Dr Dorsey. Phila- 1816-47.
No 5.

H L 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. & enlarged
during that of 1817 18' by Hugh L Hodge.
Vol: 5th







1.
Lecture 48th Jany 31st 1817.
Of the Epispastic remedies I am now to notice the most important,
this is the Cantharis or meloe vesicatorius. This insect is procured in Spain
France & Italy - Those from Italy are the largest, but the Spainish is considered
as the most active - It is said that an acrid vapour is produced 
by a large swarm of [illegible] which will blister the skin. They 
are procured by spreading a cloth under the tree, which they frequent [slay?]
the Sting the tree they are thrown down; here they are killed by vinegar. 
When well dried they can be preserved for many years if kept free from 
moisture. When they are however decomposed & fall into powder this
powder still retains the power of blistering. Blisters were employed by
Hippocrates probably that were not made of the same insect more used,
they have been at different times much celebrated but [crossed out] have often
been regluted; this was accase and by their misapplications by which much 
harm was produced - Of late years, their proper management has been understood 
& they have become very universally employed - Many however attribute
their effects to the absorption of the flies: this be is no means the case;
you might as well say that blindness could not be produced by a worm
in the stomach because the worm did not touch the optic nerve. -
Whenever, they are applied near the eyes care must be taken, that some of 
the flies do not get under the lids & produce irritation. To prevent this 
the ointment is to be preferred to the common blistering plaster. Various
additions have been made to accelerate their action - The best of these is 
the turpentine, as recommended by Dr Hartshorne. As there is occasionally,
when the flies are not finely powdered, some difficulty in washing
them from the skin, it will be convenient to cover the blister with gauze
which may be stitched to the edge of the plaster. The average time
at which a blister draws is from 6 to 8 hrs - on the head it must [illegible]
much longer, full 24 hrs - & you must not on pact to find large [five?] 
blisters on the head - this will not be the case, large quantities of 

2.
x Dr Rush's remarks on their use in yellow fever will show 
the principles on which they use to be employed in fevers generally -

serum are discharged, but seldom is there any distinct blister. This serum is 
very similar to the serum of the blood. The chief effects of a blister on a 
[crossed out] healthy persons are the local inflamn- & the strangury; but in diseases
they have a much more intended operation their mode of operation I shall consider
under another head. The diseases in which they are employed are very
numerous; to their use in these we have been led by experience & seldom by 
thematical views. In Fevers they form a most important part of the 
treatment - formerly they were employed in all kinds of fever & in all its 
stages, & of course were frequently hurtful. Where there is great arterial action,
they do little good till Venæ action has been promised. X In yellow fever
[crossed out] he observes that they are of great service: when the pain was in a great measure
reduced - he considered them as useful, in drawing off the remainder -
when there [crossed out] was much action they did harm; when every little they were 
also injurious; but that there is a [crossed out] point between the tur extrous
in which [crossed out] blistering is proper. It should be considered as auxillary to
the bleeding & purging I have often, after one bleeding & one cathartic
in yellow fever applied blisters with good effect: reduce the high action
of the system a little & then you may resort to blisters; from this you 
may see, that the blistering point is not a point in reality - best include
near the whole course of the disease except at the every commencement or at 
the close. It is often necessary in yellow fever to make a powerful impression at once;
for which purpose I employ several blisters - I have had [crossed out] 6 on a 
patient at one time. Dr Rush states their advantages in this disease
to her the following - they concentrate the pain, reduce the pain & frequency
of the pulse, check vomiting & induce perspiration - He might also 
have added, that they relieve coma - hemorrhages from the gums & delirium.
In general fever, Vin Phlegmasia, where the genl fever is 
the thick disease - it is no great matter, to what parts of the body
they are applied - local symptoms will yield, as well. When the 
application is made to one part as to another - Thus in yellow 

4

fever pain in the stomach will be relieved equally by a blister to the extremities 
as by one to the epigastric, so also pain in the head &c 
Dr Cullen attributes the whole efficacy of a blister to its antispasmodic 
power - considering that the evacuation produced by it fully compensates
for the stimulus previously imparted to the system. Blisters certainly
have this antispasmodic power, but they are useful in many cases in 
which no spasm exists as may be shown in numerous cases. I would rather 
attribute their efficacy to their inducing a new action at the part to which 
they are applied or on the whole system. To say that they equalize 
excitement is rather incorrect - as they induce greater action in particular 
parts. Strangury consists in a desire to void urine even when 
there is none in the bladder, accompanied with violent & painful spasms
of that viscus. In Fevers, they are thought to be more useful, when that occurs -
but in general it is unnecessary & should be avoided or be [crossed out] removed
as soon as possible. To prevent the occurrence of Strangury, or 5 Fard use
made an Experiment of this kind. He applied blisters to 40 patients, 
to 20 he gave mucilaginous drinks freely - & it was found that a much 
smaller number of these had strangury - then of the 20 who did not employ
the drinks. It is therefore proper to administer these, when a blister
is applied; in some cases this cannot be done; camphor may then be employed;
an anodyne glyster is however one of the best remedies: In some 
cases laudanum is very useful, when taken in to the stomach; when any of these
means are contraindicated, you may at least in former year patient, that it 
will last but for a short time that his pain & tenesonus urinæ will soon cease
The irregularity in the occurance of the attack is a little singular - in some persons 
there is no strangury - & this varies very much with the same person 
at different times. Mr Percival observes, if a blister be applied to the head 
immediately after it is shared; it will be more likely to excite strangury, that 
it delayed 24 hrs after that operation. I do not know whether this has 
been sufficiently confirmed. In typhoid cases of fever the fluid evacuated
is too great for the patients in many of these cases of great debility
the blister will not rise - or speedily produces gangrene. Cases also 

6
x. I have known a case of Scarlatina in which the patient
was so low, that sloughing occurd- from the applis- of 
a blister to the neck but life was preserved -

occasionally occur in which gangrene take place where we have no reason
to suspect it. This however is rare & should not deter us in similar cases from pursuing 
the same plan. x When you have any reason to suspect gangrene, as a consequence;
do not apply the blister to the lower extremities but to the arms or [crossed out] what 
is better to the body as the powers of life are weaker in the lower extremities than
[crossed out] other parts. In obstinate cases of intermittents, in tertians &
quaitans blisters are useful but here, it is often very useful to prepare the 
system by bleeding - then to blister & afterwards the bark which will [crossed out]
sporate more effectually. In the Phlegmasiæ all knowledge their 
utility - they should be applied as near as possible to the part affected, as 
they deplete from the vessels of the inflamed [crossed out] parts in this manner afford
relief. In chaler a morbus they should be employed early & are of other effectual 
in relieving the distressing symptoms In diarrhæa also they are
useful in Intimate cases they should be applied to the abdomen otherwise
the wrists will answer - In dysentery of after depletion they should be applied 
to the abdomen. They are useful in various spasmodic diseases, as 
colic convulsions epilepsy; asthma. In consumption & caturts they 
afford such relief & should be applied directly to the part; the wrists
are less advantageous.
Lecture 49th Feby 3rd
Blisters are also useful in croup they should be applied to the larynx & 
trachea [crossed out] but not till after depleting remedies & are been freely employed - In 
all the other any inore affections they are very useful - in the swelling of the 
testicles as a consequence to the mumps, they are very useful. Dr Rush
used them in Scarlatina - It would be useful to enumerate all the 
diseases in which they are employed - indeed there is hardly a disease in 
which blisters are not employed - Dr Physick has the credit of 
first employing them in a topping the progress of gangrene - here they 
are indeed very effectual seldom failing to arrest the further progress
of mortification - This I consider as one at the most useful improvements

8
x & sometimes superior to that of the Spanish fly - I believe 
they may be equal but not superior - the superiority he 
attributes to their being used in a recent state - the Spanish
fly being genry- employed [crossed out] after being kept a long time
but age does not influence the acty- of this article -

improvements in Modern Surgery. There are other insects which are [crossed out] employed
as vesicataries besides the Spanish fly - the only one, which I shall promotion
is the Lytta vittata. In 1799 they were very numerous, infesting
the potatoe vines in large numbers. Their vesicating power was accidentally
discoured by their inflaming the skin, when rubbed upon it - they are often
called the Meloe Americana - For their historical refer you to Dr Cones' dispensary.
Dr Schatt in his inaugural thesis has published may experiments
on this subject - He found that the fly although it had been kept 
for a long time produced vesication in a less time than the Spanish fly.
That on an adult - a blister would be raised in 5 hrs & a half & on children
a fine one in 2 hrs. He concludeds that it is more certain & active 
than the spanish meloe vesicatarii - Dr Gourd from its employment
in disease & more intensive experience [crossed out] comes to the following conclusions -
1st Powder of those flies on the skin will raise a blister - 2nd that their 
activity is equal x [crossed out]. 3rd That a saturated teniture
possesses the vesicating power - 4th That both the powder & [crossed out] well induce
strangury - 5th That this, acts in rather a shorter period 6th When 
given internally, it exhibits the same effects as the spanish fly. & 7th
That they eventually induce a purulent discharge from the skin in the 
same manner as the common fly - I have also tried this insert & I 
think, that there is very little difference between the two - & the meloe
Americana is worthy of employment - but probably cannot be obtained
in difficient quantities. As to the mode of application of blisters
I will make a few observations - When to the head the hair should be 
shaved close in some cases some of the hair only be left in front to 
prevent the unpleasant appearance of a bald head - the blister
should be large & circular - & cut so as to [crossed out] be smoothly on the 
head - A common hard kerchief well be sufficient to retain it.
To the back of the neck the blister should be lunar shaped - with 

10
x. It is now seldom resorted to for stopping hemorrhage -
the ligature has almost wholly supplanted it - yet there 
is one case in which [crossed out] it is still absolutely necessary - x 
that is for a bleeding for back in the fauces - In each 
a case I have seen it employed - & with immediate success.
# Issues discharge more pus - are more extensive & are 
on the whole must effectual - 

concavity upwards - the extremities should be perforated & strings passes
through them to be sewed to the night cap. In behind the ear they
should be excavated so as to receive the ear - there they are to be secured by a 
hard kerchief around the head & throat - In applying them to the eyelids - it 
will be most prudent to dose the eyelids by adhesive plaster - To the epi-gastric
region they may be angular so as to adapt them to the angle formed
by the ribs. To fix it here shoulder strokes should be fixed to a circular
bandage - one also passing over the perinæum will be useful - To 
a bubo a compress T. bandage are necessary. To the scrotum
a surpemary bag is best - To other part of the body, their shape is 
immaterial - a square as oblong farm is preferred.
I proceed now to the third division - viz - Raustics. The actual 
Cautery is a very old remedy - it was long employed for surgical purposes
especially to stop hemorrhage; till the discovery of the ligature by 
Ambrose Pare in some degree brought it into discredit. For medical 
views, it is occasionally employed - Dr L. Valentine, French physician
has lately recommended it in various cephalic affections of a chronic
nature, in chronic appthalmia also & says that he cured one case of 
blindness with it - I however do not think that it has any advantage 
vet the common caustic; - As to the burning of Moxa, it is still
employed by the French & Indians put it is as barbarous a remedy
as the scalping knife - & should be considered in the same light.
I will not detain you with specifying the several modes of formg
setons & issues Suet refer you to practical writers Setons are givg
apllied to the back of the neck. they are preferable to issues, in that situation
as they are cleaner & can be more easily attended to - They 
are employed in various diseases of the head - Issues or actions
are much employed in diseases, after in fr- has been subdued; - 
thus in diseases of joints or they are made after the violence of the attack
that yielded to depleting remedies - In chronic diseases 
they are usually applied at the insertion of the deltoid muscle 

12.

on the left arm as being the most convenient situation. Particular 
Escharotics. Van Helmont long asserted that nothing acted on the living
body on chemical principles - the life of a part is in some instances
however so quickly destroyed, that I do not think any other cause, than 
chemical action can be assigned - sometimes a straw in fr- appears to be 
the result, which terminates in gangrene - The Common Vegte. caustic 
is one of our best [crossed out] articles under the head - When made it 
should be kept in close battles which should be of a size proportions to the 
quantity of caustic - as it is very delinquent - The advantages of this are 
1st By its delinquent & penetrating powers, it is adabted to the formation  
of issues - take care that you do not go too deep, especially in the neighbourhood
of large arteries, of which there is some danger 
2nd From the same property it is adabted to remove the callous
edges of old ulcers [crossed out] it will not answer for healthy ulcers or for 
the removal of chancres - as too much of the surface would be destroyed -
3rd To open abscesses it is also well adabted - 
4th In tumours & ulcers of the throat it is much employed as 
it can be neutralized very quickly by vinegar -
The mineral acids are often employed as caustics, but their fluidity
is a great objection, as their action cannot be confined - They are must
in use to destroy vermin as they accumulte in hot weather - ʒi of the 
nit. acid to ℥ij of water is convenient proportion -
The lunar Caustic - or nit. argenti - is the best caustic use possess
To healing ulcers it is admirably suited; it stimulates the granulations
so that cicatrization is quickly produced; frequently in 24 hrs the part 
touched by the caustic is covered by a cuticle: as it coagulates animal matter, it does not spread
as the vegetable caustic - A convenient method it applying it to 
sinuses is to dip a silver probe into nitric acid, which forms the caustic
I can easily be passed into the fistula - There are numerous [crossed out] escharotics
in use, which I will not detain you with - but refer you 

14 
x The citron ointment is very excellent - there is such as 
no article which will succeed so generally in eruptions on the 
skin - 

to the Dispensatories - x The savine may perhaps by ranked under this head 
& is very useful to Keep up the discharge from a blister, here it is preferable 
to the epispastic ointment which not unfrequently produces a trouble -
some strangurys. From what has been said, it will be seen that 
the class of Epispastics is very important & deserving of much attention -
It would be unnecessary to be more particular in this place 
upon their practical applications as you will relieve abundant information
on this Lead from other sources - let me however remind you 
of the necessity of making yourselves well acquainted with the general
principles in the use of blisters, guided by which you will 
be able to adabt them to the circumstances of your patient.
Lecture 50th Feby 4th -
I now proceed to the second grand division of our remedies or to 
stimulants - I have already explained my views of the nature of sedatives 
& shall not now enlarge on this subject - I shall consider under 
the head of insitants those remedies which excite the system geny & which 
are commonly employed solely for this object. After all acute inflany
diseases, little else is required, than a more generous diet - & a greater
latitude in the choice of foods this may therefore be considered as if the lowest
order of stimulants this however I would not resist to, until all 
morbib action had ceased - there are however some cases of disease in 
which these stimulants are to be ordered - As to their mode of operation
little need be said - some appear to act on mechanical principles,
others on chemical - & others influenced by neither of these appear to 
be adabted to make an impression on certain organs; as odours &
vol substances on the nose - Hence in cases of asphyxia all of 
them are brought into action - Heat & Cold - besides a stimulant
operation appears to posses other properties, which 

16
x I today read a case of asphyxia - from the fumes of 
charival in which the man was round by the long continued
use of [crossed out] cold water thrown on his face - 

have been already noticed, but they are employed purely is their stimulant
powers in typhoid & other low states of fever; A precursor of death in 
many cases is cold feet & legs - warmth to these is of great importance & 
often preserves life for a considerable time - In asphyxia from submission
heat is a very valuable remedy - Cold is not much employed
as a stimulant - except in syncope where it is a very common practice 
to sprinkle the face with cold water x - Frictions have been long 
employed as a stimulant the antients used them very much & in morn 
times they are found very useful they are made best, with a 
flesh brush or piece of flannel - In syncope - in asphyxia in thro
nit rheumatism palsy &c they are very advantagous - Electricity
& Galvanism are much resorted to; In tumours palsy, amaurosis, chronic
rheumatism gout, & in some cases with advantage - In partial 
palsy from contusion - & in swellings about joints they are very useful -
I have known the deltoid muscle completely paralyzed by a flow,
which was relieved electricity. Of the two I dividedly prefer electricity
to galvanism in all cases as being more powerful & efficient -
The diffusible Stimulants. These are very improperly I think
classed under the head of Narcotics by professor Meirrg, as although
their final effect is more or less narcotic yet they are always administer
with a view to their stimulant operation - As the purest specimen of 
the class I shall first notice the Volatile Alkali. This is procured
the fly from animal substances; although it is found in some vegetables 
The solid carb. ammon. the aqua ammoni - & the aqua carb ammoni -
are all employed - but I prefer the concrete ammonia, the 
common vol. salt. I prescribe it in the form of the volatile julep.
Ch Vol - Alk - ℈ij - G. Arab. & sacch āā ʒi. Aq ℥iv 
♏︎ - Laudanum is sometimes added - gtts x L to the ℥iv.
This is given in doses of ℥ss every 1/2 hour - 1, 2 or 3 hours according 
to the urgency of the case - & has the effect of exciting the heart & 

18
x It is the suport of all our stimulantg articles - I may 
be resorted to, when other [crossed out] stimulants would be improper.
After inflamy- action is nearly reduced - & before we 
employ Tonics - or when we cant wait for the tardy
operation of those articles - the vol: alki- is a very appropriate 
medicine - There is no febrile disease in which 
it may not be employed during the convalescence but it
is contraindicated in the early stages of all diseases. 

arteries. Its operation however is very transient, perhaps here is no 
article which is more so; from this circumstance it must be given frequently x
It is employed in all febrile diseases, but not in the early 
stages as previously to proper evacuations - In Europe it is used in 
intermittents but in this country there is too much action in the system
to allow of this - The same observation will apply to remittents,
in bilious fever certainly not, till late in the disease. In the 
Phlegmasiæ it has been employed; in chronic rheumatism in some 
cases it may be allowable but not where there is any fever of an infy type.
In certain cases of retrocedent gout it is very useful & powerful, where it 
attacks the stomach. [crossed out] it is one of our most efficient remedies.
In Pleurisy it was formerly the custom after one or two free evacuations 
to resort to the vol alk - but now evacuations are carried to a 
much greater extent, & the alkali is seldom resorted to - It is however
a very excellent expectorant & is to be employed, where the system
will allow it - In typoid Pleurisy it is very valuable & in 
the tumors - debility & mania from in temperance [even?] where there
is local inflamn- there it is of immense benefit, especially in conjunction
with Assm-. Where there is a pleuritic affectn- with in temperance
it relieves the pain cough, promotes exputuration [crossed out]
excites sweating & strengthens the pulse - In Pertussis there is in 
the early stage too much fluer Suet afterwards it may prove useful 
I do Asthma arising from [orrars?] in diet it is useful but in no other case  
So also in dyspepsia = In spasm of the stomach, in Hysteria it 
is very valuable - Many have used it in diarrhœa & dysentery - In 
the class Neuroses - they have been employed; the French direct it Apoplexy
but certainly this is wrong, unless in that case which depends
on indigestion, which always produces a determination to 
the head. Lately it has been recommended in Cancer, but here I  

20.
x Perhaps longer, when induced by alcohol than 
when brought by any other stimulus
# The quanty should gradually be diminished - Abstraction
here is in reality a powerful sedative - & 
hence by diminishing the daily allowance of our patient
we actually deplete - thus in acute in by diss-
occurg in persons habituy- intemperate we are compelled
to employ moderate stimulants.

cannot believe it to be of much service - [crossed out] It is maintained
by some to be useful in poisoned Wounds, but by others this is denied
the accounts are very contradictory - The late Dr Ramsay of S. Carolina
recommended it in Cases of bites from the Rattle Snake - In Asphyxia 
& syncope it is must employed especially as a stimulus to 
the organ of smell - In the law states of bilious & yellow fever it 
is of great service & is employed to a great extent - I have given in 
yellow fever upwards of ℥i in two pro - Dr Kuhn speaks very highly
of this article - he says that he never knew it produce an unpleasant
symptom - & that the excitement it produces us superior to all 
others. - I have not placed the Vol. Alkali at the head of the diffusible 
stimulants, because it [crossed out] is the most powerful - but because
it is the purest specimen of the kind which we have - There are many
articles, whose powers, as stimulants, are greater; - & I will notice some 
of those which are employed for this end in dependent of their narcotic
effects. Alcohol is one of the most powerful - It is the product 
of the vinous fermentation & is obtained by distillation - It is a powerful
stimulant - In a small quantity it accelerates the circulating
strengthens the muscles, invigorates the mind - increases the secretions
& stimulates most of the corporeal powers - These effects continue 
for some time x & are succeeded by a corresponding depression -
In a large dose, it induces intoxication as a temporary mania 
which goes off in stupor & sleep. In still larger quantity it instantly 
kills without any previous excitement - In prescribing 
it, the habits of the patients are to be attended to, as some who are 
accustomed to it will hear large quantities & others very little -
when habit has rendered it necessary we should not suddenly take 
it away, as the patient would quickly sink. When much activity is 
required we order brandy or Rum which contains about 52 parts 

22.
x It is also less violent - & more permanent - Malt
liquors also contain alcohol - & are sometimes to the 
prefered, as they [crossed out] contain some bitter vegetable matters
& have considerable pungency from the carbonic acid 
they contain - 
# nourishing articles should also be interposed.
as essences of mutton - of but &c - Saga - Tapioca -
arrow root - yolks of eggs - &c &c - When there powerful 
Stimulants - induce heat - flushing of the face -
restlessness &c - they should be omitted for a while 
then resumed - Alcohol also is much 
employed in some nervous diseases, particularly
in Tetanus - which is usually trusted to the free 
exhbitn- of wine & opium - 

of alcohol - In most cases, wine is employed as being a safer stimulus -
Those are also other effects produced by wine - it is a much better tonic,
- than any of the other articles - x Where there is any infly action, wine &
alcohol are not to be employed, except in cases of in temperance, where it 
well be necessary to keep up the usual stimulus, as otherwise the patient 
would be carried off by various nervous affections - All agree, that wine 
or alcohol is not to be used in remittent fevers, as the bilious &
yellow till the last stage of them - but I think that is is seldom safe 
while any diseased action remains - In intermittents, it may be sometimes
be employed during the apyrexia - but often there is too much 
action even for the bark - The Port Wine is usually preferred. It 
certainly possesses considerable astringency, but it is so often adulterated,
that other wines are usually to be chosen. In typhoid pleurisy
wine has been much used & in very large quantities - In these 
low states we dug in with the Wine Whey; then wine, as diluted brandy
hardy toddy; afterwards raw brandy; sometimes with pepper & other 
condiments - When administered in this manner, it acts as a narcotic
& therefore should be frequently repeated - The patient should not be 
allowed to sleep too long - but should be round to take his stimulus at 
regular intervals - even delirium does not foolish their use in 
these cases # - 
Lecture 51st Feby 6th -
Ardent spirits, are much employed in chronic cases, but this should be done 
with cautious by excess it becomes more injurious, then the ariginae
disease - They have also been recommended in the Phlegmaiæ, but I so 
often noticed [crossed out] the circumstance that is is only, where the infn- has subsided that 
they are proper that I shall not insist on it, at present - in some 
cases of gout power or they may be used -
Alcohol & [crossed out] the miner acids, when mixed & distilled, form the others.

24
x I have also given it in puerperal fever beat up
with eggs - 
# This is a common remedy in the [crossed out] West Inds-
& is said to have affected cures other the occurrence
of the black vomit -

The sulphuric Æther is most used, in many of its properties, it resembles the ab 
what, it is very prompt in its effects but perssurtianably transient - It is employed
as an antispasmodic & a stimulant, but has less of a tonic nature than alcohol.
It is used in various spasmodic diseases, in doses of gtts xx, to upwards [crossed out] ʒi by 
measure: in extreme cases ℥ss is often given - There have been various modifications
of it - Hoffman's anodyne consists of Æther with an additil- quantity
of alcohol - it might be called diluted Æther, the doses is from gtts. xxx. to ʒi, it possesses no 
powers which are peculiar, it is preferable in some cases - as not being so volatile
as æther, it more easily taken -
The Olm- Terebinthisse - powerfully excites the system; the dose is ℥ss to ℥ij 
when given as an anthelminthic - but as a stimulant ʒi is the usual dose -
In the typhoid states of yellow fever, it is given both by injection & by the 
mouth x In spasmodic affections of the bowels it is given; especially in the 
flatulent colic by injection. Dr Baynham has recommended it in Epilepsy
this is natural where there are worms; but in other cases its use is not so clear 
& it must operate by the general impression on the system -
Of the Vegetable Stimulants - the Capsicum is more active, than most  
of the usual [crossed out] spices - but they all are more as less stimulating 
It is much used as condiment in the W Indies & other warm countries, not 
so much as in our own country - it is [crossed out] used more frequently as a 
medicine - I consider it as one of the best of our active stimulants, as being
more free from any narcotic power - I prefer given it with the 
food as in pills - I have never used it in decoction - in dyspepsia it 
is of great service; here it is preferable to ardent spirits, as not likely to
prove injurious - In protracted intermittents it is very useful with the 
sulph. of copper - but this combination or not to be employed to the seclusion 
of the tonics - the proportn- is 1/8 of a gr - of blue vitriol - to 
grs v. of the capsicum - In yellow fever I have much used it 
x with great service - in 1808 - I gave grs iij. qs t. # As it appeared
in Charleston brandy [crossed out] & Cayenne pepper were successfully

26
x This is to be employed as a gargle - & is said to 
be very effectual in accelerating the separation of 
the sloughs -
# - a good treatise on the disorders which are counterfeited 
by flatulency [crossed out] would be very acceptable -
there [crossed out] is hardly any disease, the symptoms of 
which it does not sometimes induce - which will [crossed out]
often deceive not only [crossed out] inexperid- but also 
the experid- practr - 

successfully employed as an external application; - Lately also it has been recommended 
in Cynanche maligna - the prescription in this case is to take ℥i of 
the capsicum - ℥ss of common salt - & to infuse in 1/2 pt of boiling water
after which 1/2 pt of vinegar is to be added - x This however ought not to supercede 
the use of emetics - Whether it is ever proper I cannot from my own experience 
determine - It is proper to remember, that in prescribing the capsicum,
some parcels will prove very active & other are inert - It varies
very much in [crossed out] its actively. The black pepper possesses similar virtues, but 
is not so active -
Ginger is an excellent carminative - Flatulency is a common symptoms
in [crossed out] disease & is often very troublesome # the following is very
useful in this case - R - rhei, rubing. ferri - & Zingib - aa ʒi. ♏︎
et div in chs- xij.
Dr Cullen has. as I think, very correctly classed all the aromatics
under this head - his description of them is very valuable & to it I refer -
you, The alliaceous plants as the garlic should also be included. 
I proceed now - to Narcotics - those are medicines inhibited
with a view to their sedative operation; they are known by other [illegible]
as [crossed out] Anodynes, sedatives &c but I prefer the above - Such
at Murray's account of their operation - At the head of my list 
of narcotics I place Opium. This is the produce of the Papaver
Somniferum - & is procured in Europe & Asia. It is not native in 
the U. States - but is often raised in our Gardens - From Egypt & 
Persia it comes in flat round pieces - of a reddish brown as liver colour -
The Turkey Opium is the best - It is considered as a gum resin,
it burns like resin & part is soluble in alcohol - partians are 
are soluble in water - The resinous part however possesses most of 
the narcotic power - & diluted alcohol is considered as the proper menstruum -
The Vinous tincture is also in use, Heat impairs its 

28
x Opium is the purest Specimen of a Narcotic- at 
one time the contest was very violent between those who
maintained its stimulating operation & those who magnified
its narcotic powers - The disciples of Cullen &
Brown were arranged upon [crossed out] opposite sides -
I consider it - &c 

powers, in what way is not contained, as neither is the condensed vapour or 
the residuum [crossed out] powerfully narcotic. I consider it as a gum resin, containing
other principles little known. The taste is somewhat astringent &
the colour of a dark brown or black. The whole plant is to a certain degree
active - but the extract is the important article prepared by boiling
evaporating - Kœsnfer considers it better to have the poppy head wounded 
[crossed out] & white liquor will concede, which when dry forms the opium -
Opium is very often adulterated by the inhabitants of the East, before 
they send it - [crossed out]
I consider its first effect, stimulant - but other words it is 
narcotic & one or other of them effects may be obtained according to [crossed out]
the dose - That the primary operation is stimulant is shown
by the pulse being excited in the first instance, almost invariably.
This excitement is various & powerful & consists chiefly in an increased
frequency. Dr Crumb pound that gr.i. at opm- would in 5 " raise the 
pulse from 70 to 74 - in 10 " - to 76 - in 15 " - it was the same - in 20 "
it was reduced to 74 & in 45 it was brought to 70. This power is shown 
also by the action of the skin which becomes moist. the patient is 
very sprightly & happy - it then produces its narcotic effect. In all 
other cases, in which life is attempted by the exhibition of laudm-, the 
pulse is for the first 20 minutes, full & bounding - not frequent but 
quick - This is the opiate pulse which when once felt will always be 
recognized.
Lecture 52nd- Feby 7th-
Professor Murry has observed that opium in a large dose proves 
fatal without any previous excitement - This I cannot absolutely try 
but I have never seen it - although I have attended persons who have
swallowed large quantities - many who have taken ℥ss others ℥i - & 
one case in which ℥iv were swallowed - Now in everyone of these 

30.
x when the vitriol is given alone ʒiv: is often necessary.
x I find that this method was recommended by Dr Monro
of Edinburgh in his angal- Thesis - Feby - 1818 -

of I arrived within 30 minutes I found my patient highly excited, often
which stupor &c fever produced. Now, an opium is more frequently taken
than any other article, with the view of committing suicide, I will detail 
the proper practice to be pursued where poisons have been swallowed -
When opium has been taken in sufficient quantity to destroy life, the first 
effect is stimulant - you find your patient happy & contented sometimes
but not often repenting of his purpose - & frequently in at state of apathy,
this will often last for 30 minutes - in all these cases you are to exhir
but very promptly a powerful ometiæ - the sulp. of glue is the best - but it 
should also be given with ipecac; ʒss of the white vitriol - to ℥ss of the 
ipecac. x If it does not operate in a flur minutes it should be repeated the 
fauces at the same time be irritated with a feather. No diluent drinks 
should be exhibited - as they serve only to spread the poison over a more extensive
surface & to [spartonets?] passage in to the [crossed out] duodenum. When vomiting
is induced then diluents may be resorted to- as also free bleeding
often the ℥xx. This relieves the head - & presents apoplexy.
In the next stage there is diminished action - this is said to come on
suddenly in some cases. I have never seen it sooner than 30 minutes
Here there is a total want of sense & motion the breathing is stertorous 
the pulse slow being 30, 40 or 50 strokes only in the min. but quick &
full. Here also our first object should be to remove the poison - but the 
patient cannot swallow my medicine - Here Dr Physick has afforded
us the means of relieving our patient - # He has proposed to pass a later 
into the stomach through the mouth or nose inject [crossed out] fluides through 
it & then by suction extract it - that washing the poison out of the 
stomach - It is not always necessary to wait for the 2nd stage before 
you resort to these means. I was the first who put this suggestion 
into execution in the case of a woman who was apparently 
in the article of death - the recovered deed - The 2nd Case Third it was 
in a young man who taken ℥ij of laudm- emetics did not operate 
& I resorted the flexible tube & often using it vomiting came on 

32

& my patient recovered - In the administration of medicines in these cases
it is very useful - In the cases of two children who had accidentally swallowed
a large quantity of laudm- Dr Physick injected brandy & water 
this had the immediate effect of exciting the phenomena of life the pulse
became evident - but these symptoms soon ceased & the Dr became fearful
that the brandy would hasten the event - by gradually however diminishing
its strength he succeeded in restoring one of them, the other died.
Whether opium is taken from the stomach or not, brandy & water weaker
or stronger as may be necessary is to be resorted to - vinegar also - sinapisms
should be applied to different parts & stimulating glysters be administered.
Dr Leaman of New York in one case employed the rod - with success -
which if ever allowable most be in these cases. Dissections show that the 
stomach is inflamed which in appears in spots scattered over the surface as is 
usual. - The largest dose which I have known taken with the view 
of ending life - is grs xxx vi. of opium - & yet the smallest dose has been the 
cause of death. In the case where ℥iv of laudm- was swallowed
I was called at 2 o'clock at night & arriving in a short time founding 
patient in high spirits - [crossed out] he refused to take my medicines upon threatening him
however with one exposure he consented - I gave him ʒi of white vitriol
& ℥ss of ipecac - at the same time bled him freely - he vomited copiously
but [crossed out] in 25 minutes he began to yawn & droop - stimulants were
now demanded, brandy & water was exhibited as long as he could swallow
but as Dr Physick had not at that time prepared the tube I resorted to 
Glysters & sinapisms - & in 24 hrs he happily recovered.
Opium exhibited in small doses & gradually increased has a powerful stimulant 
operation & induces habitual intoxication which is equally pernicious 
with that induced by ardent spirits - [crossed out] To obtain the effects of opium
for any length of time its dose must be constantly increased - it should 
therefore very seldom he exhibited in chronic diseases so the quantity will soon 
be enormous & [crossed out] the article become as necessary as brandy to the 
Drunkard. By its constant use, the system becomes exhausted & can 

34.

not withstand the least injury or disease without producing those troublesome symptoms
known under the title of mania or poter. The habit must be charged - this 
can sometimes be effected immediately by substitutling the hop tea or some other stimulus -
the hop tea is made by taking a handful of the hops to a quart of water
& let the patt- have it as a drink - Coffee - garlick &c - are often very 
useful - but however it is to be accomplished, you should alway endeavour to 
break this destructive habit - Lately I had a patient who for a disease of 
5 yrs standing had accustomed himself to take ℥viij of laudm- daily
in 6 weeks I was able to reduce it to a few drops - the patient should 
be kept up by a good diet - & by other stimulants if necessary, the laudm-
should be gradually diminished - By habit large quantities are taken without 
producing death Dr Mungys relates a case in which pts iij of laudm.
are taken daily - An antidote to opium has been sought for Virt it is 
not likely that it will ever the found, we must content ourselves with repenting
the cause & then addressing our remedies to the disease. Purgatives
are not proper -
As to the good effects of opium in the cure of diseases, it may be observed
1st " In cases of severe pain it is superior to all remedies - 2nd That 
it is one of our best stimuli when given in small doses frequently repeated.
3rd To induce sleep no article is equal to it, 4th The same may be observed
at it in relieving spasm - 5th in checking excessive evacuats- & 6th
It changes morbid action. In discover it is a very universal remedy;
always remember its properties when you prescribe it I adapt it to the existing 
state of the system - In Continued Fevers - Typhus, synocha
& Cynochus, it is to be employed but the infly action should be previously
induced - This is true of typhus - of which I have never seen a case, which 
did not begin inflamy- in the 2nd stage caution is still requisite 
in employing it - Some have substituted wine for it - this I 
do not think right, as urine possesses very little if any [ud?] above powers - 

36
x when there is a hot dry skin & an active pulse - it should 
not be employed- as in far from inducing sleep - it will render
the patient watchful & distressed - in the 2nd stage where
these symptoms have subsided it may be employed - but 
still cautiously - I have known a single grain produce 
some - Vol believe death - as he was never round from his 
stupor -
# opium is very improper in delirm- under any other circumstd- 
mam - pertly aggravatg of all the symptoms -
& - In all cases of nerves tremors &c arising in this disease
it is the remedy -  
A - It has also been given with the bark - but with 
no advantage - the indications to be fulfilled by these articles
are different - & they should be exhibited at diftt periods -

opium is by no means useful where urinæ is to be employed. Opium has 
a specific agency on the brain & should therefore be cautiously used in symptomatic 
affections of that organ - In fevers it is directed for various symptoms 
x In genuine typhus it is essential in small doses - where delirium occurs in 
a low state of the system it is to be used, & then only, # diarrhæa often demands its 
use as also another frequent symptom of fever subsultus ten dimum. In 
cases of great weakness opium with the vol. Alk. & [crossed out] cordials are the 
proper remedies. -
Lecture 53rd- Feby 10th-
In intermittents, Opium is now very frequently employed, but this
is by no means a modern practice. It was known to the antients, who gave it 
an hour before the paroxysm - I am  in the habit of using it - but never 
till the system is in a proper state that is, free from infly action, which 
is to be accomplished by the use of evacuations - neither do I employ it to 
the exclusion of the bark. Dr Lind has recommended it after the commencement
of the hot stage - & observes that it lessens its duration, by 
quickly inducing a general moisture over the skin. Where [crossed out] he has employed
it in this way - jaundice, dropsy, or disease of the viscera has never occurred.
I have repeated this practice - & cannot agree with Dr Lind - it will not 
produce a termination of the complaint; in some, however it lessens the 
violence of the symptoms - I prefer exhibiting it at the commencement of 
the paroxysm - & not during its continuance - To prevent its narcotic
effects, a practitioner has recommended it to be given with the vegetable
acids or with strong coffee - A For our bilious fevers it is never to 
be exhibited till after powerful evacuations; when the system sinks 
in this, & in yellow fever, & there is subsultus ten dinum, delirium, hemorrhages
from the gums [crossed out] - opm- is to be exhibited as in Typhus 
in small doses & at short intervals with vol alkeli- brandy &c &c 

38

When diarrhæa also occurs as a symptom opium is very valuable -
Some practitioners in these low cases of yellow fever exhibit opm- & calom.
with what intention or theory is not well ascertained - they say however that 
it is with a view of salivating & at the same time rest owning the diarrhæa:
with it, many of their patients recover - Camphor & opium in combination 
are also much used. Campbell recommends it where there is much 
watchfulness but I do not believe much is gained by the Camphor.
In febrile diseases with much action it is often given to [crossed out] produce 
sleep - Now in such cases it is very wrong to administer it - as it will 
not produce sleep unless the dose is very large - & then it is so disturbed &
the dreams so terrible that the patient prefer [crossed out] being - awake rather than
be thus tormented. The Stimulant effects of such doses, also aggravate the 
disease - It is much better to bleed in all such cases - & let the patient 
become weary - when he will occasionally have a pleasant sleep. But 
in cases of local infln- where pain is the principal symptom & where this is totally
disproportioned to the general disease - opium be allowed - as in 
Odontalgia, harnyehia, herierenia - [crossed out] otalgia - &c - In some of these cases very large
doses are required. Monroe to one of his patients with a stong, gave grs -
XL. & after the operation the same effect was produced by grs. x of opium.
Dr Cullen allows it in the suppurative stage of in yn-, but it may 
in many instances be given sooner - no general rule can be laid down.
One writer has said that it is not necessary, in any of those in which we 
may bleed - but there are many cases in which this rule will not answer.
Where large abscesses have formed opium is very proper - In Gangrene
it becomes very important especially in that species [crossed out] natued by 
Mr Potts as occurring in the feet of old purposes. As to Surgical 
complaints we derive from opium great advantages. In all 
local inflams- unaccompanied by much genl- fever & where the pain 

40
x It may often be employed internally in these cases 
[crossed out] it always I believe in this may fenduus some effect 
on the system - & moderates the pain - I am very much 
in the habit of adding it to poultices - where there are large 
abscesses it is useful to support the system - 

is severe it is very proper & useful x In some instances it would prove too 
Stimulant - but you should always consider, whether this effect would prove 
more hurtful than the severity of pain - & then prescribe or refuse it accordingly.
In Opthalmia it is not to be applied internally in the acute stage 
but in some of the chronic cases of this infln- it may be proper according 
to the suggestion of Mr Ware. Of this more hereafter. Pneumonia in 
this Country is an highly inflamy- disease & demands copious evacuations.
After these opium, is often useful in relieving cough & promoting expectoration.
This last effect however is denied by Cullen, but when exhibited
at a proper time & in a suitable state of the system it possesses this 
virtue: it consequently enters into the composition of the various cough 
mixtures. In the chronic form of Pneumonia it is very useful - & by some it 
has been trusted to even in the acute stage, but this most certainly very 
wrong - Its employment in catarrh & in the several forms of Cynanche
may be adduced from what has already been said. I use it very
frequently in the following cough mixture. ꝶ laud. gtts LX. Ant.
vin. ʒi. G Arab. ʒij Ol. Anisi. gtts vi. Aq. vel solut. Gly cyr.
℥vi. ♏︎. the dose is ℥ss. Another mixture often very useful is to take 
equal parts of the Paregerci elixir & of the Tr. Tolu - The dose is ʒi. 
In influenza the prejudice in its favour is greater than an [crossed out] cough mixture,
but for this [illegible] is no particular reason. In pertussis it is not to be 
used during the infy stage - In consumption it is greatly recommended
but should be employed with great discretion - Dr Gouthey are of the latest
writers on the subject observes that when we have any expectation of a 
cure it is not to be employed - but otherwise it may be given to palliate 
the symptoms. This may answer as a general rule, but its effects 
vary in different constitutions in some it proves very useful while 
in others the disease is aggravated - In Podargra it is certainly
not to be used in the early stages - The celebrated Brown fell 

42.
x Some cases of Hemopts- appear to be brought on by coughing,
the least irritn- inducing a cough which is followed by a 
spitting of blood - In such cases Opium is useful.
# In dysentery it is useful after free evacuations - in the 
first stage it is generally wrong - but in some cases where the 
pain & tenesmus are very severe an anodyne injectn- is very 
serviceable - If there is much fever - V.S. is demanded - often which 
the andoyne injectn- Ipecac: & chalk in combin- may be given
by the mouth of the the fever is subduced. In cholera - after
free evacuts- opium may be administered. Dr Hartshowne
has cured many cases of Cholera by V.S. 
#. In acute disesase of the Head as a general rule opium 
is not to be employed - in Acute Phrenitis never -
x. Opm- is not likely to cure mania - but may be employd- 
in many cases very advantageously. In Melancholy our 
medicine is in valuable - In Mania a patre, I place my 
chief reliance on opium - often alternating it with the hop.

a victim to this even theories - he died of apoplexy induced by the free use of 
stimulants during an attack of the gout. When however the disease attacks the 
stomach it is to be freely employed in conjunction with the various cordial & 
Stimulant articles - It often greatly relives the spasm but must be exhibited
in very large doses, I often given ℥ss of laudm- with no effect whatever; but it is 
necessary here to feel our way & to begin with small doses as in all 
other cases. In Acute Inflms- it is not generally to be employed
In some few cases however it may be proper as where there is a stone in the 
bladder as kidnies. In Hemorrhs- its use is to be directed upon genl-
principles that is it is not to be employed in cases of active bleedings but 
in those only where there is but little action & where the system is depressed.
In eruptive fevers it has been recommended - but in the first stage 
it is not allowable - In small pox the cool regimen & purging is preferable.
Sydenham althoug every fond of depletn- has recommended it in 
Scarlatina - but in this country it is altogether in admissible till after 
proper evacuations. In the various bowels complaints, it is much recomd 
& with proper caution is very beneficial - in diarrhea - colic, [crossed out] cholera -
In colica pictonum it is very advantageous & is said to prove laxative -
which must depend solery in relieving the spasm by which the contents 
of the intestines that been detained. In the bilious - & flatulent
colics, it has also been useful - one dose in the latter form often proving
completely successful. - # In the Acute stage of Mania, it is 
certainly improper - but in the chronic form it & other stimulants
become necessary. Dr Physick often evacuations exhibited opium
in large quantities in recent cases - & in one case succeeded but in 
others it has failed. # In the traumatic cases of Setonus opium
is very valuable, it does not always succeed, but it is much more 
successful than any other article - it should be given in large 

44.
x Idiopathic Tetanus is, I believe, very rare - I conceive,
that the cases usually termed such are Hysterical -
many Rheumatic cases are also confounded with it - [crossed out]
V.S. & cold oppurs- are the most important remedies in 
such cases
II. Where the fits return periodically, opium given just -
before the expected paroxysm is said to prevent - its occurrence - best
this is rarely the case.
III I have often seen VS. tranquillize all the symptoms.
So that a much smaller dose of opium will be successful - 
The habitual use of Opium in these cases is to 
be avoided - 

quantities to induce its Soporific effect. x In that terrible disease Hydrophobia
which has hitherto resisted all our efforts I am anxious to 
see opium carried to a much greater extent than it has hitherto been - It 
is certainly our duty to make use of powerful remedies in a very pre manner 
in diseases which are invariably fatal - Do everything boldly in all 
such disease, you cannot do much mischief & may be the happy means 
of vanquishing what has hither to been triumphant -
Lecture 54th Feby 11th
Opium has been recommended in Epilepsy, but with very little success -
we at present know too little of the pathology of this disease, to expect
any advantage from our medicines - Dr Chapman Considers it arising 
from a deprived condition of the digestive organs, but this is certainly
only one of the remote causes of this disease - & remedies addressed to the 
stomach often, very often prove totally in efficacious. Dr Wheyne has 
maintained that low diet is the most successful, which might appear to 
militate against [crossed out] the use of opiums but it must be remembered that the opm.
is to be given in such large quantities, that it would conduce to the same 
end. II In what is called the aura epiliptica - where the patient feels a sense 
of coldness as if a cool air was blowing upon him which in some cases amounts 
to a pain - Dr Cullen considers the opium as very valuable. In 
Hysteria it is of great service; where there is great arterial action, bleeding
should be promised - which renders its effects more certain - III In Asthma 
its effects are various - sometimes it is successful but often it has failed -
experience must direct you in these cases. Palpitations of the heart are 
very often symptomatic & therefore are only to be cured by opium where 
this medicine agrees with the primary disease - When they are caused by 
Dyspepsia I have found the vol. alka. very successful & in a 
majority of cases palpitation arises from the state of the digestion
organs & is to be cured by remedies addressed to them - 

46
I very seldom prescribe it in this disease - as it is of a chronic 
nature & therefore would demand its long continuance.
In Pyrosis Cullen considers opm- as the only remedy - this complaint
is very rare in this country - but is said to have appeard-
in some of our Western States - It is not clearly understood -
when it is idiopathic I have no doubt it is hurtful - when 
it is symptomatic [crossed out] then the remedies for dyspepsia are 
demanded - particularly an attention to diet - & when it appears 
in the intemperate & debauched a complete change
of [crossed out] the manner of living should be enjoined 

In Dyspepsia it often palliates the symptoms but does not care x 
In Syphilis it was at one time much esteemed, but it is not believed
to possess no antisyphilitic virtues - but is very useful in relieving many 
of the symptoms, arising from it or produced by the mercury - Dr Davies
recommended a decoction of the Poppy seeds, as a gargle in severe salivations -
In all surgical cases opium is employed with great advantage 
in relieving pain. - As to the best method of exhibiting opium
I must to say a few words. Sphere are various formula in which it enters as 
a chief ingredient: but I shall mention only the most simple ones.
It is given in substance either in powder or pills. The dose on an average 
to an adult is gr j. the pills are considered as acting more permanently
& slowly - but I do not like them, as they are often so hard that they
are with difficulty dissolved in the stomach, & sometimes become so enveloped
in the contents of that viscus as to produce no effect whatever.
whenever we wish that the operation should be speedy the power is must preferable.
If however you should wish to exhibit a pill, let it be made 
of the powdered opium with the conserve of roses - In this way it will be 
more easily dissolved in the stomach & be applied to a larger surface -
In some cases however where you are desirous of a slow operation the 
solid opium may be given - Laudanum - as the Fr. Opii is a 
very comon made of exhibiting the opium - there is ℥i of op. to ℔i of 
spirits, So that ℥i of the laudm- contains about grs xxx of opium & there is 
about gr i of opium in gtts xxv of laud, which is therefore the average dose 
for an adult. When laudm- is long made & kept very closely in a vial -
there is a deposition of the opium, so that the laudm- becomes weaker, A
more dangerous circumstance is that when [crossed out] it is not kept closely corks
up - a partian of the spirits is volatilized - & the opium not being volatile
remains by which the laudanum [crossed out] becomes much stronger.
[crossed out] I am very anxious that you should remember this circumstance
as I have known gtts ij - if such laud produce death. 

48.

you should always therefore be very [crossed out] careful, that your laudm- is in a 
proper condition - The average dose for an adult is xxv gtts, always
however bearing in mind the age of the laudm- & the habits & constitution
of your patient. To a person 15 yrs of age gtts xv is an average
dose & so for the age of the patient regulating the size of the dose to a 
child one year old gtt j. is the dose - within the month gtt ss. only should 
be given - Paregaric is considerably used - it is aromatic & stimulant
& more agreeable than laudm- but it is not more effectual & I 
never employ it - as the dose is much larger there is a great difference
in preparing it - In our Dispensatrey ℥i contains grs ij of opium but in 
one of the English Dispens-  ℥i contains no less than grs viij of opm-
which immense difference is of itself sufficient to condemn the articles as 
we cannot tell what we are prescribing. The Vins- Tr of opium
is very little used in this place; it is less certain & effectual than the laudanum - 
The watery solutn- is not much used internally but often as a 
glyster. In many instances we cannot exhibit the opm- internally by 
the stomach - in which cases we must resort to external opphrets - & to glysters -
The opium plaster is prepared by softening the opium in spirits & 
spreading it on leather - The Thrice plaster I geny employ - not as formerly,
composed of 300 ingredients - but of a few active article which [crossed out] are to be found
among our apothecaries, As I always sure it as an anodyne plaster, I geny
dust a little of the powdered opium on its surface which renders it much
more effectual - In acute inflamns- pruthies with laudm- or a solutn-
of opium - in some cases it may be useful but I usually prefer the sugar of 
lead - when given by the rectum it is in very many cases of the greatly
advantage & [crossed] is very frequently employed - About 3 times
the quantity of laudm- is to be used as when exhibited by 

50 

the mouth - it is employed in colic & various spasmodic effects of the 
bowels - in strangury from a blister it is very useful - & also in tenesmus -
Sometimes the spirits forming the laudanum is too stimulag-
to the rectum & it is evacuated - In such cases a pill formed of the powered
opm- & some soluble substance may be introduced into the rectum
& will prove of great service - Before dismissing the subjects
of opium, I must remind you of the necessity of attending to the state 
of the system in administring this article - do not give it indiscriminately
wherever the patient is desirous of its pleasant effects -
but always keep in mind its peculiar properties - & never administer when 
these are incompatible with the state of your patient -
The next article as our list is the Hyosciamus Niger as black Henbane
This is a plant of great activity - It is not a native of the H. S. but is 
easily cultivated - The leaves have disagreable, fœtid smell, but are 
insipid - all parts of the plant are narcotic - but the extract is the part 
employed - This has been long known as a poison & is very similar to 
the opium - as a soporific it is, next to opium, the best article we possess.
Its first effect, is to increase the heat of the body, the pulse &c - but in a 
short time stupor, coma - &c ensure. It is said, than when death is produced
by it, the body is covered by numerous petichiæ - It is very antient
medicine, I take used it freely in numerous diseases - The dose is 
at first grs i or ij. it may be gradually increased to ℈i. It differs
from opium in having no tendency to induce constipation. It is employed
very much in the same diseases as the opium, but the above property
renders it in some cases preferable - The seeds are said to have 
been useful in hemorrhagy - but it could not be of the active kind.
Grs. j or ij form too small a dose, it produces no effect. I have 

52.

given grs xv. here slight vertigo was sometimes produced, but I obtained 
its full narcotic powers. In Pertussis it has been much used
but it possesses no advantage over the laudanum - its agent rub
Henbane is useful where from some peculiar circumstances opim-
is contraindicated & a narcotic is wanted -
Lecture 55th- Feby 13th-
The Prunus laurus Cerasus does not grow in America but is very poisonous
& therefore have placed it among the narcotics; but it is not much used in medicine -
When given to animals in a large dose it is said to kill immediately
& therefore has been mentioned as a garden amble of a pure sedative - but this 
does not prove it to be so - as we can conceive that a powerful stimulus may 
destroy life immediately. In a certain dose it invariably proves fatal to animals -
& in all doses it produces violent convulsions - finally coma & death.
But althoug I have placed it under the head of Narcotics. I have never known 
it exhibited so as to produce sleep - The distilled water is geny used - & the the - 
mists have thought its active properties were seated in an essential oil. But it 
appears [crossed out] by later experiments to [crossed out] depend on the presence of the Prussic
acid - Besides the distilled water the infusion of [crossed out] leaves & the Tr- are 
employed - Cataplasms of it are also said to be very useful in relieving 
pain. It has been employed in Intermittents & in Consumption: it is said 
to have proved useful in Gonorrhœa which I very much doubt. The dose 
is from gtts v to x. of the water & from 30 to 40 gtts of the Tr-
The Atropa Belladonna or the deadly night shade is a perennial
plant growing in Europe - The leaves berries & root are used - the berries
have a sweetish taste & are geny the most active; but the leaves
are preferred as being more uniform In a moderate dose it in parts a 
sensation of warmth produces headache nausea &c & in a large dose acts 

54.

as the more powerful narcotics - Dissection shows that there was infln- & 
gangrene of the [crossed out] stomach as is produced by opium - When any large 
quantity of it has been taken you should act as in case of other narcotics -
1st- The stomach should be evacuated - 2nd- The apoplectic symptoms be removed -
& 3rd- The sedative effects are to be counteracted by stimuli - By gradually
increasing the dose a large quantity may finally be taken - It 
is used to promote the secretion by the kidnies as by the skin in several
diseases. It has been used in Epilepsy, in chorea Sancti Viti - & other nervous
affections - In Mania it has totally failed. Bouchet has recomd- it 
in Pertussis - In dropsy I have no confidence in it or any other narcotic -
& its diuretic power is very trifling - & it should never be used with this view 
only. Like Opium it has been given before the paroxysms of an intermits-
Cullen has said that it has been useful in schirrous - & in cancerous ulcers -
& he mentions some cases - but from my own experience on this subject. I am 
very much inclined to believe that those cases were not genuine cancerous 
affections. It has also been used in Hydrophobia - Saunders employed
it with a view to dilate the pupil of the eye, geny- as an external -
application - The dose is grs j or ij of the dried leaves.
The Conium Maculatum. This is a native of Engd- &c reatd-
& grows abundant in U. S. The seeds & leaves are both active but 
the extt- of the leaves is the most used. Its narcotic powers on the human 
species is very great, although goats eat it with impunity = in large doses 
it produces the usual terrible effects of this Class. I take recommended the 
expose bed juice in cases of cancer - but in other hands it entirely failed. I have 
tried the hemlock very extensively both internally & externally in cases of 
cancer & am hold to assert that in genuine shirrous it is absolutely inert: in some 
instances it relieves the pain, but in this, is not equal to opium - it performs 
no cures. In Scrofula I have employed it with great satisfaction -
where I consider it acting as an alterative; Dr Kuhn agrees with me & adds 
that he has used it successfully in a case of lepia - As to scrofulae 

56

have cured ulcers of this nature which had resisted everything for upwards of 
10 yrs - in two months, by the exhibitn- of cicuta & corros. subl. More over 
it has been employed in other Ulcers see Home who recommends it in 
diseases of the joints: in ulcer from bubo, [crossed out] have used it with 
great success - In syphilis connected with scrofula it is very valuable 
when exhibited with the corrosi sublimate. In tumours produced
by inflamn- & commonly called Schirrous the Cicuta is useful. But 
these tumours are not genuine schirrous affections, they very seldom terminate 
in cancerous ulcerations - & are formed merely the deposition
of coagulable lymph - Here [crossed out] bleeding, with low diet & purging 
conjoined with mercury & Cicuta geny succeeds. In chronic hernia 
humaralis also improperly called schirrous - it is very useful -
this disease in a majority of cases depends on stricture in the 
urethra, but not universally as maintained by Mr Home - In genuine 
Cancerous testicle the Cicuta is of no service castration is the 
only remedy. In the mortification described by Mr Pott it has 
been tried; but here I prefer the opium as recommended by that 
Gentleman & should also apply a blister which in once case. I 
have known very beneficial. In Pertussis I have no confidence
in it & in Tic Doloureux it has geny- failed - emetics in
this case promise more than anything else - In chronic Rheumatism
it is of no use - In Asthma where V.S. is necessary, it is of 
no service, but in other instances it is occasionally advantageous -
In all the nervous affections it has been found useless -
Dr. Chapman has found it useful in some cases of Amenorrhœa 
& jaundice - Cicuta is also externally employed in form of Cataplasm 
made of the fresh leaves - the extract is used in the same manner 
by being softened with water - the Hemlock bath is another 
form - Dr Hamiltion recommends this last in Cancer of the Scrotum.

58
x I am in the habit of commencing with gr: j. & 
increasing it 'till ʒij or ℥ss. are taken daily.

The dose of the powdered leaves is grs v. or viij x - which may be gradually
increased till large quantities are taken - Dr Chapman has 
given upwards ℥i. every day. The leaves should be taken while 
the plant is in flower & the dried slowly - after which it should be
kept in bottles well stopped. When good - it is of bright green colour 
& retains its peculiar odour. The extract is prepared by inspissating
the juice of the fresh leaves - In the employment of the 
Cicuta always remember that different parcels vary very greatly
as to strength & therefore that the dose should always be reduced
when [crossed out] a new parcel is employed - & it is a good rule never to 
change the parcel of any active medicine without being very cautious
as to the dose - Upon the Whole I do not value Cicuta as 
much as Baronttahl & others - but I have more confidence in 
it than Dr Cullen - it will not cure cancer, but is often useful
in scrofulous diseases - The following prescription is what I usually 
employ - By cor. sub. grs viij - ext. cicut. grs. 4 x iv. ♏︎
it dib in pil. NB L X iv. - You had better always use 
the plant of our country which being fresher is superior to the 
European - & is naturally equally good. The test of its action
is a dilated pupil - nausea vertigo - &c when it should be 
omitted - 
Lecture 56th- Feby 14th-
The Datura Stramonium grows very plentifully in the U.S.
& is generally considered as a native - It is an annual plant & is distinguished
by a peculiar fœtid smell - it has very improperly been called 
Henbane as we have [crossed out] another article of that name - it is known also by 
names of thorn apple, stink weed, James town weed or by corruption
Jonson weed which in this part of the country is the popular 
name. On many animals it has no effect, but this is not the case 

60
x I have never known it prove fatal -

with the human system - Dr Copper has shown it to be a powerful stimulus,
it powerfully excites the pulse, but its sedative effects are soon
manifest - It resembles very much the other narcotics - but differs in 
some little respects - when not uninternally it has a more direct effect on 
the pupil of the eye, than any other narcotic - & the dilatation of this 
opening is the first indication of its acting on the system & will enables as 
to determine with considerable accuracy that the stramonium has 
been swallowed. x Stahl first pointed out its use = he employed the 
extract in epilepsy & mania & was followed by many of the continental 
physicians - Cullen does not speak decisively in its favour -
& the Baron - himself cured but one case of Epilepsy with 
it. Dr Archer of Maryland has spoken very highly of our medicine
in this disease he observes that in those cases in which the 
fits recur after stated intervals the Stramonium is as useful as the 
bark in intermittents - he gives grs ij of the powdered seeds every 
4 hrs & soon after every 6 or 8 hrs till the time of accession has past.
He then omits it till within 3 days of the [crossed out] expected fit when 
he exhibits it as before. He alter sometime puts his patient on 
a low diet & occasionally bleeds - Now this success of Dr Archer
is greater than that of leng other practitioner & no one would second
him in the above assertion as to its efficacy - May not indeed
attribute more to the low diet & bleedg- than to the stramonium 
especially when we recollect that Dr Wheyne considers a low 
diet as the most efficacious remedy in Epilepsy.
The seeds are preferable in these cases they should be gathered as his 
perfectly wife - & then they are of a blackish colour, flour is usually
employed for making it into pills, but I prefer the G. Arab.
as by triturating the seeds with it they are more easily pulverized
which is by no means a very easy process 

62.
x The patient to whom I here refer has since died of put
Monary Consumpn-.
# Internally it has also been useful on some chrome diseases
of the eyes; in gutta Serena it has afforded some
relief but has effected no cure -

In Mania it has been very extensively employed in our Hospital
Dr Barton spoke most favourably of it observing that it was a 
safe medicine, & often effected a cure - I however have never found 
it in my own practice or seen it in that of others, of the slightest use 
in Epilepsy or Mania - I agree however with Dr Barton that 
it is a safe article - In Tetanus, I consider Opm- as much 
more powerful & have therefore never resorted to the stramonim-
In Asthma it has lately been resorted to, taken either internally or by 
inhaling the smoke Its success has been various - I knew one case 
in which the paroxysm was always relieved by it - x It is however less 
effectual than the opium - In consumption it is said to have 
been useful, but this could only be from its narcotic effects, acting as a 
palliative, in which it is certainly not to be compared with opinions
Dr Cooper recommended it before the paroxysm of an intermittent -
It has been used in palsy rheumatism dropsy - &c &c but little 
confidence is placed in it in any of these diseases -
The extract is very useful indeed in dilating the pupil by being applied 
externally, for the operations of the eye, x In its use internally 
it is necessary to be careful, to begin with grs ij of the seeds & gradually
to increase it till nausœa is produced when it must be laid aside.
I have not employed the Gr but the dose is gtts x. xv. or xx. 
it is prepared by filling a bottle half full of the [crossed out] seeds & filling
it up with spirits - The Voctt- has been externally applied in cases 
of local pain - It often does good - but generally is productive of harm & as 
it not unfrequently induces nausea Vomiting it will not be much
employed - An ointment of the Stramm- has been used in cases 
of scalds & burns, in old chronic ulcers [crossed out] from burns, I have 
used it - but merely with a view of changing my prescription 
time is the only thing which will answer for these ulcers .
In hemorrhoids - in Schirous tumours it has also been used, but 

64
x Volumes have been written on the ill effects of tobacco -
as it is commonly employed in snufy- smokg- &c 
These I think have been very greatly exaggerated - as 
we find so many constantly indulg- themselves in the 
lessend- gratificatn- without suffering any injury. In 
Dyspepstic persons it has sometimes to be forbidden -  

As no purpose - In club foot it has been applied with a view to its 
relaxing effects, than which nothing can be more absurd.
Dr Barton was in the habit in his lectures of narrating some of the 
bad effects of this article as an external application - I have never
seen it produce any effect but nausea which fully counter balances
any good which may be derived from it. In some few cases it 
may be substituted for the opium as it does not constipate the 
bowels. Nicotiana Tobacco - I need not say anything of the 
History of this plant which is well known - It is a powerful narcotic
& Dr Cullen has gone so far as to say that this effect was produced by 
snuffing it into the nostrils - This I have never seen although I have 
often Known it used freely this way by persons unaccustomed to its 
use. When taken into the [crossed out] stomach it produces nausea &
other effects of narcotics & is attended by a peculiar relaxing & debilitating
effect - & by involuntary discharges by stool - As an 
antispasmodic it is employed in colic & hernia - it is in these 
cases given in the form of glyster - which is prepared by infusing ʒi
in the pt of hot water - of which only half the quantity is to be 
injected at once - Its effects are considerably varied in different
persons - in one case related by Sir Asty Cooper the patient died
& its narcotic & debily effects vary in different persons so that much
caution is necessary - x It has been given internally in Tetanus - I 
have even given ℥ss of the satd- oss - to a child - it had no effect
whatever - In New Engd- One case of Tetanus has been used by 
the tobacco glysters - its an external application it may be tried
in letter where other articles fail - This disease acquires that the application
should be often changed. The citron ointment cures a majority
of cases - if it fails resort to the salted butter, the garden rue
to calomel, to corros. sublimate to the tobacco &c in succession.

66
x The nux vomica possesses similar properties - as the 
above - but lately it is attracting attention as a cure 
for Paralysis which will render it an object of 
more importance. -

The Digitalis is a powerful narcotic: but as I have an former
occasion fully considered this article, I now pass it bye & take up
the Humulus Lupulus or Common Hop. This is a narcotic, but possesses
also considerable tonic powers - it cannot however be much employed
as a tonic for fear of its other effects. In substane the 
dose is grs iij - The Tr- is given in doses of ℥ss - the infusen- in doses
of ℥iv - this last I prefer in Mania a pater where I have found 
it very useful, having often succeeded with it [crossed out] without any other 
remedy - It is prepared by infusg- a handful of the hop in a pint of 
water the patient may take it ad libitum - The Saturated Tr-
is often used as a substitute for the opium, but it is not suffy
certain - cataplasms have been employed to relieve pain - & to procure 
sleep the hop has been sprinkled on the pillow - but in these
I have not much confidence -
The Faba Sti Ignatii is on in time bitter & possesses some narcotic power - but it 
is not of much value on this account - & it prevents the article from 
being employed as a tonic . x.
Lecture 57th- Feby 17th-
Antispasmodics. Spasm is an irregular & involuntary contraction
of a muscle - & the medicines which relieve this [crossed out] receive the 
above appellation. With this view V.S. is often the best remedy, we 
possess in cases of spasm but the name is appropriated chiefly to certain
Narcotic & Stimulating medicines - but there is no one which uniformly
proves antispasmodic - I have already considered several of the 
narcotics which are used with this end & shall now therefore notice 
those only which are useful [crossed out] only in this manner.

68
x in drank of its stimulating operation - 

And first The Camphor This can be procured from many plants 
of the [crossed out] sassafras, sage, rosemary &c & also from the [crossed out] oil of Thyme
Peppermint & some others - The Caurus Camphora furnishes it in the largest 
quantity & from it all the Camphor of commerce is obtained - It is 
procured by exposure to heat; when the camphor sublimes - It [crossed out] has no 
colour, is transparent, possesses a peculiar odour; is bitter & ceases a sense
of coldness in the mouth - It is inflaml: all the acids act on it & the 
mineral acids decompose it; in small doses, it has a stimulant operation,
in larger doses it possesses some narcotic powers, but it is a 
medicine which very often disappoints your expectations.
As to its modus operandi in diseases we know very little, it 
always acts as a stimulant, & should only be used when this effect
is desirable - The Old surgeons. thought that it acted as a sedative
recent experiments prove, that it excites the pulse - but in depending
of these there are numerous circumstances which are satisfactory at x
least to my mind. In certain febrile diseases it may be given 
but never when there is any activity in the system; in the typhus stage 
it is employed with the opm- & vol alkali; which no doubt are entitled
to the credit of the success. In intermittents none employ it 
exclusively - but it is usually given with the bark, but adds no 
thing to its virtues. When the doctrine prevailed of the occasional
putrecenty of the fluid it was considered as an antiseptic: but 
Dr Seybert has fully proved that putrefaction never effects the living
arteries & veins - Huxham recommends it with opm- as a powerful scrotorific
As it is not useful in the first stage of acute diseases, it may 
be in [crossed out] the latter, where it assumes the Zyphus action & a still lower
grade where [crossed out] gangrene is the consequence. Puerperal fever is 
[crossed out] attened by every variety of symptoms, where there is strong,

70

inflamy action, the Campr- is inadmissible & in the weak stage it 
is insufficient. I sublime its virtues in these cases have been overrated.
Camphor has also been employed in the Philesonasiæ, but in the active
stage of all inflams- it is injurious, but by some it is [crossed out] resorted to 
in the latter stages, as a stimulant. Dr Barton has termed Camphor
a sub narcotic, that is, as possessing slight narcotic power - & it is very
useful in a certain condition of the system, where depletion cannot be 
carried to a further extent - & where there is considerable restlessness
& anxiety, in such cases it is more beneficial than any other article -
In chronic rheumatism it has been used but certainly not 
with much advantage - In the nervous it has been favourably
thought of - Cullen observed that it has preservative the paroxysm
of epilepsy, but has not cured it - he found it most useful with 
the cuprum ammoniacum & flores Zinci - This is very vague testimony
as more is to be imputed to its combinations than to [crossed out] its 
own virtues - In Tetanus it has at the present day no advocates -
neither has it any supporters in Chorea St Viti: In Asthma
with spasm it is not useful - In Mania Dr Cullen regards
one case in which it was serviceably, but this may be said of almost 
every article which has been used in that disease, & I believe
that the Camphor has little or no efficacy. Dr Barton however
says that he was completely successful in one instance - In
Convulsions of females Dr Hamilton employed it although he 
condemned opm=. The practice in this disease you will learn from 
another source. - In strangury from blisters it 
is useful although it occasionally produces the same affection
As to its mode of exhibition, the dose is on an average grs v. 
but it has been given in much larger doses, grs x to xx is not unfrequently
prescribed - even ℈ij & also ʒij have been taking but 

72.
x. Dr. Wallace of Virgina- mentioned to me, that it is best 
given in Seltzer water - by which it is dissolved.
#. In this way I use it in cases of strangury - [crossed out] gradually
increasing the dose of the tea to ℥ij & ℥iv. 
x. This is an domirable remedy - in that species of erysipelas
frequently produced by poisonous vegetables, the watery
or Spirituous [crossed out] separtn- is employed.
*. It is soluble - & gives up its virtues to water - 
#. That by this formula Tetanus has often been prevented
I have often thought. 

in an over dose it induces nausea & vomiting. It is given in the 
form of pills or of emulsion - lately it has become very fashionable
to [crossed out] rest it up in milk, which makes a very neat preparation - x I often
give it as a tea; The Camphor tea is prepared by putting a lump of 
Camphor in a cup & pouring a little spirits on it that it may be 
powdered & then adding the hot water - # In Spt of Turpentine, it 
forms a very useful internal application. x
Moschus - or Musk. This is the product of the male of an animal
in the East - It comes to us in small grains, contained in having 
bags - It is unctuous, has bitter taste & a powerful peculiar odour
It is easily volatilized & gives it [crossed out] odour to articles
distilled with it - It has some of the properties of a resin, but 
is generally much adulterated before we receive it. *
In diseases it is not much employed. Dr Cullen considers it, as 
the most powerful antispasmodic we possess. In Tetanus I have 
not found it of any service, but it is I think an admirable remedy 
in the tremors & mania arising from intoxication - in such 
cases my prescription is the followg= ꝶ Vol. Alk. & Moschi - 
āā ʒi, G Arab - ʒij. laud gtts LX. Aq. ℥vj. ♏︎ - from a number
of comparative experiments I am decided, that the above formula 
owes much of it virtue to the musk. # - Dr Owen employed it 
successfully in a singular case of spasms of the muscles of the neck.
In Hydrophobia Dr Cullen has I think, committed himself, when 
speaking of this article for it is of very little service. In Gout of
the stomach it may be useful, but in no other of the disease. - In Spasmodic
Asthma - it formerly 2nd considerable reputation - but at 
present little confidence is plaud in it. In low states of the
sytem it may be useful, Dr Mead recommends it in typhus.
- I have seen narcotic effects produced by this article, the 

74.
x an artificial musk has been introduced by Margram & is 
said to be equal to the natural musk-it is prepared by pouring 
the [crossed out] nitrous acid on the oil of Amber.

dose is grs xxx - I prefer exhibiting it in small doses often repeated -
grs v. every 2 hrs. It is given in the form of Bolus, but 
I prefer the emulsion - As an injection it has been employed, but 
for this it is certainly too expressive. - x 
Castor. This is procured from the heavier - it is situated in small 
sacks near the anus - The best comes from Russia, that from our 
own country is not near equal to it. Chemistry shows difference between
it & the [crossed out] musk - Cullen consider it as a powerful antispasmodic -
In Epilepsy it has been recommended by the old Physicians, 
but in every case it is inefficient - Castor at present is very
little relied on in any disease - Its dose is grs x. xx. or xxx. 
The same may be said of the various Emphyreumatic oils - [crossed out]
the sal [crossed out] cornu cervi is a preparation of Hartshorne sometimes employed
but it is very difficult to retain on the stomach & is not equal to the carb 
ammoniæ. - Ol. Succini - The Amber has no virtues whatever,
but the oil is useful - In Hysteria I have found it eminently
successful - here the dose is gtts x - I prefer sore also the doses small 
& frequently repeated as more liable to be retained - it is also equally beneficial 
in Gouty colic - where I have seen it act very promptly: as an 
embrocation it has also been employed but it has no advantage puerperal
lint-. The most valuable article is the Ferula Assafœtida, 
which is obtained by exudation through incisions in the bark of the tree.
It is a native of Persia - & the gum is brought to us in Large masses 
the appearance & odour of which are well known - Dr Cullen attributes 
all its virtues to its action as an antispasmodic, certainly 
much of its values depends on this property - It is therefore empty 
in various nervous & [crossed out] spasmodic diseases - in hysteria it is 
the first resort of the practitioner - & is often successful in relieving
the paroxysms. It sometimes acts as an expectorant.

76
x It is an excellent article to resort to, when opiates are 
forbidden by any of the circumstances of the case. -

I will here take the opportunity of observing that there a no expectorant 
medicines properly speaking - that every remedy which 
relieves the disease of the lungs may be considered as expectorant,
thus bleeding, purging, blistering &c are powerful expectorants only 
however as they destroy the inflamn- which prevents the natural secretions
from taken place; thus also Assafœtida may be useful as an expectorant - 
after infln- has been overcome in promoting the secretions. 
[crossed out] It is for these reasons that I have not introduced
the class of expectos- into my list - expecting, that the observations
which I have made on particular articles, will enable 
you to adapt [crossed out] them to the indications which the 
disease may require. In Asthma it is useful to relieve spasm -
& also the flatulency which often prevails - here acting as a carminative -
I may make the same observations respecting Carminatives 
as I have of expectorants all articles proving carminative
which overcome the existing disease of the digestive organs. In Pertussis
our medicine is equalled by no other - my practice in 
this disease is to exhibit a dose of calomel every 48 hrs - till about 
3 doses have been exhibited after which I resort to the 
watery solution of Assafœtida - in the preparation of ℥i to the pt. 
ʒi been given to a child 2 or 3 yrs old every 2 hrs. With this 
practice I am very much pleased, as it always renders the disease
mild [??icnes] the violent paroxysms of coughing & probably 
shortens the duration of the disease - In mania a potu it is 
useful - & where persons are endeavouring to overcome the 
habit of intoxication, the use of garlic & assafœa- are very necessary -
x The dose of our medicine is from grs v. to ℈i. Large doses 
however are apt to incite nausea & should met be used, 

78

I usually [crossed out] dissolve ℈ij in ℥iv of Rose water, ℥ss being
the dose - as that in this there is grs v. of the medicine which is 
to be given every hour or 2 hours. It is also given in Glysters ʒij 
to 1/2 pint of mucilage - half of which is to be administered at 
a time - This is said to be useful in cases of ascarides of this I 
have no experience - preferring always the turpentine.
Very analogous to this is the Gum Ammoniac - which is perhaps 
the best expectorant we possess ʒij being [crossed out]
dissolved in ℥viij. of water - the dose is ℥ss. The following
is the formula which I usually employ - ꝶ Assafa- ʒij - Acet.
Scilla ℥ss - laud. gtts Lx. mur. G Arab. ℥viij. ♏︎. this I 
have used very frequently & with great advantage -
Lecture 58th- Feby- 18th-
The Valerian is another Antispasmodic which is more used than 
most others, It grows in Europe but not in this country - the root is the 
part used which comes in slender fibers attached to one head, It has 
a disagreeable smell & a bitter taste, like all other roots it yields its
virtues to alcohol & to water - It is certainly a stimulant article &
acts as adiaphoritic & diuretic, occasionally as a cathartic & emetic
Dr Cullen thinks it has some power over epilepsy - in this disease
many have employed but it very often fails - Dr Barton thinks that 
it will relieve but that it will not cure - In chorea - in hemicrania
it has been tried but unsuccessfully - Fordyce in these cases recommends 
that ʒss should be administered 3 times a day - Richter
used it in Gutt a Serena, but I believe that in genuine cases 
of this disease it is of no service. In febrile cases it may be 

80.
x It is also given in infusn- but it deteriorates when 
long kept - its [crossed out] active parts being volatile.

useful where a tonic & diaphoretic power is wanted - It possesses
no anthelmintic virtues - although this has been supposed to be 
the case. Dr Cullen advises it to be given in substance in the 
dose of ℈i to ʒi. x 
The crocus Sativus as saffron, I have so often used without benefit that 
I am disposed to throw it out of the list altogether - so also the 
essential oils - these are all stimulant & all carminative - & are 
often given in small doses with other medicines by which these only 
be retained - this effect is obtained by their stimulant power -
Tar & tar water are used as antispasmodics - they act partly 
in this way - & partly as stimulants [crossed out] are useful in complaints of 
the chest & in dyspepsia - I have also employed them with advantage 
in scrofula. The Warm bath possess very useful 
properties - which I have not time to detail, its greatest virtue
however is as an antispasmodic. - The Allium Sativum
is another article which we must not be pass over - This is 
much used by the Spanish & French as a condiment, more as than in 
this country - Cullen has ranked it under [crossed off] his stimulants, but 
it is also an antispasmodic & may be properly considered in this 
place. It has a strong odour & a peculiar taste; the bulbous 
root is the part employed - the juice of this rubbed on the skin in 
flames & sometimes insinuates it, but in this respect it is inferior to 
the oiliquose plants - Often in cases of local inflan- it is useful,
frictions with the juice are serviceable in [crossed out] Pertussis.
Also in certain cases of deafness it is useful when inserted into
the external meatus by exciting the secretn- of corumen, but I 
prefer more stimulating articles as the Tr- of Cantharids.
In the stomach it acts as a stimulant & promotes digestion 

82.
x denied this - asserting that we have many times - which 
are not bitter & many bitters which [crossed out] give no evidence
of a tonic operation.

but in this country it is not much used - there is no article however 
that is more safe & useful as a condiment - It is customary to 
take it by swallowing a clove at a time - it is better however - divide 
it into small pieces - sometimes the juice is employed internally.
In diseases it is not to be employed where there is much
fever - it often possess by the kidnies & it is probably absorbed 
into the circulation. After the reduction of febrile action it may 
be employed with advantage in many cases - In Intermittents
it is not attended with much successes Sydenham used it in 
dropsy - in the pectoral complaints it has been much used 
but it is not equal to the squill - in many diseases of the 
stomach & bowels it has been employed.
Tonics. These form a class of remedies which leaves the 
body stronger, in this respect differing from stimulants narcotics which 
leave the system exhausted & debilitated. - But I believe that 
this is not the only difference, but that they materially differs as 
much so as cathartics & emetics. A certain state of the muscular 
fibre is necessary for strength, & tonics are those medicines which 
impart this - thus food may be considered as a tonic but we 
mean to confine the team to those medicines which give tone to the system by 
a certain impression - As to the nature of tonics - Dr Cullen
attributed it to some quantity which gave them a bitter taste.
Dr Barton x [crossed out] the question however
is of but little importance, we may however observe that bitterness
generally accompanies a tonic but the power of the medicine
is not proportioned to its degree of bitterness - Some other properties
of an article may overcome its tonic power & thus render
it useful when employed with this intention - thus the narcotic

84
x. It is in the same manner they act on the alimentary
canal -

narcotic power prevents its action as a tonic. Tonics do not 
act only on the muscular fibre, but they permeate every part 
of the body - They make an impression on the stomach which 
as in other cases is propagated to every other part - Thus it 
is in the first place propagated to the muscles increasing their time,
2nd- to the brain when that organ is debilitated - 3rd- To the 
Nerves - when these are incapable of performing their usual 
functions 4th- To the absorbents - as in dropsy where they have 
lost their [crossed out] natural activity & power - 5th- To the Cellular 
membrane which enables it to retract after the distension
water in dropsy - 6 To the blood vessels - increasing their power
-Increased frequency of the pulse is by no means an evidence
of strength - many other properties are necessary to indicate
this state - which can only be learnt by experience - 
7th- To the skin - as is well seen in the effects of the elixir of vitriol
stopping the perspiration - x Thus we might trace its 
influence to every component part of the body - The Tonics observed:
This question, I have already in a great measure on seeds.
Some of them may be absorbed, but their beneficial action 
is not to be explained by this - these operate altogether by the expression
on the stomach - Tonics have been called permanent 
stimulants - how long they continue to act is very doubtful -
they have received the above name as they are not followed 
by the exhaustion which succeeds the stimulant & narcotic 
medicines. As to the diseases in which they are useful
those will be noticed under the individual articles -
I shall consider the whole under the two divisions of 

86

vegetable & mineral Tonics - Of the former upwards of 40
are on the list - but I shall content myself with naming
the most important - & first of the Peruvian Bark 
This we place at the head of our list as being the most important
tonic we possess - Dr Barton has eulogized it too highly, maintaining,
that it is equal  to all others of the class. It is now more than a 
century since it has been in general use. In 1638, it was discovered
& was named Cinchona - from the Countess of Cinchona, - in whose case 
it was first employed; in 1649 - it was introduced into Europe
by the Jesuits - who were very successful in its use - they gave ʒij
at a dose - & it was very seldom [crossed out] that more than 2 or 3 doses were necessary - sometimes
one was sufficient - The Botanists enumerate 14 differt-
species - but there are only three species which are generally known & which 
probably compromise most of the others - 1st- The Cinchona Lancifolia -
being probably the same as the pale bark [crossed out] it was the first used but we do not see it 
here the tree is tall & thin - & is found on the Andes in Peru - The 2nd-
is the Cinchona Oblongifolia - this grows to the height of 120 ft. it 
is the same with the red bark of the shops - The 3rd- is the Cinchona
Cardifolia - this is small & has rough leaves; it is said to 
furnish the yellow bark. Much has been said of the comparative 
[crossed out] strength of these different kinds - the red is generally the best 
but it is likely to be adulterated & the preference is usually on 
this account given to the pale bark which comes to us more pure.
The bark has a bitter taste, with some degree of astringency
& some aroma - when first taken into the stomach it produces
very little effect. The investigations of the Chemist have 
thrown very little light on this subject. Look at Dr Percival 

88

89
Lecture 59th- Feby 20th-
The use of the Cinchona in the treatment of diseases, is always
to be directed under the belief of its being a decided & powerful
tonic. The case to which it is particularly adabted is the Intermittents
Fever. The first question, says Dr Cullen, is 
what time is it to be given? Boerhaave directs it, after the 
disease has existed for some time as he believes it exhibited
too soon it does mischief. It should however be exhibited early 
in the disease, - delay however is by no means dangerous - & it 
is often necessary to resort to some preparatory measures. When 
there is much action an emetic, cathartic or even V.S. becomes necessary -
It is very customary to commence the treatment of all
fevers with an emetic - this is very excellent practice - but it is 
so disagreeable, as not always to be submitted to - & in most 
cases a brisk mercurial purge is equally effectual & not unfrequently
puts a stop to the disease. In the subject of the Peruvian
bark I must beg you to consult Dr Cullen, as he is 
here very valuable - This examination how far visceral obstruction
for biles the employment of the bark is one of the best examples
of medical reasoning with which I am acquainted. 
Where there is visceral disease, the state of the organ affected
is to be attended to - if there is much inflamn- bleeding becomes
necessary - but these diseases however require remedies not usually
demanded by the fever - such as mercury which is very 

90.
x Lead is a warm advocate for its early exhibition -
there has no advantage gained by giving it the moment
the sweating has ceased - nearer the ensuring paroxysm
will be better -

useful, proper time of employing this is after inflamn- has been 
subdued - Should the bark be employed during the paroxysm or 
not. I decidedly say during the apyrenia - Vin this I am in consonance
with most of the practitioners of the present day. Should 
it be employed near the paroxysm or not? Dr Cullen directs it 
to be used near to the accession - I should directt it at the 
latter part of the interval, but where it [crossed out] incroaches on the 
accession it does harm - In Quartans - Dr Heberden directs it immediately 
before the attack - but I thank not it would be 
preferable to employ it during the last day of the intermission, & to 
give it freely before the paroxysm comes on - Dr Barton exhibited
it during the whole of the interval - but this [crossed out] is by no 
means necessary - x - I do not believe with Mr Horne that 
it is necessary for the bark to be absorbed - I have however 
already stated my views of the modus sperandi of those articles 
& need not now enlarge upon it. The usual dose of the bark
ʒi - I exhibit this quantity every hour during the last 8 hrs of 
the intermission - Some practitioners advocate its employment 
during the whole course of the paroxysm & intermission - Dr Clarke 
is one of this number who however exhibits it more freely during the 
intermission. This practice is contradicted by all our speculative
notions & what is more important, by the experience of 
all our physicians. The bark is best exhibited in substance -
but it is often necessary to consult the taste & stomach of your patients -
& to prepare it in some more agreeable form - In the W. Indies -
they usually exhibit ℥i. at a dose - & they speak with 

92.
x. These remissions should be well marked - they occur
only in the latter stages of the disease that is during the 
convalescence - During the [crossed out] violence of the disease
bark is improper -

much confidence of it when given in such large doses. If the bark
[crossed out] should be rejected by the stomach - a decoctoin may be made of 
℥i in a pt of water with a little cinnamon or orange peel,
this is to be strained & 1/8 part is to be given every hour or 2 hours 
It is often in such cases combined with the Serpentaria - In 
those cases of intermittents in which there is a determination to the 
head - V.S. & blisters must be previously used. In Remittents
bark has been much used, [crossed out] in this country they are generally
too inflamy- but where it is proper to exhibit the bark the remissions
are the proper time - x In Typhus Graviar - & Meteor 
the Cinchona is very valuable - but in general it is too feeble 
by itself - wine, brandy, vol. alk - &c - are usually demanded.
In [crossed out] the Plague bark has been employed, but this disease we 
never have had in this country - In the Phlegmasiæ, it is never
to be employed where there is much inflamn- in some slight
cases it may possibly be allowed - Cullen thinks, that it may 
be in some instances resorted to after the inflamn- is subdued -
but Morton advises that after one or two bleedings in inflamy-
rheumatism, the bark should be exhibited - Fothergill
& Haygarth go upon the same plan - the last of these states
that out of 121 cases, the bark proved injurious in 4 only -
this is more successful than my plan hitherto adabted, but 
in this country such practice will by no means answer 
The disease here requires the free use of the lancet - & 
use bark whatever - There are some cases of rheumatism 
arising from or so closely connected with intermittents,

94
x. In headache it is sometimes useful - I have lately
cured a case of periodical headache - the paroxysms of which 
had returned every other day for 10. yrs: by exhibiting
first an emetic & then [crossed out] employing the bark in 
small doses.

intermittents, short the bark may become necessary, not however if 
any Inflamy symptoms are present - In hemicrania - it has 
been recommended by two of my predecessors Drs Barton & Chapman 
Suet of its efficacy in such cases I have no experience - x In Gout - Dr 
Barton thought very highly of it - In dysentery it has been recommended
by many high authorities - & been condemned by others - These I shall 
not quote but content myself with observing that bark is altogether
inadmissible in this disease; during the convalescence - after the 
disease has creased it may be employed - & then only. In pulmonary
complaints it has been employed, but I think there is no case to 
which it is applicable - In what has been called [crossed out] Pleurisy of the 
head - where there is cough - pain in the side - dyspnea - & violent headache, 
it is said to be useful, but I have never seen any case in which 
it would be proper - Bilious Pleurisies require the lancet rather than 
the bark - In typhoid Pleurisy we often resort to the bark - serpentaria -
&c - In Consumption it has been much used - in the early 
stages it is undoubtedly very hurtful - & Dr Cullen observes that it 
is hurtful in 9 cases out of 10 of Phthisis. Morton & others 
maintain, that it is productive of no injury - this I am disposed
to deny - & have great doubts whether the bark is not in admissible
in all cases of pulmonary disease. In erysipelas the practice
in Europe & this country is very different - there they give 
bark & tonics - here we resort to V.S. and the antiphlogistic system -
Eruptive diseases are to be put on a fasting with other inflammatory

96
[x In cancer, I have never seen it useful, otherwise
than as a Tonic -]

inflammatory affections - if we find an excited state of the system
we bleed. if the system is prostrated it is to be raised by the bark 
& other tonics. x In active Hemorrhagics - the bark is certainly
not to be employed - There are however cases of passive hemorrhage 
where the bark from its tonic powers is very useful - In the New 
roses there are many cases in which it proves hurtful, in some 
it may be useful - In Epilepsy it has not proved of much service -
In Chorea - Dr Hamilton has insisted on purges almost 
exclusively. these however will not always succeed I have a case 
now under my care in which they have failed - Dr Thush & Dr Hosack
have each had a case in which they were successful
put it should be observed that each of them exhibited wine very
freely at the same time. In Pertussis bark should be confined
exclusively to the last stage - Dr Barton observes that it 
sometimes assumes the intermittent type & then the bark is useful.
These cases I have never seen. In Asthma it has not been
used with any great advantage, & only allowable where the digestive
powers are impaired. In scurvy more confidence is to placed 
in vegetables & in Acids - In scrofula when there is debility
[crossed out] the bark is to be employed. Drs Fothergill relates a case of 
Ophthalmia - arising from Scrofula which he cured in one month 
by bark & by a diet of animal food - I should place confidence
in the lancet.