Dr. Parrish
Contd


1
Twenty Second Lecture July 3 1834.
On the Treatment of Malignant Cholera.
We have stated that when Cholera appeared
here in 1832, Diarrhea prevailed very extensively as
 a premonitory symptom. As this was an evidence
of the prostration which was about to ensue if it
were not checked, it appeared plain that it would 
not be proper to treat this as the ordinary bilious 
diarrhea by a purge etc. It was the signal of an 
approaching enemy, & after various trials, Dr Parrish
found no recipe more effectual in checking it, than 
the Camphorated Mixture composed of 
Aq. Camphora f ziii
Sp. Lavnad. Comp. f zi
Sacch. Alb. zii
M. Give a tablespoonful every 2 hrs, & add from 
15 to 30 gtt Laudanum, according to the urgency 
of the symptoms. Sometimes the Cretaceous mixture
was preferred.
He also recommended some Port Wine Sangaree,
made by taking about a Wineglassful of good Port 


2
Wine, pouring it in a tumbler, adding a little 
Loaf Sugar then filling the tumbler with boiling
water & grating over it some nutmeg. Chicken
water, Spiced Beef Tea etc. were also given.
In some cases, he directed some Spiced Syr. of Rhub.
a desert or Tablespoonful every 2 or 3 hrs. with or 
without Laudanum according to circumstances.
The treatment should be Cordial, Restorative but
not Drastic.
If the stomach was very irritable sometimes apply 
the Spice Plaister, or use Injections of a Cordial
nature, as for inst. a wineglassful of Mucilage of
Gum Arabic with a little Port Wine perhaps 
a little Laudanum.
Sometimes however the Premonitory Symptoms 
were of a Dysenteric Nature, then a dose of 
Castor Oil with from 15 to 30 gtt Laudanum was 
applicable, but at the same time keeping a steady
eye upon the first approach of Diarrhea.
Soon after opening the Cholera Hospital, we gave
strong stimulant in the very first stage, such as 


3
the Camphor Mixture with the Arom. Spt. Amm.
but this was soon laid aside. It was very evident
that weak Cordial treatment was better 
adapted than concentrated strong cordial or 
stimulant. Ardent Spirit in any shape was not 
acceptable or suitable even to the drunkard.
[Illegible] Gout Cordial seemed to suit some patients very well.
The Tin Apparatus for healing the patients, was 
soon abandoned; they could not bear it.
Emetics were sometimes useful. Salt & Water 
when the stomach was overloaded proved serviceable
Dr. Stevens Remedy was tried, but its results 
were not flattering What was it?
Sinapisms were not well [borne], too great sensibility in some cases
When the patient passed to the second stage,
it was necessary to rise higher in treatment,
anodyne Injections
& we frequently employed a remedy of which 
we have before spoken as useful in hemorrhage,
pils of Acet. Plumbi  gr ifs
[Kino] grs ifs or grs ii
Opium gr 1/6
Sometimes [Galls] etc. & other astringents, but the lighter 
Cordials held the preferences.


4
Sometimes the Perspiration was profuse & morbid
according to the view of “Disintegration,” & to check 
it, the patient was rubbed with a saturated solution 
 of Alum & Brandy, then wiped dry.
Sinapisms often acted happily, but some patients 
from the excitement of the nervous system could 
not endure them. Dr Roe of N. York recommended
a stimulating ointment composed of 
Ung. Merc. Fort, Camphor & Cayenne Pepper.
Blisters were sometimes applied, the cuticle
removed & the spot dressed with Merc. Ointment 
& Grey Ox. of Merc. Minute doses of Calomel
were also tried so as to influence the Liver.
Nutritious diet was used & among other things
Pap made by taking some best wheat flour, tying
it up in a cloth, boiling it for several hours
till it becomes hard as Chalk, milk thickened
with this grated into it, together with Nutmeg,
was delightful to the patient It is Astringent
The Malt Liquors were sometimes grateful and 
serviceable as Porter


5
The indications in the treatment then were 1. To
check the inordinate discharge, 2. To bring about 
mercurial action & 3. To support the strength.
This was the treatment for profuse evacuations,
but there were other cases of violent spasms with high
arterial action. then it was proper to clear out 
the stomach, & sometimes even to resort to the Lancet
& to opiates. Inhalation of Ox. & other Gases.
In the state of Collapse, various remedies 
were tried, but all seemed of little or no avail.
Bleeding was much extolled, but upon trial, it, too,
was found ineffectual. If a recovery from 
this state, ever took place, it depended upon that
unknown, immeasured, innate power of the 
system, of which man known nothing.
We have already alluded to the deceptive
symptoms which appeared in the last stages, when 
Nature made her last expiring effort. This often
[illegible] [illegible] [illegible] time as being the result of Bleeding.
We will now close the subject with a few 
general observations, which may, perhaps, be of
service at some future period.



6
The indiscretions of medical men, were one 
great, & we might say the only cause of the popular 
commotion, which existed in this city.
The practice of trumpeting abroad medical 
pranks (as they may be termed) brought on the 
difficulty. If a man conscientiously believes
that one or another practice will produce a happy 
effect, let him make the experiment, but 
let him not sound it abroad thro’ all the [News]
papers, until he is fully satisfied of its advantage
Medial men must not only examine 
& provide for the body, but they must also look 
beyond that to the mind. Now, if we recollect
that an ignorant man is brought up with different
views & feelings from men of science,
that he has a dread of a Doctor, we can 
in a slight degree, imagine what must be his 
feelings, when, upon the page of every newspaper,
he reads various accounts of dissections etc. & at
the same time knows that if he is attacked & 
dies, [illegible] becomes a subject for similar treatment.



7
The importance then of attending to the mind,
should never be overlooked; & in filling up 
the Hospital by Dr P. it was duly attended to.
A great variety of beautiful flowers was interspersed,
& both within & without presented a beautiful 
appearance, to lay aside, if possible, the 
gloominess of the scene. Besides this, gloomy 
conversation respecting dissections etc., was totally 
excluded, & above all, due regard was paid 
to funeral decency, & indeed this latter to the 
mind of an ignorant individual is a matter 
of vast importance.
Remember then that the Influence of Mind
upon Matter is great, & that no man can be 
an intelligent physician who overlooks that
part of the subject in practice. 


8
Twenty Third Lecture July 7 1834
Cholera Infantum, is defined to consist in 
a vomiting & purging of infants, & is commonly 
called Summer Complaint. The chief cause
of it is, extreme heat in crowded & badly ventilated
places, & also bad diet. It is evidently caused
by heat, because it never occurs except in hot weather.
The summer of 1806 was remarkably cool, & there 
was comparatively little sickness.
We have already said that the common Cholera 
of adults rarely proved fatal with proper treatment,
but in children, the revers is the case, Cholera is
very fatal. Now what is the cause of this difference?
We answer that on the tender infant, heat has a much 
more powerful influence, than upon adults who have
long been accustomed to endure it. If we walk thro’
the alleys & Lanes of the City on a hot morning succeeding 
a hot night, they may be seen reclining on 
the bosoms of the mothers, with a cold, [clam??]
skin, shrunk neck etc. evidently showing their
suffering from the heat.


9
Dentition is another cause of the disease; to this 
diarrhea sometimes supervenes, & the case then generally 
proves fatal. The attempt to arrest the disease
by medical treatment while these causes prevail,
may be compared to an attempt to reduce the 
inflammation of a punctured wound, while the 
thorn remains in the flesh. The hot weather,
dentition etc. continuing, only aggravate the disease,
& make a cure almost beyond hope.
Some die in a few days, others in a few weeks,
some terminate their lives in convulsions, others, just 
[illegible] death, have the red blood traversing the eye,
from the debilitated relaxed condition of those vessels
which in health carry only Serous blood.
Another circumstance worthy of notice, is that if 
you put your hand upon the knee or leg of the little
patient in Cholera, you will find its extremities [cold].
Treatment. When Dr Griffith was asked the 
question, what could be done to prevent so great mortality 
among the young patients affected with 
Cholera his answer was one well worth remembering 


10
He said “lance their gums & send them out of town.”
This advice is very good for those in affluent circumstances,
& who are able to comply with it, but it 
unfortunately happens, that a large majority of
cases occur int e midst of poverty, where they are 
unable to be sent to enjoy the fresh country air.
Hence then when called to a child in these circumstances,
we find him with a cold, clammy skin,
shrunk neck etc. & we commonly commence with 
a little chicken water; & small quantities of Soda
Water may be given frequently repeated. It may 
put in a zfs vial  & corked & kept in a cool place,
then when the cork is drawn & the mouth of the bottle 
applied to the child’s mouth it will [illegible] with avidity
thus the bottle may be kept & often applied.
In the country, it may be found by dissolving the 
Soda Powders & giving a little at a time.
Sometimes the stomach will reject everything & 
we are compelled to resort to external applications.
Then the Spice Plaister may be employed, made
however differently from that used for adults, 


11
it must contain much less Pepper, not more than 
a teaspoonful because the tender patient cannot
bear it.
From an examination of the stools, it will be found
that the secretory functions are impaired, especially 
those of the liver. Here then, very minute doses 
of Calomel have a very happy effect. Case a few
nights since, lanced his gums, & gave him 1/8 gr Cal.
about every 2 hours, just dusted over his drink.
Sometimes the Spiced Syrup of Rhubarb, or the 
Rhubarb & Nutmeg Tea prove serviceable. 
After these have operated we may restrict the evacuations
by for instance
Pot. Carbonas (Sal Tartar) [?1]
Sacch Alb.
Acac. Gum aa zi
Aq [Ca???] zifs
Tinct Opii gtt vi
of this, give a teaspoonful every hour.
Sometimes however something more astringent
may be necessary & we may prescribe a mixture 


12
of Ost. Prep. or Creta Prep. zifs
Sacch. Alb.
Acac. Gum aa zi
Aq. Cinam. f zifs
Give in about same dose.
We have mentioned that during the attack the feet
& legs are cold & clammy, consequently, it is proper 
that the child should wear thick woollen stockings, 
as much so as in the midst of Winter, for it is all 
important that the extremities be kept warm.
But while attending to this, we must not forget that 
the child must enjoy cool air & cool water.
If the gums are swollen or doubtful, lance them.
It is sometimes objected by mothers, & even by some
medical men, that if the gums are lanced too early 
the teeth will not come thro’ but a cicatrix will 
form, thro’ which it will be more difficult for the
teeth to pass at some future period, but this is
absurd, for experience teaches us that a cicatrix
is much more tender than the original
true covering. 


13
When Dentition is connected with Cholera, if the patient
be not soon relieved after lancing the gums, apply 
blisters behind the ears. This is learnt from the fact 
that during dentition, sores frequently appear behind 
the ears of children, showing that Nature fixes upon 
that as the spot for counter-irritation. We see also
that the little creatures will sometimes be continually 
scratching behind their ears, hence, we must 
scratch for them by means of blisters.
In some low cases blisters to the wrist prove beneficial
Great attention should be paid to the Diet. If
the system be reduced to a low state, we may 
give Animal Soups, Beef Tea, & even Weak
[illegible] [illegible] [illegible] child take it till [illegible]
Milk Punch, but care must be taken that its use
do not become habitual also some best Mad. Wine
After the early symptoms have passed, we may 
prescribe Bark (powdered) zfs
Bruised [Cinam] zii
Lime Water f zviii
Stand for few hours, then decant & give a teaspoonful 
or [illegible] spoonful several times a day


14
The Infusion of Dewberry has been recommended
by Dr Chapman. Small portions of Port Wine
These remarks, it must be recollected, apply 
,more particularly to those who cannot be removed
out of town. But tho’ they cannot do this, it is 
well for them to take the children early in the 
morning to some such place as a Public Square
& remain there in the shade, enjoying the cool air
till evening, or over in the woods at Camden.
The country-air is so very beneficial that we cannot
too strongly recommend it. Case of son Isaac, 
who was almost in articulo mortis, revived by 
a journey in Steam Boat up to Burlington to enjoy 
the fresh country air.
Cholera Infantum sometimes assumes a chronic form 
& then the patient may continue for weeks.
Important to attend to language of [infancy] & of Nature.
Salt Food is generally preferred by them, & in these
cases it is often proper to allow them that food 
for which Nature more earnestly calls. Thus, cases 
have been known to be benefitted & we might [illegible]
cured by the use of [Ham?], Butter, Salted Herring 


15
etc. And knowing this to be fact, Dr P. sometimes
directs the Ess. of Ham to be bottled up & 
kept in a cool place, for use.
It is an unfavourable symptom to see a child 
with a morbidly voracious appetite; or with an 
apthous state of the mouth. One case of recovery 
from sore mouth, under the use of Lime Water & Bark
Wistar’s remedy for it was Scalded Lemonade.
Case of a child whose stomach rejected everything that 
could be given to it, until, at last, a teaspoonful 
of pure cold water was given it, which seemed to 
agree with it & it revived. Bark Jacket.
It is proper to keep the surface of the body warm, 
but the main remedy to be depended upon is Fresh Air.
We do not consider the disease, as inflammatory,
& consequently think bleeding improper.
[illegible] is [carried] on from [exhalants] sometimes too much
But “Prevention is better than Cure,” hence we would 
advise that windows should be left open during the 
warm summer nights, so that air can circulate
freely thro’ the apartment. Courts & Alleys improper.
Their cry for Cold Water is often answered by 


16
the Mother or Nurse, with warm Teas & other like
nonsense to cure the Cholic, when if a little Cool
Water were given, they would soon be quiet.
They should be washed in the morning with cool Water
& kept comfortable thro’ the day. That might 
often be prevented, a disease which carries off great
numbers of our infantile population.
Case of child of Frenchman, whose family 
had lived upon weak & vapid food, he, thinks
that was the proper diet to prevent disease;
it was directly the reverse. Several children
had died & this one was placed under prophylactic 
treatment in order to prevent an attack.
(See N Am. Med. & Surg. Journal).
Antidote for [Arsenic] lately discovered [illegible]
Hydrated Perox. of Iron recently prepared & given [illegible]
in about 12 times the quantity of Arsenic taken. 


17
Twenty Fourth Lecture July 10 1834
ON Poisons. The importance of the stomach to 
the Animal Economy is well-known, hence it is 
plain that if a poison be taken into it, the effects
of it are soon felt upon the whole system.
Among those which are most fatal when 
swallowed, we may place at the head of the list,
Arsenic. The effects of this in large doses have
often been seen & noticed. Case of 1816 a Frenchman,
who, Love Affair in a paroxysm of insanity, swallowed about 
ziii of it, & died in about an hour.
An examination showed that his stomach was
completely seared or cauterised.
We may here make a remark that the
practice of using Arsenic for the destruction of 
Rats is improper, for the poison may be conveyed
by them, to places & by means, little suspected.
To illustrate this, we will mention the case of 
a family, who went into the country for a short
time & during their absence, sprinkled some Arsenic
about the house, on the dresser etc. A 


18
salt vase stood upon the dresser uncovered & over 
this, the rats travelled, leaving it in sufficient
to affect the whole family; for one day after
their return, they partook of a dish seasoned
with this salt, & soon after every one was sick.
This practice, therefore, of thus using Arsenic should
be abandoned, for, after poisoning the family itself
the rat may, in the next minute, be rolling in the 
flour-barrel of a neighbour & thus injure them also.
It should be absolutely prohibited by law.
Another case of supposed poison from this, occurred 
in a large family, residing near Dr Parris’s
After eating a meal, they were siesed with vomiting.
Dr Neal was called in & found them all affected
with vomiting & great distress about the stomach.
Dr Parrish was called in consultation.
One youth was worse than the rest, & from the history 
of his case, it appeared that he did not partake of 
much supper & consequently had but a slight attack
in the evening, & in the morning prepared & ate his
breakfast, whereby it is probable he got another dose


19
& his attack proved fatal. Drs Griffith, Neal & P.
were in consultation. The neighbors, who went in to render
assistance, after taking all possible care as to cleanliness,
etc. ate some food prepared, & they seemed to get
sick. Their sickness, however, appeared to arise chiefly 
from imagination for they were soon relieved.
On examining the body of the dead youth, in presence
of the Coroner & Jury, the stomach presented a red
appearance as in Malignant Fever, but from the preceding
symptoms, the physicians thought that the 
death was occasioned by Arsenic.
We will now relate an incident which here
occurred, which is important in its bearing & instruction,
in more than one point of view.
The Master of the House was one of those men of 
peculiar, vindictive mind, who, instead of referring 
the thing to accident, continually sought for a victim
upon whom to charge the nefarious deed. A poor 
servant girl lived in the house with her child, & he 
fixed his suspicion upon her, he inquired more particularly 
into her character than before & learnt that 


20
the child was illegitimate. This increased his suspicion,
& he went & laid his complaint before the 
Coroner’s Inquest, consequently they were obliged to 
investigate the matter, & the whole was brought before
the public. He & his wife, both well drilled,
deposed that the girl only feigned sickness, & 
the testimony of the physicians, Neal & P. not agreeing 
with this; the accuser called their judgment
in question. Here then stood the cause 
with statements pro & con, when at that critical 
moment, a though providentially came across 
the mind of Dr P. He recollected that on visiting
the family in the morning, he had examined the 
tongues & found them remarkably furred & white;
he immediately requested, after explaining his 
views, that a line should be formed & a display 
of tongues made in order that the Coroner 
& Jury might judge for themselves. It was granted, 
a “display of tongues” was examined by Coroner & 
Jury & they were perfectly satisfied that the
tongue of the accused girl, was quite as white 


21
& as much furred, if not more so than, the others.
This then convinced them that she was similarly 
affected the rest & they accordingly acquitted her.
This, however, did not satisfy the thirst for vengeance
of the master; from a testimony which he afterwards 
made before a magistrate, he had her arrested & confined
in Prison until the Court of Oyer & [Termi?ar] came
round, when she was acquitted without hesitation.
Such a piece of brutality & revenge should receive
severe but well-merited treatment.
We will next take up Laudanum. Death, from this
taken in an overdose, generally occurs among children, 
but adults sometimes resort to it for suicide.
A prevailing & popular idea is that medicines grow
weak by age, & to Laudanum they apply the same
rule, sometimes with great detriment; for we know that
the contrary is the case, because from the evaporation of 
the Alcohol small particles of [illegible] will be deposited, & from this
turbid solution, sufficient opium might pass out in one 
drop to kill a child. Several instances of this kind,
have come under the notice of Dr P. Case of a young 


22
infant, to whom he was called, & found under the influence
of Laudanum. Upon enquiry, the mother said
she had given it but 3 drops, but from its effects, the Dr
felt inclined to call her memory in question. On 
going to the Apothecary’s however, whence it had been 
obtained, it appeared that he had dispensed it from 
the large bottle in which it was originally made, & consequently 
some op. had flowed out with it. He recd
a lecture for his carelessness which was probably useful.
Another case of child afflicted with Catarrh, some
Laud. was given it which had been long standing in 
the bottle. They shook it up, added a little water & gave 
it as they supposed a small & weak dose, when in 
reality, it was a death dose. Also another similar.
Being once called in consultations with a practitioner
in the country, Dr P. proposed giving some Laud. & upon 
asking the practitioner if his Laud. was clear & good 
he seemed to laugh & think it of little consequence
On asking to examine his bottle, he showed it, & it was
turbid. Dr P then showed the impropriety of administering 
such & gave him a serviceable lecture.


23
The symptoms which present after swallowing an overdoes
of Laud. are well-marked. In about ½ an hour or an hour
the patient feels its influence, he has stertorous breathing,
slow, full & laboured pulse, livid colour dark, purple of the countenance,
contracted pupil etc. & an experienced practitioner
can rarely be deceived as to the cause Smell his breath
Case of a young lady, whom P. was called from his bed
to see very early one morning, in consultation with a 
very respectable practitioner, who thought she was very 
singularly affected. He found her in a state of profound
coma, with stertorous breathing, livid countenance etc.
& he immediately suspected that Laud. had caused the mischief. 
He made this communication to his medical 
friend, & leaving him to make some inquiries, he returned
home for a stomach-tube. From the inquiries etc. they 
were induced to search the room, & at length in the closet,
they found the Laud. bottle almost empty, & upon it, the 
name of the Apothecary whence it came. It was ascertained
that the afternoon previous the young lady had
obtained zii Laud. & thus the disease was explained.
She had passed beyond recovery & died.


24
Treatment. Formerly Emetics were the remedies
upon which medial men relied, with a view of endeavouring
to evacuate the stomach of its noxious contents.
These, however, if not given soon after the poison,
were often ineffectual. One case of a woman to 
whom large quantities of Tart. Em. Ipecad. & Sulph. Tinc.
were given, tickled her fauces. N.S. to relieve congest of brain applied tobacco plaster
to her stomach, kept her in constant agitation until 
at length vomiting was produced. So violent was
the irritation, necessary that next day She was attacked 
with Croup. She recovered. Dash cold water on Head
A Syringe & Flexible Tube for the purpose of washing
out the stomach are much preferable. Of these we
shall treat in Surgical Lectures.
Cases may & do occur in which after we have succeeded
in evacuating & washing out the stomach the 
patient will die. This was not fully understood.
Case of a child who had taken turbid Laud. an emetic operated
[illegible] & cleansed the stomach, but it died.
Same happened to another child.
[illegible] a vessels becomes filled with blood from the excitement & afterwards 
pour out [illegible] into the lungs 


25
Twenty Fifth Lecture July 14 1834
We now come to speak of the effects of a disease produced
by Laudanum. It follows after the opium 
has been removed from the stomach & the patient seems
From the effect of a Narcotic upon the Brain the heart ceases to act on acct
of the cessation of nervous [illegible] to continue respiration but if artificial
to die, as it were “in the arms of victory.”
Respiration can be kept up until the effects of the Narcotic [illegible] passed
[illegible]. The patient had a [illegible] for recovery 
There is a certain period, when the system receives 
such a shock from the poison, that recovery afterwards
is beyond all hope This we will illustrate 
by cases. 1818. At Cooper’s Creek, a young lady
of respectable family & connexions, in a paroxysm of 
insanity, took zii of strong Laudanum. Dr Hendry of 
Haddonfield was first called, & he immediately despatched
a messenger for Dr Parrish. He gave her Tartar 
Emetic, Citric Acid, Tobacco Injection more than [illegible], which was
immediately returned, but it produced no vomiting.
Her pulse was slow, countenance livid, action of 
her carotids powerful, & she had no power of speech
or deglutition. Dr H. bled her twice.
When Dr P. saw her, her countenance was livid, pulse
still full, could understand what was said to her
when roused, respiration laboured, & her shoulders 


26
rose in breathing pupils contracted. He introduced a flexible tube into 
her stomach, & washed it out with a syringe. She
improved, her intellect became more clear, so that she
told that she took the Laud. unconsciously. She knew 
she ought not to take it, but could not help it, evidently 
having been insane at the time. She also
expressed her fear that she had given Laud. to her
little sister who was in the room. As she seemed thus
improving the washing was continued  for an hour,
with warm water & Chamomile Tea, the injected
some Castor Oil thro’ the tube to cleans her bowels,
& withdrew it. Injected Salt & Water per [illegible]
Dr H. had already applied sinapisms to her legs,
& they now directed a large mustard Plaister over 
the stomach & prepared for stimulating internally, if
the succeeding debility should require it.
They then retired about 15 minutes to partake of 
a dish of Tea & refresh themselves.
On returning, they found her pulse very frequent
& she was much worse, she complained of being 
very dry, delirium soon followed, subsultus 


27
tendinum etc. They directed a free use of Vol. Alkali,
& stimulant drinks, & Dr P. left her in care
of Dr H. & returned home. IN about 15 or 20 min.
after he drove off, she died. Thus she took the 
Laudanum at 1 P.M. Dr P. saw her at 7 P.M. & 
left her at 11 P.M. If another case should 
occur, he would not wash the stomach so long,
but would commence more quickly upon stimulants;
as Brandy Toddy etc.
11/4 1818. At 11 P.M. summoned in haste to 
see the wife of a respectable dry good merchant, 
who, in a paroxysm of insanity, had taken zi of
strong Laudanum. On arriving at the house, the
confusion existing there was beyond description.
The woman, lay in bed, with 2 infants, one about 
4, the other about 2 years of age. The poison
was just beginning to develope its effects,
the countenance was suffused, the temporal
arteries turgid, but coma had not yet taken
place, she however, wished not to be disturbed,
but to lie quietly & sleep. Dr P. sent for 


28
Dr Wood to assist him in his efforts to restore her. He proceeded
to wash out the stomach, but at first she resisted.
He then appealed to her in the strongest language, to 
excite within her a love of life, & found but one
point upon which her distracted mind could be touched,
& that was maternal affection After urging her
with a strong attack upon this point, she at length, consented
to love for her children. He then introduced the 
tube & withdrew the Laudanum, then washed out the 
stomach, emptying it into a white basin (very important 
so as to see when the liquid is colourless & the Laud. evacuated)
Her countenance was still suffused & pulse strong, consequently 
it was thought proper to bleed her about vi
Cold water was applied to her head & dashed in her
face. Their attention was now directed to the stomach,
expecting, that since it has received so violent a shock,
[along] or spasm might ensue, & they directed a large
mustard plaster to the stomach, also sinapisms to 
the legs. Ginger Tea, Vol. Alkali, etc.
Her face now became pale, skin cool, & stomach torpid,
so that she scarcely felt the Tea, Vol. Alkali, & 


29
spt. Hartshorn, and in ½ an hour, she took a large
quantity of these powerful stimulants. She complained
of cold ankles etc. & hot irons were placed 
near them, also, hot Brandy & Cayenne Pepper rubbed 
upon the extremities. She was still cool, but more rational
& grateful for what was done for her. They 
gave her Tapioca & Sago also Brandy etc.
On the net day, reaction took place with some
fever, & the parts to which the sinapisms had been applied
were somewhat inflamed; several days elapsed
before her complete recovery. 
Dr P. had a long conversation with her privately, & 
in the course of it, she gave him a history of the temptations
to suicide under which she had long laboured,
& he was particularly struck with the remark that
after once reading of a suicide which some person had
committed, she felt a desire to do it which was almost
irresistible. This added weight to the opinion 
previously entertained that the publication of suicidal 
cases is productive of much injury, cruel to surviving 
friends, & should be frowned upon by the public.


30
Another case in consultation with some young physicians. 
2 Dr Paul’s & Dr Matthews. A young woman,
who had determined to destroy herself, took a 
quantity of Laud. in about oi of Cordial. About 1 ½ 
hours elapsed, before Dr P. saw her, she was then in a 
profound stupor, the pauses between her respiration were 
so long, that she seemed as if dead. At last, a very low
pause occurred, one of them said they felt no pulse,
& they though her dead. Just as Dr P. was about to 
withdraw the tube, another effort was made a respiration.
They then persevered, washed out the stomach,
& immediately injected strong stimulants, as Ginger 
Tea, Vol. Alkali etc. applied large sinapisms, & her 
condition seemed so los, that he took a burning brand 
from the fire, & applied it time after time to the leg.
At first, she did not feel it, but shortly an impression 
was made, & she was, at length, rescued.
Another case of a young man in Market St., who 
took a quantity of Laudanum in Spirit. After washing 
out his stomach, a state of collapse ensued, sinapisms, 
external & internal stimulants were used


31
but they did not rouse him. Then tried the first
brand, touched him & he appeared to feel it, repeated
it several times, & he revived. Recovered.
The practice of bleeding largely in these cases is
not a good one, because the system will be much debilitated
& we should not weaken it still more by 
bleeding. We have mentioned a case in which we 
did it, but we would not do it again, for if the 
tube is used, there is a sudden abstraction of the poison
& debility immediately follows.
The general treatment then is to evacuate the stomach 
by the tube as quickly as possible, or by emetics 
if called to the case sufficiently early; then avoid
the debility which follows.
Dr Physick first introduced the tube & the stimulating
plan, into practice in this country & we think
into the world.
Case of a vagabond, who for a wager, undertook 
to drink oi Brandy. He was a hard drinker,
drunk when he commenced the draught, & it soon 
terminated his existence.


32
Dr P. has seen children brought to the very verge
of the grave by drink, washed out their stomachs 
with the tube & they soon recovered.
One man, who was in the habit of taking Laud.
every evening before going to bed. One afternoon,
having been spent in a gambling room, in the 
evening, he was evidently under the influence of
Ardent Spirits. On retiring to bed, he took his 
Laud. as usual, but in the morning was found
dead, and as blue as Indigo.
Dr Brown, an example of a similar kind.
The late Dr Barton used to relate an anecdote of 
him of this nature. He came to London to deliver 
a lecture, & Dr Barton, who had previously 
attended his lectures in Edinburgh went to hear 
him. After lecture, he complained of being unwell,
with a violent pain in his head etc. 
Dr Barton told him in a jocular manner
that it would be a good opportunity of illustrating
practically to the class, his peculiar
views & treatment of this disease. He said he 


33
would, & accordingly drank glass after glass of 
Brandy & Laudanum, which proved fatal to him.
Dr Sansbury, now practising in Princeton N.J. 
formerly practised at Cranberry N.J. & he told 
Dr P. that while there he had seen no less than 
6 deaths among children, from drinking liquor
in the harvest-field, while carrying it to the 
workmen. The little creatures would become 
intoxicated, & be a source of merriment for 
the elder ones, & then be carried out in the 
shade to snore it off, & sure enough, they 
would sleep it off by the sleep of death.
These cases show that death from Ardent Spirits 
may ensue in the same manner as death from 
opium, & that a state of “dead-drunk” is for those 
unaccustomed to it, a very critical period.
IT is of great importance to recollect, in treating 
this disease from opium, that prostration will ensue 
corresponding to the excitement which has been 
removed, & it is proper to provide & prepare for this
beforehand, instead of waiting its approach.


34
Dr Wistar used to relate an anecdote showing the 
judgment of Cullen, which received while he was a 
student at Edinburgh. One of the students, during
the reign of the Bramonian system, of sthenic & asthenic 
pulse etc. took several drachms of Laudanum
by way of experiment. He then parades around among 
his companions in order to counteract the narcotic impression.
In the evening, he went to the Theatre, & fell 
down in the Pit; his companions, being aware of his 
experiment, held a kind of consultation over him,
& one proposed that since the stimulating effects of
the Laudanum had now ceased, they should again 
excite him by another dose. Some however objected
& in the mean time, Dr Cullen was sent for; he came 
& was made acquainted with the circumstances of’
the youth & with the proposition which had been 
made to stimulate him with Laudanum. “Why”
said he, “will you give him a stimulant possessing 
narcotic power also, when we have stimulants 
without the narcotic power?” He then sat 
down, wrote a prescription for a pretty large 


35
dose of Musk, which was administered to the 
youth & he recovered.
Twenty-Sixth Lecture July 17 1834
On Enteritis. This term is generally employed to signify
an inflammation of the bowels.
Bichat contributed much towards extending our 
knowledge of diseases by observing the relation between
the different organs of the human system. We shall 
now treat of Inflammation as attacking particular 
structures. In books, we read of Infl. of the peritoneal
covering of the different organs, but these are all 
such as may be considered the same disease invading
the same structure.
The mucous coat is also subject to Inflammation & 
the evidences of it are distinct from those of Periton. Infl.
are that in the latter coagulable lymph is thrown out, which is productive 
of serious & even fatal consequences to the
patient. Peritoneal Infl., however, is more dangerous 
than that of the mucous coat, because it has no “back
door” by which it can escape. It seldom occurs without 


36
some external violence having been inflicted, but it may 
sometimes, but real Idiopathic Peritonitis we consider
a very rare disease. Dr P. has met with it in the 
course of his practice. It is attended, with fever, pain 
tenderness on pressure, peculiar deceptive pulse, as mentioned 
in 2 cases in Lecture on Pulse.
If the patient has chills followed by Fever, with pain 
& tenderness, cautious bleeding may be advisable, but 
mere tenderness of the abdomen on pressure is not a sufficient
warrant for the use of the lancet, because it
may be owing to that nervous sensibility of which we 
have already spoken. 
Suppose we are called to a patient, & find him attacked 
with great tenderness, distress & pain in the stomach
perhaps with a furred tongue, his distress increasing, 
physiognomy bad etc. there we may suspect a case 
of Peritonitis. The sudden relief sometimes afforded
to the patient may deceive a young practitioner.
From having been restless, in pain etc., he will become
tranquil, quiet & comfortable, & himself & friends as 
well as the doctor if unacquainted with the 


37
disease, may congratulate themselves with these 
apparently pleasing symptoms. Experience, however,
has taught that the calm is only that which 
foretells the coming storm, that it is the messenger
of approaching death; we have a cold skin, feeble
pulse etc. & the reason that the pain has subsided is
that either mortification has occurred, or something
like suppuration in the abdominal cavity.
Sometimes the pain continues till death.
This disease may approach very insidiously, & the
patient may keep about for several days during its approach,
unconscious of his danger. He has a great deal 
of pain & distress, & if he attempts to walk, leans forward
so as to relax the abdominal muscles, when 
lying down, the same principle is carried out, his
limbs are drawn up & often lying on his side.
Treatment. The Lancet is indispensable, & must
sometimes be used to a very great extent. Unload the
bowels with a mild Cathartic, such as Castor Oil
Neutral Salts etc. give demulcent drinks as Barley 
Water, Flax seed Tea etc. & injections of the same, if 


38
necessary, to sooth the bowels. By accounts received
from beyond the “Great Waters” Spts. Turpentine has
been only beneficial in Puerperal Fever etc. It acts
by stimulating the lining membrane of the alimentary 
canal, & thus depleting, by increasing the secretions.
Local Depletion is also very important. Fomentations
& Blisters to the abdomen should not be neglected.
As to the Fomentations, they should be regulated
buy the patient’s own feelings, if they make him 
comfortable, continue them, if not, omit them.
Dewers says that in Puerperal Fever, he places more
reliance upon Turpentine than Blisters.
Sometimes the Warm Bath is very useful.
The insidious approach of this disease can be 
illustrated by a few cases.
A very valuable & interesting woman was safely 
delivered of a child 6 weeks before her death, by 
Prof. James. She recovered from her accouchement,
& was well for 3 wks, when she was attacked 
with pain & tenderness in the abdomen. By bleeding
& cathartics, she was relieved, so as to ride out, & 



39
on the following day, repeated the ride. On her
return, she had a good appetite & ate freely of 
beets & vinegar, a very indigestible mass.
About 12 o’clock, she was attacked with violent 
cholic. Dr James saw her in the morning, tried
Cathartics with a view to purge her, but found her
bowels obstinately bound, & could not effect it.
Dr P. was called in consultation. He found her
with vomiting, bilious & stercoratious, her abdomen
tumid, great pain upon pressure etc. etc.
The ordered steam bath, blister to abdomen etc.
& Dr P. strongly suspected Hernia from the symptom 
but upon careful examination found none.
Dr Griffith was called in. Her pulse was very
feeble, strength declining, constipation continued,
& while the strength declined, there was no abatement
of disease consequently but little hope was left of 
her recovery. A variety of plans were suggested and
tried but no relief was afforded, & at length she 
sank, giving ample evidence in her last moments
of the Power of Religion upon the mind.


40
Dissection, post mortem, made evident what, before
had been a mystery. It exhibited a complete [adhesion]
of the intestinal canal in consequence of the Peritoneal 
Inflammation which had existed. We may also remark, 
that the left Ovarium was enlarged & in it was found 
part of a Fetus, the teeth, hair, jaw-bone, etc.
The peristaltic action had been totally suspended by 
the adhesions from deposited lymph, & this produced
the obstinate & destructive constipation.
Another case of a young man to whom Dr P. was
called, but not till medical aid was unavailing.
For a week he had complained of pain in his belly, but 
walked bout, tho’ when walking he went in the bent
position. He complained of joint pain & distress, but
soon after Dr P. saw him, his pain subsided, & with it
his whole system sank & he died. On dissection there
appeared evident marks of universal Peritoneal Infl.
& an effusion of a purulent matter.
In the same family, a younger brother was similarly 
attacked, but he was treated actively at first,
& he recovered.


41
Another case was the son of Cadwallader Evans.
Several days elapsed, before any alarm was excited
respecting him, at length, Dr P was sent for. When he 
saw him, he attempted depletion, but it proved unavailing
& he died.
Another case of a young woman, where large
quantities of Castor Oil were taken & retained upon 
the stomach, besides bleeding etc. He regretted
that he did not push the bleeding more freely 
& not trust so much to the bleeder. On dissection,
the Omentum appeared spread over the intestines & agglutinated 
with them. The small intestines were closely adhering 
so as to prevent any thing like Peristaltic action
Several ounces of fluid were found in the cavity of
the abdomen. The whole intestinal tube was filled 
with a flatus & liquid faeces, the stomach was much 
distended, adhesion of the Liver etc. etc.
A practitioner, however, should be careful not to 
permit his mind to be biassed by pre-conceived opinions,
but should note down facts as they occur, whether 
they operate for or against his favourite theories. Thus 


42
when on examination, we find all this adhesion, effusion
etc. we readily conclude that so much inflammation 
must necessarily have required the Lancet.
But this is not always the case, for we may sometimes
find after death, adhesions from the effusion of this
coagulable lymph, when during life, the lancet was
evidently improper. We say, therefore, that the 
bloodvessels may take on this action themselves
in the last efforts of expiring nature. This we
will illustrate by cases. “Facts are stubborn things.”
Case of a woman under the care of Drs Wister & Parrish.
Disease of the heart, attended with great prostration. 
At death presented this appearance of intestines.
Another case of Adam Konigmacher, (see p. 78) who died with 
dyspepsia & dropsy. He had been tapped several times
& was very much emaciated. In the last stage, he 
was attacked with pain in his belly etc. On dissection, 
after removing about a bucket of water, the intestines
were very apparent. The small ones were agglutinated 
by the effusion of recent lymph. The surface of 
the liver was covered over with the same. 


43
Drs Physick & Parrish attended a patient affected with 
Diabetes. 48 hours before his death, worn out as he 
was by disease, he complained of pain in his abdomen.
A post mortem examination showed an effusion of 
lymph from the last efforts of expiring nature.
These facts show that the effusions etc. found upon 
dissection do not always prove that they were owing 
to Inflammation during life; for in these cases, the 
patients were reduced very low by previous disease,
so that the lancet would have been highly improper.
We may remark here also that we fall into an 
error, when we bleed before a surgical operation to prevent
subsequent Inflammation.
We will relate another case which occurred in 
the Spring of 1834, of Aaron Kelly, attended by Dr
Smith. On visiting him he Dr P suspected Hernia, but on
examination found none. The patient was a tall, 
spare man, regular in his habits, but subject to Dyspepsia.
On the night but one previous to his death,
he supped on Veal & Vinegar. He was attacked
with a violent cholic, with great pain etc. Bleeding 


44
was resorted to, also Injections etc.; but they seemed 
to afford no relief. Dr P. was called in consultation.
When he saw him, he complained of violent pain in 
the belly, with no passage of flatus or any thing
else per anum. He advised a warm bath, gave
Castor Oil, Blistered etc. but all proved ineffectual.
A few hours before his death, his pulse sunk, 
his skin became cold & dry, delirium, laborious
respiration & death. On Examination Peritoneal
Inflammation was evident, the intestines
were adhering to each other by the recently effused
lymph, & there was also a seropurulent effusion.
Seven ounces of Oil had been taken into the stomach,
& some of it was found floating in the cavity of the abdomen.
In examination, an ulcer was found in the stomach
near the Pylorus, & a hole thro’ the coats of the stomach.
Thro’ this hole the Veal & Vinegar had probably escaped, 
causing the violent cholic & inflammation & medical 
efforts were fruitless. The body underwent decomposition 
very rapidly.
Adjourned till Sept. 1834.


45
Twenty-Seventh Lecture Sept. 1 1834
On Dyspepsia. This has of late become a very 
common term, & it has become very fashionable
for persons to complain of Dyspepsia, which is frequently 
more mentally than reality.
It is a disease in which the stomach is incapable
of digesting the food taken into it, producing 
consequent derangement of the system generally.
We shall first notice the causes of the disease;
and the first & most important one is the Influence
of the Mind. This is exerted over the whole 
system but no portion of it feels it so much as
the stomach itself. We see this often from the mental
emotions, from severe study & close confinement,
hence Professional Men are subject to it.
we see also the injurious effects of long continued
depression of mind from whatever cause, as in 
the merchant who has been unfortunate in business.
Case of respectable merchant, who consulted 
Dr P. for what he called a disease
in his chest, but upon inquiry, he showed that 


46
on account of ill success in business, his mind
had been much depressed, & that his stomach 
feeling its influence was in reality the seat of 
the disease; & such being the case, the difficulty 
of applying the proper remedies was great.
Disappointments of any kind, & more especially 
those of the tender affections tend greatly to produce
the disease, & here, when the physician comes
to enter into the family secrets & inquire into [illegible]
causes, when from the nature of his profession he
is admitted into the private actions of different 
members of the family, which are bound by 
courtesy from other men, his integrity & honor
are the only security upon which that family can
rely, & how base & treacherous must he be, who 
would prove faithless to such a trust!
From all these we see the importance of 
attending to the influence of the mind upon 
matter, & while applying our remedies to the 
body, not to overlook, one of the primary causes 
of the mischief, the mind.


47
Intemperance either in eating or drinking is another
cause of the disease, & that which arises 
from the latter is generally a most incurable form
of the disease, voracious eating is attended [illegible]
course with imperfect mastication of food & consequently 
injurious, so also a want of cleanliness,
 a foul mouth, & especially when the mouth 
is crammed with a large quid of tobacco, so
that the juice is mixed with the food, and all is
swallowed in the same mass.
Repelled Eruption is another cause of the disease.
Case of a very respectable man, who was 
much troubled and mortified with an herpetic eruption 
of his face & by the use of lotions, diet etc., he 
at length succeeded in removing it but, soon after
he was attacked with a very obstinate form of 
Dyspepsia. Dr P. was consulted, and after satisfying 
himself of the cause, he proposed such 
measures as would restore the eruption & the 
patient recovered, submitting to the loss of [illegible]
two evils.



48
Gout & Rheumatism may be translated from 
the muscular parts to the stomach & thus produce
all the symptoms of Dyspepsia. Thus P.
has seen Dyspepsia preceded by Lumbago, Pain 
in the arms etc. & also seen the pain translated
or alternated appearing first in the muscular part 
then in the digestive organs, & vice versa.
The disease generally commenced by depression 
of spirits, uneasiness of the stomach, sometimes
vertigo, & the pain is frequently referred to the 
chest by those ignorant of the situation of the parts.
On examination we find that the patient has 
acid eructations, pain in his bowels from flatus,
dark, tarry evacuations etc. The tongue is generally 
furred, in some of the worst cases, it is smooth,
red & glossy, especially when the disease results
from hard drinking.
Another accompanying symptom, worthy of attention 
is the want of action in the cutaneous vessels, hence
we have the cold, languid state of the surfaces & 
especially of the feet & legs.


49
As the disease advances, the patient is affected
with a most distressing, but indescribable sensation
about the stomach, especially after eating, together
with eructations, & sometimes spontaneous vomiting 
of a very acid nature, sufficient to set the teeth 
on edge, sometimes pain from flatulence etc.
Notwithstanding these results often follow from 
eating, still some patients are relieved by taking
food into the stomach.
In chronic cases, the excited state of the system
may be mistaken for fever. Dr P. has met 
with this state in children, where such a mistake
occurred, & no relief was afforded by the ordinary 
febrile remedies.
It is very important to struggle against this
disease, & never give up and sit down contented
to die with it. Dr P. believes that his life was 
saved by the exertions he made & the hardships 
he endured while suffering under it.
Cheerful company & conversation are also very 
beneficial to the dyspeptic.


50
From the disordered state of the mind, which we 
have already noticed in this disease, a partial derangement
sometimes take place, & hence we have 
Upochondriasis, not an unfrequent attendant on 
Dyspepsia. Here then we see the necessity of distinguishing 
between actual & imaginary diseases,
for a hypochondriac will sometimes describe diseases
with great accuracy, so as even to deceive an 
inexperienced practitioner. They can generally be
detected by their use of technical terms, for 
altho’ they may use them properly, yet it shows
that they have been studying medicine books, & this 
of all things is worse for a hypochondriac.
Case of an old Bucks Co. Farmer, who came & complained
of a disease in his Omentum. Upon examination
he exhibited as fine a mass of fat
as ever did a Squire, & inquiry showed that 
his disease was altogether mental & imaginary.
Another case of a man who complained of pain 
in his foot, & had been long treated for the same by 
by a country practitioner, whom he had led 


51
astray by his descriptions of the disease. The
Doct. had even gone so far, as to put a seton 
directly thro’ the foot to cure the disease.
Various causes operate to relieve the patient 
& cure their complaint. Thus we have 
known a spontaneous bilious Diarrhea to 
result in a cure.
The disease is sometimes accompanied with 
Pyrosis or Water brash. After taking food, the 
person seems disposed to throw off saliva, and 
at length he feels a spasm of the stomach, & a 
discharge of limpid fluid takes place from 
the mouth for 1, 2 or 3 minutes, then he is relieved
Cases have occurred of the disease extending to 
the neighboring parts, but of this we shall speak 
more fully in future.
We must here caution the practitioner against
allowing Dyspeptics the use of Ardent
Spirits in any form, for they are thus innocently 
7 unwittingly led into a most dangerous 
practice. Case of a lady, who, from the advice 


52
of her medical attendant was accustomed
to relieve her distress by taking a small quantity 
of first rate imported Holland Gin. She continued
increasing her portion until at length, she
took ½ a Gallon in 24 hours. Before her death
there was a remarkable loss of power in her limbs.
The same thing happened in the Case of a 
Gentleman in this City, who became perfectly 
bedridden, & powerless, so that he was obliged
to be treated with diapers etc., as an infant.
Another case of a public man, who commenced
with Gin, & ran the same course.
Anecdote of Dr Fothergill of London, related to Dr
Parrish by old Dr Park. He said that when he 
was in London, he had a letter of introduction
to Dr F. In conversation Dr F. stated to him his
success in curing Dyspepsia with Brandy & Water
He remained in London, one or two years, & before
returning visited Dr F. who took him aside,
told him of his error, & warned him not to 
adopt a similar course of practice.


53
Twenty Eighth Lecture Sept 5 1834
Before we proceed to consider the treatment
necessary for Dyspepsia, we must notice the
importance of distinguishing between Dyspeptic
cholic & Inflammatory cholic, for altho’ in 
the former case, the patient may be suffering under
violent pain, yet it may arise from flatulence,
& consequently require very different
treatment from the latter kind. If the case 
be one of pure flatulent or Dyspeptic Cholic
the lancet would be injurious, because we consider 
this disease as depending upon a want of 
tone, & upon nervous excitement, & do not view
it as in the least degree inflammatory.
By asking the previous condition of the patient 
we can distinguish between the two.
We now come to the physiological view of
the subject. Digestion, according to the ancient 
views was performed by a fermentation, but 
now it is said to take place by solvency in the 
gastric juice, & the theory of fermentation is 


54
generally rejected. But we maintain that in ‘
disease, this process of fermentation may go on,
& that the stomach itself will even secrete an 
acid which will produce it. Hence it is proper,
in prescribing for a dyspeptic’s diet, to reject all 
such articles as pass to the acetous fermentation,
all unite in being unable to take boiled cabbage.
as Cabbage, Turnips, Beets etc. Horse-Radish
however, we would consider as an exception, for 
this is often very beneficial. Coffee, too, should
be dismissed, and generally tea, all kinds 
of Pastry, Pie Crust, Hot Cakes, Buck Wheats
and all such dainties. But after taking 
away all these; one would naturally inquire 
what then, the patient must eat? As a general 
rule, we may say solid animal food simply prepared,
is very acceptable to the stomach, as beef, 
mutton, chicken etc. but sometimes we find exception 
& these things do not agree
Sometimes Animal food increased flatus. then use Condiments
The condiments are generally very palatable as 
Salt & Pepper, Mustard & Horse Radish.


55
They may also take Stale Bread, Crackers, 
Pretsal Bread, Rice with some suits well,
cream suits some well as a Diet
others eat it with Cream. Besides these, a 
soft boiled Egg. Roast Egg. properly prepared. Oysters, but in these much depends
upon the manner of cooking them, & raw
oysters set well upon the stomach. Some object 
to their being taken raw, saying that when in 
this state they are alive & consequently the gastric 
juice will not act upon them so readily, 
but we can scarcely believe that after having 
passed between the Molars, there is much danger.
When the appetite is gone, the Yolk of a Raw 
Egg suits admirably. Take it whole from the Egg,
put it in a Wineglass with a little Water & toss 
the whole down without breaking it several a day. It often has
a most happy effect. Sometimes when solid 
aliment is rejected, the Ess. of Beef is an excellent
substitute. Well prepared Salt Ham
suit some stomach well.
So much then for what the patient may eat
from the table, but we have taken from him Tea 


56
and Coffee & what must he drink? Here we must
in some measure consult the peculiarities of the patient.
Sometimes they like Rye Coffee or Barley.
Some will take Milk for a time, but at length 
the stomach revolts, & that practitioner commits 
a sad mistake who endeavours to force it.
Equal parts of Lime Water & new Milk we 
have found an excellent substitute for Tea & coffee.
Where Milk disagrees, Cream is sometimes very 
acceptable. The yolk of fresh Eggs beat up 
nicely, & while beating pour on some boiling
water, continue beating with Loaf Sugar, makes 
a very peasant article of food.
As for drinks at dinner we may say that the less the 
stomach is distended with them the better,
& that the best is Pure Water & that taken in 
small quantity. In the intervals between
meals, when the patient has a disposition to 
eructation etc. Ginger Tea is very serviceable
Also an infusion of Chamomile, Ginger & some
Aromatics Fennel Seed. Sometimes good Malt Liquor, or 



57
sound old Cider, or a moderate quantity of
the very best Wine, agrees well with the patient
The State of the surface of the Body in this
disease demands the especial attention of practitioners.
We generally find it cold, especially at
the extremities, & hence one of the first things requisite
in the treatment is to restore the heat & action 
in the feet & legs & warm them. Dr Physic directs 
the patient to immerse them in warm Water 
containing Mustard. Parish uses a solution of 
Coarse Salt in Water, & directs the patient to immerse 
the feet & legs every morning, then to rub 
them with a coarse towel. After this put on a 
pr of flannel socks well dusted with Cayenne 
Pepper, & over them a pr of good woollen stockings
But this is not all that is requisite, the endeavours
to excite warmth must be extended 
to the surface of the whole body, & the benefit 
derived from such a practice, as well as the 
manner of doing it, we may learn from the 
horse-jocky. In order to make a horse look fat 


58
and sleek, they curry him well, & will tell you,
that currying is half food; so with your patient,
you must have him well curried every morning.
For this purpose, take a coarse towel, & dip it in 
a saturated solution of Salt & water, then hang it 
up to dry. Let the patient be well rubbed with this 
every morning. From an intelligent man in N.Y.
Dr P. learnt that in the back part of the state the
same thing was effected by cobbing. By those in 
affluent circumstances, a tepid salt bath may be used
Exercise in this disease is very essential, as jumping 
the rope, rubbing furniture & other housework,
riding on horseback, hunting, etc. Much also 
depends upon the time of exercise. It should never
be directed immediately after eating. Case of two 
hounds, who were fed; one left at his pleasure, the 
other taken out to hunt. After a certain time,
both were killed, the former had digested his food 
the latter had not, & hence we infer the propriety 
of rest after eating, especially after dinner. 


59
Sometimes dyspeptics, who throw off all the food taken
during the day, will retain a meal just before 
going to bed. This should be a light & nutritious supper.
We think many an individual has been shielded 
from an attack of apoplexy by having the Dyspepsia,
especially those gormandizers, who cram almost everything
into the stomach, until, at last, the stomach 
revolts & refuses to perform its duty.
[illegible] method excites peristaltic motion sometimes.
The advantage of travelling in this disease is 
very great, because the patient then enjoys the variety,
change of scene etc. & diverts the mind; but merely to travel, without 
giving him some object upon which he may fix 
his attention, is only half the cure. Always then 
give him some object, something upon which his 
mind nay be intent. Send him, for instance 
a long journey to some grand Mineral Spring or 
the like which has before accomplished its wonderful 
cures, let him have high expectations of the 
benefit which he will derive from them, & you 
may be sure that you will find your patient
much benefitted.
Spallanzani on Digestion & [Generation]


60
Twenty-Ninth Lecture Sept. 8 1834
In Dyspepsia, we are apt to find the bowels irregular,
hence it should be our first endeavour to 
restore them to their regular action. In the 
first stages, while the patient is in robust health,
advantage may be derived from the use of Cathartics,
but in Chronic cases, it is preferable not 
to resort to active treatment, but to endeavour to 
regulate the diet & habits, so as to produce the desired
effect, sometimes even without any medicine.
One direction which the patient should receive 
is to go regularly every morning to the Privy, whether 
Nature calls or not, so that by constant practice,
the habit will be fixed, & the bowels look for 
an evacuation every morning. This habit should
be acquired by every one, dyspeptic or not.
When, however, the bowels will not yield without
the use of medicine, we should make use of 
those which, with a laxative, combine a tonic
effect. At the head of the list, then, in this respect, 


61
stands Rhubarb. But at the same time,
 a caution must be given let the use of the medicine
will become a fixed habit, as in the Case
of an old Lady, who for the last 30 years of her 
life, took a piece of Rhubarb before going to 
bed, & could not do without it.
Other articles may sometimes be advantageously 
combined with it to meet other indications, as 
for acidity of stomach, Soc. Carb. etc.
A pill which Dr P. prescribes under such circumstances
consists of Pulv. Rhei
Sod. Carb. Exsic. aa zfs
Soap q.s. ft. Pill.
m Pill. m XX
But as one medicine will not meet every indication 
it becomes necessary for the physician
to exercise his own judgment, & prescribe different
medicines, which when combined, will 
meet the several indications presented in the 
case He should never prescribe at random, but always 


62
have a reason for what he gives. Thus the
following prescription will meet several indications
according to the reasons annexed.
Rx Aloes Socot.
Pulv. Rhei	Purgative & Tonic
Sod. Carb. Exsic. aa [?ii] 	to correct acidity
Calomel grs X To act upon Liver
Ol. Carui gtt X [cominative]
Ext. Gentian q.s. ft. Pill Tonic
M ft. Pill No XL
Sometimes, however, the bowels are very torpid,
& require a more active purge, & some one of 
the active Cathartics may be added in small 
quantity, as in this. Aloes Socot
Pulv Rhei aa [?i]
Gamboga grs V
Ol. Carui gtt X
m ft. pill no XX
be occasionally some of the aromatic may be combined
with the Extracts & Purgatives & produce
a very happy effect, especially in very 


63
delicate constitutions. Case of a lady, who 
had become very much emaciated, pale, feeble
& cachetic, for whom the following prescription
suited admirably.
Cinchonne zfs Quinine
Sod. Carb. Exsic. [?i]
Cloves 
Capsicum
Aloes Socot. aa grs X
m ft. Pill No XX
Tonic
[illegible] [?ii]
Fer. Sulph.
Capsid. aa [?i]
Cloves grs X
m ft [illegible] XX
S. Take two, three times a day.
mustard seed, taken down whole, especially gouty or rheumatic.
Sometimes, when the patient has that anxiety & indescribable 
distress, he feels as if he needed something
cordial & stimulant, & hence, instead of Brandy or 
Gin Toddy, prescribe the Aromatic Pill
Ammon. Carb. zfs zifs
Cpsicum zz [/i]
Carophyl. zz [?i]
Mace
Nutmeg aa grs X a grs X
Ol. Carui vol Anis. gtt X gtt X
Ext Gentian. q.s. ft. Pill
m ft. Pill No XX HS. Aromatic Pill
Vol. Arom. Bolus.



64
Those should be kept in a vial, & one or two may 
be taken at a time. They are very well suited to 
that uneasiness, of which we have previously spoken,
& a happy substitute for Spiritous Liquors.
There are also other indications for which a 
physician will have to prescribe, but as to these
his own judgment must direct him in the choice
of Remedies. Another substitute for Ardent Spts. see p.66
In some cases, the small & dark discharges will 
give conclusive evidence of functional derangement
of the Liver, hence this must be corrected by 
a Prescription regulated according to circumstances.
Sometimes Blue Pill at night & Seidlits Powder 
in the morning, till a change takes place, Such a 
course would be proper for a man of business, who 
would be obliged to be absent from home all day.
For others, we may prescribe Calomel.
Acac. Gum aa grs ii
Ayre on [Maras???s]
m ft Pulv No XII
Dust one of these powders every hour or two over some fluid & drink
it down. One day give this & the next day perhaps  


65
a Seidlits Powder, & so continue for a long 
time till at length these minute doses of Calomel 
have a very happy effect. & changes evacuations.
In some instances, the Stomach becomes so irritable,
that the patient can take nothing, it rejects
almost every thing, whether food or medicine.
Case of a young lady from Jersey in this condition, 
whose stomach would receive nothing.
Dr P. adopted the practice (Johnson of W. Indies) of immersing her feet
& legs every night in the Nitromuriatic Acid
Bath, made by adding the acid gradually 
to Warm Water, until it produced a tingling sensation
upon the skin. He also used friction with coarse towel, with 
a weak solution of the same, over the region of 
the Liver, sometimes pustules appear, & at length a happy change took place
in the hepatic secretions & in the whole system.
The Endemic Method of applying remedies
is well worthy of consideration in these 
cases, for the fact has been fully ascertained
that in this way, very beneficial effects are often
produced. Dr. Gerhard.


66
Our opinion respecting the use of Alcoholic Liquors 
in this disease, we have already given, & have
also proposed some substitutes. There is yet
another substitute within the reach of every 
one, & which will effectually correct the acidity 
& uneasiness. It is composed of 10, 15 or 20 grs of 
Sal Tartar (Carb. Pot.) – a fw drops of Vol. Arom.
Spt. Amm, mixed up with Cinnamon Water.
Thirtieth Lecture Sept. 12 1834
There is another remedy which has proved serviceable
in Dyspepsia,& which tho’ not drawn from 
a very eminent source, is still entitled to consideration 
Many years ago lived an old farmer in Bucks
Co. Pa. who besides tilling the soil, was a very [illegible]
Cholic Doctor. His remedy was for a long time unknown,
but was, at length, found to be an Infusion 
of Hickory Ashes & Soot. One case in which it 
proved very successful was related by Dr. [Mollens]
of his own Mother. Dr Physic heard of it, tried
the remedy in his own case & was much pleased
with it. Since then, it has been very much employed 


67
& still is occasionally, but not as formerly.
It should be prepared by taking about 1 quart 
of fresh burnt Hickory Ashes, & a teacupful of soot
& infuse them in 3 or 4 qrts. Water. Let the 
mixture stand, shaking it occasionally, for 
48 hours only, then strain it & pour it off the 
dose is a Wineglassful 3times a day, weakened
with Water, if too strong. S. Alkaline Infusion.
This remedy has proved effectual in some cases
where others have failed. Case of a gentleman
who came from Barbadoes to this City for his health,
he was much distressed with a most obstinate & 
dangerous form of Dyspepsia. Dr P. put him upon 
the use of this Alk. Infusion, with a proper 
diet, & he soon recovered. He was so much 
pleased with the remedy, that he purchased a 
quantity of Hickory Wood & took home with him
in order to prepare the medicine, when needed
A  caution, however, is requisite in preparing
it, for Dr P. once had a patient nearly destroyed
from the carelessness of the Apothecary. He prescribed



68
some of this Infusion for him, directing
him, as he was in a very feeble condition, to 
commence with but a Tablespoonful. He took
it, & it caused him so much pain & uneasiness,
that he sent for the Doctor. Dr tasted it, & found
it was almost like Caustic. Upon going to the 
Apothecary & calling for the bottle from which the 
medicine was given, the mystery was unravelled 
Instead of having poured off the Infusion at
the proper time, the Apoth. had left it standing 
& consequently it was very strong & different from
what it was intended to be.
The Subnitrate or White Oxide of Bismuth
has acquired some reputation in the cure of Dysp.
accompanied with acidity. Two cases occurred 
in Dr P’s practice, in which it appeared serviceable.
When the stomach has lost its tone, & the appetite
become much impaired, some of the vegetable
tonics act very favourably, as Quassia, Colomb,
Ginger etc. more especially Quassia Shavings in 
proportion of zii or zfs to Oii Water. Cold Infusion 


69
Dr P. knew one case in which Teaspoonful Charcoal & Lime wineglass
water were of great service
The Chalybeate Preparations also are good.
Rush’s Tonic Powder was much esteemed
consisting of Columbo
Ginger aa grs X
(Ter. Carbonas) or Rubigo Ferri grs V
But Air & Exercise are better for giving tone
to the stomach & an appetite, (especially if continued
with Cheerfulness of Mind), than any 
of the Tonic Medicines.
When the stomach is irritable, the Spice
Plaister (vol A . ) is often very beneficial, but 
in some cases, we meet with a stomach so irritable
that it will retain nothing. We must 
then resort to the Rectum, to sustain the Patient.
Case related by Dr Wistar, of a young lady, upon 
whose stomach nothing would remain. After
using all the remedies of which he was master,
with no effect, he resorted to injections, & by 


70
injecting nutriment in a most concentrated form
with a little Laudanum, she was sustained
for 3 weeks, & her stomach then began to acquire 
its tone & she gradually recovered.
Another case of a Wretch who cut his throat,
he was nourished by injections, & as he had
been  toper, he looked for & regularly received
his dram per anum.
We will next offer a few remarks respecting
the caprices or vagaries of the stomach.
The Language of the stomach, like that of speech less
infants, can be readily understood by those
who will attend to it. If a physician endeavours 
to compel the stomach to adhere closely to 
the line & rule of medical authority respecting
what it shall receive, he will frequently do 
more  harm than good. But when the stomach 
calls loudly for any certain articles, & continues
the call incessantly, it is most proper to grant 
it, at first carefully, & watching its effects. 


71
This unwavering, continual calling must
be distinguished, however, from those fanciful 
desires which we frequently meet with in 
patients, for ½ a dosen things in an hour etc.
Case of a gentleman of this City,  who, for 
3 mo. had been under the care of a very respectable
practitioner, Dr Coole, with very rigid diet
etc.  to correct acidity arising from Dyspepsia.
After trying all the antacids & usual remedies 
in vain, the patient’s stomach at length called
loudly for Pickles & Vinegar, substances
which would have appeared least likely to benefit 
him. At last, however, he obeyed the call, partook 
largely of these acid substances, & they laid 
the foundation for his restoration.
Another Case of a Lady in very feeble, delicate
health with Dyspepsia, who was sent out 
of town to recruit. One day, as she was passing
thru’ the kitchen, her olfactories were saluted
with the odour arising from the Pork & Indian
Dumplings prepared for the labouring men. 


72
Her stomach called loudly for this apparently unbecoming
aliment, & so irresistible was the call, that she 
obeyed, partook of it, & gradually recovered.
A physician must bear in mind that Articles
which suit the stomach at one time, will not
at another. This, Dr P. knows from Experiences, as
with Beef, Milk & other articles, which at one time 
would agree with him, at another, would not.
Hence it is improper to persist too long, & make
a revolting stomach cringe to Medical Authority.
Idiosyncrasies. There are peculiarities of stomachs
with some patients which deserve attention & are important 
in judicial investigations
Milk, generally so suitable to every one, & designed 
by our Creator as our earliest nutriment, produces upon
some, very injurious effects. Case of a Lady from 
Cuba, in whom milk in the smallest quantity,
produced a fever & derangement of the system.
Case of one of the Judges of the Supreme Court
of Penn (Kennedy) who had a peculiarity respecting
Eggs, for the least portion of it proved almost
as violently poisonous to him as so much 


73
arsenic or corrosive sublimate. Dr P. attended
twice when extremely ill from having unknowingly 
taken a small portion of Egg. On one occasion, 
in this City, he was taken ill after a dinner, at 
which he had eaten a plate of soup. On inquiry
it was found that a small portion of Egg had been 
beaten up by the Cook to enrich the Soup.
Case of a young [Wistar] lady upon whom for several years the smallest
portion of onion, acted like a poison.
on some occasions, those very articles which we
should suppose would produce acidity, will correct 
it, s for inst. Rock Candy, Jellies, especially the pure
clear Guava Jelly from the W. Indies. Lemonade
A physician should strongly impress upon 
his patient the importance of avoiding the habit 
of vomiting his food, for altho’ it may give temporary 
relief, yet at last the stomach will look 
for it regularly after each meal. The mind can
control the stomach very much in this respect & 
the patient should exercise its powers. Dr P. mentions 
that he had frequently done it in his own case. 


74
Some patients have Lasy stomachs. They perform 
their task with a great deal of unwillingness, & grumble
& growl, “like a Bear with a sore Head,” whenever
they are required to labour. Continue urging them
however & do not permit them to throw the food 
off, & they will at length perform their duty.
Thus also we may remark  respecting the [illegible]
Scaling medicines, that much depends upon the
will, in their remaining upon the stomach. Dr P’s
own case of taking Bark in substance, he commenced
the stomach to retain it, & with reluctance it obeyed.
There is yet a Dyspepsia of a particular kind 
of which we must speak, attacking persons of 
about 50 or 60 yrs. of age. of both sexes, but more
frequently male than female. Now we will suppose 
a case of a man of this age, suppose that he
begins to lose his colour, grow thinner, & shows a 
disposition to “be breaking” (in common parlance).
One of two things will then happen, he will either 
have Hydrothorax, or this form of Dyspepsia
which we are about to describe. He soon finds 


75
that if attacked with the latter, he has no 
appetite for food, or if he takes it his stomach rejects
it, together with an irregular state of the bowels,
being sometimes affected with Diarrhea; at [others]
with Costiveness etc. till at last appears the 
red & smooth tongue, showing an [sythematous] condition
of the lining membrane of the alimentary 
canal. Still the patient keeps about, but he becomes
pale, or sometimes bloated, his lips lose their
colour, his ears become white as alabaster, his 
hands likewise, with a chalky whiteness & thickening
at the root of the nail. Gradually he becomes 
weaker & weaker, his lips somewhat tumid,
& he finally sinks into the grave. This is a description 
of several patients which have come under
the notice of Dr Parrish. He has tried a 
great variety of treatment, but all seemed alike
ineffectual in arresting the disease, & in attempting
to stimulate the stomach to perform its duty. It
appeared as if the labour of that organ was done,
that it “became dumb,  & spake not.”


76
Another fact which we mention in concluding this
lecture, is one, which perhaps will not be found in 
books, but which Experience has taught to be true.
It is, that patients labouring under Dyspepsia, sometimes
continue a long & uniform course of Diet, which 
tho’ proper at first, will at length produce Scurvy.
Such a condition of the system is brought about 
as appears in the real Scurvy from any other source
Dr Bartons case of [illegible] Listers in Britain with Scurvy.
Case of a Lady from Del. who had been affected
with Dyspepsia, & her physician very properly placed
her upon animal food. She also took a little Brandy 
Toddy. She continued this course so long that at 
length she was brought to this city, a case of complete
Scurvy. Her diet was immediately changed to vegetable
acids & [illegible] food, with Cider instead of 
Brandy, & she recovered.
Another case of an old gentleman in this City, who 
lived on Animal food principally ham, as was proper for alleviating
his Dyspepsia, but by continuing it long after
the Dr had ceased his visits, a real Scurvy was
induced. He was cured by Acids by Diet etc. as usual.  



77
Young Lady from Boarding School.
In Bucks Co there lived a man affected with 
Dyspepsia who came to ask medical advice of Dr P.
He was placed upon animal Diet, & his diseases 
left him, but he still continued the same course
of Diet. Shortly afterwards his brother, a physician,
saw Dr P. & informed him that he was afraid his
brother would die, said that his limbs were swollen
etc. showing that he was suffering from this very 
disease. Dr P. told him that he considered it a 
case of Scurvy, thus brought on & advised the diet
of the patient to be reversed. The advise was attended 
to, the patient got better & soon recovered.
Thirty-First Lecture Sept. 15 1834.
There are some cases or rather forms of Dyspepsia,
depending upon the stomach, or more parts of it,
which may be  considered as incurable. Related
the Case of Aaron Kelly (see p. 43) & threw 
out his belief, founded upon an observation of
his body after death, as well as of others before, that 
whenever death is occasioned by the contents of the 
stomach, passing into the cavity of the Belly, the 


78
body undergoes decomposition more rapidly.
A scirrhous stomach produces Dyspepsia. Case
of a gentleman merchant in this City (see p. 42), a man of honour and 
integrity, who became much embarrassed in business,
& whose affairs were in such circumstances as
to cause him great distress of mind.  The stomach 
felt the effects of his mental struggles, his health 
became impaired, & it gradually went on from 
one step to another, till at length the Pylorus became
involved in the disease. He became emaciated, 
grew weaker & weaker, was attacked with 
Dropsy, for which he was tapped several times,
& thus wasted away, till at last he died.  Dissection
exhibited a diseased Pylorus. In the first
stages, Dr P. saw the cause of the disease preying upon 
him, but the remedy, prosperity in business, was 
beyond the power of the man to give.
One fact which was particularly interesting in this 
post-mortem examination, was to see that the
subject was almost bloodless, not having
more than 6 or 8 lbs. in his vessels, but yet just 


79
before his death, he had complained of uneasiness
in the cavity of the abdomen, & in the intestines,
was found unequivocal evidence of Inflammation, 
viz. recent lymph had been effused sufficient
to cause an adhesion of the Intestines.
Now, this is a fact, & though it is counter to general
rule, that Inflammation can take place 
under such circumstances, yet medical men ought
to notice these irregularities, & be honest enough 
to acknowledge them, and Honesty in Medical
Science would produce more solid information 
and fewer books.
Hepatitis may also produce Dyspepsia by 
extending the disease to the stomach. Such
was the case of Dr Harlan of this City. Mercury
Dyspepsia is not invariably connected with Inflammation 
as supposed by [illegible], but we maintain that in most cases
it depends rather upon a deficiency of nervous excitement
in the stomach. (Barron on Tuberculous [illegible])
This disease is sometimes connected with Rheumatism
or Gout, for we know that in Gout subjects 


80
the changes which take place in their disease
are very numerous, & that when the stomach becomes 
the weakest part, it is apt to fix upon that. Thus
we have seen Lumbago, followed by Dyspepsia & 
vice versa, one relieving the other. Hence we may 
understand what remedies are applicable to such 
case, how the Vol. Tinct. Guaiac (for inst.) operates
very beneficially. Teaspoonful in Wineglass of Milk, ter die
If we have then a patient with Gout in the 
stomach, & know that it will attack a weaker
part, it becomes our duty to endeavour to make a 
weaker part to which we can induce the disease.
In making this, however, we must first ascertain to 
what part it is most likely to change itself. This is’
the “Big Toe” hence we look to the Toe & Foot, as the 
proper place to invite the disease.  Dr P. learnt this
when young from a gouty patient, who once had 
flying pains, stubbed his toe, & the disease immediately
foxed upon that as a weaker part, left hi s
head & other parts of his body where they had been 


81
wandering, & remained stationary there.
The plan, then, proper for treating those irregular
gouty cases, in which the pain is roving about,
either in the muscles or in the stomach, is to 
put on the gout socks, or put on a pair of thick
woollen stockings, & over them a pair of Gum 
Elastic Shoes, keep these on during the night as
well as the day, & they will cause a fine warmth 
& perspiration in the feet, making them the 
weaker part, & thus inducing the disease to them. 


82
Phthisis Pulmonalis.
The study of this disease is very important to every 
individual, because every year bears melancholy
proofs of its ravages among the community; & this
too, while medical aid stands afar off unable
to rescue the unhappy victims from its grasp; so
far from it, indeed, that we think the practice usually 
pursued in relation to it, is injurious.
It attacks persons in youth & middle life, but
seldom in old age. Dr P. has seen2 cases of about 
70 yrs. of age. Sometimes it appears in Early Infancy,
even while yet at the Breast, & many a child 
one 3 mo. died [illegible] being a mass of abscesses
afflicted with Phthisis, had been [illegible] doctored
by old women & perhaps physicians, for worms.
If we were to give a Condensed Description of
the disease, we should say it was an affection of 
the Lungs accompanied with Hectic Fever, that
at length, suppuration took place in the Lungs producing
Purulent Expectoration & Death ensues
Consumption is Hereditary, and it is interesting 
especially for a medical man,  to be aware of 


83
this fact, for this form of it is more fatal than others
But we must also notice, that it does not pass
from one generation directly to the next, but that 
it will sometimes omit one generation & seise up
on the next. Case of a family of seven Children
one of them died of Consumption, 3 lived more than 80, the others did 
not, but each of their children died with it.
While on Hereditary Disease we may remark that
Breeders of Horses are aware of Hereditary transposition to second generation.
in one instance, a grandparent had a singular malformation 
of his Foot, the children, however, were all
remarkable for handsome form & figure, & grew up 
to be parents. The very first child of the eldest son 
had this same mal-formation of the foot with the 
grand-parent, so that altho’ the immediate offspring
escaped yet the first-born of the second generation 
inherited the form of the foot.
Phthisis sometimes appears to be a family disease,
without our being able to trace it back to being of the
ancestors. Case of the family of Dr Craig Physician
of Washington’s, in which the parents lived to a great
age, but their children died of Consumption.



84
A great many divisions of this disease, have been 
made by different medical men, but we are disposed 
to simplify this arrangement, & distinguish between 
the different forms of it.
Abscess of the Lungs differs from pure Phthisis, it
is nothing more than common Phlegmonous Inflammation,
which, as in other parts of the body, causes
an accumulation of purulent matter, & at length
breaks & discharges its contents.
Protracted Catarrhal Affections differs from Phthisis.
[illegible] Ferguson coughed for 70 years but no tubercles in lungs.
but betw this & Pneumonic Inflammation, are apt 
to induce the disease to attack those persons who are 
predisposed to it, & hence require care & attention
Persons liable to Phthisis are generally characterized 
by a tall, slender form, warm chest, nails delicate
& [illegible] like etc. but all attacked with it, do not answer
Saml [Gas??gues] very stout man, & a striking exception.
to this description, they also possess great sensibility 
of mind, often much intelligence, & even the
most lovely & most interesting of the sex appear most
frequently to be destined to fall victims to it.
They also are subject to weakness of Body, or as 


85
Dr Rush called it a Febriculous state of Body.
they complain of weakness in the Breast, attended
with a slight cough, & a disposition to Hemoptysis.
Here, however, we must notice a very great mistake
often made by supposing that Consumption 
always necessarily follows Hemoptysis, for such is 
not the case, because it sometimes occurs in those, who
have not the slightest tendency to the former disease.
Case of an old gentleman of this City, whom probably 
it arrested from apoplexy. One night he was attacked 
with Hemop. & discharged a large quantity of blood
from the lungs, which, if instead of having been poured 
out there, had been effused into the brain, would certainly 
have destroyed him. He recovered and in 1 
or 2 yrs afterwards received an apoplectic & paralytic
stroke, which was relieved by cupping, bleeding, etc.
The consumptive patients have an irritable state
of the bloodvessels and a frequent pulse. But in 
this case, much care and judgment is necessary 
to distinguish the particular kind of pulse.
Between irritate bloodvessels & inflam diathesis


86
Some have a chronic Sore Throat, which is an unpleasant
indication.
As the disease goes on & gradually gains the ascendancy,
the patients increase in debility, emaciation
commences, the [lactic] flush is seen in the cheek, & 
in females a state of things still more to be dreaded,
the suppression of the Catamenia, & when this
has happened, the last gleam of hope may be considered
as just extinguished, for this is the last
barrier that resists the disease. This being broken 
down, it advances rapidly to its fatal termination.
Upon inquiry, you will find that many of 
these subjects have had glandular affections of the
Neck, & thence the disease has proceeded downwards 
to the Lungs.
Next follows the Hectic Fever. Chills, followed
by fever & flashes of heat, the flush in the face becomes
still more apparent, profuse, colliquative
sweats exhaust the patient, & the pulse is very 
frequent, ranging from 100 to 120 per minute
Places much reliance upon Pulse here Acute Mania


87
Twenty-Second Lecture Sept. 18 1834
If an examination of the Lungs post mortem be
made in those subjects who have died with Phthisis
Pulmonalis, Tubercles will be found in one or both
of them, & by making an incision into the substance
of the lungs, we open a great number of abscesses.
Some of these tubercles are small & indurated, & 
others, layer, & containing a caseous substance.
Phthisis, Dr P. believes to be nothing more or less
than Internal Scrofula, & for his views etc. refers to 
a Paper on Scrofula Interna read by him before
the Medical Society. Eclectic Rep. vol. 2 p. 196
We will now make some observations on the 
Practice generally pursued in treating this Disease.
Many years ago, Dr Rush, in the University of 
Penns. taught that the disease was of an Inflammatory 
Character, & consequently required the
Antiphlogistic treatment, and among these remedies,
the lancet stood conspicuous. Mercury, too, 
was used with great liberality. This practice was 


88
pursued in the Penn. Hospital while Dr Rush was
the attending physician there, but the results generally 
proved that it was more injurious than beneficial.
The patients were also restricted to a very rigid
diet, close confinement etc. and at one time a room 
was fitted up with stoves to maintain an equal temperature 
for the patients. This was also done in private
practice in the City. He considered that the disease
had, also, after the Inflammatory, a Typhoid stage,
& hence after it had passed the first, the practice must
be changed for such as would fill up the bloodvessels & 
nourish the patient, as Porter, Nutritious Food etc. opiates
Other practitioners differed in their view of this
disease. Prof. Barton placed great confidence in 
Emetics, & made frequent use of Moser’s Vitriolic
Solution, Fowler’s Solution of Arsenic etc.
Dr. Wistar was very partial to Digitalis. ON e
case did recover from a large quantity of it which 
he had taken. The Dr however abandoned the
practice before his death, conscious that it was not
the proper mode of treating the disease.


89
Besides these different modes, all the practitioners
agreed in using Palliatives, & minor remedies. Blisters
etc. This was done by all. But what was
the result? Why, they had but one. No matter
what course was pursued, in all or nearly all 
genuine cases, death sooner or later terminated
all their hopes for success.
From the different methods & observations, which 
Dr P. had been able to see, he, in the commencement
of his practice felt inclined to adopt that of Rush;
but in a few years experience taught him the necessity 
for a change, even though it was opposed to all 
his former education. One case came under his
notice, which made a very strong impression 
upon his mind, & which had much to do in altering
his opinions. It was a young man aged
about 24 yrs whom he attended together with 
Dr Physic & Russo. The anxious & affectionate
parent had lost a wife sometime previous, from 
this same disease, & when his son was attacked 
with symptoms of a similar character, he was alarmed



90
because he expected the same unhappy result
He immediately availed himself of medical advice,
& brought his son into the City, to enjoy every 
advantage which wealth could afford. He was
placed in a spacious apartment, in which was a
soap stone stove & thermometer to preserve an equal temperature.
One of the best nurses in the City attended to 
whatever his physicians ordered, & Dr Physic & Parrish
were selected as his medical attendants.
The treatment commenced with rigid dieting,
small & frequent bleeding, & the use of Mercury.
Finding, at length, that Mercury by the mouth produced 
none of its ordinary effects, it was resolved
to apply it externally. A tailor was accordingly 
sent for & ordered to make a pr of flannel pants,
& these were lined with Strong Mercurial Ointments,
the patient drew them on & lay in bed with them.
His system, however, grew weaker & weaker, & no
ptyalism was excited. The mercury was then laid
aside, & they resorted to the sweating treatment. They 
also gave Sulphur & Tar Water. But it availed not.


91
The solicitous father asked permission for Dr Rush to be
called in, which was willingly granted, & then the
whole three, Physic, Rush & Parrish continued
in regular & constant attendance.
Plumb Acet. was recommended grs ii every 2 hours for some days and tried, but 
it afterwards produced some symptoms of Cholic, & 
it was suspended Caustic Issues were [illegible]
about the Thorax. But in spite of all their exertions,
the disease progressed, until, at length, the
Typhoid stage developed itself. Then, also, came a 
change in the course of treatment; Tonics were 
employed, both weak and strong, in order to maintain
his strength, but all their efforts were unavailing, 
the youth grew gradually weaker & weaker
& at last departed for a better country. He had
come under medical care in the fall, & in the
ensuing Spring, he was no more.
Next door but one to the residence of this young 
man, lived another, Dr Saml Hopkins of Woodbury N.J. who
had been a student at the Hospital, & was there attacked
with Hemoptysis. For this he was depleted 


92
by Dr Rush, & the attack passed off, but left him in 
a very weakly condition, unable to attend to his 
duties at the Hospital & consequently he left, & spent
the summer at his father’s, in the country. In the
ensuing Fall, (the same in which the youth before
mentioned came under medical treatment) He returned
to this City to complete his Medical Course
He was yet very spare & thin, & being in the neighborhood
where these 3 physicians came every day,
his friends solicited him to receive medical advice.
This he positively resisted, saying that they would do 
him more harm than good. Thus, then, were
these 2 young men situated, one pale & emaciated,
the other, healthy in his appearance, tho’ Phthisis
had just commenced its inroads, one, resisting
all medical treatment, the other, receiving every
thing which medical advice, wealth, etc. cold give.
The ensuing Spring came, & found the latter embraced
in the arms of Death, while Hopkins still
lived. HE again went to the country, his father purchased 
him a horse, with which he commenced the 


93
toils of a country-practitioner near Woodbury N. J.
He continued improving with such exercise, & finally 
rode himself into health. He married a 
sister of Dr Barton, had a family of children, etc.
After a time, he removed to Phil. practised in the 
dispensary, when the Typhus fever prevailed here,
& like many of his brethren in the profession, took
the disease, & died with it 10 or 12 years after. HE said that when 
he commenced his practice, nothing would more effectually 
relieve the chilliness etc. to which he was
subject, than riding on horseback & that often
while sitting before a large fire with a blanket 
to his back unable to keep warm, he would receive 
a call from a patient, mount his horse, & before
he had proceeded more than 2 or 3 miles, feel
a genial glow over his whole system.
Here, then, were these 2 cases, & seeing the different 
& striking results, Dr P. began to resolve in
his mind the propriety of changing his practice & 
subsequent experience has tended to confirm the
opinions he then formed. Cases


94
As an illustration of the beneficial effect of bodily
exertion combined with mental effort, related
the case of Dr Baldwin, a very interesting, intelligent 
& unusually scientific young man, botanist but 
who was a member of a Consumptive family.
He settled at Wilmington Del. & was there attacked
with Consumptive Symptoms. He soon determined 
upon a Change of Climate & a new course of life.
In the Winter season, he embarked for Savannah, & 
on his arrival there, determined to go on foot to Milledgeville
Geo. & tho’ his friends considered him 
insane for making the attempt, he run a stick
thro’ his bundle & started. He endured many privations
on the Route, but reached there in Safety & 
was kindly received by Col. Hawkins. He passed
the Winter, afterwards accepted the office of Naval
Surgeon at St. Mary’s, after that, became Botanist
to the Yellow Stone Expedition, during which he died,
whether of Consumption is not known, but it is believed
that it was with some acute disease.


95
Dr B. G. Potts was another case, a very fine young 
man, student of Parrish’s, & one whom he never
mentions without an affectionate feeling for him.
He was attacked with Fistula in ani, which, when
no violence or ordinary reason can be assigned
for its appearance, is an unwelcome messenger
to inform us of the approach of a fatal Phthisis.
It was small, so that P. operated for it in his 
own office, but it was indisposed to heal. Soon
after this, he was attacked with Hemoptysis, & it 
was followed by the Hectic symptoms. He however
continued his practice, one day running, bustling 
about among his patients, & the next confined to 
his room, spitting p blood etc. His life was doubtless
protracted by the exertions which he made, but 
he finally sunk under the disease.
Another case of a Practitioner of N. England,
who, in early life, had the Consumption, but he
commenced the country-practice, & by his exertions
regained his health. He advised those similarly 
situated to ride 10 miles every day.


96
Col. Jos. Riley, Currier,
Another Case of a gentleman in this City, whom Dr P.
urged to purchase a horse & ride daily. He did so
through the Winter & in the Spring was improved.
When the Summer opened, war broke out, & though
he did not go according to the advice of the “man 
of peace,” yet he voluntary went into the army
& performed duty at Camp Dupont. He lived
there a soldier’s life, exposed to soldier hardships & 
[at] last recovered his health.
Another case in the family of Grif. Edwards of 
this City. His little son had cough, hectic etc. [illegible] [illegible] &
P. pursued this simple treatment. The friends of the
family were many of them dissatisfied, thinking
that Consumption was an active disease, which required 
active treatment for its cure, & they had some
influence with the Father. He, however, listened 
to the advice of the medical attendant, sent the 
boy out to the country, where he was permitted to 
paly & rove about, so that he escaped the disease 
& recovered.


97
Another case of a young lady from N. Jersey, who 
came to consult Dr Wistar, but he being out of town,
she came under Parrish’s care till his return.
She was afflicted with chills, fever, cough, pain 
in the breast, hectic etc. Dr P. paid her several
visits before Wistar’s return, & they then went to 
see her together. When they left her room, & came
down to another to consult, Dr W. expressed his
opinion that it would be better to send her to the 
country for fresh air & exercise. Dr P. perfectly coincided,
& away she went. She passed the Winter,
in exercise of various kinds, & in the Summer was 
much improved. She recovered.
Another case of a young widowed lady, whom
Dr P. attended in consultation. She had the hectic
symptoms etc. It was considered as an Inflammatory 
disease, & she received the Antiphlogisitc
treatment, with rest etc. but in a few
months she died.
Another case drawn up by a gentleman of
Ohio Dr Gilman & transmitted to Dr P. of Revd Thaddeus Harris 


98
of Mass. who having Consumption so that he was unable
to attend to his clerical duties, resolving upon 
travelling. He started & finding that he improved by 
it, he journeyed on to Marietta, where he was much 
better, & able to ride 40 miles per day, to preach etc.
He then returned home well.
Dr Chisholm, a very respectable old practitioner,
says, that an active bustling occupation & exposure like military
or maritime service is very beneficial, but 
that confinement is highly prejudicial.
Some urge the objection that this is an 
Inflammatory disease, whey, then, they say, do you
direct the patient to increase the Inflam. action
by exercise? They tell us, keep the patient at rest.
But we must remember that the Lungs are the seat 
of disease, that from the first moment of our existence,
they never rest till death, & hence, though
we can plainly understand the propriety of keeping 
an inflamed joint at rest, yet the Lungs cannot
be viewed in the same light, or similarly treated.



99
Thirty-Third Lecture Sept. 22 1834
In Hectic Fever, there is a preternatural irritability
of system. It is improper then to confine a 
patient too closely either from air or exercise, for 
these, depletion etc. only increases the irritability.
Take a robust man, keep him closely confined,
bleed, diet, purge him, exclude him from the fresh 
air, etc. & after he has continued that for a month 
or more, what is the result? His system will be 
in a very irritable state, his pulse frequent & irritable, he 
will sweat at night etc. [illegible] blood [illegible] Now if such be the
effect upon a stout man, as we know does actually 
happen, in cases of accidents etc. which require 
rigid treatment, with how much greater severity 
will such a course operate, upon one already debilitated 
by disease?
This irritable pulse may be reduced by a very 
different course of treatment, by giving tone to the 
stomach, invigorating the system etc. Case of P’s
Brother, who was attended by Dr Wistar & treated
upon a rigid antiphlogistic plan without success


100
He grew worse and worse, and at length resolved
to change his course of life. He dispensed with medical
treatment, shipped as a supercargo to India,
was much relieved, made 3 voyages afterwards, & intended a 4th
but the Embargo shut him in, Winter came on & before Spring he died
In practice, we often derive great advantage 
from noticing the cases which have passed on the
regular course, without any medical treatment.
They show the operations of the Vis Medicatrix
Natura, in which Dr P. places great confidence.
It is a certain innate principle which preserves & 
repairs the system. It has been said that life 
is a forced state, but if so, the powers would 
only keep the system from falling to pieces, & could 
not exert an influence in repairing injuries done 
to it, but Surgery teaches us differently.
Let us suppose a case & reason from analogy.
Suppose a man arrested by violence, & deprived
of all his natural rights by confinement; take 
for instance, the case of Sir Sidney Smith, confined in 
the prison at Paris, who caught a female eye as
she passed along & thus led to a correspondence, she 


101
obtained from England a sufficient sum to purchase
his release, & restoration to liberty.
Compare this with the human system, restrained 
by disease, it sets about by its own ingenuity, to 
relieve itself from the difficulties.
Pthisis Pulmonalis, we have already termed
an Internal Scrofula, & by bearing in mind
the efforts of the system just mentioned, we
may conclude that this can be relieved by 
making an External Scrofula, changing the
seat of the disease see p. 106 See Eclectic Report bd. 2. p. 201 [illegible] [illegible] case
Cases. A young man from N.J. came to consult Dr P. 
with an abscess in the side. He had laboured
under hectic symptoms, which were removed
by this discharge, & accordingly Dr P. thinking 
that his life depended upon the abscess, advised
him to keep it open.
Case of a young woman, similar advice.
Scrofula may be translated from one 
place to another. All physicians understand 


102
how a metastasis takes place in other diseases,
as in Gout, & why may it not here? The only
difference is, that while in Gout, the change is 
sudden, in Scrofula, it is slow but not less certain.
Hence in subjects predisposed to Phthisis,
we should much rather permit Scrofula, than 
use repellents, give the Vis Medicatrix the
power to throw off the disease. Sometimes 
however, it is difficult for a practitioner to 
resist the importunities of friends & of the patient, 
especially if it be a female, to drive away 
the disease & heal up the Scrofulous Sores.
But is there no particular mode of treating 
this disease? no preventive for it?
In the prophylactic treatment, it is all important
to commence early. Parents often err very 
much in the choice of employment for weakly children,
& instead of given them some outdoor active
business, they select some delicate trade, where there 
is little employment, & they lead a sedentary life. 


103
Illustrated by the Case of a Guardian who brot
his ward to consult Dr P. for Phthisis. Several of 
his family had died of the disease, & he was then
afflicted with it. Contrary, however, to discretion,
he had been placed in a Jeweller’s Shop, than 
which no situation could have been less proper.
Dr P. advised his removal from that to a more
eligible business, & his guardian fully agreed in 
the plan proposed; but his employer was unwilling
to give up the apprentice, & persisted in the
cruel measure of detaining him. He, however, 
committed his case to this Lair, & removed him,
much for his benefit.
The same treatment should be observed respecting
females of delicate constitutions.
The next object is to give tone & vigour to the
pulmonary system by approximate means.
Some cases occurred to Dr P. where he could 
pursue the prophylactic treatment from Infancy,
in which he caused them to inhale the fumes 
obtained practice from fact mentioned by old ship merchant, that
caulkers rarely or never died with consumption.


104
of Tar and Turpentine, & with some benefit.
A practitioner of N. J. Dr Fowler , Monmouth Co. informed him that Consumption’
was a more rare disease in the Pines than elsewhere
We have already cautioned against the discussion 
of Ext. Scrofula, & have stated that the effort
of the Vis Medicatrix should be encouraged.
This leads us to the curative plans. In these
we should be governed by the language which Nature
dictates. Case of Hetty Killen (Eclectic Rep.)
who was labouring under Consumption, had tumors
under the axilla, about the breast etc. Instead 
of endeavouring to cure them, they were promoted,
a discharge took place & was kept up, till at length
she was entirely freed from Pulmonary Consumption.
When the Lungs are effected, it becomes proper 
to excite the tumours in the Neck. Case, in the 
family of W. J. Miller, in 1813, when P. was called
to attend a little negro belonging to the servants
of the family. He found it far advanced in the
disease, & it soon died. Sometime after, these 


105
two negro parents were gifted with another daughter,
& she was placed under P.’s care. She was affected 
with Int. Scrofula. He explained his views of the 
disease to the parents & the master, & they coinciding,
he commenced his treatment. The child
had never been vaccinated, & accordingly he took
a lancet & made several slight incisions or scratches
from behind the ear down to the glands of the 
Neck, & in these, he introduced the vaccine Virus
as in ordinary Vaccination in the arm. Much 
swelling ensued, & instead of allowing the pustules 
to form a crust, he scarified them & supplied them 
well with stimulating Basilicon etc. ointment, so as to keep them 
sore for several months. A gradual amendment
took place in the child, scrofulous tumours were
formed about the Neck, & she was relieved from 
all pulmonary disease.
Another case was treated in a similar way, in 
a family Morgan, which had lost several by Phthisis, but 
here it proved ineffectual. One there was cured
& the other not, so that it yet remains for experiment.


106
In allusion to the treatment for adults, we recommended
riding on horseback, & we consider
it an error to commence early with medicine & 
close confinement. Instead of having a kind 
old, neighborly nurse to tell a young female to 
“take care of that cough,” P. would tell her to 
forget it, “cast it away from thee,” do not regard 
it. Instead of confining her to a room, expose
her to the fresh air, to variety of weather, bustle etc.
Dr P. says that he was predisposed to Consumption
by nature, but he attributes his preservation under
Providence to constant exercise in the open air.
In riding about, he uses a hard chair, instead 
of an easy gig, & it is so rough, that he could 
soon use up one of these little dandy merchants
by riding him thro’ the City.
Case of Drs Gallagher & Davis, who kept off the
Consumption for a long time by exercise & travelling,
Davis said confinement of a single day always made him feel uncomfortable. 
though they ultimately died.
Case of a young gentleman, whose Father died of 


107
the disease, but he recovered by sawing Wood in 
the Parlor, which he did for Exercise.
Dr P. is not disposed to let damp weather keep 
the patient in the house, unless it be very tempestuous,
and even then he directs the windows to be opened
to allow a free circulation of the air, & the patient
to walk about the room. The opposition 
which is made to this practice of allowing the 
damp air to enter the apartment, arises from 
taking but a partial view of the subject, while
they strictly observe the temperature of the weather,
they forget to notice atmospheric pressure.
The damp cannot be avoided, because air is everywhere
Flannel next the skin, is advisable. Some, 
however, are weakened by it, especially by wearing
it at night, when it produces much sweat.
Females should be directed to wear dressed
Rabbit-skins over the breast when they go out, but 
they should be removed on returning & the bosom 
covered with a piece of flannel.
Winter Air is a good Cool-Bath for the Lungs.


108
Food that is nutritious & easy of digestion are
generally agreeable.
Hemoptysis causes a temporary change of practice, 
thus a small V.S. Rest, light astringents etc. Acet Plumb.
Decoct of [Geran] Maculatum, Ice, Rush Fine Salt etc.
Care must be taken not to confine patient in a room 
too long & weaken them, & also to confounding them 
from [illegible] posteriorly, with that from Lungs. One case
came from Gums.
Case of young married lady, of consumptive family, who 
had been preserved by gestation & lactation.
Cases of aged individuals, whose mother died of pulmonary 
consumption, soon after their birth.


109
Thirty-Fourth Lecture (copied from [illegible])
It is difficult to lay down any rule with regard to 
diet, but the taste of the patient must always be
taken into consideration, as well as the feelings
which they experience from taking different kinds
of food.
The regular course of treatment will sometimes
be interrupted by Hemorrhages, but as a 
general rule, these are not immediately dangerous.
There is a striking connexion between Fistula
in Ano and Phthisis Pulmonalis. Case of Lawyer, member 
of Legislature of [Potts] of young merchant, not [illegible] but travelled & lived 2 or 3 yrs
The several peculiarities of the female sex, are
very important consideration in Phthisis, & [illegible]
cessation of the Catamenia may be considered as
overthrow of the last barrier which will resist the 
advance of the disease. Pregnancy will often
check, & sometimes completely cure the disease.
Some facts go to show that the children of a 
mother, who was pregnant while she was Consumptive,
are not more liable to the disease, than those 
who 


110
Hydriodate of Iron has been lately recommended.
The Galvanic Belt has proved serviceable
Elixir Proprietatis also
Cold Infus. of Min. [Virg.] is an excellent method of
administering it


111
who were born, when she enjoyed ordinary health.
If dysmenorrhea comes on, some Emenagogue
should be given. Dr Wistar prescribed some pills
containing Ferri. Sulph. Calcin. zi
Aloes Socot grs XX
Venet. Turpentime q.s.
m ft Pill No XXX
S. Dose 2 pills, increased to 4, twice a day.
Another prescription may be made consisting
of Ferri Sulph Calcin. Dr Griffits
Myrrhae zz [?ii]
Sapo
Sod. Carb. Exsic. aa zi
m ft. Pill No XL
Tonic Remedies also are very applicable in O.
Prunus Virginianus is one of the best tonics that
can be employed, may be given in cold infusion,
& is freed from the objection to Cinchona, that it produces
a stricture across the Chest.
Fowler’s solution given in small doses, but not long
continued, has been recommended.


112



113
Remedies applied immediately to the Lungs by 
inhalation, often produce very beneficial effects.
Hence much good has sometimes resulted from working
in a bark mill, inhaling the dust etc.
Thirty-Fifty Lecture (copied)
The influence of sea air on Consumptive patients is 
generally injurious, but to this [there] are some striking
exceptions.
If ever any important benefits accrue to human
nature respecting this disease, it must be 
in a plan of prophylactic treatment. A consumptive
person can be manufactured out of the most
healthy child, how much more, then, do
children, predisposed to Consumption, suffer from 
the ill-directed kindness of mothers and nurses?
They are always fearful of the cold ari, & in their
strenuous endeavour to avoid it, they actually kill
their children with hot air.
Children predisposed to Consumption, should, at
the age of Puberty, be put at some active employment


114
When an acute disease supervenes, treat it as usual
but do not continue the treatment too long.
The same happened to quadrupeds in the experiments
of Barron. (q. vide)
Difference of living in foreign countries, want 
of friendly sympathy, & common comforts of life.
Montpelier & Madeira, history very different
from what we should have expected.
St. Augustine (Florida) subject also to causes
which operate against


115
& allowed the full benefit of fresh air with 
plenty of exercise. A system of dieting and confinement
is very apt to produce Scrofula, as 
Dr Hewson experienced in Walnut St. Prison.
From this, too, we see the impropriety of confining
a patient for a slight cough.
Sending patients to Sea is unhesitatingly, a 
bad plan to propose for their relief, & the southern 
part of our own country can furnish all the
advantages which we hear so highly extolled as
existing in the South of France. The very 
Idea of breaking up the family ties & the separation 
will produce upon some, very injurious effects.
A surgeon in the army who was stationed far
in the North West, where the thermometer falls very 
low in Winter, said that he had severe cases of Consumption
to recover in those cold regions, while, at 
the same time, they performed soldier’s duty.
Read Barron on Tuberculous Diseases.


116
Thirty-Fifth Lecture Oct. 3rd 1834
On Peripneumonia Notha.
This is an acute disease, rapid & terrific in its 
course. Dr Rush defined it to be an Apoplexy of
the Lungs. Of this apoplexy there are 2 kinds, the 
serous & Sanguineous. It is generally met with in
old people, though sometimes in young.
To show that it occurs in old persons, & in constitutions 
somewhat impaired, we will relay some 
Cases. A very respectable merchant John Thompson in this City,
the brother-in-law of Dr James, had passed almost 
to the age of 70, when he was afflicted with the 
loss of his eldest son, a very worthy man, & one 
who was just rising in life, the right-arm of his
Father. An inward grief preyed upon the 
old gentleman’s mind, & his constitution gave
way. At length he was taken ill & Dr P. was sent
for. When he saw him, he had a most distressing
dyspnea, gasping as if every breath was his last,
with an incessant coughing, and an expectoration


117
of frothy mucus. His face was collapsed & shrunk,
with a deadly aspect, but his pulse was powerful & 
irregular, quick but not frequent. P. at once thot
congestion had taken place in his Lungs. No time
was to be lost, & he immediately bled him. As the
blood flowed, he breathed easier & felt more comfortable,
so that it was continued, with close watching,
till they took about ZXXX They then resorted
to the fumes of Rosin, as recommended by 
Rush, & it afforded great relief. Also used freely 
Sac Assafetida, alternated with Decoct. [Illegible]
& applied a large blister to his breast. From this
attack he recovered, as also from 2 others, by similar
treatment, but at last died of Hydrothorax.
Another case of a proud and lovely old Lady Sarah Lippincott
Her health had been gradually declining for 
some months, & at length Dr P. was called to see
her one morning, after she had had an uncomfortable
night with sick stomach. After listening
to her statement etc. he suspected Hydrothorax


118
but could not determine with certainty. Her pulse
was poor, & he applied a blister. In the afternoon 
he visited her & found [no] particular change.
Just before bed-time; he was summoned to see her
in a state of great agony & danger. She had been
seised with apoplexy of the Lungs, was panting 
for breath, unable to lie in bed, her skin cold & 
clammy, lips livid etc. but happily, pulse strong.
He proposed bleeding, but she objected. He then 
directed Sinapisms etc. & sent for Dr Otto in consultation.
Otto came, & they united in their desire 
to bleed, & she consented. P. bled her while Otto
watched her pulse & symptoms to see how she would 
bear it, & thus they continued ZXI this close steering,
for as the blood flowed, the distress abated.
They then used the fumes of Rosin, Sinapisms,
Ext. & Int. Stimulation, cups to the Spine, & next
morning f ziiii more blood was taken,& she 
recovered. Afterwards died of Hydrothorax
And here, it may be profitable to note the directly 



119
opposite kinds of treatment used, for while
the blood was abstracted with the one hand,
with the other, stimulants were administered.
But the case evidently required it, & that is the
only rule which should regulate our practice.
Another case of Brother of Dr Wistar, who 
was subject to Gouty Affections, was at length attacked
with Apoplexy of the Lungs. Dr P. was called
& found him labouring under the usual symptoms
with a very forcible pulse. Treated him [illegible]
with bleeding etc. & he recovered.
Soon afterwards he had another attack, for
which he was bled, but fearing lest too much blood 
might be taken, the bandage was taken from the arm
to see if the force of circulation was sufficient to expel
the blood thro’ the orifice. The blood continued
to spin out as before, & consequently it was permitted
to do so, as it was preferable that it should be forced
externally rather than internally. From this attack
he also recovered, by the usual treatment.


120
The same old gentleman had a third attack one
afternoon, just as he was going to ride out in his
carriage. Dr P. found him sitting at his window,
panting for breath, his face of a purple hue, & his
pulse instead of strong and full as before, now a
mere flutter. This showed that “all was over,” & it
only remained to lift him to the bed, where he 
died with perfect ease.
Case of Dr S [R] Griffitts, one of P’s best friends,
who, as he advanced in life, declined in health.
He was attacked during the night with difficulty 
of breathing etc. but opposed the desire of his wife to
have P. sent for. At length, he concluded he would 
get up & set in an easy chair. His wife saw that he 
was extremely ill, & sent for P. He had ordered for 
himself Ant. Wine & V.S. but there was nobody there
to use the Lancet till P. arrived. he found him 
lying on his side as if in an easy sleep, but his
face of a purple colour, & just as he entered 
the room, he died, & nothing more could be done.


121
Another case of a young man who was found 
dead in his bed, by his brother who slept with him.
Post mortem Examination showed this to be the cause.
Thus we see this rush of blood to the Lungs produces
rapid & fatal consequences, & we will relate
some cases to show that the same happens
from blood rushing to other part of the body.
Case of a fine woman, the wife of a wealthy man
of this City, who was out at their country seat, 4 
or 5 miles from Town. She was one morning sitting
at the breakfast table apparently in perfect health 
when in an instant, she applied her hand to her
side & became extremely ill Dr Betton of German
Town was called in, he despatched messengers for 
her husband, Dr James & Parrish, & just as they 
arrived, she died. Post mortem examination 
proved that she had died from Int. Hemorrhage,
her abdomen was filled with blood.
Case of Lad, who was knocked down in attempting 
to stop a pr of horses. His liver was completely broken
up, & he died in a few hours from Int. Hemorrhage.



122
Thirty-Sixth Lecture Oct. 6 1834
Asthma, is a spasmodic affection of the Respiratory
organs, of which we shall say but little.
It usually continues for a number of years, as illustrated
by an anecdote told by an old lady whose
husband was subject to it. Soon after they were
married, she was much distressed on account of 
a paroxysm of Asthma which attacked her husband.
Just at that time a cousin popped his head in at the 
window, & said, “I give you joy, you will keep 
him many years,” & it proved true; for they lived 
together upwards of 50 years.
It is annoying & disagreeable, but seldom a dangerous 
disease. We shall not be particular about it.
There is, however, a Spasmodic Cough, which is 
both troublesome and alarming, which might be 
termed a Hysterical Cough, just as we sometimes
find a hysterical laugh etc. One of the 
best plans of treating it is to produce Emesis, & 
then use some Antispasmodics.


123
There is another form of Cough more protracted
in its nature, which might readily be mistaken
for an Inflammatory Disease, but which is perfectly 
distinct. We will illustrate it by Cases.
A female friend was subject to such attacks & 
P. attended her several different times. He adopted
the antiphlogistic treatment with antispasmodics, 
opiates etc. but remarked that the remedies seemed 
to have but little or no effect. The Anodynes, 
Pect. Mixtures etc. all failed. She generally worked
thro’ it in the course of 1, 2 or 3 weeks. 
At length, he determined to pursue a different
course, & during another attack, he put her upon 
a Generous Diet, antispasmodics, & a Mixture
of Rectified Ol. Amber gtt LXXX
Pulv. Gum Arab.
“ Sacch. Alb aa zfs
Tinct. Gals. Tolu zii
Aqua Pura f ziiii
m. s. Give a tablespoonful every 3 or 4 hours
Much advantages also resulted from the use 


124
of an Infusion of Valerian, zi to oi boiling water,
let it stand till it cools, & give a wineglassful every
2 or 3 hours. Under such treatment & diet, she recovered
in a very few days.
Another case in the family of a French Merchant 
in this city, when P. was called to see the wife,
in consultation with Dr Mongers. From the acct
which he received of the case, & from his own examination,
P. found that it resembled the one above 
related. She had been attacked with Cough, soon
after her delivery, & the ordinary Pect. Mixtures were 
of no avail. She had no fever or other Inflammatory 
Symptoms, & P. became convinced that the Cough 
resulted from Debility & not from Inflammation;
he accordingly proposed the remedies administered
in the preceding case, & they were employed. She was
kept upon Tonics, & the cough soon yielded
Another case of a man, who had almost bled
to death from Hemorrhoids. After the operation
for those was performed upon him, he was attacked 
with a violent cough, which evidently resulted 


125
from debility & nervous irritation, & by no means
from Inflammation. He was relieved by the former
appropriate treatment.
These cases all show that this Protracted Cough 
is not an Inflammatory Affection of the Lungs.
Sometimes a Cough is produced by a particular 
kind of air. Case in the Alms House, where it 
resisted all medical remedies, till at length the 
patient left the house, & soon recovered. The benefit
resulting from a change of Air in Hooping Cough
is well known, & such is also the case here. The 
Sea-air sometimes suits this kind of Cough admirably,
but always in sending patients to the Sea-Shore
for trial, do it with proper caution.
A Catarrhal Affection of Children is 
sometimes met with in practice The little patient
is extremely ill, & seem as if its life was about 
departing; distressing dyspnea occurs in Paroxysms
like Asthma, & sometimes a cold skin, shrunk
countenance & cold cheek, which latter is an evidence
of a very critical case, requiring close attention.




126
The pulse is generally somewhat feeble, sometimes
irritable, & in children is a very uncertain guide.
The general treatment consists of active antispasmodics
In the family of J. Saphier, Barber, P. used Assafetida,
Seneka, & Fumes of Rosin, which were
grateful to the children. Sometimes Blisters to the
Chest, Warm Bath & attention to the bowels are requisite.
Oil answers for purge as well as Calomel.
In using the Assafet. give it according to the strength
that the children can bear, permitting the mother
or nurse to regulate it, for they can tell very accurately
what strength will suit the children.
It is proper to give to alternate the Sac Assafet.
one hour, with Seneka, the next.
The practice founded on the belief that this is
an Inflammatory Affection, is injurious.
P. has seen this disease occurs in the latter stage
of Pertussis, & then it is dangerous. So long as the 
child can cough & puke freely, there is little danger
but as soon as there is difficulty of breathing etc. the
complaint becomes dangerous.


127
Assafetica, Rect. oil of [illegible] & other Antispamodics
are generally used. In one case in the 
latter stage of Pertussis, nothing proved more serviceable
than the fumes of Rosin. Sometimes
Anodyne Injections afford the children much 
benefit, but these should be given with great care,
& the usual rule of 3times as much per anum, as
by the mouth is a dangerous one; a child can 
seldom bear more in one way than the other.
Cases in family of John H. Crisson of this City.
The parents were a fine healthy couple, who had 
never had any Catarrhal Affections; but a singular
Pulmonary Disease attacked their male children,
of which 6 died, the eldest 14 mo. & the 
youngest only 5 mo. old. Only one, the 6th & last,
died under P’s care, & from a post-mortem examination
of this, he founded his subsequent practice.
Not the slightest trace of Pulmonic Inflammation
could be found, no adhesions etc. After this, then,
his  mind was settled that the cause of the disease
was one of those mysterious constitutional tendencies 


128
to weakness in the Pulmonary Organs, & 
he determined to adopt a course which would give
tone & vigor to those organs. He directed the Mother
to cause them to inhale the fumes of Rosin daily.
It soon became a regular business in the Family, so
that at a certain hour, all looked for it.
At one time an Influenza prevailed, & they were
very fearful that the children could not escape the
epidemic. They, however, passed safely. At last,
it seemed as if the destroyer came; the same disease
attacked a child, which had carried off 6
of his brothers, and all was given up as lost
P. threw aside from his mind every idea of Inflammation.,
& pushed forward promptly & earnestly the
antispasmodic treatment, & to the great joy of both
physician & parents, the child recovered. Since
then, they have had several children, & the disease 
always yielded to the same course, so that it became
manageable & brought with it no terrors.
This shows the advantage of post-mortem examinations, 
for this led to the above salutary practice


129
Thirty-Seventh Lecture Oct. 10 1834
On Pneumonia & Pleurisy. This generally 
arises with a chill, succeeded by a fever, & pain 
in the Thorax. Often it is one side only, & any attempt 
to expand the thorax is accompanied with 
great pain, hence the patient cannot draw a long
breath or cough without difficulty. As the disease
progresses, a more free expectoration takes place, 
& about the fifth day is often tinged with a little
blood, which is apt to alarm the young practitioner
so that he will carry his antiphlogistic measures 
too far. On the 7th day, if the disease has gone
on well, a favourable crisis presents, evidenced
by a decline of pain & Fever, more free Expectoration
etc. This is a favourable issue of the disease.
But in practice, we often meet with different appearances; 
sometimes after the pain has attacked 
one side, it leaves it & attacks the other etc.
If the termination of the disease should be
unfavourable, it is generally manifested on the 
7th day also; & if at that time we find the patient 


130
with difficulty of breathing, sound of rattling
mucus in his trachea, no expectoration, feeble
pulse, hippocratic countenance [illegible]
soon expect death to close the scene.
Sometimes we have the disease attended with 
very different symptoms from those described.
The Inflammation may be transferred to the 
brain, producing Phrenitis or Apoplectic symptoms
which may always be regarded as dangerous.
In other cases, it may happen that after the 
physician has done all that is requisite & is waiting 
for crisis, when he finds that no crisis arrives;
there is only a semi-crisis, a half-way business,
with an irritable pulse, hectic blush, cough [harassing]
& often dry, occasionally a chill, followed
by Fever and Sweats, showing him that the symptoms
of Hectic are gradually wearing down the patient.
He will then have reason to believe that Abscesses
of the Lungs are forming, which, however 
sometimes terminates happily, if it points in such 
a manner as to discharges, when it opens. 


131
But if no outlet for the matter can be found,
either thro’ the trachea, or by its [pointing] externally 
through the Thorax, Death will ensue.
There is a marked difference between an Abscess
from Pneumonic Inflammation, & an abscess
from Pulmonary Consumption.
P. has seen neglected Pneum. result in Hydrothorax.
From what has been said, then, we may learn
that Pneumonia is a disease of Local Inflammation,
accompanied with Symptomatic Fever,
& that it requires the free use of the Lancet. 
The measures used should be prompt, and pushed 
as far as possible. Drastic Purges after V.S. we
do not consider useful, but make use of a gentle
Purgative, such as Salts, Oil etc. Demulcent
drinks are very proper, Barley Water, Gum etc. etc.
The antimonial medicines hold a high rank 
in this disease, & hence the Antim. Powder is often
given, after depletion, with great benefit.
In this complaint, we have to contend also 


132
with a cough, which is continually jarring & paining 
the patient, & to subdue this Dr P. recommends op.
He has not that dread of its stimulating effects
in this disease; evinced by some practitioners. If it
has any; it is not like that of Alc. but is sui generis,
& is preferable to the Cough it is the least of
two evils. Given in combination with Expectorants
in small doses, it has a very happy effect.
Laudanum is always preferable to Paregoric Elix.
because the latter contains too much Alcohol to be
given in adult Pneumonic Inflammation.
A common mixture suitable for this disease
consists of POulv. Gum. Arab
Pulv. Ext. Glycyrrh. aa afs
Tinct. Opii gtt LX
Vin. Ant. f ziii
Aqua Pura f zvi
S. Dose, a tablespoonful every 2, 3, or 4 hrs. pro re nata.
To some however, the taste of Liquorice is disagreeable,
for them omiit it, & add more Gum Arabic,
& for some, Tart. Emet. may be given suspended in 



133
a rich Mucilage, 1/6 gr to a Tablespoonful.
Dr P. often prescribes Powders, containing each
Potass. Nit. grs. X
Ipecac. gr. ½ or 1/3
Op. gr ¼
m ft. Pulv. S. one every 3 hours.
This powder is often alternated with the Saline
Draught, & thus perspiration will sometimes be
freely produced, so that these may even supersede
the Pect. Mixture, from the op. contained.
There is another part of the practice which is 
important, but concerning which Doctors do not
agree, & that is respecting the Time for Blistering.
Much has been said about the Blistering Point,
& some physicians require some days to get the system
in a proper mood for the application. But, on 
this subject, Experience has taught P. that he can
put a blister on the patient just when he has a 
mind. If he be a vigorous man, first bleed [largely],
then open his bowels, & after that he has no 


134
hesitation in putting on a blister. This should be
large, so as to cover well the painful part, & it will
often afford great relief. Sometimes, when there is 
great Pain, Cups may be applied before the Blister, 
& judicious use of opiates, especially at night, & 
in the decline of this disease, is very beneficial;
A grain or 1 ½ gr. op. with 1 or 2 grs. Ipecac.
Bleeding sometimes requires to be frequently repeated
during the progress of the disease.
To have already mentioned the tinge of blood
which sometimes accompanies the Expectoration in 
the decline of the Disease. This might induce a 
young practitioner to resort to the Lancet, but experience
says that Nature then has the Lancet in
her own hands, & the practitioner, if he attempts
to interrupt her natural course, will not prove
serviceable, but injurious to the patient.
Hence we see that great judgment is required
not only to direct the remedies with promptness, but
also to tell the stopping-point.



135
We often meet with mixed cases, so that the
treatment must necessarily be different from what
has been already stated. Thus we sometimes have
Pneumon. Inflammation with Diarrhea, & when it is
ushered in with this, we generally find them running
down into a low & dangerous form of Fever.
The Lancet cannot be much employed & only with 
great caution. Blisters in such cases are usually 
preferable. If the strength fail, & expectoration is 
difficult, we must resort to [Stimg] Tonics & expectorants
as Vol. Alkali, Seneka etc.
Case of a very respectable old Gentleman & lady’
who had drank deeply of the cup of affliction & 
who had been reduced to low circumstances. P.
was called to attend them & found them both sick
in one bed, both had Diarrhea, & low form of fever.
In neither could the Lancet be used, but a mild
& stimulating practice. He applied blisters to the
Breast, gave Serpentaria & Weak Wine Whey, op.
at night & Febrifuge Draughts. Both recovered.


136
Observations on Pneumonia in 1807.
From these it appeared that he had a number of cases
in his Dispensary Practice, & they required great caution
in their management, with a variation from 
the usual evacuating plan. They appeared disposed
to assume a Typhoid form, & sometimes were accompanied
with Diarrhea, & with a peculiar, hobbling
pulse. Case of a shoemaker in Walnut St.
where by bleeding, Cups, Ast Powder, Blisters etc.
the purging was stopped. The disease was transferred
to his brain, Coma ensued, for which Cups were applied
etc. On the 7th day, P. found him sitting in 
the shop, dressed, & said he was quite unwell, but 
his appearance showed the contrary. The disease
had changed its situation to the brain. Dr Griffits
was called in. Directed him to be purged with 
[Care], head to be shaved & blistered. Blister was
applied to the back of the Neck by the family. He 
recovered. Another case in Prince St. who, afterwards
died of Peripneumonia Notha


137
When the Lancet is inadmissible, Calomel is
the sheet-anchor. Generally given with Ipecac.
In urgent cases, 2 grs Cal. & 1 gr. Ipecac. may be given
every  hour. Blisters also are serviceable.
Appearances on Dissection show that effusion 
sometimes takes place in the latter stages of the
disease.
Since persons, especially old people are subject
to a Constitutional Cough, & the Lungs become so
accustomed to it, that they cannot do without it,
it is absolutely necessary for their health. In the
Winter and Spring, these persons often have symptoms 
of Pneumonic Inflammation, & a loss of
their Cough. Here depletion must be very cautious
& local rather than general. The principal reliance
should be upon Blisters & Expectorants,
with mild stimulants, as Wine Whey, Vol. Alkali,
Seneka etc. An excellent remedy is the Vol. Alk.
alternated with Syr. Seneb. made by boiling zfs
Senek. in oi Water down to ofs strain, & dissolve in it 
zfs of Sugar Candy


138
Thirty-Eight Lecture Oct. 12 1834
Pneumonia occasionally requires another kind
of practice from that already mentioned.
A little depletion may be tried but it must be with 
great caution. There is danger of effusion etc. & the 
object is to avoid such terminations. We can illustrate
our meaning by cases which occurred in Dispensary 
Practice, according to notes made 7/4 1806.
Case of Polly Garrison, whom P. saw on the 6th day
of her illness. She had been once bled, he directed
Blister to the Side, Powder of Nitre & Tart. Emetic.
Next morning he found with symptoms of effusion.
He ordered Blisters to the Breast etc. but all in fain.
Another case of a French Black man in [Morganensing]
Alms House. Treated with Bleeding. Blisters & 
Antiphlogistic course, & he so far recovered as to walk
about his room, but yet was not well. Some inflammation
remained, which some weeks afterwards 
terminated in Abscess in the chest, & the patient
died.



139
Another case of Isaac Roach, who had been 
bled before P. saw hm. He bled him some more,
& he felt better, but disease still existed in his Chest,
a diminution of urine etc. took place, and Hydrothorax
ensued. He directed Squill & Calomel,
& from these he was relieved, recovered.
Another case of an Irishman, who had laborious 
respiration, small pulse, & symptoms of effusion. 
He put him upon the use of Mercury & 
endeavoured to bring about Expectoration. Bled him
a few ounces from the arm, Blisters to Chest, Decoct.
Senek. small doses of [Cal.] and Ipecac, next
day applied cups, mercurial Friction etc. & altho
he had rambled a little mentally & showed other 
signs of approaching death, he happily recovered.
Another case of an Italian Sailor, who had
been ill several days & was once bled. P took 
a few more ounces of blood, applied blisters etc. On 
the next day, bled him some again. On visiting him 
on the 7th day of his illness, there was a wildness & 


140
watchfulness about him, foreboding Phrenitis, & in a 
few hours, he was perfectly furious. Cups were then 
applied to his head. Blisters between his Shoulders,
Ipecac & Cal. internally. Next morning he was 
calm & free from pain, his medical treatment was 
changed to a tonic form, & he recovered.
Another case of an abandoned Female, who, after
a frolic, was attacked with Pain in Thorax, Cough
Bitter taste in her mouth, & fever. The Lancet was
used, Blisters dressed with Mercurial Ointment,
Cal. & Ipecac. Ptyalisin ensued, on the 7th day
a favorable crisis arrived, “and Mary was restored
to health, but not to virtue.”
Another form of Pneumonia sometimes occurs 
in the Spring of a mixed character, partaking
of the Inflammatory nature of Winter complaints
diluted with those of Summer. It was sometimes 
an Intermission, assuming this form of Disease.
In the treatment, we should keep the Pulmonary
Symptoms principally in view, but not evacuate
more than is clearly demanded.


141
In treating Pneumonia, much benefit often arises
from keeping the patient constantly under the 
influence of Opium, rather by small and repd 
doses, than by one large one at night, for when 
there is difficulty of breathing etc. there is much 
doubt respecting the propriety of giving large doses
of opium. Combine it with Cal. & Ip. & you may 
give about 1/6 gr every hour. If it be desirable to produce
Pytalism, dress the Blister with Merc. Ointment.
At the same time that we use opiates, it is often 
necessary to use the vol. alkali, Cordials etc. & tho’
it may appear inconsistent, experience has proved 
that advantage often results from it.
On Diseases of the Heart.
Palpitation of the Heart arises from a variety 
of causes, & seems to depend on an irritable
condition of that organ. Sometimes it arises 
very gradually, & is then more difficult to cure.
It is occasionally an attendant upon Dyspepsia.
The Remedia which prove most serviceable 


142
are Tonics and Antispasmodics, & among these
Assafetida & Hoffman’s Anodyne hold a high 
rank. A very common mixture for transient
relief, consists of Lac Assafet. made from 
zi [illegible] to f zii Water. Take of this Lac
Assafetida f zvi
Hoff. Anodyne f ziii
But a more permanent remedy consists of 
Valer. Contus. zfs.
Ginger
Columbo aa zi
Aq. bulliensis oi
mft. infus S. Wineglassful, 3or 4 times a day.
On Syncope or Fainting
Fainting is a Temporary Death, which sometimes
occurs from trivial causes, & generally is but little 
to be apprehended. Those are generally accidental.
But when the system is reduce very low, sometimes
no reaction ever ensues. If the system be in this
condition, resort must be had to Vol. Alkali, Wine 


143
Sinapisms, Fresh air etc. The practice of Tight
Lacing is often a cause of this affection.
Sometimes we meet with what may be
called Protracted syncope. Apt to be confounded
with Apoplexy of Lungs.
Case in early part of P’s practice. He was called
one morning before day-light to see a woman
in Water St. & found her with laborious Respiration,
anxious countenance, pulse barely perceptible,
& the fearful of sudden death. At
first, P. thought of Suffocated Excitement or Congestions, but happily did not
act upon the first impulse. He ordered the Mustard
Plaster, which gave him time to reflect & 
make some inquiry into her case. H found that
she had just terminated a hard, dry & protracted
labour, which had completely exhausted her.’
he ran off to mention the case to Dr Griffits,
& the Dr told him to pour down Vol. Alk. He 
hastened back, gave the Vol. Alk. freely, used also 
external Stim. applied a large blister over her breast
etc. & she revived, reacted & soon recovered.


144
Another case of a young woman, who was attacked
just after she had been bled. She had symptoms
like the former, the same general plan of treatment
was adopted, & she recovered.
Another case of the Wife of a very respectable Saml Archer citizen
affected & treated similarly.
For other cases See Eclectic Repertory.
On Spasmodic Affections of the Heart
Sometimes the heart is affected with a Spasmodic
Disease, which in a very short time produces Death.
The Spasm may affect it directly or indirectly.
Case of Stacy Bispham, a young merchant, who,
10 days before his death, came to consult P. about some 
uneasy sensations in his chest. P. advised him 
to ride about & confine himself less to his counting room etc.
Soon afterwards, he was called in haste to see him, 
& it appeared that he had been seised with very unpleasant
feelings in his Counting House, had walked
home & fainted just as he entered his parlour. Parrish 
found with all the symptoms of Syncope, coutenance 



145
pale, pulse feeble, but mind clear. He directed
some Vol. Alk, Ether & other Stimulants. Gradually
reaction ensued, & he left him doing well.
But still there appeared to be something in Ambush,
& he resolved to watch it. He visited him 3 
times more that day, & directed him not to go to 
the Counting House the next morning, till after 
his visit. During the evening, he remarked in conversation 
that it would have been an easy death
for him in the afternoon, as he felt no pain.
On the next morning, he walked about, read the 
Newspaper etc. & felt very well. His wife was just 
handing him some beaten Egg, when in a winkling,
without a sign or a groan, he dropped,
gasped once or twice, & died. Efforts for his recovery 
proved fruitless. Post mortem examination 
showed every thing in a most natural condition,
proving that it was a sudden spasm of the Heart,
which caused his death, by immediately arresting 
the circulation.



146
Angina Pectoris, of this we shall say 
but little, as it often continues a long time.
The celebrated Jno. Hunter was affected with it,
& died in a paroxysm of [anger], showing that the 
mental emotions should not be highly excited in 
this disease.
Rheumatism of the Heart.
This occurs in young people, who, in early life, have
been subject to Inflammatory Rheumatism. They 
generally have a violent pulsation, without pain,
& seem as if the heart was enormously distended.
There is also an irregularity of the Pulse, & an irritable 
state of mind.
Case of a young woman, aged 21 yrs. who had
suffered in early life from Inflam. Rheumatism.
This disease had been her companion for 2 years,
during which time, she would occasionally have
laborious Respiration, sometimes Edema, & just
before her Death, she had Acute Mania.
Dissection showed adhesions, enlarged Ventricle, & 
ossification of Valves of Heart.


147
Another case of a child, who had been afflicted
with acute Inflammatory Rheumatism
& other symptoms. One morning early, he rushed
into his parent’s room & died.
Case of 3 Brothers, Morris’s who all 
died of Disease of the Heart, but in [advanced]
life. They all died of Ossification of Heart.
All were Subject to Gout, as was their Father
also, & their death can be attributed to the Gouty
deposition taking place in the joints of the Heart,
in stead of the Limbs, as we often see in those
subject to Gouty Affections.



148
Thirty-Ninth Lecture. Oct. 17 1834
ON Hydrothorax, or Dropsy of the Chest.
This disease consists in an effusion of serous fluid
in the cavity of the Pleura; it most usually occurs 
in advanced life, though not always.
In the course of practice, we may meet with a 
person, who before the attack was a robust, healthy 
looking man; but presently he beings to lose his 
colour & flesh, his clothes hang about him etc. & 
every thing betokens ill health, while the individual
yet continues walking about. You will find
that any exertion causes him to pant, his countenance
evinces illness etc. Soon he consults the
Doctor as to his ailment, & the experienced physician
has a set of questions for him, like a, b, c, 
which will immediately disclose this disease.
First, he will inquire into the state of secretion 
from the kidneys, & at first the patient may say 
that it is copious, but upon pushing the enquiry you 
find that he often passes water, but that the sum
total in 24 hours, is small.


149
Another question relates to whether he requires
one or mor additional pillows at night, in order
to rest comfortably? If so, here is another indication.
Then ask him about ascending the stairs., Perhaps 
it makes him pant; or in going up hill etc.,
perhaps he had to stop and take breath. Pulse.
firm & strong, & intermittent. this not always.
If all these symptoms join, they show, almost 
infallibly a case of Hydrothorax. Some patients
may have a cough, but this is not an essential
characteristic.
As the disease advances, the limbs may become
edematous, & sometimes in turning in bed, there 
is much difficulty & pain in the chest, rolling of fluid
In addition to the chest, the stomach becomes
concerned, so that we find, food that is disagreeable
to it, increases the disease. Dyspepsia.
When the disease has once fairly formed, it is
dangerous, sometimes it continues for along time 
but one important fact connected with it is
that the patient may die instantaneously. This 


150
is a fact will worthy of notice, as it may be told to 
discreet friends of the patient, much to the credit 
of the physician. Dr P. says he never received a 
sudden message to come as quick as possible to a 
person labouring under this Disease of the Chest, & 
suddenly taken very ill, & went with the expectation 
of finding the patient alive. The suddenness 
is a characteristic of the Disease, & cases of it are
numerous. Occasionally, the patient may die gradually,
& then he suffers extremely with Dyspnea etc.
Generally the patients are unable to lie with 
their heads low, but one exception occurred in the 
Alms House; a post mortem examination, however,
showed that the cavity on both sides was completely 
filled up so that position was of no consequence. These however are [rare]
P saw another exception in attending a post mort.
examination of a shoemaker by Dr Price. Both
sides were full, the lungs were natural, heart & 
pericardium both diseased, stomach contracted like
an hour glass, yellowish fluid in the Pelvis etc.


151
If the disease occurs in old people, they are
apt to die under any treatment, but by proper
treatment, it may sometimes be protracted. An
old saying is that none over 60 yrs. of age recover,
but a striking exception from this rule occurred 
in the case of an old gentleman, Stephen Maxfield,
still living in this city, & a very active man, nearly 
90 years of age, who had Hydrothorax about
15 years since, from which he recovered under the 
care & treatment of Dr P.
Treatment. At the threshold, we must announce 
that in old people a radical cure is very rare.
The remedies upon which most reliance can be placed
are Diuretics. It seems as if every thing depended
upon a free evacuation of limpid urine.
Some are more susceptible of impression upon the
kidneys than others, hence Diuretics act better.
This is not an Inflammatory disease, generally
The Lancet is seldom advisable, but may sometimes
prove serviceable in strong vigorous patients.
Cups between shoulders sometimes serviceable.
A case under Dr Wistar’s care, of a middle aged 


152
man, who recovered under the use of Digitalis, given
diligently, after Mercury & Squill had failed. But
from subsequent experience, P. has at present but
little confidence in it.
Case in the Alms House, which had been variously
treated before his admission, & which was cured by 
a practice recommended by Cullen, of giving Cr. Tart.
Gamboge & Jalap in combination.
But no remedy in P’s practice is equal to the 
proper use of Calomel & Squill (good). He has cured
several cases by these 2 Remedies. They are never
to be given in the same pill, but always keep them 
distinct; because the Squill should be gradually 
increased, but the Calomel should not. Thus he 
sometimes begins with ½ gr. or 1 gr. Cal; & 1 gr. Squill
3 times a day, gradually increasing it to as much 
as the stomach will bear, generally about 6 grs a day,
while the Cal. remains the same. As soon as the 
mouth becomes sore, lay aside the Cal. but push
forward the Squill, & the result is often happy


153
Diuretic drinks are often very advantageous, as
for inst. an Infus. of Juniper Berries of zi to oi 
water & drank ad libitum. Sometimes we
may add Sweet Spt. Nitre to Infus. of Melon Seeds etc.
Sometimes it may be necessary, at the same
time, to keep up the strength of the patient, as 
in the case of an old lady, some years since, who 
had been treated by a medical brother with 
liberal depletion, perhaps too much so, so that it 
was necessary to give her a generous diet Wine Whey etc., she recovered,
had several attacks since, from which she 
has always been relieved by Cal. & Squill.
Dr Griffits was partial to Vol. of Nitre & Cr. Tartar.
One instance occurred not long since, in which 
he also added Pot. Nit. to Cal. & Squill. Began
with small doses & gradually increased to zi or zii 
per day. This gentleman had also an edematous 
state of his lower extremities, penis, testicle, etc. & 
was much relieved by small punctures, with a
very sharp lancet, about the feet & legs.
Scarifying, however, is different, & injurious. 


154
Patients labouring under this Disease, should be
cautioned, against approaching too near the fire, if 
they have Anasarca in their lower extremities, against
sudden exertion in ascending stairs, hill etc.
But at the same time, they can bear riding, either
on horseback, or in a carriage. Such was Wistar’s case.
The bowels should not be permitted to become constipated.
The diet should be regulated by circumstances,
some require plain, nutritious, solid food.
Dyspepsia sometimes increases the disease.
Another remedy which has sometimes proved
serviceable is a motley mixture, an infusion of 
Horse Radish, Ginger, Juniper Berries, & a variety
of other similar articles in Cider, sound, strong & 
good, such as is called Deacon Cider. (For the
Recipe see Ellis’ Book). It contains a number of 
articles, so that the disease may select whichever
it likes best. Nothing is so much needed in the 
whole Mt. Med as a certain Diuretic
Care is requisite to distinguish between Hydrothorax
& Disease of the Heart.
Anecdote of Dr Fothergill.


155
Fortieth Lecture Oct. 30 1834
Hydrocephalus is an effusion of serous
fluid in the ventricle of the Brain, an Idiopathic
disease & often hereditary. This every 
physician knows, & is consequently on the alert, 
when he sees it among a family of children.
When fairly formed, it is generally fatal, & when 
we hear of any physician curing a great number 
of cases, though we may not doubt that [illegible]
yet we may call in question, their judgment
The quantity of effusion varies much from ofs.
to zfs. From the dissimiliarity of quantity of fluids, then, & 
the similarity of the symptoms, we may conclude
that there is a certain action going on in the brain 
a diseased cerebral action, which generally proves
fatal, & without exhibiting its effects by [???iction]
By practical writers, many causes have been 
assigned for the disease, but generally there is
a constitutional predisposition, and when any Scrofula has much to do with it
thing occurs to interrupt the regular functions of 


156
the brain, & bring on diseased action of that organ,
this will probably ensue.
The most prominent causes assigned are Blows
upon the Head, but that these do not produce it 
appears from the fact, that it occurs as frequent,
if not more frequently, among the rich, as the poor,
while we know that a child, nurtured amid
poverty, receives ten times as many knocks & thumps
about the head, as one in more affluent circumstances.
At the same time, in a constitution predisposed,
we do not doubt that a blow may produce 
it in the manner already mentioned.
It is a constitutional tendency, bottomed in a 
scrofulous habit.
The obscurity & insidiousness of the disease deserves 
particular attention, because in its early stage,
it is difficult to describe a single certain diagnostic symptom.
If there be any one, upon which we may 
place much stress, it is an irritable stomach, attended
with a constipated state of bowels, sometimes 


157
attended with intermittent fever & sometimes mild remittent
& is very deceptive.
The suggestions & fears of a mother or nurse respecting
an ailing of a child’s head, should be
attended to & not treated as of little consequence.
To prove this, we may cite self-experience.
Drs Hewson & P. attended the Grandmother of a family 
& daily they had to pass thro’ the nursery, where
their attention was often called to the youngest 6 mo. old child
by the Mother, who said something was the matter 
with the child’s head. They examined it & thinking 
nothing ailing, except her material fears, delicately 
hinter to her that she was unnecessarily 
alarmed. Soon after, however, they found themselves
most grossly mistaken, for Hydrocephalus 
developed itself, & in one or two days, the child
was no more.
After this P. was called to another family in this
City, where a practitioner had been attending a child
for what he at first considered a trifling disease, 



158
so much so, that when the family requested a consultation
to be held respecting it, he objected. In this,
he did wrong, for no physician should object to the family
s desire to call another in, they have the right, & 
should exercise it. There, however, it was not done,
but in 24 hrs. the physician himself saw a very 
serious train of symptoms appearing, & requested a 
consultation. Dr P. was called in, just in time to 
see the disease fully developed & the child die.
The practitioner was never again called to that family.
A symptom of the disease, which has been stated 
to Dr P. by Dr M. Wistar as occurring in one of his own
children, was, that 1 or 2 wks. before the disease appeared,
it pressed its head against every thing within 
its reach, he first discovered it by its pressing its 
head against his breast, when he took it up to [illegible]
Another symptom often met with, is, that the
child gives a sudden & violent scream, without assigning 
any reason, or with the complaint of a sharp 
pain in the head.


159
With respect to urine, we have no particular remark,
upon which dependence may be placed.
And as to the pulse, upon that we cannot rely.
Some look to the stools, but respecting these, P.
cannot say much in favour of it.
As the disease advances, the pupil becomes dilated,
strabismus occurs, & sometimes a loss of 
vision. With respect to the Pupil, it is necessary 
to distinguish between nature & disease, for if we 
raise the lid of any child & get it about half
awake, the pupil immediately flies open, & this 
might be mistaken for the disease. Case tended
with Dr Wistar, where the experiment was tried.
There is also a rolling motion of the head, particularly 
in the latter stages, may occur earlier.
The pulse, too, becomes slow, full & irregular, & there 
is a throbbing motion observable in the Carotids.
P. has also observed a peculiar fixedness in the
expression of countenance, something almost like
a devotional appearance.


160
The disease is generally closed by Convulsions, & sometimes
Hemiplegia occurs a few days before Death.
In order to illustrate the insidious nature of the
disease etc. P. related the case of a child of Dr Hewson’s
aged 2 yrs. 5 mo. which he attended with Dr Otto, in
the Winter of 1820. The child had been sick 2 wks.
During the first week, there was slight indisposition,
with a occasional sick stomach, slight constipation, slight fever, etc,
thought to be worms, but the case was very obscure.
Pulse 120, no pain in head.
At length, it was found something was wrong about his
head; it was shaved morning of 11th & blistered. Soon after, 12th evening he became
so, that he screamed out in his sleep & complained of 
pain in his head for first time, his pulse came-down to 70 per minute
[firm] & irregular, & P. & Otto left him with the intention 
of keeping up the discharge from his bowels thro’ the
night, but with gloomy forebodings as to what the [illegible]
might bring forth. Next morning 13th, however, they 
were delighted in the intelligence from the Father 
that his son was better, they found his pulse better & 
more regular etc. & all appeared favourable. The day 


161
passed well, but late in the evening, his pulse
again became slow. On the next morning he
was delirious, convulsions ensued thru the day 
& on the following morning he died. Effusion zvi.
Treatment. Those who consider the disease
as one arising from sympathy with the stomach, 
place much reliance upon Emetics, upon this,
P. cannot say much from experience.
It is proper to use brisk purgatives. If febrile
excitement exists, general and local bleeding may 
be cautiously used, leeches to the head etc.
Blistering over the whole scalp sometimes proves 
serviceable.
We have already said that Death was the 
usual termination of the disease, but to this,
P. has seen exceptions; as in one case in which 
there were convulsions & hemiplegia, & no one expected 
a recovery, or if he did recover, P. thot
he would certainly be an idiot. Such, however,
was not the case, he recovered both mind & body.


162
Another remedy recommended by some, is
the use of Mercury for Salivation. It was used 
to a great extent by Dr Wistar, but with due
deference to his judgment, Dr P. is opposed to its
extensive use among infants, because their constitution 
is too weak to bear the violent impression 
of the Mercury, & the remedy may prove worse
than the disease. Sometimes, however, in small 
& frequent doses, cautiously administered, it
may be unobjectionable.
Related 2 cases in the family of Prof. James 
in which Mercury was largely given, but without
producing the desired effect.