fact, that the same effects were produced
when they were previously dissolved. The most useful of these is the
Sulphate of Soda or Glautur's Salt. This produces little nausea or
griping & aromates a great discharge of fluids. The dose to an adult is
an ounce ℥ss to a child above 4 yrs. When deprived of the water of
crystallization it loses half its weight. & consequently only ℥ss of the efflesued
salt should be given for a dose- Its taste is very disagreable to disguise
this, it has been given in the vinegar-lemon juice & mineral [waters].
It is often given in divided doses ℥i of the salt with gr i of tart emet
being divided into eight equal portions-This combination often proved
diuretic diaphoretic & purgative-It should always be dissolved in 
boiling water-as when the whole is dissolved it is merely tepid & much more
is softness-it should then be combined with the Lemon juice & mineral laxatives.
It is often given in divided doses ℥i of the salt with gri of tart.emet.
being divided into eight equal portions-This combination often proves
diuretic diaphoretic & purgative-It should always be dissolved in
boiling water as when the whole is dissolved it is merely tepid & much more
is softness-it should then be combined with the Lemon juice 2 sugars or
with the seltzor water-It is difficult from its nauseous taste to give it to
children
Sulphate of Magnesia or Epsom Salt. This is very similar to the
former-it is no less nauseous to the taste & in my opinion possesses no advantage 
whatever-the dose is the same-& it is employed in the same
disease & with the same intention-Bath of them are very excellent conditions
to calomel & the more drastic purges when they operate slowly-
The Tartrite of Potash & Soda-Machille Salt-X This is much
used in France, is less nauseous to the taste after dose is ℥i-it is also

24.
X Its taste resembles that of the mur: sod: The French 
put ℥i in their soup instead of the common salt-when
they use it as a purgative but it is less cooling-

25.
less active & is not much used in the diseases of this country.
The saporterbite of Potash-the Cremor tartari is a very useful & agreeable
purge-It is not nauseous, the acid which exists in excess render it very
pleasant-It is very well to mix it with molasses & it give ℥ij of the mixture
every 2 hours till it operates-with jalap & the oil of mint it forms a compound the anti-whi pains
which is very useful when long continued purging is required-as it occasionally
produces flatulency, it is not to be used dyspeptic & gouty persons. It 
may be given to children with sugar as lemonade to which it is very like
Tartrite of Potash-Soluble tartar-This is a salt formerly much
used but not at present, it differs from the former in containing a less 
quantity of acid being a neutral salt. it acts as cathartic & diuretic either 
dose of ℥vi to vij. The Phosphate of Soda is similar in its 
effects-X it is not so cooling. & often induces thirst & uneasiness.-
This finishes what I have to say on individual Cathartics-The list
which I have given is sufficiently long- I have omitted several which 
have been mentioned by writers, & I do not wish any new one, to 
be added unless it possesses some peculiar powers-I will take
this opportunity of saying a few words on the combinations of medicines-
The most antient prescriptions contained a great number of articles 
Even in more Modern times the home has contained upwards of [crossed out]
400 articles in one prescription. In this variety of articles there must certainly 
be some whose chemical action will change the property of the 
medicine especially when we consider the [crossed out] little knowledge of Chemistry
which was then known-Driven from these practice may have 
gone to an opposite extreme which is equally ridiculous-that of administrating

26

administring medicines altogether by themselves, without ever any combination 
That medicines should in some instances be combined is very evident.
The observations of Dr Fordyce are excelt-on this point-
thus he says [crossed out] vitriolation purges-rhubarb simply evacuates the intestines-
but also possesses a tonic power-[crossed out] by mixture the union of
these virtues is obtained-On my mind the manifest advantage of an 
essential oil joined to some mucous substance has great weight
than jalap produces nausea & vomiting when given by itself. the addition
of an oil presents each of these & its cathartic power is undiminished-
These two points should then be noticed-1st-The absurdity
of the large combinations of the antients & 2nd The importance of
mixing some substances to obtain a desired effect.
Glysters-are substances injected into the rectum-This by the stimulus
of distension contracts & expels its contents with the injection
The whole colon is also often evacuated. & I believe frequently 
the small intestines which are excited sympathetically. They seldom if
ever penetrate beyond the valve of the colon. In Europe injections are
frequently used in habitual costiveness. tepid water is generally sufficient.
a great objection however is that the rectum becomes accustomed
to this stimulus & will not contract upon its natural contents-A very
excellent common injection is to take, ℥ss of mur-sod-of sweet oil or 
molasses also each ℥ss water 1 pt. This is very useful in expediting cathartic
medicines-I do not think anything is gained by injection of other
salts or any of the purg stim infuss; the mur sod is always at hand & is fully equal to any other. In 
some cases injections of great power are wanted as in Hernia the
only injection I have seen used in such instances has been the tobacco
which sometimes produces very alarming effects. The particular

28.

cases in which it is to be used you will learn from the professor of Surgery. 
It is prepared by infusing ℥i of the leaves in a pt of water ℥ of
which is to be injected at a time.
Lecture 26th Decr 24th
Diuretics are those medicines which augment the secretion of urine.
The quantity of urine is increased either by augmenting the quantity of
fluid in the blood vessels or by stimulating the action of the kidnies.
The quantity of fluid on the vessels is increased by checking other secretions
especially that by the skin: & by drinking large quantities of liquor.
Copious drinking is a very effectual method of increasing the flow of action,
is the most certain & should be employed when not contraindicated.
Diuretics are frequently employed to carry off effused fluids-in such
cases it has been the practice to interdict all fluids-as drinks this was done by
Hippocrates & most of the older physicians under the supposition that
it would augment the disease-This idea has been shown to be erroneous
to order stated abstinence from drink is a very painful measure & is
very inefficient & injurious. Believing this some have resorted to a contrary
practice & have ordered great quantities of fluid: water is the basis
of all these-Cullen has added the vegetable acids & spirits-I however 
think that this practice is as injurious as the former-& prefer a medium
between each extreme-A large quantity of fluid must fill the
blood vessels & in a great measure prevent absorption. Besides on such
occasions not only the urine is increased but also the other secretions & there
is no reason to believe that the fluid is not also effused into the cavities
of the body, increasing the quantity already accumulated. There is 

30 
X 
The consequence [crossed out] following the use of a diuretic, is stated by
Dr Duncan-are a change in the balance of the circulation
a diminution in the circulating fluids, especially of the serous
parts-an increased absorption-diminution of the perspiration 
& an increase of the flow of urine.

great prudence & good sense in Dr Cullen's observation, that when the 
quantity of fluid taken in, is equal to the urine discharged & no greater
there is no injury- at least, & perhaps considerable advantage. To administer
diuretics without drink is altogether useless. During the reign of
the humoral pathology, diuretics were much employed-they were considered
as of great importance in carrying off the vitiated fluids-There is certainly 
some foundation for this opinion, although it has been carried to
an extravagant length-The serum of the blood contains more salts
at one time than at another, & as we see that these are constantly eliminated
from the system, we may suppose, that when accumulated they may prove
injurious-This abused theory still holds in my opinion, more importance
than has usually been granted to it-who for instance will
deny-that urinary calculi often arise from too great a quantity of
the uric acid present in the blood.-Perspiration is in the inverse
ratio to the action of the kidnies so that when the power is
checked the latter is increased-on this account we discharge more urine
in cold weather & thus cold applications to the feet or to the pubis excited
a discharge of urine. This however I attribute rather to a sympathetic
[crossed out] contraction of the seats of the bladder, from the stimulant power 
of colds-as we find the application of cold is one of the best remedies 
for suppression of urine from debility X The time necessary for the action
of a diuretic is various. By experiment it has been found by Mr Home that in 17 minutes
the colouring principle of the part will be found in the urine-
that in 30 mins- it will be deeply tinged stronger in 41 min & very
[crossed out] deep in one hour & 10 min-& in 2 hrs the effect had nearly subsided-
The quantity of urine secreted by the kidnies varies very greatly in some

32.
X cases are recorded by Parr of persons having no urinary
evacuation for six weeks.

cases as diabetes it is greatly increased-In other cases no urine is discharged 
for a long time X Although the kidnies are the usual & chief organs [crossed out]
by which urine is produced; yet there has been great doubts whether
the ureters are the only passages to the bladder-Some circumstances
favour the idea that there is a more direct communication between the
stomach & bladder than by the circulation-Wine after being taken
into the stomach quickly induces the flow of urine; the colouring matter of
several substances, as logwood is speedily [crossed out] diluted in the urine, & also the odours
pertain substances-These induced the suspicion that the circulation
is not the only course & Haller from his expers also imagined
that there was another rout. When the ureters of a dog were tyed some
urine was not withstanding conveyed to the bladder-Dr Darwin observes that both 
kidnies have been destroyed yet the fluid was formed-I have seen a 
dissection in which one kidney was entirely obliterated by diseased
the other so far gone that it was difficult to conceive that its function
was performed. Mr Edward Home secured by ligature the pylorus
& found that when rhubarb was taken, [crossed out] it should be detected in the urine.
the vessels of the stomach did not absorb it as they were in no instance
manifest to the eye the spleen was thought to be unusually turgid & it
was surmised that this organ might have had some effect. In another
experiment the thoracic duct was tyed & rhubarb thrown into the stomach
in 1 hour & a quarter the animal was killed and an ℥i of urine highly colured with
the rhubarb, was found in the bladder, rhubarb was used in these experiments
as it can be so easily detected-one drop of the tea can be found
in ℥ss of serum-In another experiment of the same kind on a dog. the
bile was found to be affected-In all these the lacteals were found ruptured
in several places affording a clear proof that the thoracic duct had been

34.
X The fluid in the absorbents was [crossed out] uneffected by the rhurbd
no traces of it could be discovered

secured. & in the chyle discharged through those ruptures no rhubarb could be
detected. These facts go far to show that those must be some communication
besides that through the circulation. Dr Darwin maintained that
the absorbents of the stomach & bladder communicated & that it was by
an inverted action of these that the urine was coloured. This is altogether a
painful supposition [crossed out] which he cannot support either by facts or by analogy-
it is contradicted in my opinion 1st that no urine is discharged by
the absorbents-2nd That in Mr Home's experiments, that although the urine
was tinged X [crossed out] 3rd That however it might vary in
its properties, it remains a fluid sui generis, differing from every other-
4th The valves in the absorbants are entirely over looked by the Dr. [crossed out] He indeed 
appears to remember them, when he misquotes a paragraph of Mr Henson
where that gentleman observed-" that [crossed out] in [crossed out] fish, the absorbents appeared
not to have any valves as [crossed out] that they easily gave away-Dr D-setting it down
as a fact, that they have no valves-5th There is no anastomoses between the lymphatics
of the bladder & stomach. He here again misapplies an observation 
of Mr Henson's who says, that in birds some small branches
would seem to anastomose-Dr D-has actually made them unite in 
birds & in the human species-The question whether there is any 
other communicatn than the circulatn is not yet settled & I recommend
it to you for further examination-The rapidity with which the urine
is changed is no proof of the fact- but the experiments of tying the thoracic
duct appear very specious-I by no means am prepared to say anything
positively in this [crossed out] point-but I will make one or two observations
1st Set the thoracic duct is tyed if any of the contents of the stomach is
transmitted to the bladder it must be by some other passage-but
2nd no vessels but the ureters & absorbents open into the bladder-

36

3rd Dr Darwins theory is entirely erroneous. 4th It is probable that there is
some undiscovered channel. Now I think that whatever this be it is through
the medium of the kidnies-as to the absorbents we know that the opening 
of the thoracic duct into a vein is not the only instance of the kind the absorbents 
of the right arm & right side of the head unite & enter into another
blood vessel-now we have no proof that these are the only two instances  
of the kind there may be many others (In the nerve there are several at opening & into 
the blood vessels)
Diuretics have been much employed from the earliest ages-& are of 
course very numerous-Of the vast number [crossed out] modern practitioners retain
but very few. Dropsy is the disease in which they have been most celebrated-
but our practice here is more uncertain than in other cases-if we will 
merely to evacuate the effused fluids by promoting absorption they would be
useful & more certain- but dropsy proceeds generally from a diseased action
existing in the system or is a consequence of some disease-It was formerly
customary to use powerful evacuants that absorption might be promoted
by emptying the blood vessels-but this is not abandoned we find it much
better to employ medicines to stimulate the action of the absorbents-& at the 
same time merely to increase the evacuation by urine for this reason Dr Fordyce
has recommended a mixture of our medicines as being much superior
in their effect than when given singly-This observation is very correct.

38
X formerly it was supposed to be of a different nature &
more efficacious when pressured from certain plants-
some we have the salt of wormwood sal absinthii-
salt of tartar &c but all of &c

39.
Lecture 27th Dec 26th
Diuretics have been used in fevers with other evacuants but are not a
great deal employed. also in several exanthemata with advantage.
In the pulmonary complaints they were formerly much employed. The
saline diuretics-& digitalis & the squill are still retained. [crossed out] In asthma-Dyspnœa, they are much used but are
not as useful as has been supposed. When effusions have taken place
they are no doubt very serviceable-In nephritic complaints they are celebrated:
as also in morbib states of the bladder-especially as arising 
from Gonorrhœa: they have been thought very serviceable in this disease also gonorrhœa
by acting on the urethra & perhaps by communicating some
virtue to the urine.-
Diuretics have been divided by Dr Chapman into three classes, the
[crossed out] stimulating, the laxative & narcotic: but as I do not think much advantage
is to be gained by this but [crossed out] that it is better, that these properties
should be noticed under the [crossed out] individual substances I shall observe
no particular arrangement. I begin with the Neutral Salts-
Most of those act on the kidnies-then Vol. alkali perhaps excepted.
They at the same time possess a laxative property which is generally advants but sometimes [crossed out] renders them
inconvenient & unsafe. All saline matters promote the secretion of urine most
of the acids & 2 of the alkalies-but the combination of them are much 
more active.-Potash-has long been used X [crossed out]
which are [crossed out]
[crossed out] all of them are 
subcarbonates of potash & have been extensively employed-Potash

40. 
X The Bitters are supposed to increase the diuretic effect of 
the articles-Cullen adopts this opinion-This may be the 
case-my own theory however would be, that the bitters
operate merely by obviating & doing away debility-
that thus the cure is accelerated & the diuretic properties of
the salts are apparently increased. The alkalies sometimes
purge-this effect is to be restrained by opium-

proves diuretic in doses of 2i to ℥ss in a large quantity of water; but
it it often inconvenient & sometimes produces nausea, vomiting, indigestion,
The caustic potash is not used in this manner. Soda is generally allowed 
to be a good diuretic, but is more effectual as a Lithontriptic. The
Volatile Alkali is too active to be employed as a diuretic-Some persons
have doubted, whether these alkalies ever act by themselves, but that meeting with
acids in the alimenty canal, they form active combinations-The acetic
acid is often met with-& it is supposed to form the celebrated sal diuretics
of the antients. That this is [crossed out] sometimes the case I make no doubt
but I believe that they often operate by themselves-this is rendered probable,
by their being detected in the urine. Bitters and salts are sometimes combined by Pringle in
dropsy-of this more hereafter. X The Acetic potash was long relied on
as one of the most powerful [crossed out] diuretics-but it is so uncertain-that it
is little employed & I have no wish to see it revived-The Nitrate of
Potash or Nitre, I consider as one of our best medicines. It is often
found lying on the surface of the earth in calcareous places-large quantities
are brought to the U-States from the East Indies, but it is found
in several parts of our country-Dr Murray thinks that its powers are 
too inconsiderable for dropsy-My experience is entirely opposed to this
it maybe giving alone or in combination-Alone it is given in doses of 
grs viij to x.q.s.h. & may be gradually increased-It requires, that ℥ij
or iv should be administered in the 24 hrs to promote a copious discharge
from ℥ss to ℥i acts on the kidnies-Those doses are perfectly safe, when 
commenced small & gradually increased-Nitre is employed as 

42.

the basis of a great number of preparations-Dr Rush's antimonial
powder has much of it-This powder is very useful-it [crossed out] acts as a diuretic, 
diaphoretic, & laxative when properly employed In making
this, I take ʒi of nitre. Cal grs viij emet tart-grrs. ma & divide into 8 hours Nitre
is used almost daily by me in various diseases-in making the Dover's
Powder I always prefer it to the sulph-of potash. It is a very common medicine
in dropsy-& is given by dissolving ℥i in a quart of water-& taking ℥ss
at a dose which contains grs vij or vijj, which proves very useful-The
Super Tartrite of Potash or the Cream of tartar is the next one to 
be noticed-From the excess of acid in this, it is more pleasant to the taste
& setts easier on the stomach than the neutrals above mentioned-It differs
from that procured by scraping old wine casks, only, in being purified.
The crystals are small & irregular, not easily soluble in the mouth &
have a gritty feel-It is highly extolled as a diuretic in dropsy [crossed out]
by Ferriar-who has cured 33 out of 40 cases by it-a proportion much
greater than our experience affords. As it operates as a cathartic-it is
very useful in those cases of dropsy with fever-It is most beneficial 
when it promotes a flow of urine & a discharge of fluid by the bowels.
Murray says that is operates in 2 ways. first as a diuretic when
℥ss in solution is given in the day or secondly in substance, by being
diffused in water, in larger doses as a Hydrargogue cathartic. It 
is generally supposed, that drinking freely will prevent its cathartic
effects. this I have never seen-I never use it when purging is contraindicated 
as I believe that half its value depends on its operation
on the bowels-& otherwise it diuretic effects can hardly be obtaind-

44.
X
There is often severe pain in the back & bones-which circumstance 
has given it the popular name of the break-bone 
fever-

like other diuretics it often fails when some other succeds. One part
of salt of tartar & tar of cream of tartar forms the tartrite of potash
or the soluble tartar-Dr Physic is very fond of this & considers
it as one of the best-in doses of ʒi or ʒij-g.s.h. No acid drinks
should be taken during its operation, as it is very easy of decomposition 
If soda be added to the cream of tartar it forms the famous Rochelle 
salt- or the tartrite of Potash & Soda-This is a purgative
but is not so valuable as a diuretic.
Spiritus Ætheris Nitrosa-This is colourless-of a fragrant smell lighter
than water-& very volatile-When kept it is injured as a portion of [crossed out]
nitric acid is reformed: it may be restored to it primitive condition
by adding lime water & again distilling it. It is frequently prescribed 
as a diuretic & often without any precise object. This is very wrong, for it 
is very similar to æther & is much too stimulating for febrile diseases.
When there is considerable debility & when febrile symptoms remain, after
bleeding & other evacuants have been employed; this becomes a most
admirable medicine. It is often given with an equal quantity of antimonial 
wine to produce a diaphoresis in coughs &c-I prefer [crossed out] administring 1/3 of the 
wine to 2/3 of the Spt nit. dul. [crossed out] In doses of qtts xxx to ix.
the [crossed out] spt by itself proves diuretic. Dr Chapman recommends
ʒij to ʒiv in the day, but this dose too large for the activity of
the medicine-qtt xx to xxx proves diaphoretics to a child from 
3 yrs of age-qtt v may be given-In some cases after an attack
of bilious fever X-[crossed out] qtt xxx
gr sh. has a very pleasant anodyne effect, relieving the pain very greatly.

46
X In choosing the [crossed out] dried leaves-those which are most green
are the best.-
# From my experiments with the colchicum-this article
I find is more effectual & more prompt in reducing the
pulse than the Digits. (See Cathartics).

47. 
Lecture 28th,, Dec 27th,,
The digitalis purpurea of the vegetable diuretics, comes to be considered
It grows in the U States-& is frequently cultivated in such 
gardens on account of the beauty of its flowers-It is called "purpurea,"
from its flower being of a purple colour generally-some species
have the flower of a white colour-Dr Barton proposes calling it on 
this account the digitalis officinalis. Its appearance is very like the
common mullion, it grows in a dry sandy soil, flowering in June & 
July. every part of the plant is useful, but the leaves are the part usually
employed. They are bitter, nauseous & acrid, they have little or no 
odour-Dr Withering directs, that it should be gathered while in flower-
that the stalks & middle rib of the last be removed & that it should
be dried in the sun or by the fire. By drying it loses about 4/5 of it
weight & should be kept in close bottles-X Digitalis is one of our most
powerful diuretics-but this is not its only property-it acts powerfully
as a narcotic & reduces [crossed out] the pulse very suddenly; as that in a short
time its strokes will be brought from the natural standard to 
30 or 40-# On this account it has always been considered till
very lately is an excellent example of a direct sedative-I do 
not always consider the pulse as the best guide in judging of the 
stimulant or sedative operation of a medicines, as by the same
medicine it will sometimes be increased & sometimes diminished.
Dr Moore at present of this city some years ago instituted 
some experiments to determine this point- In his first he 

48

took a grain & a half of the powdered leaves-his pulse being at 72. 
In 10 mins it was 76- in 35 it was [crossed out] 78. & in 2 hours
it was reduced to 60-showing that the first operation was to accelerate
the pulse-For another experiment he took grs iij with nearly 
the same effect the greatest increase was 12 strokes. In each of
these at the expiration of 15 mins he had a head ache. & some heat the
the stomach, in 25 mins the headache increased & the pulse was fuller
in 60 the uneasiness at his stomach was augmented & also a greater 
flow of saliva ensued-In 34 mins nausea was produced in 
some cases his urine was increased in quantity-Digitalis when given
in very large doses-immediately depresses the system, nausea, anxiety, vertigo, 
syncope, convulsions, coma & death are the consequences. Its affects
vary in different persons-some are made sick from very minute
doses, & others are not affected in this manner-One peculiar property 
of this medicine is, that it will remain a long time in the system without
any manifest effects-when suddenly the pulse sinks & the next alarming
symptoms are produced. On this account after I have
given 20 or 40 grs of it without effect. I am always very careful in 
administring any more. Another singularity is, that it is influenced by
the posture of the body. Sometimes after its exhibition the pulse
will be at 100 while the patient is standing-when sitting it will
fall to 75-& when lying down it will be at 40. Some authors
have however observed a contrary effect, that the pulse has been 
at 50 in the erect position-& at 75 when in an horizontal one 
rendering it probable, that it is owing to some other cause-

50.
X as in whatever form administd its effects are often sudden
& powerful-I have known qtts: x, taken in divided parts at intervals
in 12 hrs-produce almost fatal consequences in 
the person of Dr Physick.

Digitalis is given in substance in powder-in tincture & infusion, I  
prefer the powder-generally, mixing it with nitre, grs x of nitre & grs or
grs ij of the digs. It is always safest to begin with a tone of grss, as
gr i often produces very disagreable consequences. Pills are not a good
form to administer it. The infusion is sometimes employed which is
prepared by infusing ʒi. of the canes in ℥viij of [crossed out] boiling water till
it is reduced to ℥vij, then adding an ℥i of Spirits with or without
aromatics according to circumstances, This possess no advantage Doses ℥i -
The Tincture according to the Edinburgh dispensatory is prepared
by taking ℥i to ℥viij of alcohol. at the end of a week strain, the 
dose is from 10 to 20 drops, A saturated tincture has been often directed 
by taking ℥ij to ℥vij of alcohol. the dose being nearly the 
same as it is not much stronger than the former-Some have objected 
to it in substance as being apt to remain for a long time ineffectual;
this I have never seen happen having used it in this manner
very often-Great caution is necessary in its administration, X
the pulse is perhaps the best guide, or I do not know, that without
previously affecting the pulse, it acts on the kidnies or stomach-
When it purges, opium should be joined with it. To [crossed out] overcome the 
injurious consequences of an excessive dose, vol alkali; wine, brandy,
opium, sinapisms &c should be had recourse to.
As to its employment, there have been various [crossed out] opinions-Some condemning  
it, as a pernicious drug-while others warmly recommend it.
In 1775 Dr Withering first employed it in dropsy & found it a powerful
diuretic-He remarks that nausea is not necessary to its operation

52.
X but that like all other diuretics-it will frequently 
fail.

on the kidnies-on the contrary the flow of urine has been choked by  
nausea being produced-Purging prevents its actions as a diuretic; It
was employed by Dr Hakes-& by Dr Darwin-This latter particularly
recommends it in conjunction with bark & opium in dropsy from intemperance-
Besides those it has been employed by Dr Percival-Dr Baker 
Dr Ferrier.-Dr Currie of Chester has not been so successful in its
employment. But there can be no doubt, that it is very powerful in every 
variety of dropsy; X It has been much used in anasarca & with great success.
In ascites-it like other medicines often fails, from the organic disease
which generally exists in such cases-In hydrotherax it is very
useful-I however prefer in this case-nitre with squills & calomel
Dr Withering recommends it in these cases-& Dr Hamilton of
has been very extravagant in its praise, in which he will not be imitated
by any other practitioner-I have generally found it inefficient
in hydrothorax. In dropsy the condition of the system should be 
particularly attended to. If fever is present venæsection is to be resorted
to-no one will resort to digitalis in active states of the system,
at least in this city-Dr Withering also notices this-he says that
it seldom succeeds in persons of a tense fibre & of a plethoric habit 
but it is eminently serviceable in those having a pale countenance
soft skin-belly flaccid with other marks of a lax delicate constitution-
Palsy of the limbs-calculus in the bladder do not
forbid its use-By Dr Withg & several writers it has been
highly recommended in the œdema which results from long continued

54.
X It has been warmly recommended by Dr Currie & Dr Ferriar
to subdue the pulse in cases of considerl excitement
They consider [crossed out] it as a most important remedy.

continued fevers-I have always succeeded in these cases by cremor tartari 
& other saline diuretics. Dr Withering states in the following after 
recons his opinion of our medicine in dropsy-1st That it as well 
as other diuretics, is not universally successful. 2nd But that it 
acts more frequently than any other. 3rd It is often effectual after
every other has been tried. 4th That little is to be expected from any
diuretic if this fails-This last I do not believe, I have known 
cases relieved by nitre &c when digitalis has failed.
The Fox glove has been employed in may other diseases from its
remarkable power of lessening the circulation-X Many practitioners
are so prejudiced against the lancet, that they are continually looking
for some medicine as a substitute-They think that have found one  
in digitalis. Therefore they have employed it in hemorrhagies & they say
with advantage-But this is very uncertain as hemorrhage often, very 
often, ceases of itself-but again breaks forth- On this account, many
have been the reported cures-But, certainly digitalis in common, active
hemorrhagies is not to be relied on. it acts tho slowly & with too
much uncertainty-I would not condemn it altogether-but would
restrict it to its proper place, it is very useful after the system has
been reduced by bleeding &c-to destroy irritation which may remain
or to prevent a return-It has been used on hemopthysis-in menorrhagia-
especially in Europe-here it has been tried in the last disease
but with no decided advantage; on the contrary Dr Chapman has
one case in which it was increased-indeed it is not a medicine adabted 
to bleedings-as it relaxes-instead of constringing the vessels

56

vessels-In inflamd it is laid aside by the practitioners of this
country-indeed it is astonishing why practitioners should so industriously
hunt after & seize upon any medicine as a substitute, no matter
how poor-for bloodletting-This is a remedy which is often indicated 
by nature-in natural, safe, & certain & we want no other -
Lecture 29th Dec 30th..
We come now to speak of digitalis in diseases of the thorax in which it has
been employed most extensively. In Asthma, accompanied with effusion, it is 
very useful-in spasmodic asthma its use is not so well ascertained. When there
is an œdematous state of the lower extremities in Asthma there is always more
or less fluid in the chest-& digitalis in such cases proved a powerful remedy -
It is also useful in other cases of Asthma-Dr Dawes employed it with success
in several of the common cases without effusion as in the following formula-
ꝶ Tr tolu-℥i Tr ss-℥i: Tr dig. soltur. ss-m dose gtts x-3 times a
day till [crossed out] the pulse is influenced.
In consumption it has gained much attention-Some have regarded it as
a specific in this terrible disease-An answer however to this opinion, is, that
consumption is still fatal disease very much so in our county & perhaps
still more in the Island of G Britain where Dr Heberden observes 1/4
of the [crossed out] deaths are produced by Phthisis Pulmonalis. The wasting
of the body in this disease is common with it & others-every injury of the
breast accompanied with cough & difficult breathing does not form a consumption,
Pinel defines it to be cough marasmus hetic fever-& sometimes
purulent puteration These have also occurred in violent catarrh

58

as a consquent to Plurisy, in which cases the patient often recovers-The
reason why the lungs in consumption are so backward to heal some have
attributed to a want of curative power in the lungs-But this is not the
case for the lungs heal rapidly as any other part of the body-sometimes
by the first intention by the adhesi infln & by suppuration &
has also the usual terminations of inflamn These facts, I could prove 
by numerous cases of injury to the lungs-but [cross out] which I refer you to
surgical writers,-lately I disputed, a bullet from the lungs, where
it was lodged in a cyst as in other parts of the body. Therefore it is not
in the inability of the lungs to heal that the incurability of consumption
consists-The action of the lungs in this case is peculiar-it is different
from the morbid action occurring in other parts of the body.
It generally arises from tubercles, which are of a nature analagous to,
yet different from, scrofula, which are very slow & tedious in all their
progress-this progress is sometimes completed & the tubercle heals
but it is succeeded by a multitude of others, which in succession inflame
& suppurate-& it is this constant disease, to which there is no end that 
wastes the system & renders the disease incurable-There are however
some cases without tubercles Sauvages relates 20 different species 
of consumption but no use is derived from this which is certainly erroneous-
Dr Rush considered tubercles as the produce of inflamn but we 
have nothing analogous occurring in other parts of the body as the effect of
inflamn & consequently we have no reason to suppose that it occurs
in this case-& Neglecting entirely the old opinions [crossed out] of the absorption

60
X & that [crossed out] Consumption is a pure instance of Hectic Fever
arising from the local irritation in the lungs.
# It is often found, that an increase of the urinary discharge
relieves the pulmony. organs-hence the importance of this article
in certain catarrhal cases.
⨁ the dose may be increased 'till the pulse is affected or 'till
it produces some of its peculiar effects-when it should be 
omitted.
# but chiefly by injuring the tone of the digestive organs.
but this is not the universal opinion-some considering it
as highly important in all stages & under all circumsts-
as Drake Darwin Baker &c-but none has published so 
many successful cases as Mre - Dr Hamilton
says that making every allowance his success is unprecedd-
I may add that we have nothing like it here-& that I 
must believe that those were not genuine cases of Phthisis.

of pus-I believe that hectic fever in this case arises from the sympathy
of the system with the disease of a part.X Therefore the treatment if
successful must remove the local cause-now digitalis cannot do this; but
although this celebrated medicine will not cure pulmonary consumption,
it may greatly alleviate the symptoms-by reducing the force of the circulation-
which force some have considered is almost the whole disease, but it
is merely symtomatic-the reduction of the pulse therefore will not cure.
It is also useful by promoting the urinary discharge & in this manner relieving
irritation#-In may cases of chronic catarrh, where all the symptoms
of consumption exists - but where there are no tubercles-digitalis is
a very powerful remedy in conjunction with others often effects a cure 
The manner of exhibiting the medicine of importance-a late writer
advises gtts viij or X. of the Satur 8 gr to be given [crossed out] with a saline draught that all nausea
may be avoided. ⨁ In exhibiting it, always be very cautious-pay strict
attention to the pulse, especially in the different positions of the body.
In incipient Phthisis it sometimes proves useful-In the advanced
stages many respectable practitioners in England have declared it useless
I will go still further & declare that it is injurious, by exhausting the little
strength of the patient. # Many think it beneficial by promoting
absorption, by promoting the flow of urine or by reducing the pulse.
In this country very little can be said in its favour although much
used-Dr Rush declares it to be a poisonous weed. Dr Barton knew of
but one case in which it appeared to be useful. This is pretty much the
experience of others it effects no cures in consumption but is useful in many chronic
affections. When a patient in consumption sleeps or passes the night in
one position & turning in the morning on the opposite side brings up

62.
X In organic affections of the heart it is said to prove
beneficial-Abernathy [crossed out] relates several cases of this kind.
I have lately received a letter from Virgina relating the
case of a boy-of a strong healthy condition after some
exposure being attacked by symptoms similar to the Pneua
the practir. when consulted-found that altho' his breathing
was difficult-the pulse was but slightly affected-The 
countenance was flushed-the heart sometimes beating violently-
so as to jar his whole frame-he could not lie down
being instantly roused by a sense of suffocation-the symptoms
altogether, says he, led me to believe that the disease
was exactly similar to that described by Abaney he
soon died & on dissection [crossed out] it was found, that the aperture
of the pulmonary artery as it leaves the heart was exceedingly 
contracted-exactly as in those cases detailed by
Mr Abery - Digitalis may possibly ameliorate 
the symptoms in such melancholy instances-by diminishing
the force of the circulation: but this is all -

a large quantity of pus I look upon such cases as beyond the reach of
any medicine the patient dies invariably. In cases about to end in consumption
I have seen digitalis do wonders in congestion with various 
depleting remedies-& remember, never attack a disease with one
remedy-bring up all your forces-make your most boldly, & you will
be much more likely to succeed-The conclusion then is that our
medicine is useful in many chronic affections of the lungs-in incipient
Phthisis-& in the sequel of acute infll of the thorax-but digitalis
will not cure consumption.
Lecture 30th Decr,, 31st,,
X
In Epilepsy Haller has recorded several cases in which it has been
useful-this disease arises from several causes, & in some cases is hereditary
in all which it is in the present state of our knowledge incurable
In every case in which I have seen digitalis employed in- Epilepsy it
has been utterly useless. In mania it has also been used- Some authors
have supposed this disease to depend on effusion - but this is not the case
as is now well established. Ferriar observes that it is of no service & 
it does not enter into the treatment of the case. Dr Rush in these cases which I believe is the best.
In hydrocephalus from analogy to other dropsies it has been employed
I will read to you what [crossed out] Dr Cheyne says on this subject. He observes
that its use has been established in hydrocephalus from its analogy to consumption
that in a few cases in which he has employed, in some it
has been of service; in others not. Great attention he observes, should be
paid in its exhibition as it acts differently in different persons, I have

64.
X I have not tried it as an applicatn to ulcers-& perhaps 
we should as yet be cautious in doing it-it is stated
that digitalis inserted into a wound on the thigh of a dog
proved fatal.

known cases in which an adult could not bear gtts xxx. of a tincture
of which a child was taking 120 gtts. Its effects differ from other narcotics
in this-when a small dose of any of them is given an effect is
produced of the same nature as when a large one is given, this a small
dose of opium induces a slight degree of languor-not so, with digitalis.
an under dose goes for nothing, no effect is produced until a
dose of sufficient size is given when it acts powerfully. It also does
not act uniformly even in the same individual-& after a sufficient
quantity has been administered to make an impression on the brain
stomach or blood vessels, it cannot be increased; the system does not
become accustomed to it-as it does to other narcotics. It is also more
permanent than most others-a flow of urine being produced, it will 
often continue for several days after the exhibition of the medicine
Dr Cheyne after making these observations states that out of the few
cases which fell under his notice, two cases of hydrocephalus were undoubtedly
benefited by it. This is a small proportion-I have already
stated my views on this subject-that hydrocephalus is a purely inflammatory
disease & demands more powerful depleting remedies than
digitalis such as bleeding & purging.
In Rachitis it has been recommended by Haller as being of some service-
Happily this disease is very rare in this country-& I have no 
experience of our medicine-but I cannot conceive how it can be 
useful here-tonics, cold bath &c with proper surgical supports are
the proper remedies-Digitalis has been made into an ointment
& employed as are external application to Ulcers.X [crossed out] It also been used for gout

66
X In irregular gout-& in all cases where there are dyspeptic
symptoms-the digitalis cannot be useful-
X which operate in [crossed out] the same way-namely by wamg
the Digs & Colchicum autume & [crossed out] operate on a different 
principle-

I have had no experience of it in these cases, it may possibly be of
some service in relieving pain from its narcotic power - X
Nicotiana, Tobacco. This as a diuretic is somewhat analogous to
the digitalis but is by no means so active. When administered with this
view an infusion is made of ℥i of the leaves in a pint of water. the &c
being gtts L. or ZX. but it should be given with great caution, as
I have seen very direful effects from this medicine in injections: although
I have not used it [crossed out] as a diuretic I must unless, that I never wish to
see it thus employed as we have other remedies which are safer-
Scilla-or Squill- this in one of the oldest diuretics we possess
the oxymel of squill was employed by Pythagoras. Dr Cullen 
does not consider it as stimulating the kidnies particularly, but that
it is a general stimulant, acting on all the secretions. Thus on the lungs
promoting expectoration-on the skin inducing perspiration, on the
bowels increasing the evacuation on the heart & arteries-accelerating
the pulse & so of other parts as well as the kidnies. But although
its effect is to stimulate the arteries-yet by the evacuations it occasions,
it quickly lowers the pulse-& according to Dr Withering more powerfully
than any other medicine-It has been used with great success in all kinds
of dropsy whether anasarca-ascites or hydrothorax. In the latter
I think it is most effectual & I find that my medical friends are generally
of the same opinion Perhaps one reason of this is-that there
is generally less organic derangement than in ascites-The dose as
a diuretic is from gr i to grs iij. I prefer giving it with nitric
which assists its operation. & facilitates the reduction to powder, It is

68.

sometimes given in pills with gum ammoniac-& occasionaly ginger or
some aromatic is added to prevent vomiting-I usually begin with one
grain 3 times a day-& increase it till nausea is produced I find that
the stomach will never bear more than grs v. ter die. Some have advised 
larger doses but this is the extent to which I have been able to gv.
It should be remembered that there is a great variety in the quality of the
squill some being almost inert-I am of course speaking of the most active
to be had in the city. By some physicians [crossed out] vomiting is considered
as necessary for its operation as a diuretic-Dr Home urged this opinion very
far-Dr Cullen maintained that the only advantage of the nausea was
as a test that the medicine had made an impression on the system-
Whether this is the case or no-I will not decide-but I always find
that it is necessary to push the medicine till some impression is made on
the stomach. When it purges or gripes-opium should be used, as also 
when it is given to children-It is often given with several of the mercurial 
preparations, as blue pill, carros. subli. turpeth mineral, & calomel-
the latter of which, I always prefer-Dr Cullen objects to the 
combination of calomel & squill-as more likely to purge than that of
the carros-sublimate with squill-but I am glad that he speaks from 
theory & not practice-The squill & calomel is a more admirable combination
& is more useful than any other, in cases of organic disease.
When it purges a gr of opium may be given with each dose. The calomel
may either be given seperately or combined with the squill according to 
circumstances-It often induces salivation & generally more quick than
when given alone-this is always very useful. Frictions have also been
used-Murray of Edinburgh thinks that it acts by stimulating the absorbents 

70.
X The Pyrola Umbellata requires more investigation
before we can admit it among our diuretics.
#. It is usually given in coffee milk wine &c-I prefer
a little sugar & water-

absorbents but this is not the case as it would then be equally effectual without
the squill-This combination I am very much pleased with forming
in my opinion one of our most certain & powerful diuretics.
X Balsamum Copaiba is a resinous juice procured by incisions, in the 
trunk of a tree growing in South America or the W Indies-It is thick
clear & transparent, of a yellowish colour- has a peculiar odour to most
persons very disagreeable & a pungent bitter nauseous taste. like the resins
it is soluble in alcohol & the essential oils. The best comes from Brazil,
& is, I believe, often adulterated. It stimulates the kidnies, increasing the
urinary discharge, & communicating to it a violet odour-The dose is about
30 drops ter die, it is best to begin with 20 gtts. it may be increased
to 40-but no further without omiting- # The disease which it
has been celebrated is Gonorrhœa & Sleet, as also an analogous operation 
leucorrhœa. In london it is exclusively employed in all 
the stages of this disease as also by some of our most respectable practitioners
But in this, as in all [crossed out] other diseases, I am repugnant to the
practice of neglecting existing circumstances. In the first stage there is
generally more or less inflammation, which should be treated sometimes 
by bleeding & always with purging-Injections & bougies although
they have been much abused, are undoubtedly useful in alleviating
the symptoms. The Balsam may be used in the early stage of
the disease, & should not be restricted to the latter, as some have done
but it should always be used in conjunction with others. Its effects have
no doubt been exagerated. it does not cure ordor anisate, the inflamn of 
the prepuce, harder or swelled testicle-its use notwithstanding is very
valuable-It not only increases the flow of urine-but medicates it

72.
X I have frequently succeeded with the rosin-I usually
direct my patient to scrape it very finely & to
take about a tea spoonful of 3 times a day-If 
not fine-it is apt to gripe-

communicating probably some degree of astringency. Sometimes it induces
nausea & vomiting-in which case the following prescription of Dr Chapman's 
is very useful ꝶ Bals. Copaib. ℥ss-[crossed out] lavend-comp. & spt Nit. date. aa
ʒij-laudan ʒi. G-Arab. ℥ij Aq. ℥iv. m-Dose ℥ss. If this
should also bring on vomiting, it must be omitted for sometime & again
return.-Other balsams have been used-but none is so valuable 
as the Copaiva-It is said also to be useful in Piles & 
to relieve the Strangury [crossed out] from blisters.-
Lecture 31 Januy 2nd 1817.
Ol. Terebinthinæ is a very active medicine-It is considered as an
essential oil procured [crossed out] by the distillation of Venice turpentine the residuum
being the common rosin of the shops. The residuum is diuretic 
but this property resides chiefly in the oil, which is light, pungent, volatile
& inflammable but slightly soluble in alcohol in which it differs from 
other essential oils-it communicates a violet odour to the urine-It has
not been much used in dropsy-In gleets it has frequently been given
in doses of gtts v. to. x. but to prove beneficial it must be given in
larger doses. In many other diseases as will afterwards be mentioned
I have given ʒi at a dose, so that the quantity may be safely increased.
The rosin is sometimes employed in gonorrhœa from x to xv grs rubbed
up with sugar or Gebrab but I always prefer the balsam Copaib-sometimes
however it has succeeded when the balsam failed.X
Polygala Senega grown plentifully in the U. States-the root is
the part employed, it is very much contorted & jointed & from supposed
resemblance to the tail of the rattle snake-has also been named snake-root.
When first tasted it appears to be farinaceous & insipid, of ter-

74.
X
The Colchicum Autuml has been recommedd by Baron
Stork of Vienna-that it promotes the secretion of urine
there can be no doubt-but it possess other properties-
which forbid its employment solely as a diuretic.-

it imparts some degree of pungency & astringency showing that it possesses some
active powers. In the year of 1789 Dr Tennent published an essay on this plant
& observed that it would cure the bite of the rattle snake, this however I would
be very much inclined to doubt, [crossed out] although I have had no experience in this point, [crossed out]
The medicine acts as a general stimulant proving, cathartic, Diuretic expectorant,
diaphoretic & emmenagogue-As to its diuretic property it is of no
great importance & it is certainly not to be depended on. Dr Percival has
used in ascites & hydrothorax with some success-as also Dr Barton In my 
hands the dose could not be sufficiently increased without great nausea-The 
dose of the powdered Senega is from grs x to 2i. several times in the day-
Of the infusion prepared by taking ℥i to #i of water ʒij may be given
a young child. & from ℥s to ℥ij to an adult. It has been used in several inflammatory
diseases in plurisy we have more powerful evacuants it is not
necessary in my opinion, although it has been recommended by several authors.
In Cynanche trachealis it has been devised by Dr Archer of Maryland.
I have found it too nauseous a dose for children. they will not
take [crossed out] sufficient quantity-in this disease, as it has been found useful
in preperation to its evacuating power, its effect I would explain upon general
principles, & think that we have more powerful remedies. It
has also been employed in Gout. rheumatism & many other inflamy diseases
which I cannot now mention but in my opinion with no great advantage
In headach it has been said to be useful in doses of grs. v so that a scruple or ℥ss be taken daily. [crossed out]
There are many other vegetable diuretics, X which possess some slight
powers. but which are not of sufficient importance to be noticed here

76
X 
Dr Chalmers of South Carolina relates a case of dropsy
cured in one night by this article.
# The Meloe Americana [crossed out] has very nearly the same effects-

I therefore pass to one from the animal kingdom viz the meloe vesicatrii.
This is the common blistering fly-& when applied so as to raise a 
blister or when taken internally often produces a strangury showing a determination
to the urinary organs-It often promotes the secretion of urine 
when ʒij or ʒiv have been gradually given. X Dr Morton has considered
it as specific in diabetes-Dr Cullen & others do not consider its diuretic 
powers as very considerable. It is said to increase venerial properties. In large doses the bladder & kidnes
are greatly irritated-the intestines become inflamed saturated with
a bloody purulent discharge. The Tries prepared by taking ℥i to the #s alcohol  
Of which the dose is gtt x. It has been employed In Tetanus
hydrophobia & typhus besides other diseases-In gleet & leucorrhœa
[crossed out] Dr Moberton has used it with success, take ℥ss of the tr & mix with ℥si of
water- dose ℥ss t.d-to be gradually increased 'till an effect is produced 
which will be evidently by the discharging becomes more thick
[crossed out]. Large doses have induced suppuration, inflammation
& nearly death. In two or three cases of Yellow Fever, I have used it
when I despaired of the recovery of my patient, I think with some advantage-
Dr Home states that it [crossed out] gives fullness & strength to the pulse
in typhus fever. In Tetanus it produces no good effects.#-
Antilithics. Those are medicines which relieve the symptoms
or prevent the formation of a stone in the bladder. I prefer this
name given to them by Dr Barton to the old one of Lithontriptic as
we have no medicines which destroy the stone when once formed.
To discover some medicine which would do this has been a great
desideratum in medicine for several ages but [crossed out] all attempts have [crossed out] been

78.

ineffectual. This substance is found in the most healthy urine, & would be
deposited on any nucleus, as is shown by calculous matter forming on any 
substance accidentally introduced. When very abundant in the urine a stone
will be formed without a nucleus. This formation of [crossed out] is not confined
to the urinary organs-other parts occasionally have them What is the
[crossed out] cause has not been ascertained, they are produced by disease, or they are found [crossed out]
in the most healthy person. To ascertain the nature of these calculi
the Chemists have exerted all their powers, & have obtained different 
results; from which however they venture to arrange them into different
doses, but all such arrangements are useless in practice, we have
no solvent for the stone which can be introduced into the body-acids
& alkalies are too powerful when injected into the urethra. Supposing 
that the action of an animal fluid would produce less irritation, I
made for my inaugural Thesis several experiments with the gastric 
liquor of the hog injected into the urethra & although unsuccessful
in my main subject, I proved 3 points. 1st That the gastric liquor
would dissolved the stone out of the body. 2nd That the bladder
would bear injections of this. 3rd That portions of the stone was discharged,
but I found that although the stone was partially effected
the accretion went on faster than the dissolution. From the effects 
of the alkalies on the [crossed out] urine when given internally great passes were 
entertained of their being able to effect a destruction of the calculus, but
they have only alleviated the symptoms, [crossed out] in some instances completely,
that is was thought the stone was gone, but subsequent examination 

80

examination ascertained it existence. Some cases have been recorded in which 
the stone was actually dissolved in the urine, one of those occurred to Dr
Physick-you may rely on the accuracy of the case-A Gentleman who 
possessed a stricture in the urethra with symptoms of a stone, Dr Physick
sounded & distinctly as he ever did felt a stone; & only delayed
the operation, till the patient's health should recover, this did not take
place & in 8 months he died, I examined the body & in no part, either
in bladder urethra or kidnies could I find a stone. Here the patient
has taken no remedies what ever, & the calculus must actually have
been dissolved in the urine. This shows that we need not altogether
despair in yet finding a solvent for urinary calculi.
Lecture 32nd Jany 3rd
Some of our medicines enter the bladder unchanged, & are useful in realigning
the symptoms of calculus This disease comes on by paroxysms or
fits having after considerable remissions. To relieve these fits there are
many remedies employed which act only on the general system & on general
principles & therefore do not come under the head of Antilithics. Such as
bleeding purging the warm bath &c &c There are several articles supposed
to act on the stone itself & there are others which without having
any effect on the stone, still relieve the symptoms, these are the proper Antilithics.
The Alkalies act very powerfully in relieving the symptoms
of the stone-& a solution of them is capable of dissolving the stone out of
the body-Fourcroy maintains that a caustic solution of potash will
destroy all urinary calculi out of the body. It is also found that
both potash & soda when taken in large quantities will impregnate

82.

the urine with their properties. Moreover the urine of persons who have
no calculous affections & who have taken large quantities of these alkalies
will dissolve the stone out of the body. These things being so-Why will
not the alkalies dissolve the urinary calculi? One reason, is that they
cannot be given in sufficient quantity-besides there are numerous circumstances
altogether unknown to us which must influence any such action; 
but they will undoubtedly relieve the symptoms & we may suppose
that the lithic diathesis or disposition to form stone may be destroyed as the
inflamy diathesis is destroyed by V.S. purging &c. They may also dissolve the
stone in some measure, till it becomes smooth & thus prevent irritation-
Mr. Murray has followed Mr Brande in supposing that the softness
of the calculi was not owing to a partial solution but that a deposition
of phosphate of lime took place because the [crossed out] alkalies had saturated
the acid which held the lime [crossed out] in solution-This however is founded
on no determined data & is contrary to all that we know on the subject-There
is one fact also in direct opposition to it-viz a European Chemist
has detected in the same urine the disengaged [crossed out] Soda-& also the
phosphate of lime, why in this case did not the [crossed out] Soda decompose
the phosphate of lime is out of the body. This shows the impossibility
of applying chemistry [crossed out] in its full extent to the animal body, the
bladder is not a retort or receiver in which chemical changes can take
place from the usual laws of affinity.-
Potash-Before Chemistry was much known or perhaps existed
we have the testimony of the efficacy of this in relieving the symptoms
of calculus. The caustic potash must necessarily be given in very small
doses-the aqua potassæ is usually preferred. Of which gtts xx are

84.

to be given twice a day till the urine becomes alkalescent. It is usual
to exhibit mucilaginous drinks with it, but this now is ascertained to be
unnecessary as the mucilage acts only by the water it contains, which may
therefore be prescribed. I prefer to the caustic potash, the common salt
of tartar or subcarbonate of potash, as it is termed. It is necessary to begin
with small doses as the stomach is apt to reject it, at first - grs v may be
the first dose & gradually increase to grs xx. once twice or three a-day. 
The supercarbonate is still preferable to this, a good way of preparing
it is by dissolving [crossed out] grs v of the subcarbonate in a glass of 
Seltzer [war], so that ℥viij of the solution may be taken 4 or 5 times
a day. I have often used this with great benefit & Dr Physick prefers it to
all others. Soda not often used in its caustic state-but generally
in the state of subcarbonate-It is an efflorescent salt & may therefore
be made into pills with soap ℥ss to ℥i being given every day.
Dr Bostock relates a case of a young lady afflicted with calculous complaints
who took after a short time ℥ss a day, this was increased to ℥iss
& to ℥ij. & finally to ℥iij a day which produced some uneasiness when 
she again decreased to ℥ijss which she continued for several months & with
considerable advantage-It is also given in solution & with an excess
of carbonic acid- forming a supercarbonate-this is analagous to the sup.
carb. pot. & is given in the same doses. These medicines relieve the symptoms
but do [crossed out] not cure the disease-Mr Home relates a case of a person who
used them for four or five years & became entirely free from any calculous
symptoms, & he was considered as cured. He died sometime after & 
no less than 350 stones were found in his bladder, which no doubt must
have been forming even when he was taking the medicine-That they enter in-

86
X
Two circumstances contributed to the deception of Parliament
on this occasion-First their easy faith-& secondly that the symptoms
of stone, will often disappear owing to the calculus being 
lodged in a pouch formed by the seperation of the muscular
fibres of the bladder that this sometimes occurs dissetn has
fully proved-Since this time Mrs Stevens remedy in the form
of lime water has been much employed in calculous cases
but that it has no effect on the stone is shown by a case
related by Dr Haen in which 800 quarts were taken in
six months-it was found by dissection that the stone was
unaffected-

the urine there can be no doubt as is evinced by the following experiment.
℥ij of the solut. of. potash was taken on an empty stomach, In 6 mins
it would be detected by the litmus paper in the urine. Their use is not
only to saturate the acids & precipitate the phosphates-but also to give the
urine alkalescent properties. Bostock observes that in the case of the young
lady above mentioned the serum of the blood also possesses alkaline properties
as it took 30 gtts of muriatic acid to saturate the quantity in an
ounce of serum-Soap is much used, but is only useful by its alkaline
properties, [crossed out] it is therefore to be given in substance [crossed out] as a convenient vehicle
for soda in the form of pills - it may contribute some aid, but 
cannot be relied on by itself.
Lime is sparingly soluble in water & in this small quantity forms a 
solvent for the stone out of the body in a slight degree. It is the secret ingredient
in the celebrated [crossed out] lithontriptic solution of Stevens, which 
was purchased by paliament at an enormous price. X Lime water is not
as effectual as the alkalies above mentiond but appears to have proved
useful in [crossed out] nephritic calculi but will only relieve symptoms.
Magnesia has more lately been introduced by Mr Brande, as a remedy:
he does not believe, that the stone is dissolved, but only, that its size may be
kept stationary; which he thinks is often done by the magnesia, preventing the
formation of uric acid. By this medicine the symptoms especially in 
gouty persons are removed-as also in those persons who live freely & who 
are subject to acidities in the stomach. Sometimes it purges which is to
be counteracted by opium-It has long been known to act as an antacid
but not withstanding this Mr B's experiment is of advantage & has
proved very useful in practice, especially in what are called gravelly

88
X In an Hospital in Dublin appropriated to the reception
of gouty patients-a case of Stone has not occured for the
last 10 yrs.

complaints, but these seldom if ever are accompanied by regular calculi.
gouty persons are very subject to gravel but not to the stone X & therefore
the magnesia may be useful in one case but not in the other.
The alkalies & their supercarbonates have of late been much used to destroy
the bitter acid but not with much success-From the alkalies
we proceed to a directly opposite class of [crossed out] antilithics without attempting
any explanation of the manner in which the same effects can be produced
by both. I allude to the Acids & first of the Carbonic acid. This has
been long employed, Dr Percival observes that it can be detected in
the urine of persons using it: this appears from the precipitation from lime water & by the
bubbles which arise from it vacuo. But Dr Priestly has in some measure
sett this aside by observing that the same effects are sometimes 
produced by the urine of persons not taken the acid. Dr. Percival is however
correct in the practical part-I have employed it in several cases
& with advantage - in one very decidedly: A young man about 16 yrs
had been very much troubled for several yrs with the gravel the attacks
returning at different intervals-During one of them he called upon making
in great pain-I ordered the Seltzer water freely-in 48 hours
he was relieved from his complaint having discharged 42 small
round & polished calculi-the largest about the size of a buckshot.
Perhaps the sup. carbonates may be preferable to the simple acid-
The nitric & muriatic acids are occasionally to be employed & have been
with success: Mr Copeland relates 2 cases, in the first the patient was relieved
by taking gtts xxx of the nit. acid in water A. dy then 50: gtts; till he has taken ℥ij
So the 2nd dose gtts XL. were given 3 times a day with a similar results.
He prefers the Nitric acid-

90

91.
Lecture 33rd Jany 6th,,
We have been hitherto considering those substances which have been
supposed capable of resting on the Stone itself which have been termed lithontriptics-
I will now notice those which no one imagines to have any direct 
influence on the Calculus-but which by correcting the state of the secretions
or changing what has been termed the Lithic diathesis, palliates the symptoms
of stone. Of these, the first are Bitters & Astringents. The manner in
which those act in this case, has been much disputed. Cullen supposes it to 
be owing to the absorption of acid by them-but this is not satisfactory as we
do not know that any astringent has this power; neither do we know that acid
in the stomach contributes to their formation; the probability is, that it
does not, as some of the acids are among our best antilithics. Haller imagined
that astringents reached the bladder & [crossed out] acted by robbing the stone of its mucus.
Others have entirely attributed it to their tonic power, which is the most
probable-as none are more effectual, than those which act on the stomach
most powerfully & as according to my observation, there is in calculous
persons generally some derangement of the stomach, although not depending
on acidity. The first of this class which I shall mention is the
Arbutus Uva Ursi. This grows in most of European countries
& very plentifully in the U. States-it is bitter & astringent making a very 
deep colour with the salts of iron. It is given in powder in infusion & in 
decoction. The leaves are the part employed-It produces very little
sensible effect either on the pulse or on the system generally.

92.
X
There are no cases which are more embarrassing than
chronic cases of Nephritis-you will very often fail
in all your remedies-

Dr Ferrier has given it to the extent of ℥ss of the powdered leaves-this 
produced some nausea, From my own experience as well as that of my friends
ʒss is the proper dose. 3 or 4 times a day. I prefer the powder generally
as being more certain than the infusion of decoction. Dr Barton who was
generally fond of small doses prescribes grs vi or viij but this can produce
very little effect. Some have imagined that the Uva Ursi [crossed out] actually
dissolved the stone, as the symptoms entirely vanished but we have
already noticed the fallacy of this criterion-I often employed it with
great advantage in palliating the pain of calculus. Dr Ferriar in
nepritic calculi has used it, often very properly promising Venæ Section
& purging. He has found it, he says, very useful in those cases when combined
with opium-grs. v. of the powdered leaves with gr. ss. of opium,
three of 4 times a day. I should attribute in these cases much more to 
the opium than to the leaves-To premise V.S. is no doubt useful but is 
less necessary in this than in most other cases-as the Uva Ursi excites the 
artery of the heart & arteries so little. X The [crossed out] Uva Ursi has been
employed in other affections of the [crossed out] urinary passages, in what has
been called Ulcers of the bladder & kidnies, we do not know what was
exactly meant by the expressions, as we know now that the symptoms formerly 
thought to [crossed out] indicate the presence of ulceration proceed from other 
states of these organs. it is probable that the catarrhus vesicæ & bloody 
urine are the disease alluded to: [crossed out] & in these cases our medicine is
very useful & in all those cases which do not depend on mechanical irritation
as that of a stone in which case the cause must be removed or
only partial relief will be afforded. It has also been useful in

94.
X Dr Barton's testimony of the pyrola is very strong- he states
it to be equal in his hands to the Uva ursi-especially in nepritic 
calculosa where it is eminently useful- it appears he continues,
in some instances to favour the expulsion of the calculi.
#-A friend of mine from Virga concurs with Dr Chim
as to the advantages to be derived from this article not only 
in calculous complaints-but in several other affections
of the urinary organs-he says permanent uses have 
been effected by it-

chronic Gonorrhœa & in Leucorrhcœa - but it will generally be found that 
these diseases depend on certain causes, which must previously be altered before
they will yield to medicines-The first is often dependant on strictures in
the urethra which must be overcome by bougies & the second are suppressed or
disordered menstruation, The Modus operandi of the Uva Ursi is upon
this same principles as other astringents.
The Pyrola Umbellata is said to have been useful as an antilithic 
it has been used by some of our country practitioners & has been employed in
England & Ireland-but at present I have had so little testimony of its
virtues that I would not rank it among our remedies in this class. X
The Humulus Lupulus or common Hop has been regarded as an antilithic-
From the great consumption of Malt liquors in which it forms a
principal ingredient it might be imagined that the disputes as to its efficacy
would be now settled but this is far from [crossed out] being the case there are
many who maintain that it is useful while others doing its efficacy altogether-
The number of calculous patients in France & Engd are nearly
equal yet in France no malt liquors are consumed-while they form the
common beverage of the poorest Englishman, affording it would seem
very little protection from this dreadful malady. The hop has been given
in infusion a pint every day or in Tincture the dose ℥ss.t.d. I have
not had much experience of its value in these cases but have found it useful
many others which shall hereafter be mentioned.
The wild Carrot (as Daucus Corota) Dr Chapman recommends in many cases, both the
roots & seeds are employed-I have no experience of it virtues.#
The Oleum Terebinthenæ has been recently introduced by Dr Physick

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X I have seen them employed very extensively while
I was in Europe-they then being a fashionable remedy
but I cant say that the least advantage was gain.

as an antilithic-He gives it in doses of gtts x. or xv. with the oleum  
cinnamo. or what disguise the taste better the ol-Sassafras. It allays
the pain very quickly & soon puts a stop to the discharge of sandy 
matter. I have employed it in one case with some success but in the 
hands of Dr Physick it has proved very prompt & effectual in many
cases & I do not hesitate to recommend it to your notice.
The Alliaceous plants as the Garlic & Leek have been employed as some
say with effect in dissolving the stone but of this there is no authentic
case. X If of any service they are only Palliatives.
Besides the common calculous cases described by Authors, you may 
now & then be consulted by patients who will tell you that with great pain
they discharged numerous small stones, specimens of which they will exhibit
to you. These you will find very different from the urinary concretions
but having every appearance of the common pebble stones, Chemical analysis 
showing them to be siliceous. These you may always consider to be
as imposters, having no such disease-Dr Duncan relates the Case of
a young Lady who was in affluent circumstances & who maintained a good
moral character; she complained of great pain in the back & in the bladder
& was relieved by a plentiful discharge per urethra of calculous substances.
Those were subject to many chemical analysis by different physicians
who found them to consist of the same substances as the common
gravel-Dr D-was also requested to examine them but immediately
decided that the whole was an imposition.
I have seen 2 Cases one was a negro woman who discharged a 
quantity of sand, having every resemblance to House Sand. I treated

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her with very nauseous medicine accused her of imposition but without 
any effect. A second case was a wealthy female near this place who
showed some gravel neatly resembling some that was found in her
neighbourhood. All such cases you may sit down as factitious-Why 
they should be feigned it is impossible to imagine It must be a species
of Hypochondriasis.
Lecture 34th,, Jany: 7th,,
Diaphoretics. are those medicines which promote the discharge
by the skin-They have been termed diaphoretics when they merely increase
the insensible perspiration & [crossed out] when sweating is produced
they are termed Sudorifics, I shall comprehend the whole under
the former head. They are powerful evacuants, the skin affords an 
out let for a large portion of the fluids of the body, & medicines increasing 
this discharge are useful in all those cases where evacuation is demanded.
Some having used that Diaphoretics differ from each merely in the degree
of force, how far this is true, is uncertain-The discharge from the skin
is the same which takes place in ordinary circumstances & is not altered
by the medicine as was formerly supposed-The natural discharge
has been divided into the insensible & sensible perspiration, the
former consisting according to some of [crossed out] a gaseous substance &
according to others of vapour which can be condensed-The sensible
perspirations consist of a serous fluid holding in solution chiefly gleatin-
& mur. ammoni. I think that it is probable that the exhalation
from the skin varies in different states of the system; this appears

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to be proved by the discharge as it occurs in small pox & other eruptive 
diseases.-In explaining the operation of our medicines, Dr
Cullen maintains that they act either by increasing the general circulation or
only that of the extreme vessels-sometimes seperately & sometimes together.
This cannot be altogether true as sweating often occurs, when [crossed out] the
general system is not united & even when it is distressed, [crossed out] & when the
circulation is diminished in the small vessels: this may be seen in
syncope. It will often be seen that the heart & arteries are excited & 
that there is no secretion by the skin-also [crossed out] there is often an increased
action of the cutaneous vessels & no secretion as in the common phenomena
of blushing. This proposition must therefore be incurrent.
As depleting or rather as debilitating medicines, they act in two ways
first by more evacuation & secondly by inducing a new action in the 
skin-In evacuating they also act in two ways-first by lessening the
quantity of fluid in the vessels; & secondly by filling the capillaries
& thus emptying the larger vessels. The old opinion that they acted by relieving 
constriction or spasm of the blood vessels is incorrect-there is no
foundation for the opinion & we have a much simpler & more satisfactory 
mode to account for their action-It must be granted however to the 
supporters of the above opinion that the constitution as they termed it, of
the vessels is [crossed out] injurious-the suppression of the perspiration is a suppression
of a natural function, & must therefore undoubtedly be injurious
by increasing the determination to other parts.
Various methods will excite sweating, among the most common
are exercise, an increased temperature, frictions, warm clothing, warm drinks, rubefacients

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rubefacients. plasters-& last by medicines. The heat of the body is usually 
greater than the surrounding medium; this heat is chiefly derived from the
decomposition of air in the lungs & is often morbidly increased. The means employed
by nature to relieve this increased temperature, is chiefly the operation
from the surface of the body [cross out] This operation is [crossed out] checked
by a low temperature-& must be facilitated either by the direct application
of external heat or by heat indirectly procured by clothing which conducts
heat badly. The kidnies & the Skin are the emunctories by which
the fluids are eliminated in the greatest quantity from the body, & each of
those are excited by plenty of fluid thrown into the stomach-Hence covering  
the body with conductors of heat. & drinking warm fluids from
what has been called, the diaphoretic regimen-Woollen clothes are, for
the above reason, preferable to linen or cotton-& when sweating is to long continued
& where the diseases of a chronic nature the wearing of flannel
next to the skin is absolutely necessary-There is hardly anything in the use of
chronic diseases more important than the flannel shirt. Sudden cold
during the action of a sudorific is very injurious-the patient should always
therefore be well watched to keep him closely covered, especially
when he is asleep as he is very apt at that time to throw off the bed clothes-
For this reason purging should never be employed during sweating-as 
the exposure which is necessary is very hurtful-Sweating is a popular
& often a very dangerous remedy from neglecting the above precautions.
After the sweating has subsided the patient should be dressed clean & removed
to a fresh bed, nothing is more hurtful than the filth from the 
human body. The kidnies & the skin are in a inverse ratio what

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increases the one-diminishes the action of the other, This should be remembered 
as it would be improper to [crossed out] excite one while the other is in action.
We will not notice the use of diaphoretics in the cure of diseases
and first in Fevers. These are either of the Continued or Intermitting 
form the former comprehending according to Dr Cullen Synocha, & Typhus
the latter the intermitting & remitting-Whether there is such a fever as Synocha,
I have already expressed my doubts & shall not again enter on the subject.
The most remarkable phenomena is the increased temperature, amounting 
to 105° in some cases which appears to be the maximum, in regards the human
body in disease-& therefore the diminished secretion from the body.
In intermitg & remitg fevers two circumstances point out the use of 
diaphoretics the first is the suppression of the evacuation & 2nd that 
the paroxysm always goes off by a sweat. Cullen sometimes advises those
to prevent the accession of a fever-this may answer in Europe-but in
this country, it is very dangerous to rely on diaphoretics only-I had a
very strong proof of this in a friend of mine, who had an attack of bilious
remitting fever I advised him to employ V.S. & other evacuants-but he
was determined to employ sweating-He did so-a train of malignant
symptoms ensued & he died in a few days. It is not easy to excite sweating
in in very high inflamy diseases where the temperature of the body is
105°. The heart & arteries are too much excited-V.S. &c must be previously
employed as otherwise your diaphoretics are injurious as they 
will not effect the desired object. Formerly the most stimulating medicines
were employed to promote sweating than which nothing could be more
hurtful-In intermitting & remitting Fevers they have been employed

106.
X Also in Yellow Fever-It is here that the Eupator:Perfol.
was more used than in any other complaint.
# The Eau Medicie operated powerfully in this way
so also the colchicum-but the identy of these 2 articles
appears now to be fully established.

employed both during the remissions & paroxysms-The practice is useful, although 
the theory is certainly wrong-they act in my opinion as evacuants & by
inducing a new action-In Typhus Fever they have been celebrated
as affording a mode of evacuation; where others could not be used. X In
the Typhoid Pleuresy they have been employed with great advantage-
Diaphoretics have been employed in the Phlegmasiæ-Some have advised
that they should not be employed, when the temperature is more than
103° - The simple fact is, that when the body is of this temperature it cannot
be employed with success in overcoming the disease-the system must
first be reduced by V.S. &c to the "sweating point," as Dr Rush termed 
it-that is, after the other evacuants have been employed sweating comes in
as an auxillary. In rheumatism the same thing is to be regarded, especially 
in the acute stage-& in the chronic they may be more freely used.
In Gout they have been long used & are no doubt useful especially in
those cases where other depletions cannot be employed. # In Peritoneal inflammations,
where from some cause, there is often a weak pulse with considerable
debility-they prove very advantageous. In Eruptive diseases
as acting on the part affected they have been often employed-but in [crossed out] all of
these the increased action should geny be previously reduced-In Playm
after V.S. been employed & some further [warmth] is still demanded diaphoretics
employed & also in Scarlatina
Lecture 35th Jany 9th,,
Diaphoretics have been employed in the various diseases termed profluvia
but their use in such, should be regulated by circumstances. In the Pulmonary
affections they have been much employed-especially in Catarrh This disease
(catarrh) should be treated on the usual plan of other plegmasiæ &
diaphoretics are useful only as part of this plan-The common plan of sweating

108.

sweating a patient whenever he has taken a cold is seldom useful & often very injurious 
& dangerous-In such cases the patient does not confine himself of during the continuance
of the sweating-[crossed out] or if he takes the medicine at night, from restlessness, he is
very apt to throw the clothes off & subject himself to cold during a profuse perspiration-
than which nothing can be more hurtful.-In pleurisy our made 
wines are useful after Venæ Sectn [crossed out] & other active evacuants-In dyentery
they have been long employed kept inside & others have recommended them highly
in this disease-I believe the dyentery to be purely an inflamy disease &
that the remedies for infln are proper, among which are diaphoretics-opium &
ipecac. act [crossed out] by their sudorific power; but we are not to trust to these remedies in
dysentery - other evacuants are undoubtedly demanded as I have already mentioned 
one former occasion-Dr Morely has been very extravagant in his praises
he observes that diaphoretics are as effectual in dysentery as bark in intermittent
fevers-that they will cure it [crossed out] in every occasion, climate, & constitution
This I will say is impossible-one remedy or one set of remedies never
effected such cures-diet alone would prevent the effects of diaphoretics or
any other medicine in dysntry-Richter has published a piece on this subject
in which there is a great deal of truth & error mixed. He speaks of this disease
as originating from rheumatism or catarrh & accompanied with remissions 
& intermissions-this, [crossed out] I have no doubt is the same as the bilious fever
directed downwards the bowels & which must be used by the remedies for
fever-The secretions into the bowels Richter pointed out as the effects [crossed out]
not the cause of the disease. this is no new idea in this country it has long
been taught that the secretions from the bowels were morbibly altered & increased-
after V. Section has been freely employed, castor oil & other purgers
having been administered diaphoretics safely be given-There is considerable
originality in the above paper by Richter-& it would not be difficult
to show that much is erroneous-what has been said must suffice at present.

110.

They have been employed in cholera infantum-This disease take dyenteries  
often exited by cold & I never attempt the air of it without clothing my patient
with flannel & passing him in an equable temperature-By this means alone
I have succeeded in passing up a gentle diaphoresis-& with perhaps a thick
mucilage of G. Arabic & lime water cured my patient in a majority of instances-
No cold whatever should be allowed & the practice of exposing the 
children to the cool air is very injurious-in chronic cases, flannel must be
warm next to the skin-lime water be given to correct acidity & when the irritation
has subsided a little rhubarb magnesia to cleanse the canal. Diet as
I formerly noticed is very important-In chronic dysentry a tonic course is usually
to be employed & occasionally diaphoretics-I added in all bowel complaints
to the surface of the body is to be attended to-In neuroses they have
been employed-They should not be used in coma palsy or epilepsy: in melancholy
& mania they have proved of more service, I have seen them employed 
in traumatic Tetanus, but with no advantage. In diabetes they are
extensively & advantageously employed-I have heard lately of a case of
diabetes cured by opium-The theories on this disease have been very numerous
but by no means satisfactory-Cullen considered it as intractable-&
[crossed out] so very fatal-he had never seen a case cured, although he believes that patients
have in a few instances recovered-In this country the patients however
are very generally cured & by remedies very opposite to each other; Dr Rush
recommended bleeding very strongly-Dr Physick has been very successful by
attending to the state of the system-Within those few days, he has had a 
case of a gentleman 45 yrs of age of a vigorous habit, who has been
regular & temperate in his living-about one month ago was affected by a
great discharge of urine-he paid no attention to it for some time, till he
was losing flesh & was tormented with great thirst, he discharged at this 

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time 10 pts a day-& if he drank but 8 of water he would discharge 10 pts of urine- 
Dr Physic put him upon an animal dies-& gave him according to the accommodation 
of Ferriar the uva ursi & bark-as [illegible] in the following prescription
ꝶ Peruv-cart-2i-Uva Ursi-2i-& ap. grss. m-to be taken 4 times a day-Dr Ferriar 
recommends that ℥ij of lime water should be taken after every dose. which was
also given by Dr Physick. the patient very Rapidly recovered-& is now growing 
fat-& discharges this urine as usual-I have evaporated some of the urine above
mentioned & attained a quantity of sugar from it. Diaphoretics are to employed
only when the skin is dry and there is sufficient strength which is not always the
case-In Dropsy it has been much depended on, but it has been supposed
that they are injurious because the skin & kidnies [crossed out] acting in an inverse ratio
would oppose each other-but as the object is merely to evacuate the water, it 
is no matter by what channel it is discharged-In those dropsies with fever of an
intermittng or remitting type they prove useful not only by evacuating but 
by [crossed out] promoting a new action in the skin & diverting action from other parts.
They have been employed in some cutaneous diseases with advantage especially
those depending on suppressed perspiration. Diaphoretics are not now
employed as formerly in all diseases-we use more powerful remedies. Fevers
were antiently treated by diaphoretics only, which was very injurious-the perspiration 
rendering the person much more weak than the disease itself. 
Particular Diaphoretics. The modes of action of these are different.
I think it probable that some act by increasing the force of the
circulation, others by an impression on the stomach & others may perhaps
act more directly in the exhalants themselves: but there is no use in this division
[crossed out] External heat is one of the most efficient-they are many ways by
which this is [crossed out] applied-First by confining the heat of the body by warm

114.

clothing & by means of hot applications, The popular method is to sip drinks 
almost red hot in vinegar-then surrounded them in old blankets, dipped in the
same-& place to the feet of the patient. close by covered in bed-if profuse perspiration
is induced by the fumes of the vinegar-Jennings bath is very similar.
It is merely conveying to the body of the patient closely covered heated air &
the vapour from burning alcohol-warm bricks-warm water in latter &
are frequently used by themselves, I however prefer the vapour, as it in some
measure relaxes the skin. The vapour bath has been employed but a great 
objection to it is that the patient must be moved from it to his bed while
he is sweating which will prove very injurious. The substances which are
used [crossed out] to heat the patient, should be such as retain the heat for a considerable
time as hot bricks-bags of sand, straw cut in small pieces-half salt
ashes &c boiled milk & water in bottles have been used according to the prejudices 
of the patient-This all act in the same manner, by stimulating the exhalant
vessels. These means are facilitated by warm drinks, & when a slight stimulus 
is required by wine whey-Some employ the warm bath-This as a diaphoretic
simply is often injurious & always improper-pediluvium is very
common & often very useful-Cold is occasionally employed as a diaphoretic.
Dr Currie of Liverpool first insisted much on cold applied to the skin & stomach-
& it is often very useful-Dr of Baltimore has introduced the
application of alkaline solutions to the body & speaks very highly of them,
I have not had any experience in it which would induce me to recommend 
but my employment of it has been confined to a few cases.

116.