Dr Dorsey,
No. 4.
Philaa 1816-17.
Enlarged 
1817 '18.

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: 4th.

 


1.
Lecture 36th Jany 10th Dr Dorsey-1817.
We will now notice those substances which when taken into the stomach, excite
diaphoresis. The several emeticks are perhaps the most powerful in this respect-
They all, when taken in doses not large enough to excite vomiting, promote the
exhalation by the skin, but none of them are so affected, as the preparations of
antimony, especailly the tartar emetic. When the diaphoretic operation of this 
medicine is required in fevers, I prefer the antimonial powder already noticed.
Besides the nitre, there used, the tart. emet. is given with other salts. frequently
with the Sulph. Sodæ- ℥i of the salt & gr.i of the tartar emet.
being dissolved in of water or in Seltzer water, - ℥vij to be given every hour or two hours.
The Antiml Wine is much used & is often very convenient especially for children.
It was formerly prepared by dissolving the glass of antimony in wine
which was a very uncertain preparation its activity depending on the quantity of acid in
the wine, as now prepared from the tartar emet. it is uniform in its strength
& possesses an advantage- that the dose can easily be graduated. But as there
is great variety in the irritability of different persons we must always begin 
cautiously we must feel our way in the administration of the tartarized antimony.
Within the month gt.i of the wine will be sufficient to excite sweating-
Under 5 yrs we may give qtts ij. ijj. or. v. & for an adult gtts xv to xj.
gtss xxx is a large dose as a diaphoretic. The wine will answer in usual
cases of fever in violent cases however where accuracy is required I prefer the solution in water-gr i being
dissolved in ℥viij of water for an adult ℥i to be given q.s or A.h. This is necessary
in irritable cases, in bilious fevers in dysentery in which J Pringle gives it a decided 
preference [cross out] & thinks, that there is nothing equal to it.
Antimony acts no doubt on the stomach directly & sympathetically on the 
skin; as it produces its effects sometimes very quickly- The imagination 

2.

imagination of the patient facilitates the action very much as that, when you
wish to [cross out] promote sweating only; it is often necessary to conceal from your
patient what you are given him, as otherwise it will be very apt to produce
vomiting- In Rheumatism the antimonial powder is often very useful
one being given every hour or so; by it the skin becomes moist- the pulse is
reduced, & the fever abates & artificial crisis is induced. The powders know by the title of Jame's powder
was formerly much employed; its composition is very similar to if not the
same [cross out] as the oxide of antimony with the phosphate of lime. It is insoluble 
in water & is [cross out] to be given with a little syrup of any kind, or in the form of a pill
in large doses it [cross out] incites vomiting. Dr Hahn has seen it much employed in one of
the Edinburgh institutions & he states that it is very uncertain sometimes
producing no effect & sometime acting very powerfully, & moreover, that all 
its advantages can be procured with equal benefit & more certainty by 
the emet. tarter- He has also employed it in his private practice with a 
very similar result- so that in a short time he entirely abandoned it.
A very common & excellent sudorific is the combination laudanum & the antimonial
wine in nearly equal proportions from qtts 20 to 30 of each. The emetic
tartar is not to be given to gouty or dyspeptic persons, subject to cramp of the stomach
or to termina of the bowels- as it frequently in such cases produces unpleasant
effects. Ipecacuanha has also been much used as a diaphoretic-
& is to be ranked as a relaxing medicine.- With the view of exciting
sweating only it is given in doses of gr ss. to gr i or ij. every hour or two.
with nitre is it often conveniently used- ℥i of nitre to 4 grs of ipec. divided
into viij powders. The Dover's powder is another formula in which it is often
prescribed- as also the ipecac-wine: of this ℥i is the dose for its emetic [cross out] operation,
as a diaphoretic- qtts xxx to ℥i every hour- Besides the ant. & ipec.
the other emetics are useful as diaphoretics. the use of which may be understood
from what has been said; they should not be given when the stomach is irritable-
or where there is debility- as they all must be considered as having relaxing effects

4. X Of these Potash in union with the nitric acid, is much employed
in London- in this city also it is a good deal employed-
thus prepared it is termed the nitral mixture- when taken
during effervescence- it form the anti-emetic mixture or effervescing
draught, as commonly employed to stop vomiting.
# When you are employing nauseating articles as diaphoretics- it
is useful occasionally to introduce the saline mixture- as by [cross out]
the emetic articles the stomach becomes so irritable- that the 
smallest dose cannot exhibited- in such cases- the neutral
mixture is very pleasant- tranquillizing the stomach & restoring tone to 
this organ- so that the former articles maybe renewed.
⨁ It does not excite the pulse as the other ammoniacal salts-

The Neutral Salts are employed as diaphoretics. [cross out]
[cross out]
[cross out] This operates both as a diuretic & diaphoretic & is often useful in destroying 
acid in the stomach- It is used in this place also but I think should be
more frequently employed, than it has [cross out] hitherto been, as it is very useful in many 
cases of irritable stomach, especially in fevers producing at the same time
a gentle diaphoresis # It is prepared by adding the ℥ij of lemon juice- a sufficient 
quantity. To this a little laudanum as some volatile oil- as the ol. cinnamon 
is sometimes added dose ℥ so. every hr: or 2 hrs: is a useful diaphoretic. It acts, not only on
the skin but also on the kidnies & bowels being a general evacuant- & it is in
this manner that we must explain its power of diminishing the pulse. It forms
an ingredient in the antim. pows- so after referred to. The dose by itself is
from grs x to xv. The mur. of potash & mur of ammonia have been employed,
but are now neglected. The Ant. of Ammon or the Common Spt
Mindereri, is entitled to a place on our list. It acts as a gentle diaphoretic &
has been much employed in fevers, especially intermits & forms part of the antiphlogistic treatment. 🜨
The Citrate of [cross out] potash as above noticed is seldom rejected
from the stomach- & therefore is very useful in those cases accompanied with
considerable irritability of the stomach.- The Carb. Ammoniæ
has been employed as a diaphoretic but its powers be too active to be employed
under this view alone- & I shall therefore more particularly notice it hereafter.
Calomel is sometimes said to excite sweating- if so, it is the weakness of
its numerous powers, which are generally too important to admit of its
being used in this manner. It is often mixed with ant. nitre. & in the ant
powders- The diaphoretic powers of which do not appear to be increased
by the addition.- Of the vegetable diaphortics opium has
been much employed but improperly as a diaphoretic only. It however

6.
X while the sudorific [cross out] powers of the compound are increased.
# In different diseases the article employed with the op: &
Ipecac: may be varied- this instead of nitre- we should
employ chalk- in Dysentery- & in the affections of the stomach
& bowels generally: &c &c-
⨁ In Gout it is somes used- but there is no disease in which
we should study the particular state of the system in relation
to the administratn of our remedies- as in this- remember this
in administg the Dover's Powder as the stimulating & narcotic
powers of the opium are often injurious-

always acts as a sudorific, & has been observed to form an ingredient on almost 
all the sweating powders, at different times recommended. It is often
united with antimony & ipecac, & it is noticed by Murray that in such combinations
both the opium & the emetic have their [cross out] peculiar powers diminished- the former being
less apt to produce its narcotic effects- & the latter to excite vomiting. X
The prescription of laudn. qtts xxv. & ant. urine qtts xxxv. is much used.
its also, that of op & ipec in the form of Dover's Powder. of their grs x as
the medium dose. In some cases where its cathartic effects are desired, I
have prefered, the sulph. of potash to the nitre. Dr Barton has recommended
sugar as G. Arab. but I prefer the salts, as being active articles
evaporating with sp. & ipec, & not inert as the sugar &. # As to
the employment of the Dover's Powder in producing sweating & the attention 
to be paid during its operation & beg leave to refer you to Dr Cullen -
[cross out] need not however be always given in the morning, as he directs; I often
in the evening without inconvenience. It is used in intermitg, & remittig fevers,
with advantage. In several of the Phlegmasiæ. Cullen has supposed it
beneficial during the suppurative stage of a phlegmon. It is much employed 
in inflamy Rheumatism, but remember that Venæ Section &c should
[cross out] previously reduce the systems or otherwise your medicine would not only be
useless, but injurious. The narcotic power of the opium although weakened
yet is always [cross out] manifest & should be remembered in its administration. 🜨 In
Dropsy it has been recommended- A case of diabetes has lately been detailed 
in which large doses affected a cure. Dr Ferriar has also mentioned
Camphor as a diaphoretic it is however very little employed- There are 
several other articles which may be noticed under other heads, which have been
occasionally employed- but which are not much used or are they of any importance.

8

Lecture 27th Jany 13th 
The Eupatorium Perfoliatum has been considered as a diaphoretic. It 
is a native of the U. States & is known by numerous names- It has been regarded 
as emetic, cathartic, sudorific, diuretic, & tonic- The leaves & the stone
are the parts geny used, although the whole plant possesses active powers.
Dr Barton recommended the flowers. It is given in infusion, which when taken
warm promotes diaphoresis. Our Indians are said to employ it as an emetic to cure
intermittent fevers & also as a diaphoretic in some cases- When however we
want an emetic we have better ones, than this & we have also better tonics-
By some it has been recommended as a very excellent diaphoretic- Dr Hosack of
New York has spoken very favourably of it, as also has Dr Chapman my
experience in intermittent fevers has not been very great- but from what I 
have seen of this disease we do not want any new remedy. I have always
succeeded by emetics, cathartics, occasional V.S. followed up by the bark,
or arsenic. I have seen it employed in the bilious remitting fever & extensively 
in the yellow fever. of this, then I can speak boldly & decidedly in all
the cases in which I have tried it- it has been of no more service than an equal
quantity of warm water, producing occasionally only a slight diaphoresis. Dr
Barton even doubts whether as a sudorific it is equal to the Polygala Senega-
It has been employed in dropsy & in various eruptions on the skin, of 
its [cross out] use here I acknowledge that I am sceptical. In Pnuemonia 
typhoides- it has done a great deal of good whether from any specific power of
from the sweating excited is doubtful- Upon the whole the Eupatorium
has I think been overrated, but it nevertheless possesses some active properties
which prove very useful- I shall again notice it under another head.
The Polygala Senega has been played as a diaphoretic. In 
the form of decoration ℥i to the point it has been used as a diuretic &

10

when at half the strength as a diaphoretic. It has been much used & recommended 
in a variety of diseases. All its virtues I expect are entirely owing to its 
diaphoretic nauseating power.
The Laurus Sassafras is also diuretic & diaphoretic- it affords a fine essential 
oil which is useful & agreable- The Sassafras is given in infusion-
The oil is fragrant & pleasant, is cheap & will answer as an excellent substitute
for more expensive oils; I have already mentioned it as covering the taste of the 
Spirits of turpentine.- Guaiacum. Of this both the wood & a gum resin 
is employed, the wood is commonly known by the name of lignum vitæ,
& is exceedingly hard & solid. It is procured from the West Indies & was first
introduced into Europe as a remedy for the venerial disease. if decoction of
the wood proves stimulant, & diaphoretic. The resin is a stimulant diuretic & diaphoretic. 
The decoction of the shavings of the wood thus prepared. & if the shavings
is boiled in 3 quart of water to [cross out] two quarts- one quart may be taken through the 
day. It is however not always given in this simple form. the tincture
is joined with the carb. of ammon. & forms the Vol. Tr Juice- It is prepared
by adding to ℥iv of the resin of Guaiacum to ℔, iss vi of the ammoniated alcohol.
This improves its stimulant & diaphoretic powers. I have called it a
gum resin but it has lately been shown by Mr Brands to be a peculiar
substance differing either from Gum or Resin. The dose of the Tr to promote
diaphoresis is from ℥vj to ℥iv- 3 times a day, after bleeding & other
evacuations have been pursued- Dr Chapman gives it in large doses, in that
of ℥i repeated as the other, he gives it in this manner, in chronic rhumem
& after chronic complaints- In many cases where diaphoretics [cross out] 
are necessary, the spirits [cross out] render [cross out] the Juice too stimulating; for this purpose
the powder therefore [cross out] is employed in doses of 10 or 20 grs.
Cullen has given it diffused in mucilage- the resin is first pulverized 
by the assistance of sugar or other friable substances. & then mixed 
with a mucilage- Of this Dr Cullen gives grs xv or xxx. every night

12.

which he says will open the bowels I have not found this effect to be produced in less 
quantity than from ℥ss to ℥i. In Gout it is undeserving the attention it has
received, Cullen thinks that, as all other remedies which prevent the attacks of
the gout will finally prove injurious, as also condemns the guiac- But there
are cases of gout which are closely allied to Rheumatism in which it is useful
these cases are whether gouty affections of the stomach & bowels alternate with
pains in the limbs. The diffusion in mucilage I do not like, as whenever the guiac is
allowable the quantity of spirits forming the tincture will not be hurtful,
If I wished to pass an eulogium on Guiac, I would tell you that it has
been useful in colica Pictonum- but as in this & in many other cases its
[cross out] virtues have been magnified, I have confined myself to
what is better known to be matter of fact.
The Mezerion. This comes from the North of Europe & has been noticed
by Dr Cullen as an active stimulant. It is more stimulating than the
Guiac- It is sometimes given by itself or with a little liquorice root in decoction,
it diffuses a gentle warmth over the [cross out] system in doses of ℥ij that
in larger doses proves emetic. Late writers have recommended it in chronic
rheumatism & especially in venerial cases, & have imitated in these diseases
the celebrated Lisbon diet drink by variously combining the mezerion. The
following I prefer- ℞ of the shavings of Guiac. ℥ij of liquorice of Sassafras 
root each ℥i. water 10 lbs. To this some Sarsaparilla may be added
to obtain a little mucilage for it possesses no active powers whatever. I have
employed gallons of this medicine in chronic rheumatism & in the venerial cases
& in my opinion it is inert as an antivenerial remedy; but on this subject I 
will give you the experience of Mr Pearson which is rather more favourable-
He states that sometimes it appeared to remove some second day symptoms
& to alleviate others; but that there was no satisfactory series of evidence-
that in any case it had eradicated the lues veneria- the patients
would sometimes be apparently well, but always returned, even

14.

with the same kind of symptoms as before. if he had blotches in the skin, he will 
return with a renewal of these. This is saying very little for it in the venereal dis'e.
The Savine. This comes from Siberia & Tartary. It grows in this 
country & has been recommended for the cure of chronic rheumatism- Dr Chapman 
has found it serviceable in many cases, I have not used it much but 
can state that it is a stimulating this medicine exciting. the pulse producing 
redness & itching of the skin, eruption & sweating.
Sialagogues. are those medicines which produce an increased discharge 
of saliva from the mouth. They are divided into external or masticatories 
& internal - The external are those articles which when taken in 
to the mouth excite an increased flow of the saliva- In a certain sense all 
our food & various substances would be sialagogues- but this is confined to 
certain stimulant powers which have a more direct effect on these glands. 
The most useful & the only one to be noticed is tobacco- this certainly excites 
the flow of saliva but this increased discharge can have no effect 
in a curative point of view- no one would think of employing those medicines 
unless they produced some other effect- we will therefore only consider 
the internal ones- & indeed only mercury, as all the others have very 
slight effects in this way. Hydargyries or Mercury is then the only 
powerful sialagogue- powerful because it adds to this virtue, many 
others which we are more to investigate- From its diversified effects 
by means, of its various preparations in numerous diseases, it has received 
great attention- It was not known to Hippocrates-
first noticed it as an anthelmintic- but it was at that time looked 
upon as a poison & fell in to disuse- abbout the 15th Centy it was 
again received as an anthelmintic & to facilitate parturition-
[cross out] Since this time its virtues have been gradually implored 

16

many of these are now known but I believe we have yet much to learn on  
the valuable medicine. In its crude state it possesses activity, by its
weight it was formerly employed to overcome obstinate constipation
as also in cases of ileus & hernia- but it was soon found to be useless
Its preparations however are very active & valuable & much are we indebted
to the Chemist for their introduction in our Science.-
Lecture 38th Jany 14th
There is an account given of the effects of mercury whether in a crude or [cross out] oxidated
state I will not determine which is rather singular- A British man
of [cross out] War during the siege of Calais had a keg of quicksilver [cross out] burst in her
hold- the consequence of this was that the whole crew were salivated- What of
put the rolling of the ship & the consequent motion of the quicksilver might
have, we cannot decide; it was however manifest that from some circumstance
it proved very active. The miners who procure quicksilver, are seized 
with many morbib-affections & live but a few years-, it is said few live more
than 4 yrs. after they have entered the mine; they are affected with tremors 
palpitations, convulsions & various nervous affections. Crude mercury, 
when boiled gives a particular taste to the water, but Sweaton maintains 
that it has no active powers- there is no loss of weight in the metal- yet the
water no doubt possesses this peculiar taste.
Many preparations of mercury are in use & however different there are
in some respects yet they all possess the power of salivating. This consists
independant of the more flow of saliva, if an inflamy affection of the
gums mouth, tongue & fauces; this, in children especailly, sometimes, terminates
in Gangrene- & sometimes from the swelling suffocation had been
threatened, or actually produced- Salivation is induced sometimes 
with great difficulty & sometimes with great ease- I have know it
freely brough on by 1/2 a gr of corr-subli-& in one instance death

18

took place from the ptyalism brought on by the antimonial powders. 
The effects of mercury are first a moderate fever- & fœtid breath- among the first
symptoms of its effect in the mouth- is paleness of [cross out] gums at the roots of the
teeth.- Of the preparations of mercury some are made by the trituration
with some unctious substance, which according to some a union with oxygen
will take place- Of these is Plenck's solution. prepared by rubbing one dram 
of the mercury with ℥ij of G. Arab: & ℥i of water. This was recommended by
its author as procuring the good effects of the mercury without salivation, This 
however is not the case- it is very similar to the blue pill, but is not so pleasant.
The blue pill is also made by trituration with several substances
as G. Arab, manna, rhub- &c &c- I prefer chalk as facilitating the trituration
& as being serviceable when the bowels are very irritable. The mercurial 
ointment is another preparation of the like kind made of different 
degree of strength according to the different preparations of fat or lard. In all
these, it had been disputed whether the mercury was oxidated, minutely divided
only, or what is althogether imaginary whether it was dissolved in the subaric 
acid of the lard. Fordyce declares, that the mercury is simply divided,
as with the aid of a microscope, the globules could be seen- the experiments
of Dr Blubber however seem to prove that a portion of the mercury is oxidated,
whether oxygen is really united or not, does not appear to be accurately
determined- the activity of any rate depends on the mercury & not with 
oxygen- Nitric acids & with oxygen, mercury forms compounds certainly
more active, than those already mentioned Before noting these it will
be proper to say a few words on the modus operandi of mercury.
Little was known of the operation of mercury previously to the discovery
of the circulation of the blood- at that time it was maintained by the mechanical
Philosophers, that mercury by its great weight was carried through
the capillary vessels & thus removed every cause of disease-
Paracelsus- Cullen & others considered it as an evacuant- so more


20

late writers have affirmed that it cured the venerial disease by neutralizing
the venerial virus; which is certainly not true, mercury has no
such power, the matter of chancre will produce chancre however [cross out]
mixed with mercury. Mr Jno Hunter's opinion on this point is in my
opinion, the only true explanation- It is accurate but it is deficient-
as far as it goes it is certainly true. This explanation is founded
on the doctrine, that no two morbid actions can exist at the same 
time in the same place or in the same constitution & therefore that
mercury cures the venerial disease by inducing a new disease, which
is curable or which subsides when the cause producing it, is removed &
which as it were drives out the prior disease. Dr Adams has illustrated &
confirmed this opinion in a very satisfactory manner. In 
curing the venerial then mercury must act on every part. of the body.
Is mercury absorbed from the skin stomach &c when it produces
a salivation? In all cases, we cannot (as has been maintained) suppose,
that any medicine acts before it is actually formed; this, at present, is
self evident. In the living body, there are certain properties- one of
which is irritability- this is, that property by which action is produced
from the application of a stimulus; A second property of every living 
body, is the Capability of propagating this action to every part of the 
system- this is Sympathy. By these two properties are all actions
both healthy & diseased performed. Now it must make no
difference, [cross out] whether the stimulus is applied to the skin, stomach
or blood vessels: by saying, that it is applied to the inner coat of 
the blood vessel gives us no solution of the difficulty; it is not here
in contact with the solids, upon which it acts- it is only bringing
it nearer, than when it is in the stomach, but the action on the 
solids must be explained in one instance, precisely upon the
same principles as in the other- But is the mercury absorbed?

22.

This has been said to be proved, by globules of mercury having been found
in the milk, in the bones & in the blood, Walker relates numerous cases of
this kind, collected chiefly from other authors; it has also been advanced by
Mead- B Boeerhaave, Boyle. Now it is very difficult to 
sett aside the testimony of such man, yet we may say, that men are
very liable to be deceived on points, in favour of which they are prejudiced,
& besides the experiments & observations of all late writers have never
giving the least sanction to these opinions; these persons have never
found mercury in the milk, bones or blood. Dr Physick was
taught to believe, that mercury was absorbed into the system, but
meeting with a case, where salivation was induced [cross out] during the continuance of a violent purging, 
[cross out] which he had been told was impossible, he was induced
to make some experiments on this subject in the year 1798; which were
published & which completely satisfied him, that mercury was not absorbed
into the system- or at least, that it did not appear in the
blood or secretions, & that salivation could be induced by a impression
on the alimentary canal by the mercurial preparations.
Lecture 39th Jany 16th.
I now proceed to the combinations of mercury & omitting the long
list which you will find enumerated, I shall select those which 
are the most useful. With sulphur Mercury forms two combinations.
the first is the Sulphuretum Hyd. nigrum or Æthiops mineral
made by triturating equal parts of sulphur & mercury together- it is
not much used: sometimes as a purge in doses of 5 to 10 grs. The 
second is the Hydrar-Sulphure-Rubrum which is prepared by adding
5 parts of mercury to 1 of melted sulphur- which is then powdered
& sublimed. This is very inert when taken into the stom- which is
now only used in a vapoury state- in which it is more active.

24

With muriatic acid mercury forms two of its most valuable preparations
calomel & corrosive sublimate- These names I prefer as they are less apt to be
mistaken for each other, than the new ones of muriate & sub-muriate, although
these last are very properly given- In these salts the mercury exists in
two different states, although formed of the same materials. But of their
chemical history I shall say nothing as on this point you will receive ample 
information from another source. Calomel in my opinion is the best
preparation of mercury we have- indeed it is equal to all the others.
It acts as a cathartic, for which it is very often employed- & also as a sialagogue 
with this view it is given in small doses of grs i or ij- twice a day 
or 1/4 gr three or four times a day. The first doses usually produce some 
purging & on this account many have objected to it- but it should be remembered
that after the first or second dose it has no effect in the bowels; if
it should have, the addition of a little opium will prevent it- In febrile 
cases where we wish not only to salivate but also to evacuate the
bowels gently- calomel is undoubtedly the best medicine we possess.
The corrosive sublimate is escharotic & in large doses poisonous, inflaming the
stomach & quickly destroying the patient. I do not know what would be
the best antidote to this when taken in too large quantity- the stomach
should certainly be washed out, as when other poisons are taken & large quantities
of lime water or solution of potash be swallowed which would probably 
decompose the article. Its dose is from 1/8 gr to 1/6 or 1/4 twice or
thrice a day either in the form of pills or of a solution- the former is geny
preferable- care should be taken that each pill contains the due quantity
Oxidum Hydrar. Rubrum- is prepared by boiling mercury under 
exposure to the air- It is seldom used The dose is grs ij twice a day.
Oxidum Hyd. Rubrum per [cross out] acidum nitricum, the 
common red precipitate of the drops is prepared by dissolving mercury

26.

mercury in nitric acid- evaporating the solution & exposing the powder to a great
heat, till it becomes of a bright red colour- This contains a small portion 
of the acid united to the oxide of the metal, & is more active than the red oxide 
just mentioned- it is seldom given internally but is much used as an external
application, as it possesses considerable escharotic powers.
Oxidum Hyd. Cinercum is prepared by precipitating the mercury from its
solution in diluted nitrous acid by means of the water of the carb. ammonia. 
its doses grs ij or iij.
Sub. Sulp. Hyd. flavus commonly called the Turpeth mineral is prepared
by dissolving the mercury in sulphc acid & throwing the powder obtained by
evaporation into boiling water. This has been used in an emetic cathartic & sialagogue,
but possessing no peculiars, advantage at ought to be diseased.
Hydrary precipit. albus. prepared by precipitating corros. mercury by means of
the mur ammon. It is used sometimes in ointments but except by its white 
colour has no advantage over the red precipitate.
These are the preparations of mercury at present much used & the only ones
which I have ever employed or indeed seen employed I refer you to the
Dispensatories for a number of others, if you should wish to employ them-
I proceed to the employment of mercury in the cure of diseases & first in 
Fevers. In the treatment of these, it was introduced about the beginning of
the last century by several of the West Indian Practitioners & with considerable
success- Dr Chrisholm however has the [cross out] credit of its introduction
& he undoubtedly was the first, who employed it with any fixed object & who 
publickly recommended it. In the years 1793- 4, 5, & 6. he made numerous
trials of it in the fevers of the W. Indies. These he considered under
the heads- the first he called a malignant, pestilential, & contagious fever-
& the second mild yellow, remitting fever. He did not employ any
previous evacuations but prescribed the mercury in very large doses
5 grs every 4 or 5 hrs [cross out] till salivation was induced- by [cross out]

28

some 10 grs have been given every 3 hours, so that salivation has been excited
in 24 hrs, & with success. This bold practice has been sanctioned by 
many others- & they observe, that when the mouth becomes sore, the patient
always recovers But, as in every other medical subject some respectable practitioners
are opposed to the practice.-Dr Warren has drawn up a very 
able account of the fevers of the W. Indies well worthy of much attention.
In this country, mercury has been much used & the experience here is very favourable-
Dr Rush has published the result of it; which is, the salivation is 
a most certain remedy, I have not, says he, lost a patient who has been salivated.
Sometimes however salivation cannot be produced- When the mercury
acted on the bowels Dr Rush added opium. Dr Duffield of this City went
still further & always gave opium with the calomel- This I do not
approve as in many instances opium is contraindicated. In all the cases
in which in this city we employ this or indeed any other remedy, we consider
it as auxillary, & at the same time employ other methods of cure-
In typhus fever its advantages are not so well determined. It is said
to have been successful in some trials in the W Indies- but in the jail-
& Hospital fevers it does not appear to answer. It is certainly not to be employed 
[cross out] where there is great prostration of strength. In the typhus epidemic
of New Engld which prevailed during the years 1798, & 1802-
Dr Warren employed it very extensively & with success, in large doses of
grs. x. or xv. of calomel but he used it the same time Antiml powders, blisters
&c. In typhus mitior Dr Rush has employed it with advantage
he states that it renders the pulse stronger & fuller- Dr Hamilton has
pointed out that the system bears evacuations better than might be
supposed- In the Phlegmania it has been much employed, [cross out]
especially in the local inflamy affections. In small doses
the mercury proves very useful in many chronic cases, without our knowing

30

the reason why altogether; it does not salivate or produce any sensible evacuation.
In such cases it is called an Alterative. Chronic ophthalmia is very 
often benefited by it after every other remedy has failed, in cases also of opacity 
of the cornea I have often known it successful. In phenits after powerful
evacuations as V.S. purging &c- salivation is very useful- In mania
it should also be tried as it often restores the patient. althoug it is often as
every thing else is, totally insufficient; but it has succeeded oftener than others
In Pneumonia after evacuations it is very useful- In New Engd where
V.S. has been less employed in pleurisy than here, the physicians speak 
very highly of calomel as pursuing a most valuable expectorent & relieving
the difficulty of breathing. In this part of the country however we [cross out] do not
depend so much on calomel we trust more to the lancet. we are not altogether
guided by the pulse, but we bleed for pain & oppression of breathing & 
then resort to calomel & not before.-
In Consumption Dr Rush has highly recommended it. He relates many
very many cases of success in his own practice & in that of others throughout the
U. States. I however believe that Dr Rush never in reality, cured a patient
of consumption- he & I & many others who adabted his practice cured
[cross out] chronic inflamns of the lungs, attended with hectic fever &c- but
no case, I believe of real tuburcular affection- In the former, mercury
will often effect a cure, but in the latter it will only relieve the symptoms &
render the patients, in it from this life more tranquil & pleasant- By some it
has been recommended in cynanche maligna. Dr Douglas observes that in these 
cases an advantage is gained in promoting the alvine evacuation by mercury.
Dr Barton also advises that we should puke with turpeth mineral
& purge with calomel- The mercurial fumigations have also 
been employed. In croup Dr Hahn has employed calomel 
very extensively- & Dr Hamilton has succeeded him, who has given

32.

to a child of 2 yrs of age 100 grs in 24 hrs to operate as a purge- Dr
Kuhn also gives it in large & repeated doses, although not equal to those; his
theory of its operation is very simple that by a powerful action on the glands
of the intestines, a new action is produced which is incompatible with the primary
disease- he was in conjunction with it the usual remedies, blisters, [cross out]
leeches & emetics- & then calomel. Purging with this, should be continued so
long as any of the effects of the croup remain as hoarseness, cough &c, & we should
remember that this disease is subject to remissions as that we must not anticipate
too soon that our remedies are successfull. Bronchotomy has been performed 
in some instances of this disease- I once tried it without success.
In another case in which the patient was apparently dieing-with a livid
countenance less of course &c, I was requested to make an opening into the
trachea, I made an incision through the skin, a small vessel was divided-
in a instant the patient began to breathe & in 5 minutes she 
enjoyed this faculty with perfect freedom. How this operated is not very
clear whether by fright, by the pain, by the bleeding or all, united, is doubtful.
Lecture 40th Jany 17th
The calomel should be continued in all cases of protracted catarrh from 
croup- Dr Archer of Maryland has recommended the corros. sublimate
in such cases- In Rheumatism it is often employed with advantage
after other evacuations have been promised- In chronic rheumatism it
has often succeeded where every thing else has failed, but it is frequently
unsuccessful: in what has been called a phititic rheumatism, it has
been forbidden by some authors who imagined this disease to be produced
by mercury previously taken- this is not the fact- & the best proof of
it is, that mercury will cure it- I have always succeeded in rheumatism
following protracted syphilis; by salivation it is therefore not

34

the cause but [cross out] will even [cross out] cure disease- In gout it has not
been much employed- In hepatitis it is deservedly considered as very valuable,
first in large doses as an evacuant- & afterwards in small doses
to salivate. In India where this disease is very common, it is used in
all the stages, & is found useful where the organization of the liver is not destroyed-
Faithar, who pracised considerably in that country, considers
it as indispensable in the last stage of the disorder. Dr Bailys make it
anatomy proves that many diseases [cross out] after a certain period become incurable
[cross out]
This is very true of hepatitis. There are several states in
what it is found by dissection- enlarged simply; enlarged & schirrous;
containing tubercles- destroyed by suppuration, containing hydatids
&c now in the 3 first of these calomel should be used & there is
some prospect of success, but in the last it cannot possibly cure & must add
to the weakness of the patient. In practice we cannot thus determine 
the state of the liver & therefore we employ it, whenever the strength of the 
patient will be sufficiently [cross out] great. In the West Indies they do
not promise these of mercury by bleeding & are not so successful as in the East Indies
where they employ V.S in conjunction with calomel & where they are
very successful in its treatment. In Icterus it is a useful remedy especially
when of long standing- Indeed it all affections of the liver
calomel is a very popular & useful remedy- & when not forbidden by peculiar
circumstances is to be prescribed- In the several profluvia 
it has been found useful especially in dsenstery. This I consider as a case of bilious fever
with inflammations of the intestines- Clarke, Lind & Clyborn have
found calomel very useful in dysentery- In the chronic stage Clyborn
confided much in a salivation & in the East Indies they also employed
it under similar circumstances. Dr Berton after having used it for

36

a few days omitted it, if it did not prove beneficial in that time, from 
a fear that a dangerous salivation might ensue- This however is a very
rare occurrence & the remedy certainly ought to be persevered in till some
effect is manifest. In chronic diarrhœa, & in the opposite affection
constipation the mercury has been useful- Some have also noticed its efficacy
in colica pictorum- In the class Neuroses mercury is a very valuable 
remedy- in Epilepsy it has been used but with not much advantage, in some
cases it is apparently of service- Sometimes in this disease there is an effusion
of water- I have dissected a case where a large hydatid was situated on
the basis of the brain & another in which there was an exostosis- In all those
mercury promises more than any other remedy from its power of promoting
absorption. In Tetanus it has been employed but in this disease I 
do not place much confidence in anything but brandy & opium- In hydrophobia
it is entirely useless- either as a remedy for the disease or as prophylactic-
Dr Barton recommended, that a salivation should be induced just before 
the attack was expected. But the only prophylactic in which I have any
confidence whatever, is the excision of the part, which when properly performed
& sufficiently early is always successful. I have performed this operation
several times & always with success. In Hypochondriasis accompanied 
with dyspepsia- Dr Barton has recommended & I think that
it is very likely to prove serviceable I should undoubtedly try it. In
long continued cases of dyspepsia it has no doubt been of service.
Try the mercury in all nervous cases where other remedies have failed
& where you wish to produce a change in the system-
In the Cachexia it has been much celebrated- especially in dropsy
In all cases of dropsy it have been employed as an evacuant & whenever
there is any visceral disease it is given as sialogogue, In Hydrocephalus

38

Hydrocephalus has been advised-This disease I believe to arise from a hint of 
inflamman of the brain, differing from common inflamn but still of the same 
nature- & therefore that this disease is in the first instance a species of Phenitis
or inflamn of the brain- & that like other inflam [cross out] it terminates sometimes
in [cross out] effusion- From this, it appears that the patients may die
from the inflamn or from the secondary effect, the effusion which produces
compression of the brain- From this inefficacy of our remedies to promote
absorption in the brain, we should endeavour to avoid this termination 
of the disease by the most powerful evacuants as V.S. leeches
purging, blisters &. &c- now in the early stages administer the mercury
as an evacuant- & in the latter stages we resort to it as a sialogogue
In Cutaneous diseases mercury was first employed, generally externally
as an ointment, as the interior ointment for the cure of latter- In leprosy
it has been employed- I have seen but two cases of this disease, in both of
which it was ineffectual; leprosy has been regarded as a modification of the
Venereal & mercury has accordingly been [cross out] thought serviceable- but there
is no ground for these suppositions- In deafness it has been said to be careful
& perhaps it may have been in some cases, but this complaint arises from [cross out] so
[cross out] many causes to us unknown, that no hope can be entertained of relieving
it by our remedies, In some affections of the eyelidides, inflamn it has 
been employed, as in recent opacities of the cornea in which I have seen
it of great service in some cases- in some few instances also in opacity of the
crystalline cases- It has also been employed in Gutta Serena but with 
no success.- I come now to the treatment of that disease
in which mercury has been so justly & so greatly [cross out] celebrated.
I allude it Syhilis- This disease, I believe from an examination
of the various authorities did not exist in Europe prior to the 
discovery of America whether it was brought to Europe from America

40

America is a matter of [cross out] very little importance- At this time however it appeared-
& surprised the practitioners of that period- who could not cure it.
They were astonished in finding the disease so loathsome & appearing successively
in such a variety of disgusting forms- It raged through Europe,
baffled the skill of the ablest physicians & proved more destructive
& terrible than the small-pox, itself- The primary forms
of this disease are two, Chancre & Gonorrhœa- to which some have added,
Buboe-but this always appears as a consequence, & occur as a prior affection-
As to the nature of Gonorrhœa & chancre, I will not say anything at
present- contenting myself with observing, that there is no medical pact whatever
better established, than the identity of the two diseases- I shall
now confine myself to chancre & its consequences.
Lecture 41st Jany 20th
Chancre is an ulcer originating from the application of venereal matter.
It is usually to be found on the organs of generation in both cases, as those
are the parts most exposed to infection. Some persons are more liable to
be contaminated, than other Persons whose pressure is short are less liable
than those who have a long pressure- as in the former there are fewer lodging
places for the matter & perhaps also, the parts are more hardened from 
their exposure- on this account, Jews & Mahometans escape the disease more frequently
that Europeans- Chancres, do not occur so often as gonarrhœa
4 or 5 cases of the latter appearing to one of the former- In Hospitals
the reverse of this might appear to be the case, as persons affected with
Gonorrhœa seldom are so unwell as to divert, their usual occupations &
apply for advice- Chancres in men occur most commonly, on the frænum
prepuce, glans & skin of the penis- In women it is usually on the labia
& parts exterior to the vagina- but beyond all doubt, sometimes in the 
vagina itself- The time of their appearance after infection varies in
different subjects, & in the same person at different times & also according

42.

to the parts injured. The first appearance if all more contaminated would
be on the frænum then prepuce next the glans & finally on the skin which is
the slowest in [cross out] taking on the morbib action. In 24 hrs chancre has sometimes appeared,
& sometimes it is after the lapse of 3, 4, or even 7 weeks. It is preceded by an
itching of the part; & on the glans a small pimple is observed, accompanied
with slight pain, but every little induration, On the fræneum & prepuce, there is
more pain & hardness attending its formation- The appearance of a chancre 
is sometimes so well marked, that it can immediately be told, but this is not
invariably the case, you cannot always decides by inspection. The pimple
soon disappears, ulceration taking place, the itching is changed to pain &
there is a thickened, solid, hard base with thick, prominent ridges. When near
the frænum, ulceration after makes a hole through it, when on the skin of
the penis, it forms first a pimple which is even covered with a thick scab,
presenting more of the characteristics of a chancre- When on the prepuce
the swelling & induration often cause phymosis [cross out] or periphymosis.
The matter, from a chancre varies very much in colour, quantity & consistence-
It is sometimes then, vivid, greenish- & sometimes its characteristics
are very different so that you should never hastily decide, that it is venerial-
Sloughs sometimes appear & enlarge the size of the chancre & sometimes
it increases by ulceration, as in common phagedenic ulcers- from this they
have been divided into sloughing & ulcerating chancres. They sometimes
rapidly spread over penis: I have known the whole penis to be affected
in a very short period. This has been attributed to some peculiar
violence of the matter, but it is more reasonable to suppose, that it depends
on the constitution of the patient. To prevent the contamination
of the system, mercury is the only remedy, which should be relied on. The
destruction of the part has been trusted to, [cross out] caustics & the knife have
been used to remove the diseased part- & they have succeeded & that also
very quickly- They can also be cured by [cross out] specific remedy, which however
is very tedious, in this manner chancres prove the [cross out] more tedious in the
cure- than any of other forms of syphilis. The best practice is

44

to combine the two methods & resort to mercury & caustic applications.
Fever, occasionally attends, which is to be treated on general principles. so
also when debility, tonics &c are to be had recourse it. I give the preference
to caustics in removing the diseased surface, as the knife removes a very 
large surface & often produces great hemorrhage- Of the caustic & escharotic
applications the lunar caustic & red precipitate are most used- from
some experiments I am indured to prefer the latter as I found that more
but has resulted when the lunar caustic was employed than when the red
precipitate- When the cure is trusted to local remedies, the mercurial preparations
have been preferred as they were considered to be capable of changing
the action of the part. This may, in part, be the case- but I think it depends 
much more generally on their escharotic power- In their use Mr Barton
invalued them in a mucilage, as more likely be effectual than when any
oily substance was applied- the red precipitate ointment is much used
for chancres as also the common mercurial & ointment- calomel-solutions of
the blue or white vitriol of the corrosive sublimate- the citrin 
ointment & various others. To prevent the occurrence of phymosis, or to 
cure it when present- rest- & a proper proportion should be studied- the person
should be supported against the pubis, so as to facilitate the return
of blood- When chancres are underneath, they prepuce they are to be washed
by injections of mild fluids & sometimes by solutions of corros. sub. or other
particles- gr i of the corros. sub. & ℥i if water is very useful- calomel
suspended in a mucilage of G Arab is often useful, sometimes a bitter
laudm may be added- When however these injections are too irritating
then cleanliness only is to be attended to by injections of mild fluids.
The inflamn of the prepuce is to be counteracted by lead water or the 
cold poultice & by leeches- The only permanent & certain mode is the stiching 
up of the prepuce which is last done by the guarded bistoury; when the 
tension is very great an incision is to be made from without. As the

48

object is to expose the chancres you should always examine whether this is attained-
When this operation is omitted nature attempts it by producing ulcerations 
or sloughing of the prepuce- This operation of the surgeon however is imperfect, as it causes
[cross out] large irregular flaps which prove troublesome after the cure, in such
cases circumcision is to be performed. Sometimes the prepuce has firmly united
to the penis forming one solid mass. In the Paraphymosis the glans is 
denuded & a stricture is formed behind [cross out] it- This is to be divided as
the former- but it is oftener necessary to cut from [cross out] without; when this is not
done gangrene of the prepuce ensues & sometimes of the glans- but the vitaity
of this last being greater than the other- it generally remains.
In every case whatever of chancre mercury is to be given- gr s or grsij
of calomel are to be administered twice a day, the first doses will often
purge but this effect soon ceases- if it does not a little opium is to
be added- The blue pill is also every excellent & of late the Phosphate of
mercury has been recommended. This last I have not much employed in
one case however in which I found great difficulty in salivating. I 
gave the phosphate which was quickly efficacious- The mercury is
always to be continued during the whole of the cure unless the chancre be
very large, when it may be desisted from when the process of skinning commences:
when very small it should be continued a few days after the chancre
has healed. As to the ptyalism- this is a great inconvenience & mercury has
been on this account much objected to by patients, if the system can be affected
without it, let it be done [cross out] it is sufficient to keep the gums a little
tender- till the chancre opens a healthy granulating surface- when its
venerial dispostion is destroyed. Among patients & also their physicians
great fear is entertained of expose to cold or wet I have employed mercury 
under all the vicissitudes of our climate- & I have never seen 
those effects- Wet no doubt will produce its injurious effects sooner on a patient under 
the influence of mercury- than on a healthy [cross out] person but there is nothing-

50

peculiar in the effects. Cold is one of the best checks we have to the further
progress of mercury. When the chancre occurs on the lips, caustic very
rapidly affects a cure. In women the chancre is easily cured, but as dressings
cannot easily be applied washes are more used than in major inflamm of the labia
very analagous to that producing phymosis in [cross out] men sometimes occur; this
will soon be dissipated by the usual measures for reliving infln in other 
parts- When chancres occur in the vagina, care should be taken that adhesions
of its sides do not take place. Whether from absorption of the virus
or from a sympathetic action, buboes result frequently from chancres
of course are generally found in the groins. The system not necessarily 
affected on this account the disease [cross out] can be cured as well [cross out]
when the bubo is present & when it is absent. Mr Bell considers bubo
in some instances as a primary form of the disease: in this he is opposed
by many writers- Mr Adams considers such swellings in the groin
as are not preceeded by the other forms already noticed as not venerial
& in winters that no constitutional symptoms ever result from them
& that no mercury is required for their cure- I have had several cases
of a similar nature- In one lately I gave no mercury whatever, my 
patient recovered completely.- The lymphatics going from the
chancre to the gland are not always inflamed, a hard cord can sometimes
be felt. & sometimes a red line can be seen marking the course
of the inflamed vessel- but this is seldom the case- In some cases
these vessels inflame & ulcerate Sometimes a bubo will be formed
after the chancre has completely healed-
Lecture 42nd Jany 21st
A bubo is the inflamm of a lymphatic gland, accompanied with
considerable pain & tumour- it quickly ends in suppuration, & 
ulceration takes place so rapidly, [cross out] that it quickly points, Sometimes

52

however it is slower in its progress- The skin is a florid red colour- & the
quantity of matter discharged is very large- The discussion of bubo is always to 
be attempted. At first, the disease is local, but the constitution will become
contaminated, & mercury should therefore always be given. All the remedies 
for inflamn are to be had recourse to- Frictions are to employed on the inside
of the thighs, that the mercury may pass through the gland; if this proves too
tedious, it is to be administrated internally. Leeches are to be employed, &
above all blisters, as often as is necessary, even after suppuration has taken place
& in this manner the whole is generally discussed. Sometimes however we cannot 
prevent the suppuration. In such cases it must be opened, but we
should not cut through any depth of parts. The question has been agitated
whether caustic or the lancet should be employed- I think that 
when small, the lancet is to be used as there is no soft livid skin
which will form a tedious sinus, but when the abscess is large & there 
is a considerable portion of skin, which must be removed at one time
or other, the caustic is preferable- A poultice should afterwards be 
employed- When the system sinks we must look to the bark & other
tonics- The sea bath is also very important; when this cannot be commanded-
I have resorted to a salt bath with great benefit- Half
a peck of salt being thrown into a common bath; in all scrofulous
dispositions especially, this is serviceable- & when this taint is suspected
I use cicuta very much, & I think, with advantage- I combine it with
the corrosi. sublim. ꝶ extrac. Cicut. grs lxiv. corros. sub. grs viij on 
A div in pil. No LXIV.- If not interrupted in their course 
chancre & bubo will inevitably produce certain symptoms, which 
are called constitutional symptoms, syphilis. lues venerea- confirm
pox &.- These secondary symptoms appear on the skin in the nose
mouth, fauces, on the tonsils & sometimes on the tongue- The parts
first affected are generally [cross out] the throat & mouth- these are very easily

54

cured by mercury although, this medicine will not prevent its occurrence
after those parts have acquired a predisposition to disease- Mr Hunter relates
several cases sufficiently illustrating this doctrine. (See Hunter) Lues veneria appears
usually six week of the contamination, with blotches on the skin, or with
ulcers on the tonsils, sometimes one & sometimes the other has the precedence-
The ulceration of the tonsils is [cross out] different from that of common 
inflams it is preceded usually by Languor, loss of appetite, some fever
& headach- when the skin is affected similar symptoms precede & are
succeeded by a coppered coloured spot, having a whitish appearance
frequently in its centre, owing to the degeneration of the cuticle- The
size of the spot does not increase but the number of them does; where
they are exposed to frictions ulceration sometimes takes place & in other 
parts also there is often a slight collection of matter under the cuticle.
The cure of these symptoms depends on mercury, & is generally speedily 
affected. Nitric acid has been recommended & is of service in 
affections of the throat but I suspect more, from its local application
than from any power of destroying the poison; as I have sometimes found it
serviceable as a gargle simply- when taken into the stomach, the
followg is the formula- ꝶ-Nit. acid ʒij. G. Arab. ʒij. Aq. ℥vi. m 
℥ss is the dose two or 3 times a day. As to the quantity of mercury necessary,
Mr Hunter formerly directed it to be continued a fortnight after
the cure- The practitioners in London advise 3 months, which is probably
necessary. As a local application the caustics are useful- the vegetable 
is the the best as it can immediately be neutralized with vinegar
& they prevented injuring the contiguous parts. The diet & regimen of 
the patient should also be attended to. The second stage of syphilis
consists in swelling of the periosteum, tendons, fascia & ligaments-
These are slower in their progress & require several weeks for
other developement, so that it is always doubtful whether [cross out] the
patient will have them or not. The cure is to be accomplished

56

in the same manner as the former, only that the treatment is to be continued
for a long time- Frictions here are preferable as the long use of mercury
internally would injure the tone of the stomach. In general no local
treatment is necessary; when very obstinate the nodes may be opened by an 
incision or be blistered. When a node suppurates, the bone or a
lamina of the bone [cross out] exfoliates, after which, it readily granulates &
heals. Often indurations remain- these are merely the effects of the disease,
the disease itself having ceased.- This finishes what I have
to say of Syphilis & of mercury as employed in its cure- I have
still to notice some of the morbib effects of mercury- Any substance,
which, when applied to any part of the body, produces an action, differing
from healthy action, may be considered as the cause of disease: in
this way, emetics, cathartics & all medicines produce, a temporary disease
in this way, mercury, also, may be considered as effecting a morbid condition
of the body producing an inflamy affection of the mouth & fauces 
& also some fever- It also in some cases producing injurious effects
this infy state of the mouth is aggravated, the cheeks swell the tongue
enlarges- so as to prevent deglutition or even breathing- [cross out] unless performed
through a tube, [cross out] location of the lower jaw has also been produced
by the swelling of the tongue- the cheeks become gangrenous & slough 
off- This is a most dreadful condition, the teeth all gone- the whole
mouth exposed- deglutition almost impossible- & the chin nearly reachg
the [cross out] breast- the bones are affected with deep & lasting caries- the health of the
patient gives away, he sinks & dies. From those circumstances violent
prejudices prevail against the remedy & there is only one [cross out] case in which
it should be exhibited so as to endanger those symptoms & that is where
death is otherwise inevitable- In such cases you must employ it- you 
are bound to use it- these direful effects do occur- but they are rare. I 
have never had a case in my own practice, but I have seen them several times

58
X an objectn to the use of mercury is that it acts not
under your control- when you induce a sore mouth, it is 
at a venture not knowing how far it will go-
# damp & cold air is prejudicial-
O- The use of mercury in some cases injures very
much the digestive organs- producing various dyspeptic
symptoms-

Yellow Fever is one of those cases in which mercury is sometimes indispensable.
X To stop the progress of the mercurial effects in the system
many remedies have been tried on chemical principles & some on medical;
of these last evacuants have been freely employed, but all without
effect. To diminish irritation opium may be used & a decoction
of poppy heads may be employed as a gargle; the linen of the patient-
the cloths & everything likely to be soiled with the mercury should
be removed & the patient be washed clean- He should be placed on a 
cool, dry air- # if able to walk about he should exercise himself in the air
& in this manner all unpleasant symptoms will gradually disappear-
These are nearly the extent of the morbid effects of mercury in this country-
but in Europe various & till lately unheard of diseases have been recorded. Mr Hunter long ago noticed
its effects, as of two kinds on the constitution; in the first, there was
considerable increase of irritation, the pulse became accelerated,
sometimes small & quick with restlessness, anxiety, loss of appetite. 
& sometimes the mercury acting as a poison producing great debility & exhaustion. 
Mr Pearson has lately described a disease originating from mercury
there is great depression, anxiety & sighing, from [cross out] a slight exertion
the patient has fallen down dead. This [cross out] he has considered as arising
from Mercury & has called the [cross out] Erethismus mercurialis. This disease
thus dignified by a long name, has all the symptoms of hectic fever
& is merely an aggravated state of those symptoms mentioned by Mr 
Hunter, when mercury acts as a poison: I have never seen this disease
of Mr Pearson's- he states that it is to be cured by a generous diet &
free exercise in the cool air- By the 10th or 14th day, the mercury may
be resumed without any ill effects. 0 Mr Pearson has also noticed a
rash appearing on the body sometimes from a single dose of the calomel-
or a dram of the ointment- generally occurring however in
8 or 10 day, & sometimes not till the course is finished.

60
X by Mr Allen- & Eczema mercurialis by Mr Pearson

Lecture 43rd Jany 23rd
This eruption has been termed Hydrargyia. X it commences with pain & itching on
the scrotum, thighs, groins where in a short time, there appears a number of eruptions,
which are red & painful appearing chiefly on the anterior part of the body
& in the lower extremities & finally extending. It is always a vesicular disease,
the vesicle however is very small & [cross out] sometimes only to be
seen by the aid of the microscope- it is surrounded by a small red circle, sometimes 
the vesicle is as large as a pins head; the fluid is often thick-[cross out] & always
acrid, so that when the vesicle is broken, it excoriates the [cross out] contiguous parts,
& in this manner the whole body become one continued sore. There is considerable 
variety in this disease & it has been divided into 3 stages by Mr Allen according to its
violence. In treating this, the remote cause is to be removed, all mercury is to be 
entirely omitted. Mr Pearson advises [cross out] the saline draught, the Spt. Minderis
opium to relieve irritation, & sometimes opium & camphor- For a more particular
account, I refer you to Mr Pearson & to Mr Allen. I have seen only
2 cases of Hydargyria & as I have seen many cases, in which mercury has
been employed-X I may say that it is very rare. But an opinion has
of late years been advanced, that this & many other mercurial disease are
very frequent. Mr Matthias is the chief author on this subject, who has
drawn up a long list of the direful effects of mercury on the body; some altogether
the peculiar to itself & others resembling the venerial. Mercury will produce 
some injurious effects as I have already informed you, but these are requisite 
& there is not one of its preparations, which will induce effects analogous
to those of venerial nature. It is true, that chancres buboes- ulcers in the
throat & on the skin become stationary & do not heal under the use of mercury,
now, because the mercury will not cure, it [cross out] does not follow that it is the cause of the disease- as horton 
wisely concluded. Here mercury produces no good effect, it acts prejudicially on the 
system or as a person according to Mr Hunter- All that is to be done here,
is, to anoint it for a short time, when it is again to be reasoned. For mercury
[cross out] only will cure these eruptions, & I have succeeded often very often in 

62.

these supposed mercurial diseases by mercury itself. They are in reality
nothing but venerial. The Venerial disease has lately been considered as a 
rare disease, & that most of the ulcers on the penis are not of this nature. This
in my opinion is wrong. Syphilis is a very frequent disease. No doubt, there
are many cases of ulcers on the genitals, which are not syphilitic, & these can often
be readily [cross out] known, but in every case of doubt I think mercury ought to be
given, for the only inconvenience to the patient will be, a slight salivation for a short period
& he will escape all anxiety on the subject. I have seen several cases of
this kind which no doubt might & would have got well by themselves, but I
have found that the cure was greatly expedited by mercury. But, at any rate, always be very 	
careful that you do not omit the proper remedy in genuine chancre. There is often
on the penis especially around the corona glands a collection of little vesicles,
which contain other matter, & are very different from chancres. There is a
small vesicle, raising the delicate epithelium only, containing a straw colour
thin pus; These are to be washed with lead water, rather large, are to be 
punctured & when almost healed it should be washed with brandy- But for one 
case of these, that you must, you will have 20 cases of the opposite kind.
As to the proper administration of mercury I must say a few words. The 
saline preparations are not more ready to produce morbid effects, than the other 
preparats- This is the result of the experience in Europe & in this country. I prefer
calomel to the blue pill the corros. sublimate I have used in obstinate
cases, in such cases I combine with it cicuta or opm Dr Logan of Vienna
has lately published, that corros. sub. can cure a chancre without inducing
a Salivation & it is also proper to state here, that Mr Kingston proposes its
use in Gonora 3 grs being dissolved in ℥i of alcoh. one half of which is to be taken
at a dose at bedtime; a profuse salivatn is induced- the next day some salts
are to be given after the operation of which the remainder of the medicine is to 
be exhibited, & in this manner gonorrhœa is often cured in [cross out] 48 hrs This
requires further confirmation- 2nd Mercurial ointment, is the next method
of exhibiting mercury. It should be rubbed in, if possible, by the patient
[cross out] himself- & not merely laid on the thigh; in other cases it may be applied
to other parts of the body than on the inside of the thighs. 2nd The patient

64

is to be confined to the house, as cold greatly diminishes the action of mercury
& not [cross out] sometimes induces disease. This may sometimes be dispensed 
with in cases of chancre- but occur in syphilitic eruptions. 4th The blue 
pill is to be employed, [cross out] when the calomel purges too much; Plenk's solution
I have never used, but suppose it may be useful in similar cases.
5th Fumigations. Mr Abernethy employs the fumes of cinnabar collected
around the body- This is much used on the continent of Europe, & as topical
applications is very useful. Mr Abernethy states, that by them the venerial sore
throat has been cured in 60 hrs. Mr Pearson thinks that when there is any 
great urgency in the case they may be employed with advantage as a local remedy
that they are not sufficient to secure the constitution- in this I agree
with him & think that mercury should also be administered in another pain
6th Rubbing Calomel on the Gums & fauces, 7th When the disease remains
stationary we should examine whether it is owing to cold- to a change
of weather, indigestion of any other cause inducing [cross out] fever-if not then the
mercury is to be omitted, the proper remedies to be administered, & again it
will be necessary to resort to the mercury to effect [cross out] a cure
Lecture 44 Jany 24th
Emmenagogues are those medicines which excite the menstrual 
discharge. They are so uncertain in their operation that doubts have
been entertained of the existence of such remedies. But although not always
effectual, there certainly are such medicines. Females are constanly
resorting to them & the practioner stands in many instances inactive [cross out]
not, because he has no remedy, but, because he does not enquire into the
nature & causes of the disease. I need not enter into the Physiology of 
the uterine system- Menstruation is now allowed to be a secretory office
of the uterus- & the periods, at which it commences & at which it
ceases, are important specks in the female life. Dr Rush has well
observed, that in children we should always regard the progress
of dentition in treating their diseases & in females the state of their

66
X 
cold bath- mineral waters- stimulating enemata, dry 
cupping &c-

menstrual discharge. Amenorrhæa arises from these conditions of 
the system. When the discharge does not commence at the usual period, &
there are present various constitutional symptoms, it is termed retention,
when, after it has once once commenced, & at any time ceases, from any cause, except
pregnancy, it is called suppression. As to the time at which the menses 
should appear it varies greatly in different climates & individuals, but the [illegible] non appear [cross out] is
not considered as a disease unless it is marked by certain morbid symptoms, constituting 
the disease called chlorosis. A correct Pathology of this disease
is much to be desired. Dr Cullen has entered very fully into this subject &
considers it as depending on a diseased state of the Ovaria- but can go 
no further. Dr Hamilton refers it to a depraved condition of the alimentary
canal. I cannot agree fully with either- The opinion of Dr Cullen
is confirmed by dissections as the ovaria are usually found in a dropsical
& diseased state- The theory of Dr Hamilton is founded on erroneous
promises- he concludes that the disease depends on the condition of the 
alimentary canal, [cross out] because there is a torpor in their action & sickness
& [cross out] it is relieved by purgatives. Now there are many diseases, by no means
depending on this canal, which are accompanied by these symptoms
& are cured by these remedies. Purging is used in a variety of complants
having nothing to do with the intestines. His practice is better than his
theory, Purgatives are useful & necessary to relieve constipation & to
prepare the way for tonics & other remedies. In the treatment of Amenorrhæa
or retention of the menses various general remedies are resorted
to- Dr Rush frequently bled his patients- but the pulse will seldom bear 
this- emetics are also used- electricity- fomentations warm bath- frictions 
to the lower extremities, pediluvium x &c- but the most certain remedy
is matrimony. Particular symptoms are to be counteracted by
the usual remedies- change of climate is often useful- & sometimes
also the action of emmenagogue medicines to be presently noticed.
Suppression of the menses arises from various causes, as fever,
cold, especially to the feet, anxiety a sedentary life-&c- When any

68.
X These are Hooper's pills.

other disease is present in the system, this function is more or less interrupted.
Suppression is too often considered as a cause of disease, when 
in reality it is only a smptom or an effect of the [cross out] general affection
of the system. I have often seen the healthy remedy very good after
the age of puberty, although the menses did not flow & cannot these are 
believe that every suppression must be the cause of disease.
Of Particular Emmenagogues. These are very numerous & possess a very
diversified action on the body- In using them we should always attend
to their properties & adabt them to the existing state of the system.
All classes of medicine in one view may be considered as possessing
one emmenae power, even [cross out] bleeding as they all in some cases may
be useful in promoting the discharge- but there are certain remedies which
appear to have a more particular effect in this way. The first I shall
mention is Aloes. This we have already noticed as a powerful cathartic.
As acting chiefly in the rectum, it is considered as superior to other cathartics
as an emmenagogue. It is administered by itself in pills or tincture also frequently
in combination with other remedies. Dr Gallagher of this city, long
before the appearance of Hamilton's work employed it in combination with
rubigo ferri- & with very good effect. In combination with the sal martis
is is much employed. ꝶ Sulph. Ferri. ℥ss. jalap ℥i. Hyera picra ℥ss
Gum Myrrha ℥im- make it into pills of a convenient size & take
3, 4 or 5 a day. x Calomel also occasionally combined with the aloes.
Helleborus nigrum is also used, chiefly in the form of tincture ꝶ Hellebor-
℥iv-Cochineal ℥ss- Alcohol #ijss-m-dose is gtts xxx to a teaspoonful.
Dr Cullen has no great confidence in the Hellebore & his opinion 
considerably lessened its popularity, but it has again revived in some 
measure- Dr Barton recommended it as also Dr Chapman. I am very
willing to agree with them- Dr Physick uses it very much he gives gtts.
xxx every days for several days before the menses ought to appear- he 
increases the dose if the stomach will bear it. In conjunction with 

70.

this he employs semicupium or pediluvium, frictions &c- but even here
it is often ineffectual sometimes however it excites the discharge. Purging is not 
necessary for its action. Stimulants are often demanded in Amenorrhœa. 
Dr Dewes dissastisfied with the usual remedies employed the vol.
tr. guaiac & in may cases with excellent effect. he gave a dram every 2, 3, 
or 4 hrs. He was very much pleased with its employment- I am sorry to 
add that in my hands it has produced no effort whatever. The Polygala 
Senega has been introduced as as Emmene by Dr Hartshorne whose
judgment is too sound to easily deceived in any practical point. Dr
Chapman has been employed it in the Alms House & speaks favorably of it.
It is employed in powder or decoction, usually in the latter form. This is prepared
by boiling in ℥i in a pint of water to 2/3- the dose is ℥i every hour
or 2- Dr Champan gives ℥ij & Dr Hartshorn as much at the stomach will
bear- I have been successful with it in one instance, but in several others 
have failed- The Ergot has been introduced lately & some experiments
have been made on the subject but those have not been sufficiently 
numerous. Dr Erskine in his theses has shown that it has a strong
action on the uterine fibres, inducing abortion in pregnant animals, he
tried in 4 cases of Amenorrhœa with evident advantage, I have tried it
in 3 cases- one of which it cured. the dose is grs xv every night, for 
several successive nights- Sabina or Savine, this is an evergreen
plant having long narrow leaves the powder of which is empd
Some have supposed it a specific- Dr Barton related a case of a woman
who applied to him in a consumption, which she attributed to
2 abortions, which she had induced by the Savin- Horne recommends it use
as an emmenagogue [cross out] in doses of ℥ss twice a day. Dr Chapman has
tried in chronic rheumatism also with advantage where a stimulag
medicine is required it is useful. The Ol. Sabinæ is said to possess
the virtues of the plant in doses of gtts v to x. Pressing the crural
artery has also been employed, but at present is ommitted. There are a variety
of other vegetable medicines employed beside those I have mentioned.

12.
X This State is termed Dysmenorrhea-
# As [cross out] I have always found symptoms of fever- V.S-
purging, low diet- are to be employed in conjunction
with the warm bath andyne injections &c &c
⊕ This is the opinion of the French writers- particularly of
Diams- who visited most of the nunneries in France &
found that the females with cancerous affects a great
majority were first attacked at the cessan of the menses-
[cross out] Ulcers at this time [cross out] occasioy occur in the legs-&
when they heal, it is usual to substitute an issue or seton 
These however are very simple asent & I prefer a less offensive 
discharge, as by purgatives- 2 or 3 times a week
to be graduy diminished

but they certainly have little or no power. Of the mineral emmenagogues mercury 
has been tried as inducing a powerful change in the system & has been
often useful. The various preparations of iron have been celebrated, but they
are seldom given by themselves, but usually in combination- the rubigo ferri
in doses of grs. v. to x. with aloes. They are all only useful, as tonics but
have no specific action. Chylybeate waters have often been thought very
useful-& no doubt sometimes do good, but much more is to be attributed
to the numerous circumstances, attending an excursion to the spring
Sometimes, not withstanding, all our care this disease is very hard & 
difficult to cure. There is always more or less derangement of the health
with fever & considerable irritability of the system- The warm bath
is very useful, diaphoretics, anodyne injections, 60 or 100 gtts of laud:
in a little starch, often moderate the symptoms. In some cases
there is not actual suppression, but the discharge is effected with 
great difficulty & pain, and there is great affection of the system- x This
is generally tedious; in the cure the above remedies are to be resorted to [cross out]
the warm bath, & anodyne injection, which greatly relieve
the pain- to which may be added fomentations of hot brandy to the 
abdomen- To strengthen the system, considerable time is 
required by exercise, nourishing diet- freedom from care moderate
indulgment of amusements & gentle tonics when necessary. Much attention
is to be paid to females at the cessation of their menstrual
evacuations- at which period, there health is generally delicate, some 
have supposed that at this period they are more [cross out] liable to cancerous affections
but this I have not perceived- 0 They are usually more plethoric
than natural & the lancet & low diet is demanded-

74.
X
the heads- 1st The round worms 2nd The flat
worms- Of the first kind- there are 3 species. the lumbricoid,
the ascaris- & the tricuris- of the, second- there
are 2 species- the Tape worm- & the Cucurbitaceæ

75.
Lecture 45th Jany 27th 
Anthelmintics. Those are medicines suited to expel worms from the alimentary 
canal- They have been a very favorite class of [cross out] remedies & consequently their number 
is very great. In the human alimentary canal, there are found various animals
some of which are genuine worms, & others the larvæ of various insects. The worms are
[cross out] diversified forms & are situated in [cross out] different parts of the tube. Their origin is little
known-They are of several kinds but may be comprehended under x [cross out]
[cross out]
The lumbricoides is similar to the common earth worm 
or lumbricus terrestris, but [cross out] it is in reality different as will be evident on
those inspection. The lumbricoides is long, having a round head, [cross out] in which
there are 3 visicles, which are arranged so as to form a triangle. In this triangle
there is a depression which is considered as the mouth. It is sometimes from 12
to 15 inches long, but geny from 5 to 7 inches- it is about the size of a common
goose quill. About its middle, there is a depression which is mentioned
as a passage to the lungs- There are two longitudinal bands which are
the tendons to which the circular muscles are attached. This worm does not
progress like the earth worm in circular lines- but moves in a straight
line; on this account, when once entangled in the intestines, they have not the
power of disengaging themselves, but form a ball which no doubt has
often been the cause of death. I have objected one or two cases in which
this circumstance with the cause of death. There are a number of little bodies
situated around the alimentary canal of this worm, which canal is nothing
more than a straight tube, directly passing from the mouth to the 
anus- When first discharged from the bowels they are semitransparent & of a 
light red colour, but soon become of a yellow tinge. They are generally found
in the ilium, often in the jejunum but never in the large intestines or in the 
stomach. The Ascaris vermicularis is seldom more than 1/2 an inch in

76
The Tricuris- I have never seen They are said to be about
2 inches in length- to have a tail twice as long as the body
& a proboscis, which [cross out] is occasionally enlarged
or diminished- It is usually found in the ilium-
The Tænia- & Cucurbitinæ differ only as to length 
the latter being merely the joints of the former-

length, having the appearance of a thread: the common name is the ascaridis.
They are generally found in the colon & rectum & more frequently in children
than in adults. They have been said to have been found in the uterus, vagina & 
bladder. They are generally very numerous, covering the fæces when first evacuated,
but soon bury themselves in them, when exposed to the light. They [cross out] are
exceedingly active, from what circumstance they have been named. Their structure
is very little known: they are said not to be hermaphrodite, but that the sexes 
are distinct.X [cross out]
[cross out]
[cross out] The Tænia is a flat & broad worm 
becoming sometimes of an enormous length; 50 ft. & in one case 150 ft have been 
discharged at one time.- Generally however, they come away in detached pieces;
consisting of 2 or 3 of the joints, which are disposed every half inch or only
on the body; they come away, generally very much convoluted. The pieces or joints have 
been considered as alive, when discharged: with how much truth is doubtful
The tape worm has been found in fœtuses, which have been born dead.
As causes of disease worms have received much attention. Some have [cross out]
considered them as the proper inmate of the body; which others have looked upon
these as producing every variety of disease. They generally occur in children from
one to 5 yrs of age- The symptoms indicating their presence are varied & numerous-
in general, there is a paleness of the circumstance, emaciation, [cross out] derangement
of sight- itching of the nose, irregularity of appetite, grinding of the teeth,
fœtid breath, great variations on the state of the bowels, sometimes diarrhœa is present
& again the bowels are very costive- There is sometimes an œdedma of the [illegible]
of the nose & of the upper lip: this Mr Home considers as a certain digagnostic
but I have never seen it in the several cases of worms which have fallen
under my notice. Many cases of disease have been the consequence of
worms; convulsions epilepsy mania & other nervous affections. Dr
Welch relates a case of blindness from worms. In October 1775

78

he had a patient. 12 yrs old; who was affected by a depraved appetite, costiveness,
fever- he had his eyes constantly open the pupils were dilated & there was strabismus,
with a complete loss of vision. This fact he says ascertained with certainty
by numerous experiments. I tried [cross out] a great variety of medicines,
& treatment, all to no purpose; at last I administered an emetic which brought
up a large worm, all the symptoms immediately vanished- In a case
of a child 7 yrs ago- I found on dissection a large plug of worms of the 
lumbricoid kind, in the intestin- The case has been very obscure, some
considered it as enteritis, others a chronic dysentery- intes are septic &c. Melancholy 
has resulted from worms; I have a young lady who was in the most demanding
state possible entirely relieved by a discharge of ascarides- The 
febris cuminosa of nosologists is of the remitting kind with pain in the bowels heade
but there can be no difference between this & an ordinary symptomatic fever.
There is a curious idea, that these animals are not only innoxious but actually
useful, by acting as arrangers in the intestines. No doubt they have existed
sometimes without producing injury, but this is seldom the case
they are often & very generally productive of great injury.- Many of
of the Anthelmintics are useful from their purgative properties alone Dr Hamilton
has maintained, that this is the case with the whole of them. This is 
certainly not true; yet all the various cathartic remedies have been employed to repel 
worms. The emetics have also been employed. There are however remedies, which
act from their poisonous qualities others which act mechanically & others again as
tonics. Of the Cathartics the most efficient is calomel. It is much used & should 
be given in doses, sufficient to purge; thus to a child from 4 to 5 yrs- grains vi.
may be given- When slow in its operation, it should be assisted by castor oil, or
some other medicine. Besides this, the various drastic purgatives have been
employed, as scammony, gamboge &c- but calomel is the best, especially
in combination with the sulphate of iron- grs iij of cal- with gr i of 
the sulphate being administered & its purgative operation, assisted by the oil of senna.

80.
X & I know of no article which is more useful-

81.
Lecture 46th Janys 28th,,
Of the Anthelmintics, more properly as called the first, is the Chenopodium
Anthelminticum. The leaves & seeds are the parts employed- Of these a tea
is made, which is often very effectual- the only objection is the odour, which is
very unpleasant- To children, it may be given in the morning, sweetened with
sugar, instead of their ordinary food. the taste is pleasant: let it be given in
the morning, in this way for 2 or 3 days when a cathartic should be administered;
after 2 or 3 days let it be resumed, & continued for the same time; in
this way alternate, for a few times & it will generally prove successful in bringing 
away the worms The tea, upon the whole, is the most enabling; lately the oil of 
the seeds has been introduced as possessing all its virtues x-gtts. v are to be given to
a child from 5 to 10 yrs. & perhaps very little more for an adult, as the mede 
acts on the worms chiefly, very little on the system; gtt i. may be given to a 
child under the year. To correct the odour some of the essential oils are added,
I think the best is the oil of Sassafras. Of the powdered seeds ℥ss is given to
children- & sometimes the expressed juice is employed.
The Spigelia Marylandica. This is considered as a very powerful vermifuge-
[cross out] The leaves, stems & root are employed: the dose of powder
is grs v. to a child 5 yrs old. To an adult ℥i. The decoction of the [illegible]
is mostly employed ℥i being boiled in a pint of water ℥ss to a child &
℥s to an adult, being given, as the dose. The root is the most active part
Dr Trumen took seperate decoctions of the root, stems & leaves. Into each of which 
he placed 4 of the comn earth worms, in the first they become motionless
in 5 minutes & were completely dead in 25 min. In the decoctn of the leaves, they
lived 4 hrs in that of the stems 3 hrs. If this be accurate, the root is
much the most active part. From the use of the Spigelia, alarming symptoms
are said to have resulted, Various nervous affections- delirium, vertigo-
convulsions &c, are sometimes the effects of it. By may these effects

82.
X The physicians of this city are very much attached to a formula,
first employed as a secret medicine- It is composed 
of equal parts of the Spigelia- & Senna- with a
small quanty of the Savine leaves- which last is supposed
to possess anthelmintic powers- the Savine however
may be omitted- This I believes act chiefly on the 
worms- comparatively little on the system.

effects are attributed not to the spigelia; but to the roots of another plant, frequently
growing with it. I however respect that it is owing to the Spigelia alone,
as it appears by the experiments of Dr Thomas, to be possessed of a narcotic power 
If when the pulse is at 76 in the mine, ʒi of the rest to be taken; in 3 it
will rise to 78, in 5 to 30- & after that, it will sink to 75, in this it 
resembles certainly the narcotics. Dr Barton gives it, with the serpentaria,
which he thinks prevents its bad effects. It is best however to be cautious
in its use. Dr Horne of Edinburgh denies its narcotic power; he says that he
has never seen any unpleasant consequence, although [cross out] he has cured it very freely.
On the whole, it should be employed cautiously & be combined with purgatives.
Dr Gaellagher gives it with Senna or Rhubarb, & thinks that it is
most effectual in small doses. x I however prefer the Chenopodium as being
superior in efficacy & less dangerous.
[cross out] Melia azedarach, the pride of India, the root is the part used- a cathartic 
decoction of the bark of the root is much employed- especially in the 
Southern States. Besides these, there are many other anthelmintic Medicines, but
which have little power- The Helleborus fœtidus & the Geoffroæ inermis 
may perhaps be deserving of notice- but they must be further investigated.
From the mineral kingdom, we may first notice the Iron. This is very often
prescribed with great advantage. The carbonate or Rust of Iron is
prepared- [cross out] the following combination
of the carbe-x & sulphate of iron is useful- ꝶ of the prepared rust of iron ℥ij
of the sulphate ℈i min & divide into 12 powders, one to be given every
morning to an adult, half the quantity to a child. This is an admirable tonic
& often excites a discharge of the worms, It is thought, also to prevent their generation 
by imparting tone to the intestines. Dr Grahm speaks very highly of the 
iron. Common Salt is found to be very destructive to the worms out of the 
body & has therefore been administered internally by the mouth & by injections:
to children, a tea spoonful is given every morning in some convenient article.
Ascarides. The symptoms of these are detailed by Heberden, from a 

84.

physician who was afflicted with them. They present sleep, excite a heat on 
the body- itching at the anus, tenesmus & mucus discharges from the rectum. There is a
griping pain which is often sometimes followed by a discharge of worms; the general
health suffers very little, but they are very troublesome & unpleasant. I 
had a patient who was subject to them from his infancy. but would remain free 
from them for several months at a time, the first symptom he would have of their reappearance 
would be an itching at the anus & soon after he would have a discharge
of ascarides. They are often attended with the same symptoms as the 
lumbricoides viz the several nervous affections as Epilepsy, mania &c. The
purgatives are in these cases, much employed as calomel & aloes- this last is often used 
with the canella alba & dissolved in brandy ℥i to the pt.- ℥ss being given to a
child 3 or 4 yrs. A variety of glysters have been employed, olive oil & castor oil
are both very useful in this way [cross out] they do not kill the ascarides but promote
their evacuation- The tenesmus is best relieved by warm injections of milk &
water- Heberden recommends a tobacco injection; but this is too dangerous
Camphor has been found very useful. The camphor tea is prepared by powdering 
a ℥i- of the camphor with the assistance of a little alcohol & then
pouring on the powder a pint of boiling water- It is to be administered
as an injection. The powder mixed with milk is also employed. Besides
those there are various other remedies- as the bitters- tonic, aloes, glysters of asafœtida-
common Salt. also the mercurial preparations- the hepar sulphuris is occasionally 
employed; the Ol. Terebinthinæ is more useful, than most of these.
The Tænia is denoted by symptoms which do not much differ from those already
mentioned. there is no particular diagnostic symptom. In addition
to the remedies mentioned for the other cases, we may add the salt- corr. sub. 
in doses of 1/8 of a grain- & the Æthiops mineral - this is not of much service.
Iron is a very powerful remedy here- the rust should be given in large
doses ℥iij or ℥iv a day; the iron filings are also very useful in large quantities.
Tin is also given in a granulated form which is made by throwing 
the melted tin into water by which it becomes granulated. The pilings are

86.
X It is said that by it the tænia is evacuated in large
quantities- & that frequently by means of a glass the -[cross out]
hairy spiculæ can be seen sticking in the worm-
# After the worms are evacuated- we should then resort to 
Tonics- as it is true, that exactly as the digestive organs are
debilitated will be the liability of the patient to worms-

also given in doses of ʒi or ʒij to be followed by a drastic purge. Dr Fisher
has recommended an amalgam of tin prepared by taking 5 parts of tin- 2 of
quicksilver & n the powder to be given in doses of 15 to 20 grs twice a 
day- If it does not open the bowels a purge should be given- It however geny
partially evacuates the bowels. Of the vegetables, the male fern is recommended
first it is not to be depended on. The Dolichos Pruriens has been much
used both in the East & West Indies, the hairy spiculæ are the parts used. It 
is much more employed in Europe- ʒi is the usual dose for a child. It is to be
increased for an adult. I have not used it. x Dr Fisher employs Fowler's solution
& recommends it very warmly, he has never failed with it. The Oleum terebinthinæ
is one of the best remedies in tænia, The dose is ℥ss to an adult. It
produces occasionally some disagreable effects as headache, pain & fever- the worse 
consequences are pain in the back belly & bloody urine but ℥ij have been taken
daily without any inconvenience. Large doses purge & are less apt to produce
bloody urine than smaller ones- Many [cross out] heat will sometimes produce this effect.
I have employed it in a few cases, in one it was of great service; the patient
immediately evacuating a large mass of the worm he says, 27 yds no doubt
greatly exagerated but still very long. The turpentine is also serviceable in 
the case of the lumbricoides.#
Lecture 47th Jany 30th
Epispastics. These I shall consider under the 3 heads of rubefacients, vesicatories
& caustics. As to their proper location there is some difficulty. I have
placed them under the head of evacuants, as forming part of the antiphlogistic treatment;
but it is of no great importance whether this or another situation is adabted 
for them. First of rubefacients. These are articles which excite [cross out] redness on
the skin- there are a thousand mechanical & chemical means of exciting irritation 
of the skin- frictions with the hand, brush, wollen clothes &c are much employed,
flagellating is sometimes resorted to- In asphyxia from drowning frictions 
are useful- & berry of the birch is ever proper, it may be employed. In
Palsy- in vars other nervous affections, in the low typhoid state of fever, in our

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X I usually prefer the heated oats- to all the liquid fomentations-
as they are light & can easily be borne- they are
dry- & will not air the heat for a long time- where we
suppose any advantage is to be gained by fomentn with
liquids- we may cover the cloths with a pillow filled
with the heated oats- These are small & apparently 
trifling direct but you will find [cross out] them of importance in
practice-
# usually ʒij of the Alkali is employed for ʒij of
the oil- but frequently- equal parts of each are necessary

late epidemic the Pneumonia Typhoides, they are important remedies. They are
also useful in other diseases for which I refer you to another chair. Of the chemical
means heat is much employed, [cross out] as a rubefacient or
as an emollient, with the view to the last property & to excite perspiration, hot
bricks- oats- sand. & chaff- &c; bottles with warm water are very useful-
These we have already noticed under a former head- At present those are to notice
heat as a rubefacient. Intense heat has been successful in restoring persons
from a state of asphyxia- In one case Dr Physick applied cloths dipped
into boiling water to a child in this state & had the pleasure of seeing it revive 
Dr Rush recovered a person by throwing hot ashes with a few coalls 
on the breast. Boiling water has been recommended in Paronychia- but here
a blister is preferable- In low fevers life has been protracted by external warmth.
In [cross out] spasms of the stomach, various hot applications have afforded 
relief- for this purpose I prefer heated oats- other articles have been employed
with perhaps equal [cross out] advantage. a common mode of applying heat is by cloths wrung
out of hot water. This I do not like, as the fluid speedily evaporates & leaves
the cold damp rags on the surface X- In Hysteria- there is very often coldness
of the feet- or at any rate, a sensation of cold- this should always be attended
to- & relieved by warm applications, as bladders filled with warm water, this
coldness is not only felt in the feet but in other parts also- often at the stomach, this
should be relieved in a similar manner. In local pains external heat is very
useful, as in hemicrania- in all the rheumatic complaints & in other cases: this
flannel around the neck is beneficial in cynanche. One of the principal irritants
well employ is the Vol. Alkali- usually the Ag. Ammon, is mixed with
olive oil forming the Vol. Liniment so much used. The proportion of the oil may be
varied so as to have it of various degrees of activity. # When long employed it is apt 
to vesicate the skin. In common sore throat it is found very useful, an objection
to its use in such cases is that the vapour is likely to irritate the nose & eyes & is often 
very disagreable on this account. The Ol. Terebinthinæ is perhaps one of
the best rubefacients we possess, answering all the usual purpose for which
such articles are employed- cloths dipped in it & applied to parts often relieves 

90
X Whitehead's Essence of Mustard has for its basis 
Turpente [cross out] the smell of which is tolerably well disguised-
So also is Tissot's liniment-
#. This I have found very useful in several pulmonary 
Complaints-

relieves inflamn & pain- To increase action on the surface & thus relieve parts
beneath it is found serviceable in rheumatism & sore throat & other local affections.
It is customary to dissolve camphor in it, ℥ij of the camphor being
dissolved in ℥iv of the turpentine; I do not know that much advantage is
to be gained by this, the camphor does not disguise the odour of the turpentine. 
Although when applied to the sound skin, turpentine produces considerable
local imfln, yet this is not the case when applied to parts infd by heat as
scalds & burns- it greatly relieves these, changes the action of the part & promotes
its restoration to health. In cases of extreme debility the turpentine
is much used- Dr Physick immersed an infant in a state of asphyxia in
a bath of warm spt of turpentine the child recovered- a superficial irritation
was induced which in a short time disappeared. The Ol. Sassafras covers the
smell better, than any other of the essential oils. Tarter Emetic is 
much employed as an external application. The dry powder confined on a part
[cross out] is dissolved by the perspiration & [cross out] then induces an eruption, This is not a genuine inflamn
but [cross out] a infy eruptn which form small vesicles & are "sui generis." # Besides
these there are a variety of plasters employed, under the name of strengthening
plasters these are of some service & may often be tried; Burgundy pitch 
the adhesive plaster- the emplas. roborans &c are used. There are certain
Cataplams which are much used & which every practitioner should well know
The simplest & perhaps the least irritating is rye meal with a little vinegar
Sometimes with the addition of a little salt. These applied to the feet & legs, &
often with great service in the febrile & bowel complaints of children, by producing 
a determination to these parts. A stronger cataplasm is made of
the bruised cloves of garlick of black pepper of powdered mustard &c- sometimes of horse 
radish- this is one of the least valuable- The cataplasm of mustard is preferable.
It is called a sinapism & is made by mixing the powdered mustd
& rye flour with oint in difft proportions as may be necessary. When
the pulse flags in fever, they are useful when applied to the soles of the feet.

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In such cases 1 part of mustard- with 2 parts of rye flour made into a paste
with vinegar is sufficiently active. I very often [cross out] spread the sinapism on paper,
as it is not as apt to do, as when on rags. In coma, apoplexy & in extreme
spasmodic cases, I generally make them with equal parts of mustard & flour
sometimes with the mustard & vinegar only. In such cases they should not
be continued too long- as the patient cannot notice their action, I have seen gangrene 
produced- they therefore should be examined very frequently & when the
skin is red let them be removed. In cases of cold feet- either the black or
red pepper may be applied- the best method is to dust it on the stockings-
These little things you will find very useful in practice-
Vesicatories. These excite a certain degree of infn & a discharge of serum
which raises the cuticle in form of a blister. But the degree of infn is not the
only difference between them & rubefacients- there is something peculiar in the
inflamn excited by a vesicatory, which [cross out] produces the discharge of serum, for although
rubefacients often produce blisters it is only where the infln is very
great- Mechanical means- as [cross out] hard labour will often raise blisters; heat
also generally produces them. But the vesicatories, properly so called are those
articles whose uniform effect it is to excite blisters, without much inflamn
& passing by numerous articles said to produce this effect- I shall
notice the Cantharides.

94.